Geriatrics

Question 1

Investigation for all forms of dementia?

Answer 1

Adenbrooks investigation, GPCOG, 6 item CIT

Question 2

Tau tangles and amyloid plaques are classic of what form of dementia?

Answer 2

Alzheimers

Question 3

Risk factors for alzheimers?

Answer 3

Downs syndrome, age, 1st degree relative, amyloid precursor protein gene mutation

Question 4

Symptoms of alzheimers

Answer 4

STML - progressive and persistent
Global cog impairment
Irritable, mood swings

Question 5

Treatment of alzheimer’s

Answer 5

Ach-esterase inhibitor
NMDA receptor antagonist

Question 6

Symptoms of lewy body dementia?

Answer 6

EPSE
Visual hallucinations
REM sleep disturbance
Fluctuates but overall worse over time

Question 7

Investigations for lewy body dementia?

Answer 7

SPECT shows reduced metabolism and reduced occipital perfusion

Question 8

Treatment of lewy body dementia?

Answer 8

Levodopa, dopamine agonists, (Antipsychotics contraindicated)

Question 9

Symptoms frontotemporal dementia?

Answer 9

< 65 yo onset, impulsive, irritable, crying, overweight (appetite increase, portly man/ woman)
Later on halluc and parkinsonism

Question 10

Treatment of FT dementia?

Answer 10

SSRI for depression, olanzapine for agitation and hallucx, Alzheimers drugs are contraindicated

Question 11

Causes of delirium?

Answer 11

HE IS NOT MAAD
Hypoxia
Endocrine - cushings, thyroid, glucose
Infection - UTI/ pneumonia
Stroke - raised ICP, head trauma
Nutrition - thiamine/B12 deficiency
Others - pain, lack of sleep
Theatre - anaesthetics
Metabolic - electrolytes
Abdominal - urine retention
Alcohol - intox + withdrawal
Drugs - BZD, opioids

Question 12

What causes vascular dementia?

Answer 12

Many strokes/TIA

Question 13

Signs and symptoms of vascular dementia?

Answer 13

Sudden onset
Stepwise deterioration
Motor disorders
Behavioural changes
Cognitive impairment

Question 14

How is delirium managed?

Answer 14

Treat underlying cause
Calm environment
IM Haloperidol ( or Lorazepam in Parkinson’s)

Question 15

Main cause of injury/disability/death in elderly?

Answer 15

Falls

Question 16

Causes of falls?

Answer 16

I HATE FALLING
Inflammation (joints)
Hypotension
Arrhythmia
Tremor
Equilibrium
Foot pain
Leg length discrepancy
Lack of conditioning
Illness
Nutrition poor
Gait issues

Question 17

T-score interpretations?

Answer 17

> -1 = normal
-1 - -2.5 = osteopenia
< -2.5 = osteoporosis, with fracture = severe

Question 18

Management of osteoporosis?

Answer 18

Calcichew and Bisphosphonates e.g. alendronic acid are first-line
Alternatives : HRT, denosumab, strontium

Question 19

Risk factors for osteoporosis?

Answer 19

Female
Increasing age
Long term corticosteroid use
RA
Low BMI
Low mobility

Question 20

Ix for osteoporosis

Answer 20

FRAX score - shows risk of # in next 10 years
Hip DEXA scan performed if Frax is > 65 in females and > 75 in males.

Question 21

What is a z-score?

Answer 21

BMD corrected to patient age and gender

Question 22

Criteria for a total anterior circulation stroke (TACS)?

Answer 22

• Unilateral weakness and/or sensory deficit of face, arm, leg
• Homonymous hemianopia
• Higher cerebral dysfunction e.g. dysphasia, visuospatial disorder
  ALL 3 MUST BE PRESENT

Question 23

Criteria for partial anterior circulation stroke (PACS)?

Answer 23

Need 2 of the 3 TACS criteria, or just higher cerebral dysfunction

Question 24

Criteria for posterior circulation syndrome (POCS)?

Answer 24

One of the following must be present…
- Cranial nerve palsy and contralateral motor/sensory deficit
- Bilateral motor/sensory deficit
- Conjugate eye movement disorder e.g. horizontal gaze palsy
- Cerebellar dysfunction (vertigo, nystagmus, ataxia)
- Isolated homonymous hemianopia

Question 25

Criteria for lacunar stroke (LACS)?

Answer 25

One of the following…
- Pure sensory stroke
- Pure motor stroke
- Sensori-motor stroke
- Ataxic hemiparesis

Question 26

What is donezepil used for and how does it work?

Answer 26

Alzheimer’s - cholinesterase inhibitor - improves mental function