Geriatrics

Question 1

Side effect of Donepezil

Answer 1

Insomnia
Relatively Contraindicated in Bradycardia

Antipsychotics are associated with a significant increase in mortality in dementia patients

Question 2

Vascular Dementia Treatment

Answer 2

Control Vascular Risk Factors

Only consider AchE inhibitors OR Memantine if Comorbidity with Parkinson’s, LWBD or Alziemers

Question 3

MMSE Scores

Answer 3

Mild = 21-26
Moderate = 10-20
Severe = <10

<24 is indicative of Dementia

Question 4

Waterlow Score

Answer 4

Grade 1
Grade 2 - Partial Thickness Loss (E+D)
Grade 3 - Full Thickness Loss
Grade 4 -

Question 5

APOE Allele Associated with Alziemers

Answer 5

Apoprotein E allele E4 - encodes a cholesterol transport protein

Autosomal Dominant
Amyloid precursor protein (chromosome 21) Presenilin 1 (chromosome 14)
Presenilin 2 (chromosome 1)

Tau is a protein that interacts with tubulin to stabilize microtubules and promote tubulin assembly into microtubules

Question 6

Dementia Treatment

Answer 6

Alzheimers

Mild - Moderate: acetylcholinesterase (AChE) inhibitors - donepezil, galantamine and rivastigmine as monotherapy

Moderate + intolerant of AChE-i or severe
Memantadine (MMSE < 12)

Mild-Mod-Severe LBD
1st: Donepazil or Rivastigmine
2nd: Galantamine (Mild-Mod) or Memantine (Any)

Vascular Dementia
Only offer above if signs of overlap

FTD
Don’t offer AChE inhibitors or galantamine

Question 7

Pain Relief Safe in Renal Impairment

Answer 7

My FAB

Methadone
Fentanyl
Alfentanil
Buprenorphine

Question 8

Causes of Non Pitting Edema

Answer 8

1. Lymphedema
2. Myxedema
3. Lipedema
4. Angioedema

Question 9

Which medication is added to Ondansetron for Refractory Intractable Vomiting ?

Answer 9

Add Dexamethasone to Ondansetron

Question 10

Cancer of Unknown
Primary Investigations

Answer 10

CT AP
AFP & hCG
CXR
Urinalysis
FBC UE Ca LDH LFT

Question 11

Pressure Ulcer Dressings

Answer 11

Iodine and Silver Dressings - If Infection

Hydrocolloid Dressing - 1st Line - Promote Moisture which in turn promotes wound healing (DONT KEEP DRY IS THE TRICK)

Alginate Dressing if Lots of Exudate which Alginate will absorbing and forming a gel keeping the wound moist

Question 12

TTF 1 Stain Positive Lung Cancers ?

Answer 12

All Non Small Cell Lung Cancers
Adeno Large Cell and Squamous

Question 13

Hiccups Treatment ?

Answer 13

1st Line - Chlorpromazine

Domperidone as well (cannot be added into Syringe Driver)
Metoclopramide as well
Dexamethasone as well

Think if has Nausea + Hiccups –> Metoclopramide

Also think which can be added into Syringe Driver and Which Cannot be

Hic Cups Don’t Go - haloperidol, chlorpromazine, dexamethasone, gabapentin

Question 14

BRCA 1 vs BRCA 2

Answer 14

BRCA 1 -
Breast
Ovarian

BRCA 2
Breast
Pancreatic
Prostate

BRCA 1 > BRCA 2 for Breast Cancer 55-65% if BRCA 1

Question 15

Spinal Mets 1st line imaging ?

Answer 15

MRI Spine within 7 days
If Neurological Impairment then IMMEDIATE

Question 16

Which pain killer works on NMDA Antagonist ?

Answer 16

Methadone
Ketamine

Magnesium as well (not for pain in general for you to remember)

Question 17

5 FU - Capecitabine broken down by ?

Answer 17

dihydropyrimidine dehydrogenase (DPD)

Question 18

If Bed Transfer Pain then Breakthrough Morphine given how many minutes before Transfer

Answer 18

30 mins

Question 19

If Renal Impairment on Cisplatin for NSCLC then ?

Answer 19

Switch to Carboplatin

Question 20

What’s the best Test to Differentiate Delirium vs Dementia ?

Answer 20

CAM

Features suggesting Delirium > 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)
5. Agitation, fear
6. Delusions

Question 21

Features of FTD ?

Answer 21

<65
Insidious
Social Conduct Issues
Preserved Visuospatial / Memory

Pick’s Disease

Question 22

Picks Disease (Form of FTD) CT Brain findings

Progressive non fluent aphasia (chronic progressive aphasia, CPA) - Form of FTD

Semantic dementia (Form of FTD) Feature

Answer 22

Macroscopic - Focal Gyral Atrophy with a knife-blade appearance

Microscopic changes include:-
Pick bodies - spherical aggregations of tau protein (silver-staining)
Gliosis
Neurofibrillary tangles
Senile plaques

Non Fluent Aphasia (Short Utterances of Agrammatic. Comprehension Preserved

Fluent progressive aphasia - Empty and No Meaning

DO NOT GIVE AChi or Memantine in FTD !!!

Question 23

Radiotherapy-induced Mucositis Treatment

Answer 23

Benzydramine Mouth Wash

Question 24

Opioid Toxicity from Fever how ? Transdermal Patch

Answer 24

Hot Temperatures increase Fentanyl Absorption