MFE - acute presentations // dementia

Question 1

what can predispose acute confusion

Answer 1

infection // metabolic // environment change // constipation // pain // dementia

Question 2

symptoms delirium

Answer 2

short term amnesia // agitated // mood change // hallucinations // disturbed sleep // impaired consciousness

Question 3

1st line mx sedative delirium

Answer 3

haloperidol or olanzapine

Question 4

sedation mx in patients with parkinsons

Answer 4

atypical antipsychotic eg quetiapine or clozapine

Question 5

mx causing postural hypotension

Answer 5

nitrates // diuretics // anticholingeric meds // antidepressants // BB // L-dope // ACEi

Question 6

what special tests can be done OE to asses fall risks in elderly

Answer 6

turn 180 // times up and go

Question 7

what is multimorbidity

Answer 7

2 or more long term conditions (can be psych, substance, learning disability, physical)

Question 8

what questionnaire can assess frailty

Answer 8

PRISMA-7

Question 9

what is STOPP/ START med review

Answer 9

stop risk meds + start good ones

Question 10

RF for pressure falls in elderly

Answer 10

malnourishment, incontinence, mobility, pain

Question 11

where do pressure ulcers usually occur

Answer 11

sacrum or heel

Question 12

questionnaire for pressure ulcers

Answer 12

waterloo score - BMI, nutrition, skin type, mobility, incontinence

Question 13

mx pressure uclers

Answer 13

moist hydrocolloid dressing // surgical debridement if necessary

Question 14

assessment tools for dementia

Answer 14

10-CS, 6ITs, adams brooke, 4 AT

Question 15

what invx for dementia is recommended

Answer 15

blood screen –> neuroimaging

Question 16

top 3 causes of dementia

Answer 16

Alzheimers –> cerebrovascular –> lewy body

Question 17

less common causes of dementia

Answer 17

Huntingtons, CJD, Pick’s, HIV

Question 18

RF Alzheimer’s

Answer 18

age // FH // genetics + white // Down syndrome

Question 19

genes that can predispose Alzheimer’s

Answer 19

presenilin 1 + 2 // apoprotein E4

Question 20

macroscopic changes Alzheimer’s

Answer 20

cerebral atrophy esp in cortex and hippocampus and meynerts nucleus

Question 21

microscopic changes Alzheimer’s

Answer 21

tau protein –> neurofibrilliary tanges // beta-amyloid deposits

Question 22

1st line medical mx Alzheimer’s

Answer 22

AChE inhibitors eg donepezil, galantamine, rivastigmine

Question 23

2nd line medical mx

Answer 23

memantine (NDMA antagonist)

Question 24

when would 2nd line medical mx Alzheimer’s be used

Answer 24

intolerant to AChE inhib // dual therapy // monotherapy in severe disease

Question 25

mx for symptoms of depression in patients

Answer 25

antipsychotics (not anti-depressants)

Question 26

when is donepezil contraindicated

Answer 26

bradycardia (+ it causes insomnia)

Question 27

3 main subtypes of vascular dementia

Answer 27

stroke related // subcortical (small vessel) // mixed dementia

Question 28

RF vascular demention

Answer 28

PMH stroke or TIA // AF // HTN // DM // smoking // obesity// CVD

Question 29

presentation pattern Vascular dementia

Answer 29

months or year stepwise deterioration

Question 30

symptoms vascular dementia

Answer 30

focal neuro // attention // seizure // memory // gait // speech // emotional

Question 31

which criteria is used for vascular dementia

Answer 31

NINDS-AIREN

Question 32

imaging in vascular dementia

Answer 32

MRI (or SPECT)

Question 33

mx vascular dementia

Answer 33

not much - only AChEi in paitients with AD

Question 34

symptoms lewy body dementia

Answer 34

early cognitive impairment (attention and execute function and memory loss) // Parkinsonism (AFTER cognitive symptoms // hallucinations

Question 35

how does lewy body dementia present differently to AD in early stages

Answer 35

AD mainly memory // lewy body has other impairments such as attention and function

Question 36

imaging lewy body

Answer 36

SPECT

Question 37

mx lewy body

Answer 37

AChEi (donezepil, rivastigmine) + memantine

Question 38

what drugs should be avoided in lewy body dementia

Answer 38

antipsychotics (they will deteriorate a patient)

Question 39

pathology lewy body dementia

Answer 39

Lewy bodies (alpha inclusions) in substantia nigra

Question 40

3 types of frontotemporal lobar degeneration

Answer 40

frontotemporal dementia (picks) // progresive non fluent aphasia // semantic dementia

Question 41

features frontotemporal dementias

Answer 41

early onset (<65) // insidious onset // preserved memory in early disease // personality + inappropriate changes

Question 42

pathophysiology Pick's disease

Answer 42

atrophy of frontal and temporal lobes // Pick bodies // gliosis // neurofibrillary tangles // senile plaques

Question 43

what causes creutz-feldt jacob disease

Answer 43

prion proteins --> beta sheats

Question 44

symptoms creutz-feldt jacob disease

Answer 44

rapid onset dementia + myoclonus + slurred speech

Question 45

invx creutz-feldt jacob disease

Answer 45

CSF: raised 14-3-3 proteins // EEG // MRI

Question 46

early --> late symptoms AD

Answer 46

early = misplaced keys, fogotten appointments // late = personality changes, cognitive changes