Geries

Question 1

DDx for falls

Answer 1

Vasovagal, micturition, orthostatic hypotension, epilepsy, arrythmia, hypoglycaemia, loss of balance (PD, alzeihmers, peripheral neuropathy), vertigo, muscle weakness, OA, visual, depression, drugs

Question 2

Important Qs to ask in falls assessment

Answer 2

Start off asking to describe event
Loss of consciousness?
Warning signs? loss of vision, dizziness
Trigger for fall? sitting, micturition, hungry
After the fall- get up quickly?, injury? bladder incontinence? confusion?
Past history of falls- 2 falls in past 6 months? usual type of fall?

Question 3

Important meds for falls

Answer 3

Antihypertensives, anti-psychotics, anti-depressants, Benzos, diuretics, anti-convulsants, beta blockers

Question 4

Physical exam for falls

Answer 4

Heart, legs, neuro (eyes, balance, power), postural BP

Question 5

Organic causes and Ix for fall

Answer 5

FBC (infection, anaemia), UEC (volume status), Glucose, Calcium (delerium), TFT, Urinalysis, Echo, CXR, CT head, Bone density

Question 6

Mx for fall

Answer 6

review meds, pressure stocking for orthostatic hypotension, OT assessment, physio, personal alarm, regular exercise

Question 7

Hemiplegic gait key

Answer 7

Arm flexion, circumduction of leg

Question 8

Diplegic gait key

Answer 8

hip and knee flexion, circumduction leg, no arm involve

Question 9

Myopathic gait key

Answer 9

pelvis drop to non-weight side

Question 10

Parkinsonian gait key

Answer 10

shuffling, festination, bradykinesia, turning by numbers, small steps, stooped posture

Question 11

Cerebellar gait key

Answer 11

Drunken sailor! wide base, unsteady, uncertain

Question 12

Sensory ataxic gait key

Answer 12

slamming of foot

Question 13

Timed up and Go

Answer 13

From sitting, walk 3m and sit again (>20s= impaired) normal= 10s

Question 14

Other exams for Gait assess

Answer 14

Cardio, neuro, MSK, vision, falls risk assessment

Question 15

DDx hemiplegic gait

Answer 15

stroke, infective, neoplastic, MS, cerebal palsy

Question 16

Neuropathic gait Ddx

Answer 16

Peripheral neuropathy, charcot marie tooth, compression peroneal nerve, L5 radiculopathy

Question 17

Myopathic gait Ddx

Answer 17

muscular dystrophy, hip dislocation

Question 18

Continence Hx

Answer 18

When was first time, how many/day
When does it usually occur, any precipitating (cough, laugh, lift)
Do you feel a sudden urge?
Dripping afterward?
Difficulty getting there?
Difficulty starting the flow, change in size of stream, desire to pass again straight away? (urinary obstruction)
Feeling thirsty (DM, kidney failure)
Change in appearance of urine (UTI)
Coffee, alcohol drinking
Med Hx- strokes, back injury

Question 19

Meds cause incontinence

Answer 19

Diuretics, prsozin, benzo, anti-psychotic

Question 20

Cause of stress incontinence

Answer 20

age, preganncy, post-prostate, weak pelvic floor

Question 21

Causes urge incontinence

Answer 21

stroke, prostate, bladder infection, parkinsons

Question 22

Causes of overflow incontinence

Answer 22

prostate

Question 23

Functional incontinence cause

Answer 23

immobility, memory, coordination

Question 24

Ix for incontinence

Answer 24

Urinalysis, FBC,
US bladder and ureter
Urodynamic testing- PVR, EMG (sphincter strength)

Question 25

Mx Incontinence

Answer 25

Pelvic muscle exercise Avoid alcohol, coffee, lose weight, quit smoking pads, catheter prostate surgery

Question 26

Rx for urge incontinence

Answer 26

Oxybutinin (anticholinergic)

Question 27

Prostate Rx

Answer 27

``` Alpha blockers (prasozin) 5-alpha reductase inhib: finasteride ```

Question 28

Cognitive assessment

Answer 28

Ask about memory, writing, reading, speaking, attention, depression, daily activities PMHx- stroke, head injury, meds Fhx- parkos, alzheimers Smoking/alcohol

Question 29

MMSE

Answer 29

1) Day, date, month, year, season (5) 2) Where are we? name of hospital? floor? country? state? suburb? (5) 3) Pencil, Table, Apple. Repeat and remember (3) 4) Serial 7s (5) 5) Recall objects (3) 6) Point to watch and pencil, name (2) 7) No ifs, ands or buts (1) 8) Take paper in right hand, fold in half, put on floor (3) 9) Obey written command 'close eyes' (1) 10) write a sentence (1) 11) draw intersecting pentagons (1)

Question 30

MMSE scores

Answer 30

10-24 mild impair. <10 severe impair

Question 31

Clock drawing

Answer 31

Draw clok and set time 10 minutes past 11

Question 32

Frontal assessment battery

Answer 32

Words beginning with S, similarities between bannana and orange, repeat hand tapping movements

Question 33

ADLs

Answer 33

DEATTH | Dressing, eating, ambulation, toilet, hygeine,

Question 34

Instrumental activities of daily living

Answer 34

SHAFT | Shopping, housework, accounting , food, transport

Question 35

Barthel index

Answer 35

Measure of function /100

Question 36

Assessments to ask for in geries

Answer 36

FBC, UEC, LFT, TFT, Urinalysis, CXR, CT head, Calcium, Cognitive assessment, MMSE< Frontal assesment battery Physical exams ACAT assess, OT, Physio, Geriatrician, Dietician, social work (power of attorney, guardian)

Question 37

Nursing home requirement is...

Answer 37

assistance with transfers