Geriatrics

Question 1

First Line Rx for sedation in acute confusional state if Rx of cause doesnt work

Answer 1

Oral Haloperidol/Olanzapine> IM Haloperidol

Question 2

Management of confusional state in Parkinson’s disease (if Rx of cause doesn’t work)

Answer 2

Reduction of dose of parkinon meds
Atypical antipsychotics -quetiapine and clozapine are preferred

Question 3

The characteristic pathological feature of Lewy Body Dementia

Answer 3

Alpha-synuclein cytoplasmic inclusions (Lewy bodies) in the substantia nigra, paralimbic and neocortical areas.

Question 4

How is Lewy Body Dementia Diagnosed?

Answer 4

• usually clinical
• single-photon emission computed tomography (SPECT) is increasingly used. Diagnosis
  usually clinical
  single-photon emission computed tomography (SPECT) is increasingly used. The sensitivity of SPECT in diagnosing Lewy body dementia is around 90% with a specificity of 100%

Question 5

Lewy Body dementia characterized by

Answer 5

Lewy body dementia (LBD) is characterised by
- fluctuating cognitive impairment
- visual hallucinations
- parkinsonism
- pronounced sensitivity to neuroleptics/antiosychotics

Question 6

Assessment tools recommended by NICE to diagnose Dementia for the non-specialist setting include

Answer 6

• the 10-point cognitive screener (10-CS)
• the 6-item cognitive impairment test (6CIT)
• the 6-item screener
• the Memory Impairment Screen (MIS)
• the Mini-Cog
• Test Your Memory (TYM).

Question 7

Visual hallucinations with dementia = ?

Answer 7

Lewy body dementia

Question 7

MMSE Interpretation

Answer 7

No cognitive impairment 24–30
Mild cognitive impairment 19–23
Moderate cognitive impairment 10–18
Severe cognitive impairment ≤9.

Question 8

MOCA Interpretatation

Question 9

MMSE Interpretation for Alzheimer’s Disease

Answer 9

mild Alzheimer’s disease: MMSE 21–26 or >20
moderate Alzheimer’s disease: MMSE 10–20
moderately severe Alzheimer’s disease: MMSE 10–14
severe Alzheimer’s disease: MMSE <10.

Question 10

Several months or several years of a history of a sudden or stepwise deterioration of cognitive function along with risk factors for cerebrovascular disease (hypertension and smoking) point towards a diagnosis of ——-

Answer 10

Vascular Dementia

Question 11

Vascular Dementia

Answer 11

Several months or several years of a history of a sudden or stepwise deterioration of cognitive function along with risk factors for cerebrovascular disease (hypertension and smoking) point towards a diagnosis of Vascular Dementia

Question 12

——— drugs are associated with a significant increase in mortality in dementia patients

Answer 12

Antipsychotics.

antipsychotics should only be used for patients at risk of harming themselves or others, or when the agitation, hallucinations or delusions are causing them severe distress

Question 13

Factors favouring delirium over dementia

Answer 13

• Acute onset
• Impairment of consciousness
• Fluctuation of symptoms: worse at night, periods of normality
• Abnormal perception (e.g. illusions and hallucinations)
• Agitation, fear
• Delusions

Question 14

Oral Morphine to Subcut Morphine to Diamorphine conversion

Answer 14

Oral morphine to Subcutaneous morphine ( Divide by 2)
Oral morphine to Subcutaneous diamorphine ( Divide by 3)
DIAmorphine (3 letters then morphine
Morphine / 3 = diamorphine