Geriatrics

Question 1

What are the different types of elder abuse?

Answer 1

Neglect
Physical 
Psychological 
Sexual 
Financial

Question 2

What are clinical features that might indicate elder abuse?

Answer 2

Unexplained fear
Withdrawn attitude
Physical injuries (bruises, cuts, punctures, restraint marks, fractures)
Malnutrition and dehydration
Improper medicine use
Carer dominance
Pressure ulcers
Shabby appearance

Question 3

What are some causes of falls in the elderly?

Answer 3

Motor: gait or balance problems, muscle weakness

Sensory: peripheral neuropathy, vestibular dysfunction, vision problems

Cog: Dementia, depression, delirium

Orthostatic hypotension

Polypharmacy

Stroke/TIA

Seizure/Syncope

Environmental hazards

Question 4

Define frailty

Answer 4

the group of older people who are at highest risk of adverse outcomes such as falls, disability, admission to hospital, or the need for long-term care

Question 5

What does frailty mean practically?

Answer 5

relatively ‘minor’ health problem, such as a urinary tract infection, can have a severe long term impact on someone’s health and wellbeing

Question 6

How can frailty be measured?

Answer 6

Electronic frailty index

Question 7

What are some common causes of immobility in the elderly?

Answer 7

Arthritis
Osteoporosis
Hip fracture
Stroke
Parkinson's

Question 8

What are some effects of immobility?

Answer 8

Pressure ulcer
DVT
Pneumonia
UTI
Myopathy

Question 9

What factors must all be intact to assess capacity?

Answer 9

a. understand the information relevant to the decision
b. retain that information
c. use or weigh that information as part of the process of making the decision
d. communicate the decision made by talking, sign language or other means

Question 10

What is a LPA?

Answer 10

Lasting power of attorney

Appointee to act on behalf

Question 11

What is an advance decision?

Answer 11

drawn up by anybody with capacity to specify treatments they would not want if they lost capacity

Question 12

What is a visual hallucination?

Answer 12

Visual percept not associated with a real object

Question 13

What can cause visual hallucinations?

Answer 13

Alcohol withdrawal
Dementia
Schizophrenia
Psychotic disorder
Parkinson's

Question 14

How does NICE define malnutrition?

Answer 14

a Body Mass Index (BMI) of less than 18.5; or
unintentional weight loss greater than 10% within the last 3-6 months; or
a BMI of less than 20 and unintentional weight loss greater than 5% within the last 3-6 months

Question 15

How do you screen for malnutrition?

Answer 15

Malnutrition Universal Screen Tool

Question 16

How is malnutrition managed?

Answer 16

Dietician support
Food-first approach e.g. full cream to mash
If not then oral nutritional supplements e.g. Ensure in between meals but not meals themselves

Question 17

Which patients are at risk of becoming malnourished?

Answer 17

Eaten nothing or little > 5 days, who are likely to eat little for a further 5 days
Poor absorptive capacity
High nutrient losses
High metabolism

Question 18

What is the first choice for enteral feeding?

Answer 18

Always gastric unless upper GI dysfunction

Question 19

How do you check NG placement?

Answer 19

AXR

ph on aspiration