Geriatrics

Question 1

What are the different types of dementia?

Answer 1

Alzheimer’s disease
Vascular dementia
Fronto-temporal dementia
Lewy body dementia

Question 2

What are the pathological changes in Alzheimers disease?

Answer 2

Beta-amyloid plaques
Neurofibrillary tangles (tau protein)
Widespread brain atrophy

Question 3

Where is there particular atrophy in Alzheimer’s disease?

Answer 3

The hippocampus

Question 4

What is the disease pathway in Alzheimer’s?

Answer 4

Progressiv decline

Question 5

What is the pathophysiology of vascular dementia?

Answer 5

Caused by vascular damage to the cerebral blood vessels leading to ischaemia and brain cell death

Question 6

What changes are seen on CT in Alzheimer’s?

Answer 6

Volume loss and enlarged ventricles

Question 7

What changes are seen on CT in vascular dementia?

Answer 7

Small vessel ischaemic changes

Question 8

What is the disease pathway in vascular dementia?

Answer 8

Stepwise progession

Question 9

What are risk factors for vascular dementia?

Answer 9

Stroke/TIA
AF
Hypertension
DM
Hyperlipidaemia
Smoking
Obesity
CHD
Fhx

Question 10

What is the pathophysiology of Lewy body dementia?

Answer 10

Lewy body protein deposits

Question 11

Which areas of the brain are most affected in lewy body dementia?

Answer 11

Substantia nigra and basal ganglia

Question 12

What is the disease pathway of lewy body dementia?

Answer 12

Parkinsonism occurs after or within one year of memory problems

Question 13

What are the psychiatric features of lewy body dementia?

Answer 13

Hallucinations
Delusions
REM sleep disorder

Question 14

What is the pathophysiology of fronto-temporal dementia?

Answer 14

Tau protein deposits in frontal and temporal lobes cause cell death

Question 15

Features of fronto-temporal dementia?

Answer 15

Onset before 65
Insidious onset
Cognitive deficit not so obvious

Personality change and social conduct problem:
Loss of inhibition
Personality changes
Crave food

Question 16

Which type of dementia can be familial?

Answer 16

Fronto-temporal

Question 17

Differentials diagnoses for dementia?

Answer 17

Delirium
Substance misuse
Traumatic brain injury
Other mental illness (e.g. depression)
Medications
Metabolic disturbances

Question 18

What are included in confusion screening bloods?

Answer 18

FBC
U&E
Vit B12 and folate
LFTs
TFTs
Glucose
Calcium

Question 19

What is depressive pseudodementia?

Answer 19

Dementia-like symptoms (attention/memory) secondary to depression

Question 20

What are some of the assessment tools for mental function?

Answer 20

Abbreviated mental test = AMT
Mini-metal state exam = MMSE
Montreal cognitive assessment = MoCA

Question 21

What questions are included in the AMT? (aim for 5)

Answer 21

Age
Time
Address for recall
Year
Place
Identify 2 people
Date of birth
Year WW1 began
Current monarch
Recall address

Question 22

Which score in the AMT needs further investigation?

Answer 22

<8

Question 23

Which domains are tested in the MMSE?

Answer 23

Orientation
Registration
Calculation
Recall
Language
Attention

Question 24

What score in the MMSE is diagnostic of dementia?

Answer 24

<23
(if patient has at least 8y education)

Question 25

What is the main limitation of the MMSE?

Answer 25

Depends on educational background

Question 26

What is the Montreal cognitive assessment?

Answer 26

In-depth assessment of cognitive function

Question 27

Which drugs can be used in dementia?

Answer 27

Cholinesterase inhibitors = donepezil, rivastigmine, galantamine NMDA receptor antagonists = memantine

Question 28

How is dementia managed?

Answer 28

Medical - drugs Psychological - therapy, OT Social - care, equipment, meals

Question 29

What are the three main categories of causes of dehydration?

Answer 29

Reduced oral intake Increased losses (vomiting, diarrhoea, haemorrhage) Third space fluid loss

Question 30

Which reasons for admission may increase fluid requirements?

Answer 30

Burns Trauma Febrile illness/sepsis GI - D+V

Question 31

What clinical signs should be considered when assessing fluid status?

Answer 31

Cap refill time Skin turgor Mucus membranes Urine output Blood pressure JVP Eyes (sunken) Peripheral oedema

Question 32

Possible causes of delirium?

Answer 32

PINCH ME Pain Infection Nutrition Constipation Hydration Medication Environment

Question 33

What are the features of delirium which differentiate it to dementia?

Answer 33

Acute onset Fluctuating (e.g. worse at night) Abnormal perception (hallucinations) ALOC

Question 34

What is delirium?

Answer 34

Acute, transient, and reversible state of confusion (usually due to other organic processes)

Question 35

Which intrinsic factors (e.g. conditions) can contribute to falls risk (5) ?

Answer 35

CVD = arrhythmias, syncope, postural hypotension Neuro = neuropathy, parkinsons MSK = arthritis, deformities Visual impairment = glaucoma, cataracts Cognitive = dementia, delirium

Question 36

What extrinsic factors can contribute to falls risk?

Answer 36

Poor footwear Poor lighting Inappropriate walking aid Trip hazards Medications

Question 37

Which behavioural factors can contribute to falls risk (5)?

Answer 37

Fear of falling Lack of exercise (muscle/balance) Alcohol Poor diet/fluid intake Risky behaviour - not asking for help/rushing

Question 38

Which medications can increase risk of falls?

Answer 38

Sedatives - benzodiazepines, opioids, z-drugs Anticholinergics - TCAs Antihypertensives Diuretics Vasodilators

Question 39

Investigations to consider in falls (bedside)?

Answer 39

Obs Lying and standing BP Blood glucose Urine dip ECG

Question 40

Investigations to consider in falls (bloods)?

Answer 40

FBC U&E CRP CK (if long lie) LFTs Bone profile

Question 41

Investigations to consider in falls (imaging)?

Answer 41

Xray injured limbs CT head (head injury/anticoagulants)

Question 42

Falls management in elderley?

Answer 42

Patient education - get up slowly, use aids, use glasses etc. Physio/OT - strength/balance training, home assessment, non-slip socks/mats/shoes Medical - meds review, analgesia, cognitive screen

Question 43

Which factors predispose someone to the development of pressure sores/ulcers?

Answer 43

Malnourishment Incontinence Lack of mobility Pain (reduces movement further)

Question 44

Which score predicts patients who are at risk of developing pressure areas leading to ulcers?

Answer 44

The Waterlow score

Question 45

Management of pressure ulcers?

Answer 45

Hydrocolloid dressings Avoid drying soaps Tissue viability nurse Surgical debridement for some wounds