Ageing

Question 1

Parkinson’s pathophysiology

Answer 1

Reduced motor cortex stimulation due to destruction of D2 receptors in the substantia nigra (nigrostriatal tract)

Question 2

REM sleep disorder and micrographics

Answer 2

Parkinson’s

Question 3

Treatment for Parkinson’s

Answer 3

Start with dopamine agonists or MOA inhibitor if not affecting QoL. The progress to levodopa combined with a peripheral decarboxylase inhibitor (carbidopa) to increase bioavailability. If getting symptoms or disk Ines is despite optimal levodopa, give MAO-B inhibitor, COMT inhibitor or dopamine agonists adjunct.

Question 4

What to do if orthostatic hypotension occurs in Parkinson’s patients

Answer 4

Midodrine (peripheral alpha adrenergic receptors)

Question 5

Benzhexol/ Benzatropine uses

Answer 5

Helps to reduce tremors and useful anti-cholinergic side effects (dry mouth)

Question 6

Common side effects of levodopa

Answer 6

Diskinesia, on off effect, dry mouth, anorexia, postural hypotension

Question 7

Side effects of dopamine agonists

Answer 7

Day time drowsiness, hallucinations, pulmonary retroperitoneal and cardiac fibrosis risk so perform ECG ESR and CXR prior to commencing bromocriptine or cabergoline

Question 8

Neuroleptic malignant syndrome causes

Answer 8

Sudden stop of levodopa and mainly patients taking antipsychotics.

Presents with pyrexia, muscle rigidity, hypertension, tachycardia, tachypnoea, delirium and confusion and elevated CK

Question 9

SPECT findings in Parkinson’s

Answer 9

Lewy bodies and alpha synuclein

Question 10

What to give in delirium with Parkinson’s

Answer 10

Benzodiazepines - not antipsychotics due to their D2 antagonist effect.

Question 11

DXA scan results in osteoporosis

Answer 11

If between -1 and -2.5 osteopenia

Below 2.5 is osteoporosis

Question 12

Vascular dementia

Answer 12

Executive dysfunction, early motor and mood changes , stepwise decline in function. Often coexists with Alzheimer’s

Question 13

Lewy body dementia

Answer 13

Pill rolling tremor, Parkinsonism, recurrent visual hallucinations (furry animals), cognitive fluctuations, REM sleep disorder

Question 14

Frontotemporal dementia

Answer 14

Presents either as personality and social conduct issue or primary language disorder.
Behaviour includes early loss of empathy, emotional reactivity, hypoerorality, more sweet foods
Language deficits

Question 15

Language deficits in frontotemporal dementia

Answer 15

Semantic : loss of knowledge of single words, surface dyslexia but spared speech production and repetition

Progressive non fluent is maintaining of single word knowledge but progressive loss of speech, agrammatism.

Question 16

MRI in frontotemporal dementia

Answer 16

Shows focal atrophy in frontal and or anterior temporal lobe.

Question 17

Alzheimer’s pathophysiology

Answer 17

A neurodegenerative disorder starting in hippocampus but affecting temporal lobe. Senile plaques and neurofibrkllary tangles are seen.

Question 18

Genetic link in Alzheimer’s

Answer 18

ApoE 4 increases risk of disease, ApoE2 decreases risk but increased risk of CV disease.
APP and presenilin genes 1&2 usually early onset Alzheimer’s,

Question 19

When to start bisphosphonates

Answer 19

Give if at medium or high risk of a fracture, or if had fracture. Complement with vit D and calcium if levels are low.

Question 20

Calcium and phosphate levels in pagets, osteomalacia and osteoporosis

Answer 20

Osteoporosis: all usually normal
Osteomalacia: low vit d <25, low Ca, low Phosphate and high PTH (compensating)
Pagets: high ALP

Question 21

Urethral stricture causes

Answer 21

Pelvic fracture, erethritis, infection (gonorrhoea lichen sclerosis)

Question 22

Down syndrome associated disease

Answer 22

Alzheimer’s dementia

Question 23

Clinical frailty scale 1-9

Answer 23

1-3 very fit to managing well
4- vulnerable but not dependent
5 - dependent for high order AODL
6- moderately frail
7- severely frail (need help with everything)
8-9 very bad usually hospital or care homes

Question 24

Management of delirium

Answer 24

Reassure, isolate and reduce medical interventions as much as possible

Only if absolutely necessary, give haloperidol/lorazepam if Parkinson’s or seizures or elongated QT.

Question 25

Deprivation of Liberty safeguards (DoLS)

Answer 25

Allows restraints and restrictions in a hospital or care home to be used if in the persons best interest if the patient lacks capacity. This must be made by a doctor (mental health assessor) and best interest assessor (social worker, nurse, occupational therapist…).