Geriatrics

Question 1

What are common causes of falls

Answer 1

• tripping
• LOC/dizziness
• postural hypotension

Question 2

What should you examine for after a fall

Answer 2

causes
* evidence of cardiovascular disease, neurological deficits, MSK issues

consequences

• neuro and MSK exam
• fractures and bruises

Question 3

What should you consider medication-wise after a fall

Answer 3

• consider stopping anti-coagulation

* consider stopping any medications that may contribute to confusion

Question 4

What elements of the MDT should be involved after a fall

Answer 4

PT + OT

Question 5

In urinary incontinence, must carry out a rectal exam to rule out ___

Answer 5

in urinary incontinence, must carry out a rectal exam to rule out faecal impaction

Question 6

what is the main cause of urinary incontinence in men?

Answer 6

prostatic enlargement

Question 7

What are the three types of incontinence in women

Answer 7

• functional incontinence
• stress incontinence
• urge incontinence

Question 8

What is stress incontinence

Answer 8

leakage of urine due to incompetent sphincter

Question 9

what are examples of stress incontinence

Answer 9

coughing, sneezing

commonly due to pelvic floor prolapse

Question 10

What is urge incontinence

Answer 10

urge to pass urine is quickly followed by uncontrollable complete emptying of the bladder

Question 11

What are some causes of urge incontinence

Answer 11

• dementia
• stroke
• UTI
• diabetes

Question 12

What is delirium

Answer 12

acurte impaired cognition and impaired consciousness/awareness

Question 13

What are some causes of delirium

Answer 13

• infection
• alcohol withdrawal
• medications
• metabolic disorder
• stroke
• head injury

Question 14

How should delirium be managed

Answer 14

• treat cause
• minimise stimulation and maximise safety
• sedate if safe and necessary

Question 15

what are some types of dementia

Answer 15

• korsakoff’s
• alzheimer’s
• vascular
• fronto-temporal
• lewy-body

Question 16

what are risk factors for refeeding syndrome

Answer 16

• BMI <16
• low K, Mg, phosphate
• weight loss >15% in last 3-6 months
• little/no nutritional in last 5-10 days
• alcohol/drug abuse
• chemotherapy

Question 17

What blood levels should be checked for refeeding syndrome

Answer 17

potassium
phosphate
magnesium

Question 18

what is refeeding syndrome

Answer 18

severe electrolyte and fluid shifts in malnourished patients

Question 19

What test needs to be done to assess a safe swallow

Answer 19

STOPPS test

Question 20

what kind of patient is suitable for enteral feeding

Answer 20

a patient with an accesible and functional GI tract

Question 21

what are the options for enteral feeding

Answer 21

• nasogastric tube
• nasoduodenal/jejunal tube
• percutaneous endoscopic gastrostomy (PEG) tube

Question 22

what does PEG tube stand for

Answer 22

percutaneous endoscopic gastrostomy tube

Question 23

what medication might patients receiving enteral feeding require

Answer 23

motility agenst (eg metoclopramide) because of possible delayed gastric emptying

Question 24

what is given if enteral feeding is unsuitable

Answer 24

parenteral feeding (IV)

Question 25

Why would enteral feeding be unsuitable

Answer 25

non-functional/inaccessible/perforated GI tract

Question 26

How does osteoporosis present

Answer 26

usually with a fragility fracture

Question 27

what is a fragility fracture

Answer 27

a fracture sustained from a fall from standing height or less

Question 28

what are the three most common fragility fractures

Answer 28

* vertebrae * neck of femur * distal radius

Question 29

What are risk factors for osteoporosis

Answer 29

* female * post menopausal * age >60 * malignancy

Question 30

What are cancers that have a particular affinity for bony mets

Answer 30

* prostate * breast * liver * renal * thyroid

Question 31

What investigations should be done for osteoporosis

Answer 31

* DEXA scan | * bone profile, PTH, calcium, vit D, FBC

Question 32

What DEXA score is diagnostic of osteoporosis

Answer 32

< -2.5

Question 33

What medical treatment can be given for osteoporosis

Answer 33

* bisphosphonates * vit D + calcium * denosumab

Question 34

When would denosumab be given for osoteoporosis

Answer 34

for postmenopausal women at increased risk of fractures who cannot tolerate a bisphosphonate

Question 35

What information must be communicated to patients taking bisphosphonates

Answer 35

they must remain upright for at least 30 mins because it causes oesophagitis

Question 36

What non-pharmacological treatment can be given for osteoporosis

Answer 36

* PT + OT * med recs * optimise hearing and vision

Question 37

What should you consider doing med recs in a patient with falls

Answer 37

* drugs that increase confusion, analgesics, antihypertensives, antihistamines, drugs that cause dehydration

Question 38

What is the main contributing factor to pressure ulcer development

Answer 38

immobility

Question 39

What is treatment for pressure ulcers

Answer 39

* barrier creams * repositioning * pressure redistribution (eg foam donuts) * antibiotics if neccessary * analgesia * debridement if neccessary

Question 40

What should you assess for in pressure ulcers when considering infection

Answer 40

* sepsis * cellulitis * osteomyelitis