Geriatrics randomised

Question 1

Frontotemporal lobar dementia: different types and how to differentiate

Answer 1

Frontotemporal dementia (Pick’s disease)
Most common
Personality changes and impaired social conduct
Focal gyral atrophy with a knife-blade appearance
Macroscopic: atrophy of frontal and temporal lobes
Microscopic: Pick bodies - aggregation of tau protein
Don’t manage like Alzehmiers

Chronic progressive aphasia = non fluent progressive aphasia
Non fluent speech
Comprehension preserved

Semantic dementia - fluent progressive aphasia
Fluent speech but doesn’t make sense

Question 2

Pressure ulcers scoring and Mx

Answer 2

Scoring system: Waterlow

Mx: Moist wound environment e.g. hydrocolloid dressings and hydrogels, No routine wound swabs, Surgical debridement

Question 3

Mx LBD

Answer 3

ACHi mainly rivastigmine as improves cognition as well as neuropsych symptoms e.g. hallucinations

AVOID NEUROLEPTICS AS MAY CAUSE PARKINSONISM

Question 4

RF alzehimers

Answer 4

Apoprotein E allele E4

Question 5

Mx Alzheimer’s Disease and non cognitive symptoms?

Answer 5

Mild-moderate: Acetylcholinesterase inhibitors (Donepezil, galantamine, rivastigmine)
Add on/for severe/above contraindicated e.g. bradycardia: NMDA receptor antagonists (memantine)
Non cognitive: no antidepressants unless severe and only antipsychotics if harming themselves or others

Question 6

DD dementia

Answer 6

Hypothyroidism, Addison’s
B12/folate/thiamine deficiency
Syphilis
Brain tumour
Normal pressure hydrocephalus
Subdural haematoma
Depression
Chronic drug use e.g. Alcohol, Barbiturates

Question 7

Mx delirium

Answer 7

Haloperidol if no parkinsons
Otherwise lorazepam or atypical antipsychotic (e.g. quetiapine)

Question 8

Scoring system for delirium

Answer 8

Confusion assessment method

Question 9

Ix LBD

Answer 9

Clinical
SPECT (aka DATSCAN)

Question 10

Pathophysiology of LBD

Answer 10

alpha-synuclein cytoplasmic inclusions (Lewy bodies) in the substantia nigra, paralimbic and neocortical areas

Question 11

Vascular dementia Ix and Mx

Answer 11

Ix: MRI, NINDS-AIREN criteria
Mx: Like alzehmiers if comorbid Alzheimer’s, LBD, No evidence for statins or aspirin

Question 12

Mx urge incontinence

Answer 12

Due to overactivation muscle

Bladder retraining
Antimusc - Oxybytin, solifenacin, tolertidide, mirabegon
Botox

Question 13

Mx stress incontinence

Answer 13

Urethra is too weak to stay closed with increased intra abdo pressure

Pelvic floor muscles
Duloxetine (surgery contra indicated)
Mid urethral sling surgery

Urinary tract infections can often mimic or exacerbate incontinence symptoms.

Question 14

Parkinsons dementia presentation

Answer 14

Motor symptoms for 1 year prior to onset of cognitive symptoms

Question 15

What are the causes of delirium?

Answer 15

PINCH ME + retention

Question 16

Alzehimers macro, micro and biochem pathophysiology

Answer 16

Macroscopic: widespread cerebral atrophy of cortex and hippocampus
Microscopic: plaques due to deposition of type A-beta-amyloid protein and tangles caused by aggregation of tau protein
Biochem: deficit of ACh and excess glutamate

Question 17

Presentation of LBD

Answer 17

Fluctuating cognition