Geriatrics

Question 1

What is the management of Acute Confusional state?

Answer 1

haloperidol 0.5 mg or olanzapine as the first-line sedative always offer oral
if not working then bezo

Question 2

Who should yo be carefull with Holoperidol, what should be used instead?

Answer 2

Parkinson’s patietns
if symptoms require urgent treatment then the atypical antipsychotics quetiapine and clozapine are preferred

Question 3

What should be included in the confusion screen?

Answer 3

B12/folate: macrocytic anaemias, B12/folate deficiency worsen confusion
TFTs: confusion is more commonly seen in hypothyroidism
Glucose: hypoglycaemia can commonly cause confusion
Bone Profile (Calcium): hypercalcaemia can cause confusion

Question 4

What will be seen on a CT in Alzheimer’s

Answer 4

Alzheimer’s disease causes widespread cerebral atrophy mainly involving the cortex and hippocampus

Question 5

What will be present in CT of frontotemporal dementia?

Answer 5

Atrophy of the frontal and temporal lobes is

Question 6

When is FAST
PRISMA-7
STOPP
Waterlow score
questionnaires used?

Answer 6

FAST is an alcohol screening tool used in the emergency department

PRISMA-7 is a validated questionnaire that can be used to confirm frailty in an individual.

STOPP tool is used to assess which drugs can be potentially discontinued in elderly patients undergoing polypharmacy.

Waterlow score is widely used to screen for patients who are at risk of developing pressure areas.

Question 7

Which dementia has social disinhibition, often has a family history and personality change?

Answer 7

Frontotemporal

Question 8

How to differentiate between Parkinson’s disease dementia and Lew Body?

Answer 8

Parkinson’s disease dementia - Motor before Cognitive
Dementia w/ lewy bodies - Cognitive before Motor

Question 9

Why should amitriptiline be avoided in dementia?

Answer 9

Cholinesterase imhibitors are given in dementia and amitriptyline is anticholinergic so would be counter active to the medication for dementia.

Question 10

history of a patient who has deteriorated following the introduction of an antipsychotic agent

Answer 10

LewBody dementia
neuroleptics are contraindicated

Question 11

How should you treat alzheimer’s?

Answer 11

1. Acetylcholinesterase inhibitors (donepezil, galantamine and rivastigmine) as options for managing mild to moderate Alzheimer’s disease
2. Memantine is an option for managing Alzheimer’s disease for people with:
   Moderate Alzheimer’s disease who are intolerant of, or have a contraindication to, AChE inhibitors or
   Severe Alzheimer’s disease

Question 12

For which patients should you avoid Donepezil?

Answer 12

is relatively contraindicated in patients with bradycardia

Question 13

Dementia with fluctuating congition

Answer 13

Lewy BOdy

Question 14

Middle aged adult with insidious onset dementia and personality changes

Answer 14

Picks diseae (frontotemporal)

Question 15

Patient presents with:
gastrointestinal disturbance (nausea, vomiting, abdominal pain), dizziness, confusion, blurry or yellow vision, and arrhythmias
what med?

Answer 15

Digoxin

Question 16

How to manage pressure ulcers

Answer 16

1. a moist wound environment encourages ulcer healing. Hydrocolloid dressings and hydrogels may help facilitate this.
2. The** use of soap should be discouraged** to avoid drying the wound
3. wound swabs should not be done routinely
4. consider** referral to the tissue viability nurse**
5. **surgical debridement **may be beneficial for selected wounds

Question 17

Stepwise progression of symptoms in dementia

Answer 17

vascular dementia

Question 18

How to differentiate Delliriuhm from dementia ?

Answer 18

Which factor would suggest a diagnosis of delirium rather than dementia?

1. acute onset
   2.** impairment of consciousness**
   3.** fluctuation of symptoms: worse at night, periods of normality
   4. abnormal perception **(e.g. illusions and hallucinations)
   agitation, fear
   delusions