Geriatrics

Question 0

What are the predisposing conditions of delirium

Answer 0

Old age 
Preexisting dementia 
Poly pharmacy 
In dwelling catheter 
Malnutrition 
Physical or psychiatric co morbidity 
Physical restraints 
FunctionL dependency 
Substance abuse

Question 1

Define delirium

Answer 1

Acute disturbance of consciousness with reduced ability to focus, sustain or shift attention
Change is cognition- memory, language, disorientation and perceptual disturbances

Question 2

What are the classifications of delirium

Answer 2

Delirium due to
Medical condition- hypoxia, hypoglycemia, hyperthermia, infection (CNS, HIV related, septicaemia, pneumonia, UTIs), metabolic abnormalities(electrolyte disturbances, acid base disturbances, vitamin deficiencies, endocrinopathies in thyroid and parathyroid, hepatic/renal failure), structural changes (head injuries, brain tumours), hypo perfusion states (shock, anaemia, CCF, arrthymia) 
Substance intoxication- incl alcohol 
Substance withdrawal 
Multiple aetiologies 
Not otherwise specified

Question 3

Define dementia

Answer 3

Development of multiple cognitive deficits including memory, and at least one cognitive disturbance causing impairment in occupational or social functioning

Question 4

What is the criteria for dementia

Answer 4

Memory impairment
Criteria A1- memory impairment (required)
Cognitive disturbances
Criteria A2a- aphasia. Deterioration in language
Criteria A2b- apraxia. Impaired ability to execute motor activities.
Criteria A2c- agnosia. Failure to recognize or identify objects.
Criteria A2d- disturbances in executive functioning

Criteria B- represent a decline in previous level.

Question 5

Effective of dementia of individual

Answer 5

Cognitive- concentration, memory, learning, confusion
Functional- using appliances, handling money
Behavioral- aggression, poor social skills
Psychological- irritability, mood swings, anxiety, depression, loss of motivation

Question 6

Outline the mini mental state exam

Answer 6

Orientation- date, day, year, country,hospital, floor
Registration-naming three objects
Attention and calculation
Recall- ask for three objects again
Language- name pencil and watch, repeat no if ands or buts, follow 3 stage command

Question 7

How is gait and balanced assessed

Answer 7

Using the get up and go test
Get up without using armrest- proximal muscle weakness
Stand still momentarily-postural control
Walk forward 3m- frailty
Turn around and walk back to chair- balance
Turn and sit in chair- postural control

Using Rhomberg
Stand with feet together eyes closed- peripheral nerve sensation, slow postural reflexes
Sternal nudge-
Stand with feet together eyes open- postural reflexes

Question 8

What are the different types of incontinence

Answer 8

Urge- urine leakage and associated need to urinate. Eg UTI, vaginitis, bladder stones, uninhibited detrusor muscle (stroke, Parkinson’s)
Stress- raised intra abdominal pressure. Muscle laxity in pelvis- Childbirth,
Overflow- bladder past full. BPH, lack of parasympathetic innervation.
Functional- fully functioning urinary system but poor mobility, mental confusion
Mixed e

Question 9

How are ADLs scaled

Answer 9

Barthel scale- sever mental or physical disabilities
Feeding, bathing, grooming, dressing, bowels, bladder, toilet use, transfers (bed to chair and back), mobility, stairs/100

Question 10

How are IADLs scored

Answer 10

Lawton scale- milder cognitive or physical impairment

Telephone use, shopping, food prep, housekeeping, laundry, transportation, responsibity for own meds, handling finances.