Geriatrics

Question 1

Give 4 common features of frontotemporal dementia

Answer 1

• Onset before 65
• Insidious onset
• Personality change and social conduct problems
• Preserved memory and visuospatial skills

Question 2

Score used to assess the risk of pts developing a pressure sore

Answer 2

Waterlow score

Question 3

4 RF for pressure ulcers

Answer 3

Malnourishment
Incontinence
Lack of mobility
Pain

Question 4

Management of mild alzheimer’s

Answer 4

Donepezil

Question 5

Mechanism of action of donepazil

Answer 5

acetylcholinesterase inhibitor

Question 6

Management of moderate - severe alzheimers

Answer 6

Donepazil + memantine

Question 7

Mechanism of action of memantine

Answer 7

NMDA receptor antagonist

Question 8

Give 3 features of leqy body dementia

Answer 8

1. Progressive congitive impairment
2. Parkinsonism
3. Visual hallucinations

Question 9

Explain the presentation of the cognitive impairment seen in lewy body dementia

Answer 9

• Occurs BEFORE the parkinsonism
• Can fluctuate

Question 10

what should be avoided in lewy body dementia due tothe risk of causing irreversible parkinsonism ?

Answer 10

Neuroleptics (e.g. haloperidol)

Question 11

give 5 predisposing factors to delirium

Answer 11

• > 65
• Background of dementia
• Sig onjury (e.g. hip fracture)
• Frailty or multiborbidity
• Polypharmacy

Question 12

Give 7 precipitating events for delirium

Answer 12

1. Infection
2. Constipation
3. Change in environment
4. Metabolic
5. Sig CV, resp, neuro or endo condition
6. Severe pain
7. Alcohol withdrawal

Question 13

2 medications used for management of delirium

Answer 13

• Haloperidol (IM lorazepam if parkinsons)
• Olanzapine

Question 14

what tool is used to identify medications where risk outweighs therapeutic benefits in certain conditions

Answer 14

STOPP tool

Question 15

when is haloperidol used for management of delirium ?

Answer 15

If treating underlying cause and environmental modification has not helped (verbal and non verbal de-escalation techniques)

Question 16

4 RF for alzheimer’s disease

Answer 16

• FHx
• Increasing age
• Down’s syndrome
• Caucasian ethnicty

Question 17

Macroscopic changes seen in the brain in alzheimer’s

Answer 17

Widespread cerebral atrophy involving the cortex and hippocampus particularly

Question 18

what is required in secondary care for a diagnosis of dementia

Answer 18

MRI brain

Question 19

Explain the grading of pressure ulcers

Answer 19

1. Non blanchable in tact skin
2. Partial thickness skin loss involving epidermis, dermis or both
3. Fukl thickness skin loss involving damage to or necrosis of subcut tissue
4. Extensive destruction, tissue necrosis, or damage to muscle, bone or supporting structures.

Question 20

example of a medicaiton that should be stopped following diagnosis of alzheimers

Answer 20

amitriptyline

Question 21

what tool is used in ots with multiple morbidities to dertermine whether the introduction of a new medication will be beneficial

Answer 21

START

Question 22

Give 7 RF for vascular dementia

Answer 22

• History of stroke or transient ischaemic attack (TIA)
• Atrial fibrillation
• Hypertension
• Diabetes mellitus
• Hyperlipidaemia
• Smoking
• Obesity

Question 23

Explain the presentation of congitive dysfunction seen in vascular dementia

Answer 23

Several months or several years of a history of a sudden or stepwise deterioration of cognitive function.

Question 24

what medications are associated with an increased risk of mortality in dementia pts

Answer 24

Antipsycholtics such as olanzapine

Question 25

If a pt is on digoxin, what can trigger digoxin toxicity

Answer 25

- Renal failure - Hypokalaemia (viral gastroenteritis)

Question 26

Symtoms of digoxin toxicity

Answer 26

N&V Abdo pain Dizziness Confusion Blurry / yellow vision Arrhythmias

Question 27

Medications that can precipitate gout

Answer 27

Thiazide diuretics (e.g. gout)

Question 28

Explain how parkinsons and lewy body dementia can be distinguished

Answer 28

- Parkinsons : parkinsons symptoms BEFORE congnitive decline - Lewy body dementia : cognitive decline BEFORE parkinsonism