Care Of The Elderly

Question 1

What is the definition of a TIA?

Answer 1

An acute focal neurological event affecting cerebral or visual function with symptoms lasting LESS THAN 24 HOURS due to embolic or thrombotic disease

Question 2

What are the NICE guidelines surrounding secondary prevention of osteoporotic fractures in women aged 50-74 years, compared to those aged >75 years?

Answer 2

Women aged >75 years: given oral bisphosphonates (alendronic acid) with no need for a DEXA scan
Women aged 50-74 years: DEXA scan first to determine whether they need bisphosphonate treatment

Question 3

What options are there for patients who require secondary prevention of osteoporotic fractures, but who are unable to tolerate oral bisphosphonates?

Answer 3

Denosumab (given s/c every 6 months) 
Zoledronic acid (as an annual infusion)

Question 4

What T score is diagnostic of osteoporosis?

Answer 4

-1 to -2.5 is osteopenia and anything lower than -2.5 is osteoporosis

Question 5

What is the target time frame for patients with a NOF# to undergo surgery?

Answer 5

Within 48 hours if stable

Question 6

Name some risk factors for osteoporosis (and fragility fractures)

Answer 6

Genetic background, chronic Vit D deficiency, poor calcium intake, waning levels of gonadal and adrenal sex steroids, tobacco smoking, alcohol consumption, low levels of exercise

Question 7

What are the ‘3 main headings’ for the causes of incontinence in old age?

Answer 7

Ageing, diseases and drugs

Question 8

What is the impact of anti-cholinergic drugs on the bladder?

Answer 8

They impair detrusor contraction and result in urinary constipation

Question 9

What are the 3 acetylcholinesterase inhibitors that are all considered first line in the management of mild-moderate AD?

Answer 9

Donepezil, galantamine and rivastigmine

Question 10

What type of medication should you NOT give patients who have Lewy body dementia?

Answer 10

Antipsychotics e.g. haloperidol

Question 11

Lewy body dementia classically presents with what kind of perceptual disturbance?

Answer 11

Visual hallucinations (often involving animals)

Question 12

What is the most important risk factor for pressure sores?

Answer 12

Immobility

Question 13

What do all patients who have pressure ulcers require as part of their management plan?

Answer 13

Wound dressings, appropriate analgesia and a nutritional assessment

Question 14

What scoring system is used as a risk assessment tool for pressure ulcers?

Answer 14

Waterlow score

Question 15

When would antibiotics be indicated for pressure ulcers?

Answer 15

If cellulitis, septicaemia or osteomyelitis occurs