Common Geriatric Conditions

Question 1

Causes of incontinence

Answer 1

Multiple sclerosis
Stroke
Dementia
Confusion/delirium in the elderly

Question 2

Consequences of incontinence

Answer 2

Damage to skin, urinary tract infections, an increased risk of falls, avoidance of going far from home (leading to isolation).

Question 3

Problems with self-catheriterisation

Answer 3

UTI
Trauma to urethra
Difficulty in removing it.

Question 4

Those at risk of falls

Answer 4

Motor impairment (Parkinsons, stroke, reconditioning)
Sensory impairment (vison, peripheral neuropathy)
Cognitive or mood impairment (dementia, delirium)
Orhtostatic HTN
Poly-pharmacy and psychotropic medications
Environmental hazards (clutter, rugs)

Question 5

Fall prevention

Answer 5

Address risk factors.
Advocate exercise to strengthen and improve balance.
Review medications.
Test vision.
Home safety assessment.

Question 6

Pressure ulcer prevention

Answer 6

Barrier creams.
Pressure re-distribution and friction reduction.
Repositioning

Question 7

Management of a pressure ulcer

Answer 7

Wound management.
Friction reduction
Pressure redistribution
Antimicrobials if appropriate
Assess nutrition and hydration of patient

Question 8

Those at risk of developing a pressure ulcer

Answer 8

Nutritional deficiency
Limited mobility
Unable to reposition themselves
Cognitive impairment.

Question 9

Difference between fall and collapse

Answer 9

Collapse is a result of an acute medical problem e.g. arrhythmia. Fall is not due to an acute pathology but can involve chronic diseases.

Question 10

Complications of a fall

Answer 10

Fracture

Hospitalisation = hospital acquired pneumonia and other illnesses.

Question 11

Tools to assess risk of fall

Answer 11

Time Up & Go test

Turn 180 degree test

Question 12

Skeletal muscle injury after a a fall

Answer 12

Rhabdomyolysis

Question 13

Presentation of rhabdomyolysis

Answer 13

Muscle pain, muscle weakness, dark urine, high creatinine kinase.

Question 14

Treatment of rhabdomyolysis

Answer 14

Hydration of patient - dilute toxic muscle metabolites.

Question 15

5 A’s of Alzheimer’s

Answer 15

Apathy, amnesia, apraxia, aphasia, agnosia.

Question 16

Types of aphasia

Answer 16

Wernicke’s area = receptive can’t comprehend.

Broca’s area = expressive, can’t produce language.

Question 17

What is apraxia

Answer 17

Can’t produce complex, voluntary motor skills

Question 18

6 tools to test cognitiion

Answer 18

MMSE
Addenbrookes - ACE-III
Montreal - MoCA
Abbreviated - AMT
6-item - 6-CIT
GPCOG

Question 19

What stage of cognitive impairment has minimal impact on ADL

Answer 19

Mild

Question 20

Definition of delirium

Answer 20

Acute, transient, reversible state of fluctuating consciousness, cognition, attention and perception.

Question 21

Delirium screen

Answer 21

FBC
U&E
LFT
TFT
Calcium
B12 & folate
INR
Septic screen (urine dip and msc, CXR, FBC, blood culture, LP)

Question 22

Medical Rx for delirium

Answer 22

Haloperidol

Question 23

Components of comprehensive geriatric assessment

Answer 23

Used in discharge planning:

Medical, functional, psychological, social and environmental.

Question 24

Main Ix for osteoporosis

Answer 24

DEXA, if T score

Question 25

Medical Rx of osteoporosis

Answer 25

Bisphosphonates S/E = GI upset, photosensitivity, oesophageal ulcers.

Question 26

Bloods in a patient after a fall

Answer 26

High potassium
High phosphate
High myoglobin
High creatinine kinase

Question 27

Why AKI and arrhythmia after a fall?

Answer 27

Myoglobin toxic to kidneys.

Hyperpotassium causes arrhythmia - peaked T waves, no P waves, ventricular fibrillation.

Question 28

What is a pressure ulcer

Answer 28

Break in the skin or mucous membrane that fails to heal.

Question 29

Score used to assess pressure ulcer

Answer 29

Waterlow score

Question 30

Causes of a collapse (not fall!)

Answer 30

Arrhythmia
Generalised seizures
TIA/stroke
Alcohol/drug overdose