Geriartic Medicine

Question 1

Addenbrooke’s Cognitive Exam-3 (ACE-3)
Out of 100, pt scores 68. There is a global deficit in all domains tested in the ACE-3.
Which dementia is it?

Answer 1

Alzheimer’s Dementia produces global deficits on the Addenbrookes Cognitive Exam

Question 2

ACE Scale suggests dementia if the score is?

Answer 2

A score of 82 or less strongly suggests dementia.

Question 3

what are the domains of ACE?

Answer 3

domains tested are Memory, Attention, Fluency, Language and Visuospatial.

Question 4

PEOPLE WITH ALZHEIMER’S dementia have a global deficit which means?

Answer 4

all 5 domains mein masla Hai

Question 5

frontotemporal dementia will show deficits

Answer 5

in fluency and language

Question 6

Vascular dementia deficits will depend on

Answer 6

previous stroke
no consistent pattern seen in ACE-3 examinations.

Question 7

Mild cognitive impairment

Answer 7

An ACE-3 score of 82-88 suggests MCI.

Question 8

Parkinson’s dementia

Answer 8

deficits in the visuospatial domain as well as memory and attention.

Question 9

In view of dementia, which medication should you consider stopping?

Answer 9

TCA;Amitriptyline
worsens Dementia

Question 10

assessment tools recommended by NICE for the non-specialist setting include:

Answer 10

10-point cognitive screener (10-CS), 6-Item cognitive impairment test (6CIT)

Question 11

In dementia cases it is important to rule out a primary/organic causes with certain test;

Answer 11

FBC, U&E, LFTs, calcium, glucose, TFTs, vitamin B12 and folate levels.
Neuroimaging is performed* to exclude other reversible conditions (e.g. Subdural haematoma, normal pressure hydrocephalus)

Question 12

oral modified-release morphine should be used in preference to transdermal patches

Answer 12

if no comorbidities use 20-30mg of MR a day with 5mg morphine for breakthrough pain

Question 13

what is preferred to morphine in palliative patients with mild-moderate renal impairment

Answer 13

Oxycodone

Question 14

and with severe renal impairment?

Answer 14

alfentanil, buprenorphine and fentanyl are preferred

Question 15

elderly agitated pts
which drug is first choice and 2nd choice

Answer 15

1; haloperidol
2; chlorpromazine an dlevomepromazine

Question 16

elderly agitated pts with cancer(but not in terminal phase/EOL)
which drug is first choice and 2nd choice

Answer 16

1; haloperidol
2; chlorpromazine an dlevomepromazine

Question 17

a woman has breast cancer mets gone to ribs and pelvis.Pain is not controlled with analgesia and bisphosphonates has caused arthralgia and myalgia.
What is the next best option?

Answer 17

To increase MST(analgesia) and go for radiotherapy.
Metastatic bone pain may respond to analgesia, bisphosphonates or radiotherapy

Dexamethasone should be considered if there is metastatic spinal cord compressions.

Question 18

Management of hiccups

Answer 18

chlorpromazine is licensed for the treatment of intractable hiccups
haloperidol, gabapentin are also used
dexamethasone is also used, particularly if there are hepatic lesion

Question 19

Bleomycin belongs to which Onco drug group?

Answer 19

Bleomycin is a cytotoxic antibiotic used to treat metastatic germ cell cancer, squamous cell carcinoma and in some regimes non-Hodgkin’s lymphoma.