Geriatrics Flashcards
A 78 year old woman presents with incontinency associated with coughing. What type of incontinency is it likely that she has?
Stress incontinence - 50% of post-menopausal women will have this to some degree
A 75 year old gentleman presents with stress incontinence and you notice from his notes that he has had surgery recently. What procedure is it likely he has undergone?
prostatectomy - can cause stress incontinence in males
What muscles might have been damaged in a mother of two who presents with stress incontinence?
pelvic floor muscles - damaged in childbirth leading to stress incontinence.
A 35 year old woman presents with optic neuritis and diplopia which gets worse when she exercises. What type of incontinence is she at risk from?
overflow incontinence - patient has MS and as condition worsens may affect the signals from the bladder that communicate how full it is.
In a gentleman with incontinence due to prostatic hyperplasia, give one class of drug you might prescribe and one class of drug you would not prescribe.
He will have overflow incontinence therefore prescribe alpha-blockers e.g. doxazosin, tamsulosin
Do not prescribe anti-cholinergics, these make symptoms worse and are for urge incontinence e.g. tolterodine
A patient with myasthenia gravis presents with urge incontinence, which class of drugs typically used to treat this condition is contraindicated?
Anticholinergics e.g. oxybutinin or tolterodine.
Consider B3 adrenergic agonist.
Give some examples of LUTs you might ask about in a 71 year old gentleman who presents with incontinence?
urgency, frequency, flow, nocturia, pain, hesitancy, flow, incomplete voiding, post-micturition dribbling, straining, spraying.
You wish to prescribe tamsulosin to a gentleman with overflow incontinence. What is an important contraindication to take into consideration?
Postural hypotension - side of alpha blockers which may be made worse so don’t prescribe in these patients.
Give a cause of functional incontinence.
Patient has mobility issues or is in unfamiliar surroundings so can’t reach toilet in time.
A patient presents with significant post-micturition dribbling. Which of the following is the most likely cause? A. UTI B. BPH C. Myasthenia Gravis D. Coughing E. Dementia
Answer = B, patient has overflow incontinence
A: UTI causes urge incontinence
C: not a typical cause of incontinence
D: coughing may cause stress incontinence
E: may be a cause of urge incontinence as no longer any control over micturition pathways
Give 3 risk factors for incontinence.
Pick 3 from…
Childbirth, hysterectomy, obesity, menopause, caffeine/alcohol intake, diuretics, tricyclic anti-depressants, age, pregnancy.
Define urge incontinence.
a sudden, intense urge to urinate followed by an involuntary loss of urine.
Define stress incontinence.
Urine leaks when you exert pressure on your bladder by coughing, sneezing, laughing, exercising or lifting something heavy.
Define overflow incontinence.
Involuntary release of urine from an overfull urinary bladder, often in the absence of any urge to urinate
Which of the following is a cause of urge incontinence? A. BPH B. MS C. Kidney stones D. Parkinsons E. All of the above
D. Parkinsons, may cause loss of control over micturition pathways.
A, B and C are causes of overflow incontinence
What are the two primary causes of overflow incontinence?
urethral strictures: due to enlarged prostrate, bladder stones, kidney stones
detrusor weakness: due to reduced signals about fullness of bladder e.g. in MS or diabetic autonomic neuropathy
Which of the following is an appropriate examination to carry out in a patient with new-onset incontinence? A. abdominal exam B. PR exam C. urine dipstick D. neurological exam E. all of the above
E. all of the above
A: checks for a distended bladder
B: checks for constipation and prostatism (if male pt.)
C: checks for UTI
D: checks for MS, Parkinson’s, stroke
A female patient with a 4 day history of incontinence gives a urine sample for a dipstick. It gives the following results…
Leukocytes: +
Nitrites: ++
Blood: +
Ketones: normal
Glucose: normal
What is the most likely cause of her symptoms from these results? What type of incontinence will she have?
UTI leading to urge incontinence
Raised nitrites indicates presence of bacteruria, blood is also a marker of infection. Leukocytes show pyuria.
n.b. Leukocytes are not always raised in UTIs in women as may have a low bacterial count UTI therefore do not exclude this diagnosis automatically.
Define dementia.
A progressive global decline in cognitive function without impairment of consciousness.
Define delirium.
An acute fluctuating disturbance in level of consciousness, attention and global cognition.
Which of the following might you include in a delirium screen? A. Urinalysis B. B12 + folate levels C. Chest x-ray D. Ferritin E. All of the above
E.
Delirium screen…
U+E, FBC, Creatinine, CRP, glucose, B12+folate, ferritin, LFTs, TFTs.
Chest x-ray, urinalysis, ECG, CT head (if indicated)
A 75 year old woman presents with a 3 day history of increasing confusion. When you see her she has impaired attention span and fluctuating level of consciousness.
Is she suffering from delirium or dementia?
Delirium
Acute onset, low attention span and impaired consciousness.
A patient with a MMSE of 9 is referred to the memory clinic. Is there anything that they can prescribe in this case?
No. Medications indicated for an MMSE over 12 (or between 10-20 depending on what text you read)
Give an example of an acetylcholinesterase used in the treatment of Alzheimer’s .
Donezepil, Rivastigmine, galantamine
A patient whose mother has just been diagnosed with Alzheimer’s comes to see you. She is worried about her risk of developing the condition, which gene mutation might you test for?
apoe4
Which type of dementia might have a sudden onset and step-wise deterioration?
Vascular dementia
Give 3 practical steps that can be taken in the treatment of a patient with dementia.
Care-coordinator, establish LPA/advanced directives, develop routines, try to avoid moving house/care home in the later stages of the disease, respite services for carers, avoid drugs which reduce cognition, memory books, label cupboards, organise medications
Which of the following drugs would be innappropriate to prescribe in someone with dementia? A. paracetamol B. Donezepil C. Amitriptyline D. memantine E. All of the above
C.
TCAs can reduce cognition and so make symptoms worse.
Which of the following types of dementia classically causes visual hallucinations? A. Lewy Body B. Alzheimer's C. Vascular D. Pick's E. All of the above
A. Lewy Body dementia, classically causes visual hallucinations which then may develop into Parkinsonism
Which of the following types of dementia classically causes disinhibition and personality changes? A. Lewy Body B. Alzheimer's C. Vascular D. Pick's E. All of the above
D. Pick’s aka Fronto-temporal dementia
Which of the following types of dementia will often present initially with short term memory loss and visuo-spatial problems? A. Lewy Body B. Alzheimer's C. Vascular D. Pick's E. All of the above
B. Alzheimer’s.
While can appear in all types dementia, they are classical early symptoms of Alzheimer’s.
A person must be assumed to have capacity until proven otherwise. True or False.
True - this is one of the five key principles of the Mental Capacity Act, 2005.
A person lacks capacity if they are unable to…
A. Understand the information relevant to the decision;
B. Retain the information;
C. Use or weigh the information;
D. Communicate the decision (by any means)
E. All of the above.
E. All of the above.
This are the four things needed for an individual to prove they have capacity
When does a person lack capacity under the Mental Capacity Act, 2005?
‘if, at the time the decision needs to be made, he or she is unable to make a decision because of an ‘impairment of, or a disturbance in the functioning of the mind or brain’
