Conditions

Question 1

Causes of cognitive impairment in eldelry

Answer 1

Dementia
Delirium
Infection
Thyroid disease
B12/folate deficiency
ETOH
Chronic SDH
Normal pressure hydrocephalus
Brain tumour
Medication - anticholinergics
Depression
Anaemia
Hyponatraemia

Question 2

Work-up of cognitive impairment in elderly

Answer 2

Bloods; FBC/LFT/ESR/Ca/TFT/B12/FOLATE
CTB
CXR
FPG
ECG
MSU
HIV/syphilis if indicated

Question 3

Lewy body dementia and Parkinson disease dementia features

Answer 3

Gradual progressive decline
Visual hallucinations
Fluctuating arousal and attention
Parkinsonism
REM sleep disorder

Question 4

Frontotemporal dementia features

Answer 4

Impaired executive and language function
Behavioural/personality changes

Question 5

Vascular dementia features

Answer 5

Sudden onset or progressive / stepwise cognitive decline

Question 6

Mx BPSD

Answer 6

Recreation; cooking, gardening
Reminiscence; books, photos of family
Exercise
Music
Animal
Touch therapy
Antipsychotics
- Risperidone

Question 7

Aspects of health to review when on antipsychotics

Answer 7

Every 3/12
Behaviour
Bowel
Sleep
Weight gain
Pain
QTC prolongation
Agranulocytosis

Question 8

Vascular dementia mx

Answer 8

Aspirin; consider based on CVA/TIA risk vs bleeding risk
Cholinesterase inhibitors
- Donepezil 5mg 4/52 -> 10mg nocte

Question 9

Anticholinesterase inhibitors

Answer 9

Prescribe if; dx by specialist and MMSE >=10
Donepezil, galantamine, rivastigmine
ADR; n/v, diarrhoea, drowsiness, bradycardia, vivid dreams
Avoid use with NSAIDs

Question 10

NDMA receptor antagonist for Alzheimer’s

Answer 10

Memantine 5mg and uptitrate to 20mg daily
Indication; mod-severe Alzheimer’s if intolerant to ACHEI’s and MMSE 10-14
Can’t use if seizures
Can combine with ACHEI

Question 11

Non-pharm mx dementia

Answer 11

ACAT referral
Appoint EPOA
AHCD
Notify Driver License Authority
Webster Pack
Refer to National Dementia Helpline for advice
Refer to Dementia Australia for support/services
Encourage social activities
Exercise 30min daily
Reduce ETOH
Dental health
Healthy diet
Sleep hygiene

Question 12

Delirium work up

Answer 12

FBC
U+E
Ca
LFT
BGL
O2
ECG
Urine dipstick
Consider; CTB, CXR, BC, Tn

Question 13

Mx delirium

Answer 13

Psychotic sx or behavioural disturbance
- Haloperidol 0.5mg stat
- Parkinsons/LBD; quetiapine 25mg PO

Question 14

Drugs implicated in delirium

Answer 14

Anticholinergic; atropine, amitriptyline, oxybutynin, stemetil
Steroids
NSAIDs
Opioids
Alcohol
Levodopa

Question 15

Delirium prevention measures

Answer 15

Avoid polypharmacy
Pain relief
Prevent constipation
Safe mobilisation
Adequate hydration
Glasses/hearing aids
Good sleep hygiene
Close involvement of family
Reorientation methods

Question 16

Acute severe behavioural disturbance in adults mx

Answer 16

1st line; Droperidol 10mg IM
Rescue sedation
- Ketamine 4mg/kg IM

Question 17

Complications of hospital admission in elderly

Answer 17

Delirium
Infection
Constipation
Pressure Ulcers
Deconditioning
Medication errors
Insomnia
Malnutrition

Question 18

Indications to discontinue medications in elderly

Answer 18

Life expectancy < 2 years
Harm > benefit
Low utility
Pt not in favour of using

Question 19

Reasons for medication non-compliance

Answer 19

Lack of understanding
Fear of side effects
Cost
Lack of symptoms
Too many medications
Worry they will become dependent
Mistrust of doctors

Question 20

Work-up of malnutrition

Answer 20

FBC + film
U+E
Ferritin/folate/INR
Zinc
Vitamin D
Lipid
Selenium
Albumin

Question 21

Mx malnutrition

Answer 21

1-1.2g/kg protein daily
Variety of foods; meat, vegies, fruits, 2x glasses milk
Resource
Dietician
Meals on Wheels
Community cooking classes
Encourage social engagement

Question 22

Risk factors of falls

Answer 22

Gait issues
Visual/hearing issues
OA
Postural hypotension
Incontinence
Cognitive impairment
Environmental hazards
Footwear
Medications

Question 23

Exam for recurrent falls

Answer 23

BMI
Vitals
CVS exam
Neuro
Visual acuity
Hearing
Gait
Timed up and go test; >=12 seconds is at risk of falls