Medicine for the Elderly

Question 1

Initial management of postural hypotension

Answer 1

Advise pt to dorsiflex feet or cross legs before standing up slowly
- prevents excessive diuresis and fluid shifts
- pharm management may incl fludrocortisone

Question 2

Why does constipation cause delirium?

Answer 2

Marked increase in intestinal production and absorption of ammonia which tends to lead to a similar pathophysiology in hepatic encephalopathy

Question 3

How can a falls inducing syncope best be investigated?

Answer 3

Implantable loop recorder
- likely cardiac cause

Question 4

Key med not to stop in dementia patients

Answer 4

Paracetamol/analgesia
- proven that paracetamol reduces agitation in dementia patients

Question 5

Delirium, profound hypoxia, nothing to hear in the chest and normal temp

Answer 5

PE
- old people don’t tend to present in the usual way so may not have breathlessness of chest pain

Question 6

Calcium causes which symptom in old people

Answer 6

GI upset
- nausea
- abdo pains etc
Stop if they don’t need it and assess for change in GI function

Question 7

Management non-aggressive delirium with falls risk

Answer 7

1-to-1 nursing

Question 8

Management of pt with delirium, no PoA, unable to function independently at home, care package failed previously

Answer 8

Apply to courts for guardian

Question 9

4 key palliative drugs and their doses

Answer 9

Morphine 2mg subcut PRN
Midazolam 2mg hourly subcut PRN
Hyoscine butylbromide injection 20mg PRN
Levomepromazine 2.5 mg injection 8 subcut PRN

Question 10

Course of symptoms in LBD

Answer 10

FLuctuating

Question 11

Hx of nausea and vomiting in a pt with IHD and AF, now developed visual changes and dizziness

Answer 11

Digoxin

Question 12

5 Ps causing delirium

Answer 12

• Pee
• Poo
• Pus
• Pills/poison
• Pain

Question 13

Confusion screen

Answer 13

B12/folate = macro anaemia can worsen confusion
TFTs = hypothyroidism
Glucose = hypoglycaemia
Bone profile =hypercalcaemia

Question 14

Which drugs greatly increase mortality in dementia pts?

Answer 14

Antipsychotics

Question 15

What law means that patient’s rights are protected despite them being detained?

Answer 15

Deprivation of liberty safeguards

Question 16

Key med contraindicated in concurrent sildenafil use

Answer 16

Nitrates
- causes hypotension, heavy vasodilation, can lead to death

Question 17

Microcytic anaemia with noooooo symptoms and normal iron studies

Answer 17

Thalassaemia trait

Question 18

FL pain management in palliative pts with renal impairment

Answer 18

Oxycodone

Question 19

When would you give each laxative?

Answer 19

• Offer a bulk-forming laxative first-line, such as ispaghula—> making stools softer and easier to pass.
• If stools remain hard to pass, add or switch to an osmotic laxative, such as a macrogol.
• If a macrogol is ineffective or not tolerated, offer treatment with lactulose second-line.
• If stools are soft but difficult to pass, or there is a sensation of inadequate emptying, add a stimulant laxative (Senna).
• If the person has opioid-induced constipation: Offer an osmotic laxative and a stimulant laxative.

Question 20

First CN to be affected by SOL or raised ICP

Answer 20

CNVI