Geriatrics

Question 1

Alzheimer’s

Answer 1

short term memory loss
disorientation to place
disordered sleep pattern
early: depressive symptoms, social withdrawal, agoraphobia
later: apraxia, difficulty with sentence construction, planning, decision making, incontinence

inhibitors (donepezil, galantamine and rivastigmine): mild to moderate Alzheimer’s disease
contraindications :
sick sinus syndrome
resting bradycardia
concurrent verapamil use
s/e:
can cause insomnia

memantine (an NMDA receptor antagonist): reserved for patients with moderate Alzheimer’s who are intolerant of/contraindication to, acetylcholinesterase inhibitors
- add-on drug to acetylcholinesterase inhibitors for patients with moderate or severe Alzheimer’s
- monotherapy in severe Alzheimer’s

Question 1

Lewy body dementia

Answer 1

Lewy body - alpha synuclein

Progressive cognitive impairment
- typically occurs before parkinsonism, but usually both features occur within a year of each other
- worse with antipsychotics
- cognition may be fluctuating, in contrast to other forms of dementia
- early impairments in attention and executive function rather than just memory loss

Parkinsonism

Visual hallucinations (other features such as delusions and non-visual hallucinations may also be seen)

Mx: same as Alzheimer’s

Question 2

Delirium vs dementia

Answer 2

reduced GCS
fluctuations in symptoms
reversal in sleep wake cycle

Question 3

FTD

Answer 3

onset before 65
insidious onset
relative preserve memory and visuospatial skills
personality change and social conduct problems

3 principal forms
Behavioural variant - change in social skills, emotions, personal conduct and self-awareness
Semantic - difficulties recognising faces, naming objects
Progressive non-fluent aphasia - unable to verbalise normally, slow and laboured speech

Mx: SSRIs

Question 4

Dementia with Lewy bodies vs Parkinson’s +

Answer 4

dementia: hallucinations, autonomic dysregulation, treatment resistant Parkinsonism (Levodopa can worsen confusion)

Parkinson’s +: hallucinations are uncommon

Question 5

Ulcers

Answer 5

Arterial: distal, dorsum of foot or toes, well defined edges

Diabetic foot ulcer: weight bearing areas e.g. soles, metatarsal heads
- diabetic foot infection = Co-amox

Neuropathic ulcer: pressure points e.g. soles, 1st or 5th MTP joint, painless

Venous: medial malleoulus
- less painful, relieved by elevation
- surrounded by hyperpigmentation

Question 6

PD

Answer 6

REM sleep behaviour disorder
Tx: melatonin or clonazepam

Psychotic symptoms
Tx: quetiapine, clozapine

Question 7

Rapid tranquiliser

Answer 7

Haloperidol - safe in renal impairment
Lorazepam
Olanzapine

Question 8

Reduced dosing in elderly

Answer 8

reduced GFR e.g. opiates
increased VoD e.g. BZD

Question 9

Transient global amnesia

Answer 9

sudden onset of global loss of recent memory and impaired new learning with no other cognitive defects
very aware of their memory loss making them extremely anxious

Mx: reassurance, no need to inform DVLA