Geriatrics SAQ

Question 1

Answer 1

1. Dementia most commonly AD
2. NPH, intracranial lesions, depression, neurosyphilis if at risk, hypoglycemia
3. Depressive symptoms from Hx, Drug hx, CT, BG, RFT, CBC, vit B12/folate, VDRL
4. < 65y = presenile. May have AD inheritance consider PSEN1/2, APP

Question 2

Answer 2

1. Neuro (stroke, vestibular, delirium), CVS (arrhyhtmia, VHD, MI, postural BP), metabolic (hypogly, other electrolytes, anemia, hypoT), MSK: previous fracture with sarcopenia, arthritis
2. SPLATT Hx: symptoms, previous falls, location, timing, trauma, PMHx
   BP, neuro, CVS, MSK exam + gait, dix hallpike, TUGT
3. electrolytes, arrhythmias, hypotension, sarcopenia from previous fracture

Question 3

Answer 3

1. AD
2. AChEI
3. Hypoglyc from reduced intake (GI upset)
4. D50 (glucagon)

Question 4

Answer 4

• Polypharmacy: drug drug interaection, drug disease interaction, poor compliance
• Absorption: increased gastric pH, delay gastric emptying, decreased absorption surface
• Metabolism: lower hepatic function (decreased first pass, decreased clearance)
• Excretion: decreased GFR (decreased clearance)
• Changes in pharmacodynamics: different sensitivity to drugs from younger adults

Question 5

Answer 5

1. Dementia as require B-ADL assistance
2. PD-D, AD
3. CT brian (medial temporal lobe atrophy), amyloid pET (increased amyloid load), FDG PET (decreased metabolism in medial temporal)
4. AChEI: rivastigmine

Question 6

Answer 6

1. delirium(drugs, electrolytes, low paCO3, iatrogenic, ROU, infection, hydration, metabolic esp hypoglycemia, head injury
2. CBC, LRFT, ECG, blood cultrue, CaPO4, A/VBG, urinanalysis
   CXR, urgent NECT
3. ABC, O2 volume resuscitation