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MCQs – 8 Jan 2015

Q.1

IN ELDERLY DEPRESSED PATIENTS

Early-morning waking is not a feature.

Complaints of loss of memory are likely to be of fairly acute onset.

All episodes of self-harm, however trivial, should result in a referral to a psychiatrist.

False incorrigible beliefs signal severe illness.

Presentation with hypochondriac worries may be a clue to the diagnosis.

Q.2

CHILDHOOD OBESITY 

Affects 25 per cent or so of six-year-olds.

Is associated with an increased risk of dyslipidaemia.

Only significant aetiological factor is inappropriate/excessive eating.

Reasonable weight management goal might be ‘no weight-gain as height increases’.

Dietary suggestions would include eating at least five portions of fruit and vegetables each day.

Q.3

RECOGNISED FEATURES OF BELL’S PALSY INCLUDE

Muscles of lower part of face only affected.

Sensory loss over the affected area.

Impaired taste sensation.

Hyperacusis.

Eyeball rolling upwards on attempted complete closure of eyes.

Q.4

SIMPLE SNORING 

Affects about 40 per cent of the population.

By definition is not loud enough to disrupt sleep (the snorer’s).

Sufferers may be at a greater risk of developing high blood pressure.

In obese patients, may be lessened by weight reduction.

May be treated by a radio-frequency thermal tissue ablation (RFTA).

Q.5

RECOGNISED SIDE-EFFECTS OF LONG-TERM USE OF TOPICAL FLUORINATED STEROIDS INCLUDE

Perioral dermatitis.

Adrenal suppression.

Thickening of the skin.

Increased hair growth.

Increased skin pigmentation.

A.1.

False. Depression in the elderly usually presents in similar ways to depression in younger people but biological symptoms may not be as prominent.

True. And shorter history than in dementia.

True. Elderly people rarely make manipulative gestures.

True. As do suicidal ideas.

True. Or a change in help-seeking behaviour or recent-onset anxiety would suggest the development of depression.

A. 2.

False. 10 per cent (BMI >95th centile) and 22 per cent overweight (BMI> 85th centile).

True. And hypertension, diabetes.

False. Also lack of exercise.

True. Or weight gain slower than height gain.

True. Plus smaller portions, and avoid using food for rewards and so on.

A. 3.

False. Is a lower motor neurone paralysis of the facial nerve with muscles of both upper and lower parts of face affected.

False. Motor deficit only.

True. In the anterior two-thirds of the tongue.

True. This may be experienced with lesion involving nerve to stapedius.

True. Bell’s phenomenon.

A. 4.

True. With 1-25 per cent of this group having obstructive sleep apnoea (OSA).

False. May cause frequent waking and disruption of sleep.

True. And heart attack and stroke.

True. Most important self-help measure.

True. Latest surgical management.

A. 5.

True. Papules on the face in young women.

True. Especially if applied to thin skin, raw surfaces or under occlusion.

False. Thins the skin.

True. Also acne at site of application in some patients.

False. Get mild depigmentation.

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