Geriatrics (0-5%) Complete

Question 1

Dementia: A note on executive function:

The more specific test for executive function is ___________

The more sensitive test for executive function is __________

Answer 1

The more specific test for executive function is the clock draw

The more sensitive test for executive function is the MoCA, given it has multiple tasks that assess for it (e.g. sample Trails B, CDT, abstraction, letter fluency).

Question 2

Distinguish DLB and Parkinson’s disease dementia (PDD)

Answer 2

“1-year rule” to distinguish DLB and Parkinson’s disease dementia (PDD)

– if dementia precedes or begins within 1 year of onset of parkinsonism, then DLB

Question 3

Dementia:
–ChEIs (Donepezil, Galantamine, Rivastigmine)

Avoid if?

Answer 3

ChEIs (Donepezil, Galantamine, Rivastigmine)

– Avoid if pts have conduction defects (except RBBB), bradycardia, or unexplained syncope.
– Use with caution in asthma, COPD, seizures, GI bleeds, urinary incontinence

Question 4

Pharmacotherapy for Alzheimer’s Dementia

What if?
“Mild dementia on donepezil then progresses to moderate dementia - What would be recommended for pharmacologic management?

Add memantine, d/c donepezil and add memantine, or not change anything?”

Answer 4

= Don’t change anything based upon DOMINO-AD trial.

Question 5

Pharmacotherapy for Alzheimer’s Dementia

“a patient has moderate dementia – would you start Memantine without first trying ChEI?”

Answer 5

= Unless there’s a clear contra-indication to ChEI usually not used first-line due to cost.

Question 6

Summary of Pharmacologic Treatment

Answer 6

Question 7

Depression:

– Avoid: ___________, ___________, ___________

Answer 7

– Avoid: paroxetine, fluoxetine (anticholinergic), MOA-i

Question 8

Normal Aging – An internist’s summary

Answer 8

Question 9

Diabetes in Older Adults*

Generally: ________, then ________ or ________ (however known s.e. of ________), then ________ (may be at higher risk of ________) then ________

Answer 9

Generally: metformin, then DPP-4 inhibitors or GLP-1 (however known s.e. of weight loss), then SGLT2 (may be at higher risk of dehydration) then long-acting insulin

Question 10

Diabetes in Older Adults*

A1c targets should scale based on functional status
– Functionally independent, A1c __________
– Functionally dependent, A1c __________
– Frail and/or dementia, A1c __________

Answer 10

A1c targets should scale based on functional status
– Functionally independent, A1c ≤ 7.0%
– Functionally dependent, A1c 7.1 - 8.0%
– Frail and/or dementia, A1c 7.1 - 8.5%

Question 11

A note on elder abuse

– The most common fracture is the _______ but can be accidental.
– ________ fracture less likely to be accidental

Answer 11

– The most common fracture is the humerus but can be accidental.
– Zygomatic fractures less likely to be accidental

Question 12

Vaccinations in Older Adults

Answer 12