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MCQ knowledge > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

Elderly women often get recurrent UTIs, what is the main reason for this?

A

Oestrogen deficiency

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2
Q

What is the treatment of urinary incontinence?

A
  1. Pelvic floor exercises for at least 3m

2. Anticholinergic medications may be used as monotherapy or in conjunction with pelvic floor exercises.

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3
Q

What drugs might exacerbate urinary incontinence?

A

Acetylcholinesterase inhibitors

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4
Q

Which type of dementia is likely most susceptible to an episode of delerium leading to deterioration of baseline cognitive function?

A

Lewy-body dementia

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5
Q

Give 4 potential causes of constipation in the elderly population in nursing homes.

A
  1. Laxative abuse
  2. Polypharmacy
  3. Poor dietary habits
  4. Sedentary lifestyle
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6
Q

What is the MOST common cause of blindness in elderly Caucasians?

A

Macular Degeneration

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7
Q

Give 4 preventative strategies that reduce the risk of hip fractures in the elderly female nursing home patient.

A
  1. Oestrogen replacement therapy
  2. Bisphosphonates
  3. Balance and muscle strenghtening exercises
  4. Hip protectors
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8
Q

T/F: Calcium supplements in elderly nursing home patients reduce the likelihood of hip fractures.

A

False.

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9
Q

What is the most common cause of disability in the Australian elderly population great than 65 years?

A

Arthritis

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10
Q

What is the life expectancy of the ‘average’ elderly Caucasian male?

A

80yrs

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11
Q

In the treatment of depression in the elderly, why do SSRIs have fewer SEs that TCAs?

Which of these is therefore first line treatment?

A

TCA (e.g. amitryptiline, doxepin) = inhibit the reuptake of
SSRIs BOTH serotonin and noradrenalin. Also blocks histamine, acetylcholine, and alpha1-adrenergic receptors conferring worse SE profile.

SSRIs (e.g. citalopram, fluoxetine) = more selective in in inhibiting reuptake of serotonin and weaker with noradrenalin, therefore fewer SEs.

SSRIs are therefore preferable and 1st line.

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12
Q

In Alzheimer’s Disease - what is the pathophysiological finding on autopsy?

A

Mis-folded proteins: amyloid plaques and neurofibrillary tangles.

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13
Q

In Alzheimer’s Disease - what regions of the brain are found to have hypometabolism and decreased cerebral blood flow in?

A

Parietal and temporal lobes.

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14
Q

In Alzheimer’s Disease - which brain regions are likely to have ATROPHY?

A
  1. Hippocampus
  2. Amygdala
  3. Entorhinocortex
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15
Q

Why is there detrusor overactivity in the elderly?

A
  • Detrusor contraction is mediated by PSNS and inhibited by SNS.
  • Less inhibition leads to detrusor overactivity.
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16
Q

Why do elderly patients tend to have orthostatic hypotension?

A

Decreased baroreceptor sensitivity

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17
Q

Why to elderly patients tend to have a widened pulse pressure?

A

Stiffening of blood vessels cause reduced arterial compliance that leads to widened pulse pressure.

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18
Q

What happens to the following parts of the heart in the elderly:

  1. LA
  2. LV
  3. Valves
A
  1. LA - enlarges
  2. LV - stiffens
  3. Valves - stiffens
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19
Q

Which pituitary hormones are INCREASED with normal ageing?

A

ADH

FSH / LH

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20
Q

T/F: insulin levels decrease with normal ageing.

A

False - INCREASED due to insulin resistance

21
Q

T/F: PTH is reduced in normal ageing.

A

False - INCREASED and associated with bone resorption

22
Q

What occurs to the following brain parameters in normal ageing:

  1. Brain volume
  2. Cerebral blood flow
  3. Neurotransmitters
A

ALL decrease

23
Q

What type of protein deposition is found in increasing levels with the normal ageing process?

A

Neurofibrillary tangles (NFT) and amyloid deposits

24
Q

T/F: Memory loss is NOT considered a part of normal ageing.

A

True

25
Q

T/F: minor slowing in cognitive processing speed is NOT associated with normal ageing.

A

False - it is.

26
Q

With normal ageing, what occurs to the following renal characteristics:

  1. Renal blood flow
  2. Nephron number
  3. Glomeruli number
A

ALL decrease

Smaller kidney with decreased concentration capacity and reduced GFR

27
Q

Regarding renal physiology, what occurs to the following with normal ageing:

  1. Serum renin and aldosterone levels
  2. Vit D activation
A

Both REDUCED

28
Q

Early onset Alzeihmer’s Disease (AD) is less than 1% off all and due to increased levels of amyloid beta protein.

What 3 causative genotypes have been described?

Are they worth testing?

A

All known to cause increase of amyloid beta protein.

PS1 (presenilin 1) - chromosome 14
PS2 (presenilin 2) - chromosome 1
APP (amyloid precursor protein) - chromosome 21

Yes - worth testing

29
Q

Late onset Alzeihmer’s Disease (AD) is less than 1% off all and due to increased levels of amyloid beta protein.

What 1 genotypes have been described?

Is it worth testing for?

A

APOE-epsilon 4 - increased likelihood for developing AD.

No - no point testing, patient already with AD.

30
Q

Elderly patient have present differently with depression.

Describe 4 features of an elderly patient with depression.

A
  1. Poor memory / concentration
  2. Irritability
  3. Slowed cognition
  4. Executive dysfunction
31
Q

What are the 3 types of incontinence in the elderly?

A
  1. Urge incontinence: involuntary urine loss preceded by urgency
  2. Stress incontinence: involuntary leakage from stress or exertion
  3. Mixed incontinence: mix of above
32
Q

What is the treatment of urge incontinence in the elderly?

A
  • Reduce detrusor muscle contractility

- Bladder training

33
Q

What is the treatment of stress incontinence in the elderly?

A
  • Increase urethral resistance

- Bladder training and pelvic flow exercises +/- Sx

34
Q

For STRESS incontinence in the elderly sling surgery (pubovaginal/urethral) give better symptomatic relief at 1 yr compared to just pelvic floor exercises alone.

Which test must precede surgery to exclude URGE incontinence?

Why is this important?

A

Urodynamic studies - if urge incontinence demonstrated then the surgery may WORSEN symptoms.

35
Q

What are the 4 principles of medical decision making?

A
  1. Autonomy: informed, capacity, voluntary with no coercion
  2. Justice: equality
  3. Beneficence
  4. Non-Maleficence
36
Q

Elderly patient is too unwell and cannot make a decision regarding medical treatment. Which of the following can NOT be refused by a ‘Enduring Guardian’ or ‘Medical Enduring Power of Attorney’:

  1. Withdrawal of futile or burdensome treatment by medical professionals
  2. Appropriate palliative care
A

Both.

37
Q

Which of the following locations in hospital is most likely to be associated with delerium in the elderly:

  1. Medical ward
  2. Surgical ward
  3. ED
  4. ICU
A

ICU

38
Q

What are 5 parameters of Frailty in the elderly (SEWWW):

A

SEWWW:

Sedentary - low physical activity
Exhaustion - self-reported
Weight loss
Weakness
Walking slow
39
Q

T/F: Presence of frailty is a predictor of increased falls, poor recovery, protracted hospital stay, disability, need for NHP and mortality.

A

True

40
Q

T/F: Falls are more common in nursing homes compared to the community in the elderly population.

A

True: NHP (50% of population) vs. community (30% of population)

41
Q

What percentage of elderly patients have fear of falling post-fall:

  1. 10%
  2. 25%
  3. 50%
  4. 80%
A

50%

42
Q

Comment on the following clinical features of delerium in the elderly:

  1. Onset
  2. Course
  3. Cognition / Attention / GCS
  4. Delusions / hallucinations
  5. Sleep-cycle
  6. Emotional state
A
  1. Onset - acute onset
  2. Course - fluctuant
  3. Cognition / Attention / GCS - fluctuant
  4. Delusions / hallucinations - common
  5. Sleep-cycle - reversed
  6. Emotional state - labile
43
Q

Which is associated with a worse outcome, hyperactive or hypoactive delerium?

A

Hypoactive delerium

44
Q

Elderly patient is discharged after an admission with delerium. What is the % mortality at:

  1. 6-12months
  2. 5 years
A

HIGH

  1. 6-12months - 40%
  2. 5 years - 50%
45
Q

What percentage of patient has delerium NOT fully resolved at time of discharge from hospital:

  1. 10%
  2. 25%
  3. 50%
  4. 80%
  5. 95%
A

95%

46
Q

T/F: Dexmedetomodine reduces post-op delerium in non-cardiac surgery patients.

A

True

47
Q

Which of the following 2 are useful in reducing the incidence of delerium in the elderly:

  1. Melatonin agonist (Ramelteon)
  2. 2nd generation antipsychotics (olanzepine, risperidone)
A

Both

48
Q

The NSW Guardianship Act has a clear heirachy for decision-making in a patient that cannot decide.

What is the 4 tiered hierarchy?

If there is a conflict - what is the means of escalation?

A
  1. Court appointed or enduring guardian
  2. Most recent de-facto with ongoing relationship
  3. Primary unpaid carer
  4. Relative or friend with close relationship

Escalation = Guradianship Tribunal

49
Q

What is a biomarker for Alzeihmer’s disease on a CTB?

A

Mesial temporal atrophy (aka hippocampal atrophy)

MCQ knowledge (22 decks)

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