Geriatrics

Question 1

TIA Mimics

Answer 1

• syncope
• migraine
• temporal arteritis
• hypoglycaemia
• seizures
• retinal hemorrhage or detachment

Question 2

Complications of stroke

Answer 2

• Aspiration pneumonia
• Pressure ulcers
• DVT
• Speech problems
• Depression
• Visual problems
• Weakness
• Urinary retention
• Constipation

Question 3

Acute stroke management

Answer 3

• ABCDE
• CT
• Aspirin 300mg for 2 weeks
• Thrombolysis within 4.5 hours after excluding bleed

Question 4

Falls Differentials

Answer 4

• Vasovagal Syncope
• Postural hypotension
• Myocardial infarction
• Epilepsy
• Poor eyesight/mobility

Question 5

FRAX domains

Answer 5

• age
• sex
• parent fractured hip
• weight
• height
• current smoker
• steroids
• rheumatoid arhtritis
• secondary osteoporosis (type 1 diabetes, premature menopause, malabsorption disease)
• more than 3 units of alcohol a day
• BMD

Question 6

Side effects of bisphosphonates

Answer 6

• Heartburn
• Indigestion
• Jaw pain
• GI upset

Question 7

Contraindications to bisphosphonates

Answer 7

• Oesophageal disease

- Gastric ulcers

Question 8

Causes of delirium

Answer 8

• infection
• change in environment
• medication
• surgery/post GA
• alcohol withdrawal
• pain
• head injury
• liver/kidney failure
• hyponatraemia
• hypoglycaemia
• B12/folate deficiency

Question 9

Drugs that cause delirium

Answer 9

• Opiates
• Levodopa
• Sedatives

Question 10

Delirium differentials

Answer 10

• Dementia
• Alcohol withdrawal
• Mania
• If hyperactive - psychosis
• Depression

Question 11

Tools for assessing confusion

Answer 11

• CAM

- 4AT

Question 12

Investigations in delirium

Answer 12

• Obs: Temp, pulse, BP
• Bloods: FBC, U&Es, Glucose, LFTs, CRP, B12& folate
• CXR
• Bowel chart
• Fluid charts
• Urine dip

Question 13

4 features of CAM

Answer 13

1. Acute onset and fluctuating
2. Inattention
3. Disorganised thinking
4. Altered level of consciousness (hypo or hyper alert)

Question 14

4AT Test

Answer 14

1. Alertness
2. AMT4
3. Attention
4. Acute and fluctuating course

Question 15

Causes of parkinsonism

Answer 15

• Parkinsons disease
• Drug induced
• Progressive supranuclear palsy
• Multi systems atrophy
• Vascular parkinsonism (lower limb parkinsonism)
• Dementia with lewy bodies
• Cotico basal degeneration

Question 16

Core features of parkinsonism

Answer 16

• Resting tremor
• Hypertonia
• Bradykinesia

Question 17

Features of progressive supranuclear palsy

Answer 17

• Vertical gaze palsy
• Early postural instability and falls
• Rigidity in the trunk

Question 18

Features of multi systems atrophy

Answer 18

• Postural hypotension
• ## Bladder instability

Question 19

Drugs that can cause parkinsonism

Answer 19

• Metoclopramide
• Prochlorperazine
• Typical antipsychotics

Question 20

Differentials of a tremor

Answer 20

• Essential tremor
• Drug induced
• Parkinsonism
• Cerebellar tremor
• Hyperthyroidism
• Anxiety

Question 21

Causes of malnutrition

Answer 21

• Increased needs: stress from surgery or illness
• Increased losses: diarrhoea/vomiting, wounds, burns
• Reduced intake: loss of appetitie, dysphagia, cognitive/communication issues

Question 22

Consequences of malnutrition

Answer 22

• Increased length of stay
• Increased costs of care
• Impaired wound healing
• Depression/ reduced QOL
• Impaired immune response
• Poor digestive function
• Inability to mobilise

Question 23

What tool is used to identify malnutrition?

Answer 23

MUST (Malnutrition Universal Screening Tool)

Question 24

Management after calculating MUST score

Answer 24

LOW RISK - repeat screening (weekly in hospital, monthly in care homes, annually in GP)
MEDIUM RISK - Observe and document dietary intake for 3 days
HIGH RISK- refer to dietician, improve overall intake, monitor and review care plan

Question 25

Conditions at risk of dysphagia

Answer 25

• PD, stroke, head and neck cancer, dementia, delirium, sepsis