Care of the elderly

Question 1

5 As of alzheimers

Answer 1

amnesia
aphasia
apraxia
agnosia
apathy

Question 2

what is mild cognitive impairment

Answer 2

cognitive impairment but minimal impairment of ADLs

Question 3

What is delirium

Answer 3

acute, transient, reversible state of fluctuating impairment of consciousness, cognition and perception

Question 4

What are the 2 types of delirium

Answer 4

hyperactive - agitation, inappropriate affect, hallucinations
hypoactive - lethargy reduced concetration

Question 5

Causes of delirium

Answer 5

D - drugs
E - ear and eyes
L - low oxygen
I - 
R - retention of urine or stool
I - infection
U - underhydrated/nourished
M - metabolic
S - subdural

Question 6

Delirium screen

Answer 6

FBC
U+Es
LFTs
blood glucose
TFTs
hypercalacium
haemantinics
INR
septic screen

Question 7

Treatment of delirium and delirium tremens

Answer 7

delirium - haloperidol

delirium tremens - benzos

Question 8

investigation for osteoporosis

Answer 8

DEXA BMD < -2.5

Question 9

Risk factors for osteoporosis

Answer 9

S - steroids
H - hyperthyroidism/hyperparathyroidism
A - alcohol
T 0 thin
T - testosterone low
E - early menopause (low oestrogen)
R - renal/liver failure
E - erosive.inflammatory bowel disease
D - dietary intake

Question 10

How does PTH increase calcium in the blood

Answer 10

increases osteoclast activity so bone releases more calcium

increase calcium reabsorption from gut by using 1,25 - (OH)2D)

Question 11

treatment of osteoporosis

Answer 11

bisphosphonates (alendronate)
strontium ranelate
raloxifene
calcitonin
denosumab (RANKL - activates osteoclasts)

Question 12

How should bisphosphonates be taken

Answer 12

with plenty of water

sitting upright

Question 13

define syncope

Answer 13

transient LOC - fast onset, short duration and spontaneous recovery

Question 14

causes of collapse (3 cardio, 3 neuro, 3 other)

Answer 14

cardio

• postural HTN
• aortic stenosis
• arrhythmia

neuro

• epilepsy
• TIA/stroke
• vasovagal
• micturition syncope

other

• drugs
• alcohol intoxication
• mechanical fall

Question 15

risk factors for falls

Answer 15

motor

• gait disturbance
• muscle weakness

sensory

• vision problems
• peripheral neuropathy
• vestibular dysfunction

cognitive

• dementia
• delirium
• depression

polypharmacy

• benzodiazepines
• antipsychotics
• antihypertensives
• NSAIDs

Question 16

what is rhabdomyolysis

Answer 16

skeletal muscle breaks down due to traumatic, chemical or metabolic injury

Question 17

muscle breakdown bloods

Answer 17

increase potassium, phosphate, myoglobin and CK

Question 18

what medical problems can falls lead to

Answer 18

falls –> rhabdomyolysis –>

• myoglobin –> harmful to kidneys –> acute tubular necrosis
• raised potassium –> increase in arrhythmias

Question 19

ECG changes in hyperkalaemia

Answer 19

Prolonged PR
Ventricular fibrillation

ST elevation
Tall tented T waves
Absent P wave
Broad QRS

Question 20

Management of hyperkalaemia

Answer 20

C BIG K DRop

C- calcium gluconate (cardioprotective)

B - bisphosphonates
I - insulin
G - glucose

K - kayexalate (binds potassium in the GI tract)

D - diuretics (if kidneys are ok)
R - renal dialysis (if kidneys bad)

Question 21

Define ulcer

Answer 21

a break in the skin or mucous membrane which fails to heal

Question 22

Prevention of pressure ulcers

Answer 22

barrier creams
pressure redistribution and friction reduction
repositioning
regular skin assessment

Question 23

Risk factors for pressure ulcers

Answer 23

immobility
poor nutrition
incontinence
multiple comorbidities
smoking
dehydration

Question 24

what score is used to assess the risk of developing a pressure ulcer

Answer 24

Waterlow score

Question 25

What are the cognitive assessment tools

Answer 25

Addenbrooks cognitive examination-III (ACE3)
Montreal cognitive assessment (MoCA)
Abbreviated mental test score (AMT)
6-item cognitive impairment test (6CIT)
GP assessment of cognition (GPCOG)

Question 26

Comprehensive Geriatric Assessment and team involved

Answer 26

Medical - medications, diagnosis (doctor, pharmacist)
Mental - cognition, mood (psychiatrist, nurse)
Social - carers, finances (social worker)
Functional - mobility, transport (OT, PT)