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Question 1

Regarding Hypothermia in the elderly are the following true?

1. Is usually due to endocrine cause?
2. May be due to chlorpromazine therapy?
3. May be related to thiamine deficiency?
4. May present with prolongation of muscular relaxation time?
5. Should be treated with rapid rewarming?

Answer 1

1. F
2. T
3. T
4. T
5. F

• CNS depressants (chlorpormazine and benzos) as they increase hypothermia risk
  
  • depressed conscious level
  • slow relaxation of tendon reflexes and up-going plantars
• pancreatitis
• rhabdomyolysis

Treatment:

• warm gradually as rapidly precipitates organ failure/heart failure.

Question 2

From this list which ones can cause dementia?

1. disseminated sclerosis
2. folate deficiency
3. pellagra
4. Schizophrenia
5. Syphilis

Answer 2

Causes:

• syphilis
• vitamine B12 deficiency
• folate deficiency
• pellagra (B3 deficiency - 4 Ds - dementia, diarrhoea, dermatitis, death)
• vascular disease
• HIV

Schizophrenia is not associated with dementia.

Question 3

Recognising the Dying Patient? Treatment?

Answer 3

• sleeping more
• drinking and eating less
• change in cognition or mental state
• late signs:
  
  • change in breathing (Cheynes-Stokes) - ordiene reduces anxiety
  • change in colour,
  • terminal agitation - haloperidol
  • secretions - buscopan (hyosceine hydrobromide) glycopyrolate
• communication (breaking bad news - spikes and preempting worries).

Question 4

What do you look at when assessing consent?

Answer 4

• Obtain informed consent:
  
  • No in a schizophrenic episode - no delusions about mole, no repercussions.
  • Frame of mind, not experiencing other hallucinations or delusions.
  • Informed consent - given freely cannot be coerced (voluntary capacity) and risk/benefits/consequences (soreness, infection, bleeding, scarring).
• If you don’t go ahead with the procedure what will happen?
• Mental illness cannot mean no capacity but specific to that procedure. Involve family if possible.