Neurology

Question 1

how is the risk of falls determined?

Answer 1

The Timed Up and Go test, also known as the TUG test, is a simple evaluative test used to measure your functional mobility. The TUG test measures how long it takes to stand up, walk a distance of 10 feet, turn, walk back, and sit down again.

Question 2

donepezil

Answer 2

acetylcholinesterase inhibitor used in the management of the dementia of Alzheimer’s Disease

Question 3

ropinerole

Answer 3

used in parkinson’s
Ropinirole is a non ergoline D2/D3 dopamine agonist which stimulates striatal dopamine receptors.

Question 4

what is the triad of parkinson’s used in diagnosis?

Answer 4

pill rolling/intention tremor
shuffling gait/parkinsonian
bradykinesia

Question 5

what is another fx of parkinsons to examine?

Answer 5

stops in doorway…takes longer to walk and turn around

Question 6

what is LPOP?

Answer 6

liason psychiatry older people

Question 7

what is the anticholinergic burden?

Answer 7

The ACB effects are proportionate to the dose and duration of exposure. ACB score of 3 or more may increase the risks of cognitive impairment, functional impairment, falls and mortality in older adults (> 50 – 65 years). Increased doses and long duration of use are associated with increased risk of dementia. Long term effects of anticholinergics on cognition is unknown

Question 8

define delirium tremens

Answer 8

alcohol dependence withdrawal delirium

Question 9

lewy body dementia v parkinsons dementia

Answer 9

Lewy body dementia is more likely if dementia starts before or within 1 year of the onset of the parkinsonian symptoms. Lewy body dementia also commonly causes visual hallucinations of people. The poor response to co-careldopa is also a clue, as the ‘Parkinson’s plus’ syndromes are often less responsive to classical antiparkinsonian drugs.

Question 10

alzheimer’s affects which part of the brain

Answer 10

cortex and hippocampus - atrophy

Question 11

what drug should you consider stopping in dementia?

Answer 11

The STOPP-START Criteria (Gallagher et al., 2008) outlines medications that we should consider withdrawing in the elderly. One example of this is the use of tricyclic antidepressants in patients with dementia, due to the risk of worsening cognitive impairment

Question 12

how is frailty assessed?

Answer 12

Frailty should be specifically assessed through the evaluation of gait speed, self-reported health status, or the PRISMA-7 questionnaire

Question 13

what drug should be avoided in lewy body dementia?

Answer 13

haloperidol - D2 receptor antagonist
can result in parkinsonian features

Question 14

how can delirium be acutely managed?

Answer 14

IM haloperidol

Question 15

medical management of alzheimers

Answer 15

Acetylcholinesterase (AChE) inhibitors (donepezil, galantamine, and rivastigmine) [NICE, 2006; NICE, 2011]:
These drugs can be used for mild to moderate Alzheimer’s disease but must only be prescribed by healthcare professionals with expertise in this area …

Memantine is an option for managing Alzheimer’s disease for people with:
Moderate Alzheimer’s disease who are intolerant of, or have a contraindication to, AChE inhibitors or
Severe Alzheimer’s disease.

Question 16

what score is used to assess a patient’s risk of bed sore?

Answer 16

Waterlow score - used to identify patients at risk of pressure sores

Question 17

what medications increase the risk of falls in the elderly?

Answer 17

Medications that cause postural hypotension Medications associated with falls due to other mechanisms
Nitrates Benzodiazepines
Diuretics Antipsychotics
Anticholinergic medications Opiates
Antidepressants Anticonvulsants
Beta-blockers Codeine
L-Dopa Digoxin
Angiotensin-converting enzyme inhibitors - (ACE) inhibitors Other sedative agents

Question 18

delirium v dementia

Answer 18

Delirium involves an impairment of conscious level and often involves psychotic symptoms

Question 19

pick’s disease

Answer 19

Middle aged adult with insidious onset dementia and personality changes = Pick’s disease

Question 20

which investigations are required for dementia?

Answer 20

A blood screen including FBC, U&E, LFTs, calcium, glucose, ESR/CRP, TFTs, vitamin B12 and folate levels should be done in patients with suspected dementia to check for reversible causes

Question 21

what is normal pressure hydrocephalus?

Answer 21

Condition in which there is excess cerebrospinal fluid in the ventricles, and with normal or slightly elevated cerebrospinal fluid pressure

Question 22

how many ventricles are there in the brain?

Answer 22

2 x lateral
third
and fourth ventricle