Geriatrics

Question 1

class of medication for urine incontinence

Answer 1

antichollinergic (can have adverse effects like constipation and dry eyes though)– may avoid in people with impaired neurologic function.

Question 2

Delirium criteria CAM

Answer 2

attention span decreased
age (can recall certain facts)
acute and fluctuant
altered LOC. (disorganized thinking)

Question 3

largest drug classes that cause falls

Answer 3

antidepressants
antipsychotics and anticholinergics.
benzodiazepines
sedatives
antihypertensive
NSAIDS
diuretics
betablockers.

Question 4

what is donzapil

Answer 4

reversible inhibitor of acetylcholinesterase for moderate to severe dementia of Alzheimer’s type.

Question 5

4 subtypes of primary dementia

Answer 5

alzheimers–gradual decline over time. involvemnet of exceutive function, inability to read etc.
vascular– event of sudden decline of cognition, stabilization, then another event. Short term memory changes, but may also have functional reduction as well.

lewy body– parkinsonism, visual disturbances, acting out dreams/flailing out arms.

frontotemporal dementia- marked behaviour changes as well as progressive aphasia. Antisocial behaviour, poor impulse control.

Question 6

T/F catheterization is a risk factor for delirium

Answer 6

true. should remove the catheter if possible.

Question 7

T/F should use odanzetron instead of diphenhydrimate

Answer 7

true. Diphenhydrinate is anti-cholinergic . Central inhibition leads to an agitated (hyperactive) delirium - typically including confusion, restlessness and picking at imaginary objects - which characterizes this toxidrome.

Question 8

best antihypertensive

Answer 8

according to the HYVET trial, indapamide is the best. +/- an ACE inhibitor. If possible, replace with diltiazem with indapamide.

Question 9

in cases of acute delirium where the person is agitated to the point of being at risk to themselves, what is the best agent to use?

Answer 9

Haloperidol (antipsychotic). The approach is non-pharm first and fixing the underlying cause of delirium.

Question 10

VDRL

Answer 10

syphillis antibody test

Question 11

key neurosyphillis findings

Answer 11

Abnormal walk (gait), or unable to walk.
Numbness in the toes, feet, or legs.
Problems with thinking, such as confusion or poor concentration.
Mental problems, such as depression or irritability.
Headache, seizures, or stiff neck.
Loss of bladder control (incontinence)
Tremors, or weakness.