Geriatric Medicine

Question 1

Acute Confusional State
Predisposing Factors (5)

Answer 1

age > 65 years
background of dementia
significant injury e.g. hip fracture
frailty or multimorbidity
polypharmacy

Question 2

Acute Confusional State
Precipitating events (7)

Answer 2

infection: particularly urinary tract infections
metabolic: e.g. hypercalcaemia, hypoglycaemia, hyperglycaemia, dehydration
change of environment
any significant cardiovascular, respiratory, neurological or endocrine condition
severe pain
alcohol withdrawal
constipation

Question 3

Acute Confusional State

Features (7)

Answer 3

memory disturbances (loss of short term > long term)
may be very agitated or withdrawn
disorientation
mood change
visual hallucinations
disturbed sleep cycle
poor attention

Question 4

Acute Confusional State

Management (4)

Answer 4

treatment of the underlying cause
modification of the environment
haloperidol 0.5 mg as the first-line sedative- CI in parkinson’s and LBD
alternatives incl olanzapine and lorazepam

Question 5

diagnosis of postural hypotension

Answer 5

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 6

risk factors for pressure ulcers (4)

Answer 6

malnourishment
incontinence
lack of mobility
pain (leads to a reduction in mobility)

Question 7

grading of pressure ulcers

Answer 7

Grade 1 Non-blanchable erythema of intact skin.
Grade 2 Partial thickness skin loss involving epidermis or dermis, or both. The
ulcer is superficial and presents clinically as an abrasion or blister
Grade 3 Full thickness skin loss involving damage to or necrosis of subcutaneous tissue that may extend down to, but not through, underlying fascia.
Grade 4 Extensive destruction, tissue necrosis, or damage to muscle, bone or
supporting structures with or without full thickness skin loss

Question 8

Mx of pressure ulcers

Answer 8

• a moist wound environment encourages ulcer healing. Hydrocolloid dressings and hydrogels may help facilitate this.
• The decision to use systemic antibiotics should be taken on a clinical basis (e.g. Evidence of surrounding cellulitis)
• consider referral to the tissue viability nurse
• surgical debridement may be beneficial for selected wounds

Question 9

Pharmacological Mx of alzheimers

Answer 9

mild to moderate - acetylcholinesterase inhibitor (donepezil, galantamine and rivastigmine
memantine is used when
- moderate alzheimers 2nd line
- add-on therapy in moderate to severe alzheimers’s
- monotherapy in severe alzheimer’s

Question 10

Non-pharmacological Mx of Alzheimers

Answer 10

• activities to promote wellbeing
• group cognitive stimulation therapy
• group reminiscence therapy and cognitive rehabilitation

Question 11

features of frontotemporal dementia

Answer 11

onset before 65
insidious onset
memory and visuospatial skills preserved
personality and social conduct problems