General

Question 1

What is frailty?

Answer 1

State of increased vulnerability resulting from ageing associated decline such that the ability to cope with every day stressors is comprised.

Question 2

What are the geriatric giants?

Answer 2

Falls 
Confusion 
Off legs -immbility
Incontinence 
Chest pain, SOB 
polypharmacy
fatigue
depression
Social admission

Question 3

What is deconditioning?

Answer 3

Idea already worse state gets worse when ill

Question 4

What is the endocrine physiology of ageing?

Answer 4

reduced testosterone, renin, angiotensin, growth hormone and IGF. Diurnal ADH lost –> nocturnal urine production

Question 5

What is the renal physiology of ageing?

Answer 5

reduced renal blood flow, increased arteriole resistance, reduced in GFR

Question 6

What is the CNS physiology of ageing?

Answer 6

beta amyloid plaques, small vessel ischaemic disease, reduced memory learning

Question 7

What is the respiratory physiology of ageing?

Answer 7

reduced elastic recoil and chest wall compliance, reduced RV, VC and FEV1.

Question 8

What is the MSK physiology of ageing?

Answer 8

reduced skeletal muscle, reduced bone density

Question 9

What is the immunological physiology of ageing?

Answer 9

reduced specific AB, reduced T cell, blunted fever response

Question 10

What is the gastrological physiology of ageing?

Answer 10

less saliva production, diverticulitis, malnutrition

Question 11

What are the phenotype and cumulative deficit models of frailty?

Answer 11

phenotype models are unintentional weight loss, reduced muscle strength, reduced gait speed, low energy expenditure.
Cumulative Deficit model- add up co morbidities, correlate with outcome

Question 12

What is a method of assessing frailty?

Answer 12

Bartell index

Question 13

WHen should postural hypotension be diagnosed?

Answer 13

Orthostatic hypotension can be diagnosed when there is:

a. A drop in systolic BP of 20mmHg or more (with or without symptoms)
b. A drop to below 90mmHg on standing even if the drop is less than 20mmHg (with or without symptoms)
c. A drop in diastolic BP of 10mmHg with symptoms (although clinically much less significant than a drop in systolic BP).

Question 14

mx for postural hypotension

Answer 14

Non-pharmacological treatments include increasing water and salt intake, or using compression garments or bandages and physical manoeuvres to counter the drop in blood pressure.
can take them off anti-htn meds

Question 15

What is the mx of moderate alzheimers?

Answer 15

1st line: Acetylcholinesterase (AChE) inhibitors (donepezil, galantamine, and rivastigmine)

Question 16

What is the mx of severe alzheimers?

Answer 16

Memantine -NMDA receptor antagonist

Question 17

What are the 5 As of alzheimers?

Answer 17

aphasia (speech)
agnosia (recognition)
apraxia (motor pathways eg doing up button)
amnesia
apathy

Question 18

How does FTD/ picks disease present?

Answer 18

<65.
insidious onset
changes in personality and behaviour.
One form in particular (primary progressive aphasia) can present with the inability to produce speech and loss of literacy skills.
Relatively preserved memory and visuospatial skills

Question 19

How does vascular dementia present?

Answer 19

>65
progressive step wise
may be pmhx vascular issues
focal neuro
nocturnal confusion

Question 20

How does Huntingtons dementia present?

Answer 20

possible personality changes,
it typically presents differently with motor dysfunction and tends to be a strong inheritance pattern.
younger

Question 21

A 72-year-old man presents with his daughter. She reports that he seems to have been struggling intermittently with his attention, and sometimes his speech is muddled. She says he has been very low in mood and does not seem to enjoy anything anymore, saying he doesn’t have any energy. He has also been experiencing visual hallucinations and at night he ‘acts out’ his dreams. His gait appears slow and shuffling. WHat is likely cause?

Answer 21

LBD - as fluctuates, hallucinates, speech and attention, mood effected, parkinsonisms, sleep disturbed

Question 22

What med should be avoided in LBD?

Answer 22

Avoid neuroleptics (eg haloperidol) in Lewy body dementia- may cause irreversible parkinsonism

Question 23

1st line mx of LBD?

Answer 23

Donepezil is a cholinesterase inhibitor which is the first-line treatment for cognitive impairment and behavioural symptoms in DLB.

Question 24

other mx of LBD?

Answer 24

Carbidopa/Levodopa are dopaminergic agents used to treat motor symptoms which present in Lewy body dementia

Clonazepam is used to treat REM sleep behaviour disturbances and should be given in low doses 30 minutes before bedtime.

Sertraline is an SSRI which are the preferred drugs to treat depression with Lewy body dementia because they have limited side-effects and favourable pharmacokinetics

Question 25

LBD vs parkinsons dementia?

Answer 25

Lewy body dementia is more likely if dementia starts before or within 1 year of the onset of the parkinsonian symptoms. Lewy body dementia also commonly causes visual hallucinations of people. The poor response to co-careldopa is also a clue, as the ‘Parkinson’s plus’ syndromes are often less responsive to classical antiparkinsonian drugs.

Question 26

Outline meds on stop-start criteria for pt with dementia

Answer 26

anticholinergics
Antimuscarinics
antipsychotics