Geriatrics

Question 1

RF falls

Answer 1

• Muscle weakness
• Balance/gait disturbances
• Polypharmacy
• > 65
• Postural hypotension
• Arthritis/diabetes/Parkinson’s
• Cognitive impairment

Question 2

Questions to ask in falls history

Answer 2

• Where were they?
• When did they fall?
• Collateral history
• Prodrome?
• Why do they think they fell?
• Systems review
• PMH - balance/sight/gait

Question 3

Medications causing postural hypotension

Answer 3

nitrates, diuretics, ACh meds, anti-depressants, BB, l-dopa, ACEi

Question 4

Ix falls

Answer 4

BP, glucose, urine dip, ECG, FBC, U and E, LFT, bone profile

Question 5

what is an intracapsular NOF fracture

Answer 5

within capsule of hip joint (affects neck)
the blood supply to the NOF is retrograde - intracapsular injury causes high chance of AVN

Question 6

Tx undisplaced intracapsular NOF

Answer 6

IF or hemi-arthroplasty

Question 7

Tx displaced intra-capsular NOF

Answer 7

total hip replacement

Question 8

What is an extra-capsular NOF

Answer 8

• Trochanteric fractures
• Must be <5cm below the lesser trochanter - otherwise treated as femoral fracture
• If stable, treat with dynamic hip screw - if not then intra-medullary device

Question 9

NOF presentation

Answer 9

• Pain radiating from groin to thigh
• Inability to weight bear
• Shortened and externally rotated limb
• Bruising

Question 10

VTE prophylaxis NOF

Answer 10

all need treatment <48h and VTE prophylaxis with LMWH

Question 11

what is a pressure ulcer?

Answer 11

Ulcers developing on bony prominences (sacrum or heel) that occur when a patient is immobile for prolonged periods

Question 12

RF pressure ulcer

Answer 12

Malnourishment, immobility, incontinence

Question 13

Ix pressure ulcer - which score do you use?

Answer 13

Waterlow - considers BMI, nutrition, mobility etc

Question 14

Mx pressure ulcers

Answer 14

Hydrocolloid dressings encourage healing, help pt to move

Question 15

Grade 1-4 of pressure ulcers

Answer 15

1 - erythema of intact skin, it may be warm, oedematous, or hard
2 - partial thickness skin loss, ulcer is superficial and looks like an abrasion/blister
3 - full thickness skin loss extending through fascia
4 - extensive necrosis and damage to muscle, bone or structures

Question 16

what is Huntington’s disease

Answer 16

• Autosomal dominant neurodegenerative disorder caused by a tri-nucleotide (CAG) repeat
• Degeneration of cholinergic and GABAergic neurons in basal ganglia due to defective huntingtin gene on chr4

Question 17

sx Huntington’s disease

Answer 17

• Chorea
• Personality changes - irritability, apathy, depression
• Dystonia
• Results in immobility, mutism and inanition

Question 18

treatment Huntington’s disease

Answer 18

• Supportive treatment only
• Treat chorea with benzodiazepines/antipsychotics
• Treat depression with SSRIs

Question 19

RF delirium

Answer 19

Pain
Infection
Nutrition
C - constipation
H - hydration

M - metabolic/medications
E - environmental changes

Question 20

Causes of delirium

Answer 20

P = pain
I = infection (UTI)
N = nutrition (or lack of)
C = constipation
H = hydration

M = medication or metabolic
E = environment changes

Question 21

Symptoms of delirium

Answer 21

• Loss of short term > long term memory
• Agitated or withdrawn
• Mood changes
• Visual hallucinations
• Poor attention

Question 22

Treatment for delirium

Answer 22

• Treat cause
• Haloperidol 0.5mg orally as first-line sedative
• Treatments involving antipsychotics (haloperidol) can worsen Parkinsonian sx

Question 23

Subarachnoid haemorrhage

Answer 23

Thunderclap headache, caused by berry aneurysm

Question 24

Subdural haemorrhage

Answer 24

Banana shaped
Venous bleed following trauma

Question 25

Epidural haemorrhage

Answer 25

Lemon shaped
Trauma
MMA