Geris lectures

Question 1

Key deteriorating intrinsic factor that predisposes to falls?

Answer 1

vestibular function deteriorates–>more dependent on vision

Question 2

timed get up and go tests

Answer 2

if more than 10 secs descriminates faller from non falle

Question 3

strongest visual RF for falls

Answer 3

depth perception

Question 4

How to use a cane?

Answer 4

Hold cane on good side
bring cane forward when step with bad leg

to go up stairs “up with the good”
to go down stairs “down with the bad”

Question 5

systemic oestrogen therapy for incontinence?

Answer 5

Worsens

Question 6

M1 blockade

Answer 6

impaired memory and cognition

Question 7

M2 bllockade

Answer 7

Prolong QT

Question 8

M3 blockade

Answer 8

dry mouth, constipation, blurred vision

Question 9

M4

Answer 9

impaired cognition

Question 10

M5

Answer 10

nothing

Question 11

Solifenacin MOA

Darifenacin MOA

Answer 11

Block M3 alone
more constipating
no cognition effect

Darifenacin is the most M3 selective

Question 12

Drug of choice for management of behavioural and psych symptoms of dementia?

Answer 12

but then americans say haloperidol

atypicals: probbaly benefit when doses used larger. at small doses no benefit atypicals over haloperidol. atypicals fewer extrapyramidal side effects if using over 4.5 haloperidol

but risky

panadol some evidence

Question 13

What can urinary flow rates not distinguish?

Answer 13

detrusor underactivity (ie diabetic neuropathy) vs outflow obstruction

Question 14

benefit of patch oyxybutynin?

Answer 14

bypasses first pass metab

reduces dry mouth ++

Question 15

How to manage detrusor overactivity in BPH?

Answer 15

alpha blockers for BPH= prazosin, tamsulosin

idea is that overactive bladder may be due to BPH

Question 16

Why is oestrogen important in incontinence?

Answer 16

Oestrogen usually modulates adreneergic receptors in the bladder. If replacem then ther eis increasing contractile support which prevents urethral hypermobility

Question 17

What is Mirabegron?

Answer 17

beta3 agonist–>bladder relaxation

fewer side effects than anticholinergics

Question 18

treatment for detrusor underactivity

Answer 18

NOT cholinergics
treat constipation
catheterisation if poor emptying

Question 19

stress incontinence treatmenta?Q

Answer 19

MINIMISE RISK FACTORS LIKEweight and constipation
pelvic floor
topical oestrogens
surgery

Question 20

ApoE2, 3?

Answer 20

protective 2

neutral 3

Question 21

wORST predictors of delirium?

Answer 21

restraint use
malnutrition

(more than dementia, catheter, new meds, dehydration, lines, dehydration)

But then list of 6 overall: 
prior cog imp
sleep dep
immobility
visual imp
hearing imp
dehydration

Question 22

New antidepressant vortioxetine MOA

Answer 22

serotonin 5HT1A AGONIST- stimulate and modulate

Question 23

Ketamine acts at

Answer 23

glutamate NMDA receptors

Question 24

Duration antidepressant:

Answer 24

stay at effective dose 6-12 months ist ep
recurrent - stay at effective dose 3-5 years

no data beyond this

Question 25

Differentiate normal pressure hydrocephalus gait disurbance from lower limb parkinsonism otherwise

Answer 25

normal leg function when supine or sitting