Geriatrics

Question 1

What are clinical features of delirium?

Answer 1

Disorientation

Hallucinations

In attention

Memory problems

Mood/personality changes

Poor sleep

Question 2

What are causes of delirium?

Answer 2

Drugs – alcohol, anticholinergics, opiates, anticonvulsants, recreational drugs

Infection (particularly UTIs)

Urinary or faecal retention

Ictal

Dehydration/malnutrition

Metabolic

Low output state (MI, IDS, PE, CHF)

Question 3

How is delirium treated?

Answer 3

Treat underlying cause

Haloperidol or Olanzapine can be given

If the patient has Parkinson’s them the drug of choice is Lorazepam

Question 4

What medication can be given to treat delirium in a patient with Parkinson’s?

Answer 4

Lorazepam

Question 5

How can you differentiate between delirium and dementia? What are features which favour delirium?

Answer 5

Impaired consciousness

Fluctuation of symptoms

Abnormal perceptions e.g. hallucinations

Agitation

Fear

Delusions

Question 6

What is the most common form of dementia?

Answer 6

Alzheimer’s disease

Question 7

What are features of Alzheimer’s?

Answer 7

The four A’s

Amnesia (memory loss)

Aphasia (inability to speak/understand)

Agnosia (inability to recognise/identify objects)

Apraxia (inability to perform learned movements)

Question 8

What pathological changes are seen in Alzheimer’s disease?

Answer 8

Widespread cerebral atrophy

Cortical plaques

Acetylcholine deficiency

Question 9

How is Alzheimer’s disease managed?

Answer 9

Cognitive stimulation

1) Acetylcholinesterase inhibitor – donepezil/galantamine/rivastigmine

Note that donepezil is contraindicated in bradycardia

2) Memantine if acetylcholinesterase inhibitors are CI/not tolerated (caution in history of epilepsy)

Question 10

What are features of Lewy body dementia?

Answer 10

Progressive cognitive impairment

Early impairments in attention and executive function

Fluctuating cognition

Parkinsonism

Visual hallucinations

Question 11

How can we differentiate Lewy body dementia from Alzheimer’s?

Answer 11

Lewy body dementia also has parkinsonism and visual hallucinations

Alzheimer’s has memory loss only in the early stages Lewy body dementia also has early impairment of executive function

Question 12

How is Lewy body dementia managed?

Answer 12

Acetylcholinesterase inhibitor e.g. donepezil/rivastigmine

Galantamine is not licensed in Lewy body dementia

Question 13

Which acetylcholinesterase inhibitor is not licensed in Lewy body dementia?

Answer 13

Galantamine

Question 14

What are features of vascular dementia?

Answer 14

Presents in patients with risk factors – AF/hypertension/diabetes/smoking/obesity

Maybe history of stroke

Presents as stepwise deterioration

Question 15

How is vascular dementia treated?

Answer 15

Reduce risk factors

Symptomatic treatment

Question 16

What are features of frontal temporal lobar degeneration?

Answer 16

Onset before 65 years

Insidious onset

Relatively preserved memory

Personality change

Social conduct problems

Question 17

What is the definition of multi morbidity?

Answer 17

Presence of 2 or more long term health conditions

Question 18

What are risk factors of multi morbidity?

Answer 18

Age, tobacco, alcohol, poor nutrition, obesity

Question 19

What is the definition of malnutrition?

Answer 19

BMI <18.5 or
unintentional weight loss more than 10% in last 3-6 months

or
BMI <20 + unintentional weight loss >5% in last 3-6 months

Question 20

What screening tool can be used to diagnose malnutrition?

Answer 20

MUST score

Question 21

What are risk factors for pressure ulcers?

Answer 21

Pain
Immobility
Incontinence
Malnourishment

Question 22

What score can be used to screen for pressure ulcers?

Answer 22

Waterlow score

Question 23

How can pressure ulcers be graded?

Answer 23

Grade 1= non-blanchable rash
Grade 2 = partial thickness skin loss. blisters
Grade 3= full thickness skin loss
Grade 4= extensive destruction

Question 24

How are pressure ulcers managed?

Answer 24

Maintaining a moist wound environment

Question 25

Which medications are prescribed as pre-emptives?

Answer 25

Pain --> Mophine
Agitation --> Midazolam
Nausea --> Cyclizine
Respiratory tract secretions --> Hyoscine
Dyspnoea --> morphine