Geriatrics

Question 1

Risk factors for delirium

Answer 1

Elderley
Pre existing cognitive impairment
Poly pharmacy and multimorbidity
Previous delirium

Question 2

What are possible triggers for delirium

PINCHME and DELIRUM

Answer 2

Pain
Infective - UTI or CAP
Nutrition - hungry or dehydrated
Constipation or urinary retention
Hydration
Medication
Environment

Question 3

Key features of delirium

Answer 3

Acute onset confusion/cognitive impairment
Evidence of fluctuations
Attention is affected
Alertness affected (can be hyper or hypo active, or mixed)

Question 4

Managment of delirum

Answer 4

Assessment by MDT
Look for source of infection
Teat pain
Relieve constipation or urinary retention
Medication review

Question 5

What cognitive test can be done to screen for delirium

Answer 5

4AT

Assess alertness- try to rouse

AMT4 - age, DOB, current place and current year

Attention- months of the year backwards from December

Acute change or fluctuating course

Question 6

What medication can be used for delirium if conservative methods fail

Answer 6

0.5mg haloperidol oral / IM

Question 7

What are the four geriatric giants

Answer 7

Immobility
Incontincne
Impaired cognition
Instability

Question 8

What is the definition of postural or orthostatic hypotension

Answer 8

A fall of more than 20 systolic or 10 diastolic within 3 minutes of stamding

Question 9

Side effects of anti cholinergic

Answer 9

Blurred vision, dry mouth, urinary retention, confusiom

Question 10

Side effects of tricyclic anti depressants

Answer 10

Or tho static hypotension, sedation

Question 11

Side effects of glibenclamide

Answer 11

Hypoglycaemia

Question 12

If a patient is on 4 or more drugs, how often should we do a medication review

Answer 12

Every 6 months

If less drugs, do every year

Question 13

What is polypharmacy

Answer 13

If a patient takes 5 or more drugs on a daily basis