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My MRCPsych Paper B > MRCPsych Paper B - Old Age > Flashcards

MRCPsych Paper B - Old Age Flashcards

1
Q

Atypical antipsychotics increases risk of vascular events by a factor of how much?

A

2

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2
Q

MAPT gene is located in which chromosome?

A

ch17

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3
Q

APP gene is located in which chromosome?

A

ch21q

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4
Q

Geriatric bipolar disorder targe serum lithium level

A

0.4-0.7 mmol/L
*usually 0.40-0.60mmol/L, can increase to maximally 0.70 or 0.80 at 65-79yrs and to maximally 0.70mmol/L over 80yrs

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5
Q

10yr probability of conversion from MCI to dementia

A

30-40%

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6
Q

Risk of developing TD in the elderly vs younger adults (how much more)

A

5-6x

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7
Q

Most common symptom of late paraphrenia/ late onset schizophrenia

A

persecutory delusions, 90%
*auditory hallucinations, 75%

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8
Q

Prevalence of psychotic symptoms among older individuals with major neurocognitive disorder (AD)

A

40%

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9
Q

Apolipoprotein allele that is protective? that is a risk factor?

A

APOE E2 - protective, APOE E4 - susceptible

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10
Q

Measure for ADL function in the elderly

A

Barthel Index

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11
Q

Most likely neurological findings in vascular dementia

A

Focal neurological findings - unilateral brisk DTR, asymmetrical hyperreflexia or weakness

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12
Q

Most common cause of death in AD

A

pneumonia

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13
Q

instrument for the ddx of dementia

A

Cambridge examination for mental disorders of the elderly (CAMDEX-R)

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14
Q

CASE: Geria px + cognitive difficulties + slurring of consonants + staccato pattern

A

Cerebellar degeneration

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15
Q

NIA-AA criteria for probable dementia

A

criteria for dementia + insidious onset, worsening condition, cognitive deficits (amnestic presentation -most common or non-amnestic presentation -language, visuospatial, or executive), no evidence of substantial CVD

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16
Q

PDs usually seen in late life

A

HD SOAP
histrionic, dependent, schizoid, OC, avoidant, paranoid

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17
Q

Cortical dementias

A

AD, FTD/ Pick disease

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18
Q

Cortico-subcortical

A

LCC
LB, CJD, corticobasal degeneration

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19
Q

EEG findings in CJD

A

periodic complexes - bi- or triphasic against slow voltage background

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20
Q

Delirium scale with good symptom coverage and distinguishes it from from other disorders (dementia, depression, and schizoprenia)

A

Delirium rating scale (DRS)

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21
Q

Neurobehavioral syndrome: squalor (dirty and unpleasant), pathological hoarding, lack of insight, no desire for help

A

Diogenes syndrome
*greek philosopher living in a barrel

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22
Q

Assessment of dementia for people with LD

A

Dementia questionnaire for People with LD (DLD)

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23
Q

Cardinal manifestations of progressive supranuclear palsy

A

Postural instability and falls (backward)

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24
Q

Variant CJD is characterized by early…

A

anxiety and depressive symptoms,
*early 20s, … then personality changes, then progressive dementia. Ataxia, myocolonus. Death in 1-2yrs

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25
Q

A feature seen commonly in early onset depression when compared with late onset depression

A

episodic memory dysfunction (temporal lobe dysfunction)
* vs late onset depression: deficits in attention and executive function (frontal lobe dysfunction)

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26
Q

Signs it is pathological grief

A

intense guilt related to issues beyond those surrounding the death of the loved one, preoccupation with death (excluding being with the deceased), morbid preoccupation with worthlessness, marked psychomotor retardation, prolonged severe functional impairment, hallucinations (excluding transient voice of the deceased)

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27
Q

First choice medication for elderly with delirium (in a surgical ward)

A

haloperidol

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28
Q

Huntington’s disease

A

autosomal dominance, CAG trinucleotide repeats, HTT gene, ch4p, onset 30-40s

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29
Q

Most common psychological and behavioral symptom in Huntington’s disease

A

apathy/ reduction in drive

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30
Q

Deficits on tests of attention and visuospatial ability maybe especially prominent in…

A

LBD

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31
Q

Psych drug that can aggravate psoriasis and acne

A

Lithium

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32
Q

Most common psychiatric side effects of rivastigmine

A

anorexia, dizziness, nausea, vomiting

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33
Q

Most common psychiatric side effect of levodopa

A

nightmares & vivid dreams 30%, night terrors 7%, delirium 5%, delusional disorder 3%

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34
Q

Most prevalent personality disorder in the elderly

A

OC

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35
Q

Most effective antipsychotic for psychosis/ agitation/ BPSD in dementia

A

risperidone

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36
Q

Most effective antipsychotic for agitation in dementia

A

olanzapine

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37
Q

Most effective antipsychotic for overall BPSD in dementia

A

aripiprazole

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38
Q

Most prevalent anxiety disorder among the elderly

A

Specific phobia (esp. fear of falling - basophobia)

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39
Q

Compared to early onset depression, late onset depression in the elderly ten to present more often with symptoms of…

A

psychomotor changes (30%)

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40
Q

antipsychotic treatment for Parkinsons with psychosis unrelated to levodopa

A

Quetiapine
*clozapine is efficacious but limited by agranulocytosis; pimavanserin - another option, atypical antipsychotic

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41
Q

Biological changes associated with normal ageing

A

decrease brain weight (17%), reduced cortical gray matter, ventricular enlargement, increased transport across BBB, decreased cerebral flow

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42
Q

Pharmacokinetic changes in ageing

A

decreased gut motility, decreased gastric acid secretion, 35%-50% decline in renal function, serum creatinine is not 100% reliable

elderly have more body fat, less water, and less albumin, increased vol of distribution and longer duration of action for fat-soluble drugs, decreased liver size, more prone to accumulation due to declining kidney function, eGFR used as measure for renal function

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43
Q

Antipsychotic with great risk of severe postural hypotension for the elderly

A

risperidone, clozapine
*alternatives to treatment: amisulpride, sulpride, aripiprazole, haloperidol

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44
Q

Anti-dementia drug that demonstrated benefits in treating hallucinations in LBD

A

rivastigmine
*newer data finds donepezil is effective as well in LBD

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45
Q

Knife-edge atrophy is found where?

A

behavioral FTD variant, frontal lobes

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46
Q

test of executive function in an elderly with schizophrenia

A

Tower of London/ Hanoi

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47
Q

Gingko biloba increases the risk of …

A

bleeding

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48
Q

rate of VH in LBD

A

80%

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49
Q

test to measure the likelihood of vascular dementia pathology

A

Hachinski ischaemic score (HIS), 4/12 cut off indicative of vascular dementia

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50
Q

most common sensory modality in the hallucinations of Parkinsons related psychosis

A

visual

51
Q

core clinical features of LBD

A

fluctuating cognition, recurrent visual hallucinations (80%), REM sleep behavior disorder, parkinsonism

52
Q

case: elderly + being isolated + neglecting himself + living in filthy poor conditions

A

Diogenes syndrome

53
Q

case: elderly + hearing impairment + delusions (persecutory, partition) + hallucinations

A

lates onset schizophrenia

54
Q

case: elderly + blindness (cataracts) + hallucinations + independent/ relatively normal

A

Charles Bonnet syndrome

55
Q

scale for the elderly focusing on cognitive and subjective symptoms more than physical symptoms

A

geriatric depression scale (GDS)

56
Q

scale for the elderly useful to detect depression in people with dementia

A

Cornell scale for depression

57
Q

scale for the elderly useful for hearing impaired subjects

A

Brief assessment schedule depression cards (BASDEC)

58
Q

scale for the elderly for standard screening people with dementia

A

MMSE

59
Q

less appropriate scale for the elderly due to a number of somatic items

A

Hamilton rating scale

60
Q

neuroimaging in Alzheimer’s disease CT Scan

A

cortical atrophy over parietal and temporal lobes, dilation of 3rd ventricle

61
Q

neuroimaging in Alzheimer’s disease SPECT

A

reduced cerebral blood flow in the temporal and posterior parietal lobes

62
Q

neuroimaging in Alzheimer’s disease PET scan

A

reduced oxygen and glucose metabolism in temporal and posterior parietal (30%)

63
Q

neuroimaging in Alzheimer’s disease MRS

A

reduced levels of N-acetyl aspartate

64
Q

case: elderly + treatment resistant (one of which is SGA)

A

clozapine

65
Q

case: elderly + Parkinson’s disease + psychosis

A

atypical antipsychotic - quetiapine, before clozapine

66
Q

side effect of antidementia cholinesterase inhibitor that is related to excessive cholinergic stimulation

A

insomnia

67
Q

most common side effect of antidementia meds on the cardiovascular system

A

bradycardia

68
Q

most frequent gastrointestinal side effect of antidementia meds

A

nausea

69
Q

case: recurrent strokes + step-wise deterioration in cognitive function

A

multi-infarct dementia/ vascular dementia

70
Q

case: progressive cognitive decline + dysfunction + fluctuating cognition + recurrent visual hallucinations (Liliputian) + neuroleptic sensitivity

A

Lewy body dementia

71
Q

case: worsening memory + increased tone with rigidity + abnormal jerky movements + strong family history of dementia

A

Huntington’s disease dementia

72
Q

case: memory problems + urinary incontinence + broad-based short stepped gait + CT: ventricular enlargement

A

Normal pressure hydrocephalus

73
Q

case: memory problems + falls + depressed mood + tremors + cog wheel rigidity + motor and cognitive symptoms develop more than 12mos from each other

A

Parkinson’s disease dementia

74
Q

case: elderly memory problems + falls + depressed mood + tremors + motor and cognitive symptoms develop within 12mos from each other

A

Lewy body dementia

75
Q

case: elderly with memory loss + disinhibited behavior + CT: knife blade atrophy of frontal and temporal lobes

A

Pick’s disease dementia

76
Q

case: elderly with changing pattern of cognition + history of trauma + clotting disorders + aspirin/ warfarin intake

A

chronic subdural haematoma

77
Q

case: gait ataxia + dementia + urinary incontinence

A

normal pressure hydrocephalus

78
Q

case: progressive frontal dementia + hallucinations & delusions (grandiosity) + lightning pain with tabes dorsalis + personality changes

A

General Paresis of Insane (GPI) (from untreated syphilis)

79
Q

case: elderly treated for resting tremors - psych SE: acute confusional state + paranoia + visual hallucinations

A

dx: Parkinson’s disease
tx: levodopa
*euphoria, depression, insomnia, abnormal dreams

80
Q

case: elderly treated for swollen legs - psych SE: visual halos, confusion

A

dx: cardiac failure
tx: digoxin

81
Q

case: elderly treated for polymyalgia rheumatica - psych SE: hypomanic, confused

A

dx: autoimmune disease (polymyalgia rheumatica)
tx: prednisolone/ corticosteroids
*iatrogenic depression, mania, confusion

82
Q

case: elderly treated for vtach - psych SE: confusion, agitation, paranoid delusions

A

dx: ventricular tachycardia
tx: amiodarone
*altered mental status, hallucinations, delirium

83
Q

case: elderly recent onset memory loss + early morning headache & nausea

A

dx: cerebral tumor
tx: dexamethasone for compression symptoms, surgical evacuation for best treatment of choice

84
Q

case: adult (~45yo) with alcohol use disorder + fluctuating alertness and asterixis

A

dx: hepatic encephalopathy, from hepatlic failure
tx: neomycin & lactulose

85
Q

case: elderly + grandiose delusions + irritability + memory loss + abnormal pupils

A

dx: GPI - neurosyphilis
tx: antibiotic therapy - IM procaine penicillin x 10-21 days

86
Q

case: 45yo chronic alcoholic + apathy, fatigue, irritability, depression and cognitive impairment

A

dx: chronic thiamine deficiency - Wernicke’s encephalopathy + Korsakoff’s psychosis - beri beri
tx: thiamine

87
Q

case: elderly + atrophic gastritis + fatigue, tingling and numbness of hands and feet, depression + memory problems

A

dx: vitamin B12 deficiency - pernicious anemia
*diarrhea or constipation, loss of appetite, swollen red tongue, bleeding gums
tx: vitamin B12

88
Q

case: elderly (~57yo) + mouth ulcers, diarrhea. lassitude (lack of energy) + impaired cognition + depression + dementia

A

dx: folate deficiency
*grey hair, peptic ulcers
tx: folate supplements

89
Q

case: adult (~45yo) with lethargy, tiredness, constipation, low mood, and memory problems

A

dx: hypothyroidism
tx: thyroxine

90
Q

case: elderly usually in the 60s + paralysis of EOM, cervical dystonia, ataxia + dementia

A

dx: Progressive supra nuclear palsy
*balance issues, falls (retropulsion), slurred speech, personality changes,

91
Q

case: elderly (~50s) + clumsiness, uncontrollable twitching of face and shoulders, ataxia + cognitive impairment + family history

A

dx: Huntington’s disease

92
Q

case: adult (~25yo) + jaundice, wing-beating tremor of shoulders, rigidity + memory problems

A

dx: Wilson’s disease
*flapping tremor of wrists, wing-beating tremor of shoulders, Kayser-Fleisher rings (greenish corneal deposits)

93
Q

case: elderly with gradual change in personality + increasing disinhibition, forgetfulness + collecting multiple items over the course + family history of memory problems

A

dx: Pick’s disease
*repetitive behaviors - counting, checking, cleaning, collecting, hoarding, pathological gambling, touching and grabbing rituals, superstitious acts

94
Q

case: adult (~43yo) with lymphoma + clumsiness, problems with coordination + cognitive impairment

A

Progressive multifocal leucoencephalopathy
*AIDS, chronic corticosteroid therapy

95
Q

case: elderly (~59yo) with rapidly progressive dementia + myoclonus, ataxia

A

dx: sporadic CJD
*cortical blindness

96
Q

chromosome location: Presenilin 1 gene

A

chromosome 14
*associated early onset Alzheimer’s diseaese

97
Q

chromosome location: Presenilin 2 gene

A

chromosome 1
* associated with early onset Alzheimer’s disease

98
Q

chromosome location: beta-amyloid precursor protein gene

A

chromosome 21q
*associated with early onset Alzheimer’s disease

99
Q

chromosome location: APOE4 gene

A

chromosome 19
*associated with late onset Alzheimer’s type

100
Q

investigation: elderly (79yo) with progressive short term memory loss x 18mos + difficulties ADL

A

dx: Alzheimer’s disease
inv: CT - medial temporal atrophy

101
Q

investigation: elderly (83yo) with progressive cognitive decline + apathy + visual hallucinations + PMH Parkinson’s disease

A

dx: Lewy Body Dementia
inv: DaTSCAN - reduced striatral dopamine uptake

102
Q

investigation: elderly (67yo) with memory loss, language difficulties, disinhibition, personality changes + over 1 year

A

dx: fronto-temporal dementia
inv: HMPAO SPECT scan - decreased perfusion in the frontal lobes

103
Q

investigation: elderly (63yo) with recent memory problems + rapid decline + abnormal twitching and gait disturbances

A

dx: CJD
inv: CT - atrophy of cortex and cerebellum

104
Q

investigation: elderly (67yo) + memory problems x last 6mos + hypertension, TIAs

A

dx: vascular dementia
inv: MRI - focal white matter lesions

105
Q

EEG: generalized periodic 1-2hz sharp wave complexes

A

sporadic CJD, NOT in variant form

106
Q

EEG: episodic discharges every 1-3secs (with variable focal waves over temporal areas)

A

Herpes simplex encephalitis

107
Q

EEG: (initial loos of alpha waves), later flattened trace

A

Huntington’s disease

108
Q

EEG: triphasic waves and slowing of the normal background

A

Hepatic encephalopathy

109
Q

antidementia medication: neuroprotective and disease modifying

A

memantine (10mg bid)

110
Q

antidementia medications: on rivastigmine, likes it and does not want to switch + unlikely to cause gastrointestinal effects

A

rivastigmine transdermal patch (9.5/24h)

111
Q

antidementia medications: safest choice for patients with cardiovascular disease and multiple other medications

A

rivastigmine

112
Q

antidementia medications: acetylcholinesterase inhibitor that is well tolerated / relatively minimal side effects

A

donepezil (10mg OD)

113
Q

antidementia medications: vascular dementia

A

low dose aspirin, statins, diabetic and BP control

114
Q

core features of Lewy Body Dementia

A

Parkinsonism + progressive cognitive decline + visual hallucinations
*fluctuating consciousness

115
Q

core features of frontotemporal dementia/ Pick’s disease

A

insidious onset and gradual progression, striking loss of insight, personality change and behavioral disorder
*emotional blunting, disinhibition

116
Q

core features of Creutzfeldt-Jakob disease

A

rapidly deteriorating dementia + myoclonus + cerebellar and extrapyramidal signs + death in 1 year
*cortical blindness

117
Q

neuropsychometric test: executive function

A

Wisconsin card sorting test, Stroop test, Tower of London test, controlled word association

118
Q

neuropsychometric test: practically useful episodic memory linked to daily functioning

A

Rivermead behavioural memory test
*everyday memory problems

119
Q

neuropsychometric test: nonverbal intelligence

A

Ravens progressive matrices

120
Q

neuropsychometric test (?): measure of ADLs

A

Blessed dementia rating scale

121
Q

clinical features of multi-infarct dementia

A

abrupt onset + history of multiple strokes + stepwise deterioration

122
Q

clinical features of Binswanger’s disease

A

subcortical dementia + gradual intellectual decline + generalized slowing

123
Q

clinical features of CADASIL

A

onset during 40s, subcortical dementia, history of migraines
*autosomal dominant, chromosome 19q

My MRCPsych Paper B (8 decks)

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