Geriatrics

Question 1

What does Compos mentis mean?

Answer 1

Compos Mentis =
Having control of one’s mind.
I.e able to make self decisions and able to consent

Question 2

What is meant by “ Lasting power of attorney”?

Answer 2

A legal document that appoints an individual to make decisions on patient’s behalf regarding health and financial affairs.

Question 3

What are the 2 types of Lasting power of attorney?

Answer 3

1. Health and welfare

2. Property and financial affairs

Question 4

What is an advance directive?

Answer 4

A living will
A legal document in which a patient writes the treatments/procedures that he/she does not want to receive if they become unable to make decisions.

This document is written when a patient is competent and fully conscious.
Healthcare workers are legally required to follow the AD

Example - Jehovah witness usually have this to state they do not want to receive blood products

Question 5

What is the DS 1500?

Answer 5

Document of medical facts of patient with a terminal illness who is expected to die within 6 months
Allows patient to claim certain benefits from the government

Question 6

91 year old admitted for pneumonia , no medically fit for discharge and insists she would like to go home, son refuses and thinks she’s frail
What do you do?

Answer 6

Refer for fitness for discharge assessment

Question 7

89 year old male with history of prostate ca not on active treatment as developed confusion, polyuria and incontinence
What do you suspect?
What investigations are to be done? 1st step

Answer 7

Suspect UTI and bone mets
1st step - urine culture and sensitivity
Check serum calcium

Question 8

What is a common cause of delirium in the elderly?

Answer 8

UTIs

Question 9

An elderly man in a nursing home suffers from constipation. He is agitated and slightly confused
DRE = impacted stool
What is the management?

Answer 9

Impacted stool - phosphate enema

Question 10

An elderly man in a nursing home suffers from constipation. He is agitated and slightly confused
DRE = hard stool not impacted
What is the management?

Answer 10

Stool softeners

Question 11

An elderly man in a nursing home suffers from constipation. He is agitated and slightly confused
DRE = soft stool
What is the management?

Answer 11

1st line - high fibre diet/ senna stimulant laxative

2nd line - Lactulose/Macrogol

Question 12

Pregnant woman with constipation what do you give?

Answer 12

Lactulose

Question 13

A man in a care home on morphine develops difficulty defecating
Fluid and diet intake are good
Stools are soft
What do you give?

Answer 13

Senna (stimulant laxative)

Question 14

What is delirium?

Answer 14

Acute confusion also state
Tends to occur secondary to an ongoing infection (UTI Resp infection etc) especially in elderly patients

Acute onset (hours to days)
Mood + behavioural changes
Hallucinations (mainly visual)

Question 15

Elderly woman with a UTI develops confusion and fluctuating levels of consciousness.
She is disoriented to time and place
What does she have ??

Answer 15

Delirium

Question 16

What can long term insertion of urinary catheter lead to ?

Answer 16

Bacteriuria (bacterial colonisation)

Question 17

An asymptomatic patient with long term urinary catheter develops bacteriuria
What do you do ?

Answer 17

Change the catheter

Question 18

A patient with long term urinary catheter develops fever, urine culture shows bacteriuria
What do you do ?

Answer 18

Start antibiotics

Question 19

What do you do in case on obstructed/blocked Catheter

Answer 19

Bladder washout

Question 20

Pregnant woman develops bacteriuria, but does not complain of any symptoms
What is the management?

Answer 20

Cefalexin 500mg BID for 10-15 days

Question 21

When should stool bulking agents be given?

Name an example

Answer 21

Prophylaxis of constipation
Less useful in established constipation

Give in case of small hard stools when increasing dietary fibre cannot be done.

Ispaghula husk

Question 22

What laxative require an adequate fluid intake?

Answer 22

Stool bulking

Osmotic

Question 23

Name osmotic laxatives
How do they work?
When should they NOT be used?

Answer 23

Lactulose
Macro gel

Draw water into interstitial lumen , the increased volume encourages peristalsis

Do NOT give in palliative care - not enough water intake
It can cause bloating and flatus

Question 24

Name stimulant laxatives
How do they work?
When should you NOT give them?

Answer 24

Senna
Bisacodyl

Stimulate motility
ONLY use as required as they can cause laxative dependence

Do NOT give in hard rocky stools, bowel obstruction