Geriatric medicine + Palliative

Question 1

Dementia pts class of medication

significantly associated with increase in mortality?

Answer 1

antipsychotics

Question 2

Dx Dementia?
primary care

Answer 2

MMSE/ GPCOG

10-CS
6CIT

full blood screen
> Hypothyroid
>FBC, U&E, LFTs, Calcium, Glucose, ESR, CRP, TFTs, Vit B12, folate

> memory clinic referall
old age psych

Question 3

secondary care Dementia Dx

Answer 3

neuroimaging

Question 4

medications associated with postural hypotension

Answer 4

antidepressants
ACEi
anticholinergic
beta blocks

diuretics
L-Dopa
Nitrates

Question 5

medications associated with falls due to other mechanism?

Answer 5

benzo
antipsychotics
opiates
anticonvulsants
codeine
digoxin

Question 6

Ix falls?

Answer 6

Bedside: basic obs, bp, blood glucose, urine dip, ECG

Bloods: FBC, U&E, LFT, Bone profile

Imaging: xray chest, CT head and cardiac echo

Question 7

AD
pathophysiology

Answer 7

widespread cerebral atrophy
cortex and hippocampus

Question 8

Huntingtons?

Answer 8

caudate nucleus and putamen

Question 9

MS

Answer 9

white matter of the brain and spinal cord

Question 10

Substantia nigra is impacted how in Parkinsons?

Answer 10

degeneration of dopaminergic neurons in substantia nigra

Question 11

AD first line meds?

Answer 11

acetylcholinesterase inhibitors

Donepezil

Question 12

Memantine and AD?

Answer 12

NMDA antagonist
2nd line

intolerant of acetylcholinesterase inhibitors

or if as an add on

Question 13

Digoxin toxicity

Answer 13

narrow therapeutic index

GI disturbance, dizziness, confusion

Question 14

Thiazodes like diuretics

Answer 14

indapamide can precipitate gout

Question 15

confusion screen?

Answer 15

TSH
B12
folate and glucose

Question 16

mx of delirium?

Answer 16

haloperidol / olanzapine

but in Parkinsons can worsen so maybe give quetiapine / clozapine

Question 17

Delirium in PD management?

Answer 17

IM lorazepam

Question 18

pressure ulcer treatment

Answer 18

do not routinely give abx

Question 19

Waterlow score

Answer 19

screen for pressure ulcer
> bmi
> nutritional status
> skin type
> mobility
> continence

Question 20

frailty assessment?

Answer 20

PRISMA-7

age,sex, health, help at home, mobility and social support

Question 21

how can idiopathic PD dementia be differentiated to Lewy Body Dementia?

Answer 21

PD symptoms first
> dementia features

Question 22

DLB management?

Answer 22

rivagstigmine

Question 23

first line antipsychotic for delirium pts in palliative care?

Answer 23

haloperidol

Question 24

Palliative care prescribing: agitation and confusion

Answer 24

haloperidol
chlorpromazine

Question 25

In the terminal phase of the illness then agitation or restlessness is best treated

Answer 25

midzolam

Question 26

Intracranial causes of nausea and vomiting

Answer 26

cyclizine first line anti emetic

Question 27

Chemically mediated symtpoms of nausea which anti emetic?

Answer 27

ondansetron

Question 28

6 broad causes of N+V

Answer 28

1- reduced gastric motility 5ht4 and dopamine receptor 2-chemically ; drugs hypercalcaemia, opioids, chemo 3- visceral /serosal > constipation/ candidiasis 4- Raised ICP 5- Vestibular opioid related 6- Cortical > GABA/H1 receptors

Question 29

pro kinetic agent?

Answer 29

domperidone preferred in obstruction, GI perforation

Question 30

Hiccups in palliative care?

Answer 30

chlorpromazine > haloperidol/ gabapentin

Question 31

Pain management in cancer breakthrough dose?

Answer 31

1/6 of daily dose of morphine

Question 32

severe renal impairment and pain mx?

Answer 32

alfentanil buprenorphine fentanyl not renally excreted and so less likely to causes toxicity

Question 33

hyoscine butylbromide

Answer 33

antimuscarinic drug reduces smooth muscle contractions tx for colicky pain

Question 34

Pain relief in palliative care with severe renal impairment?

Answer 34

buprenorphine

Question 35

starting morphine

Answer 35

20-30mg of MR with 5 mg morphone

Question 36

when increaisng dose of opiods next dose should be?

Answer 36

30-50% more

Question 37

conversion between opiods 50mg of codeine > morphine

Answer 37

0.5mg of morphine

Question 38

oral tramadol to oral morphine?

Answer 38

divide by 10

Question 39

from oral morphine to oral oxycodone?

Answer 39

divide by 1.5-2

Question 40

oral morphine to subcut morphine?

Answer 40

divide by 2

Question 41

oral morphine to subcut diamorphine?

Answer 41

divide by 3

Question 42

oral oxycodone to subcut diamorphine?

Answer 42

divide by 1.5

Question 43

when is syringe drivers used?

Answer 43

patient unable to take oral medication due to nausea

Question 44

respiratory secretions are managed by?

Answer 44

hyoscine hydrobromide glycopyrronium bromide

Question 45

opiate toxicity is more commonly with?

Answer 45

morphine due to accumulation especially in chronic kidney disease

Question 46

oxycodone / morphine / diamorphine in mild renal impairment?

Answer 46

oxycodone

Question 47

painful mouth management > end of life care

Answer 47

Benzydamine hydrochloride mouthwash

Question 48

palliative patients with mild-moderate renal impairment ?

Answer 48

oxycodone metabolised in liver

Question 49

oral morphine to diamorphine?

Answer 49

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Question 50

oral oxycodone to sub diamorphine?

Answer 50

/ 1.5