Care of the Elderly

Question 1

3 main features of Parkinson’s

Answer 1

bradykinesia
cogwheel rigidity
pill-rolling tremor

Question 2

Parkinson’s pathophysiology

Answer 2

degeneration of dopaminergic neurons in the substantia nigra

Question 3

initial treatment in Parkinson’s

Answer 3

Levodopa

Question 4

What is levodopa sometimes combined with?

Answer 4

decarboxylase inhibitor - carbidopa or benserazide

Question 5

side effects of levodopa?

Answer 5

dyskinesia, ‘on-off’ effect, dry mouth, postural hypotension, psychosis, drowsiness

Question 6

other treatments for Parkinson’s?

Answer 6

Dopamine receptor agonist - Ropinirole

Question 7

Pathophysiology for Osteoporosis

Answer 7

decreased bone mineral density which increases bone fragility and therefore increases fracture risk

Question 8

Define osteoporosis, osteopenia and normal T-scores

Answer 8

Normal >-1
Osteopenia -1>t>-2.5
Osteoporosis t

Question 9

Osteoporosis risk factors

Answer 9

SHATTERED
Steroids
Hyperthyroidism
Alcohol
Thin BMI<22
Testosterone decreased
Early menopause
Renal or liver failure
Erosive/inflammatory bowel disease
Dietary intake (T1DM, malabsorption)

Question 10

Conservative osteoporosis treatment

Answer 10

lifestyle changes

weight-bearing exercises

Question 11

Medical osteoporosis treatment

Answer 11

Bisphosphates - Alendronate

Denosumab - Monoclonal

Question 12

Define delirium

Answer 12

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

Question 13

Define the two types of delirium

Answer 13

Hyperactive = agitation, inappropriate behaviour, hallucinations
Hypoactive = lethargy, reduced concentration

Question 14

Causes of delirium

Answer 14

Drug use - opioids, steroids, benzodiazipines, infection - UTI or pneumonia, constipation, alcohol, hypoxia, vitamin B12 deficiency, thiamine deficiency, epilepsy

Question 15

Delirium screening

Answer 15

Bloods - FBC, U&Es, LFT, TFTs, Calcium, INR

Question 16

Supportive delirium management

Answer 16

Have a clock available, have familiar objects from home around patients - glasses, walking aids, staff consistency, adequate lighting, sleep hygiene

Question 17

Medical delirium management

Answer 17

Haloperidol

Benzodiazepine e.g. diazepam for delirium resulting from alcohol withdrawl (delirium tremens)

Question 18

Define an ulcer

Answer 18

Break in the skin or mucous membrane which fails to heal

Question 19

Define pressure ulcer

Answer 19

an ulcer caused by pressure or shear force over bony prominence

Question 20

Pressure ulcer risk factors

Answer 20

immobility, poor nutrition, incontinence, comorbidities, smoking, dehydration, obesity, diabetes mellitus, old age

Question 21

Define syncope

Answer 21

temporary loss of consciousness, characterised by fast onset, short duration, spontaneous recovery

Question 22

Causes of falls

Answer 22

Stroke/TIA, syncope, drugs (alcohol, sedatives), Parkinson’s, visual impairment, hypoglycaemia, osteoarthritis of hip