Old Age Psychiatry Flashcards
A 68-year-old man presents to ED with his concerned daughter who found him wandering lost late at night trying to find the pub. She tells you that her dad has been a bit more confused in the last few months, has not been sleeping well, and has been tearful at times which she thinks could be in relation to the recent passing of her mum 10 months ago. When you ask him some questions, many of his replies are simply “I don’t know”. What is the most likely diagnosis?
A) Depression B) Vascular Dementia C) Chronic subdural haemorrhage D) Alcohol withdrawal E) Alzheimer’s disease
A) Depression
Which screening tool is preferred when formally assessing for memory loss in secondary care settings?
A) Montreal Cognitive Assessment (MOCA)
B) Addenbrooke’s Cognitive Examination (ACE-III)
C) Mini Mental State Examination (MMSE)
D) Patient Health Questionnaire 9 (PHQ-9)
E) Abbreviated Mental test (AMT)
A) Montreal Cognitive Assessment (MOCA)
You are the FY1 on call overnight and you are asked to come and review a 72-year-old lady on the surgical ward who recently underwent a hemiarthroplasty 4 days ago. The nurses tell you she has become quite aggravated and confused in the last couple of hours. Her NEWS score stayed at 0 during the day and had not been complaining of any discomfort or other symptoms. What is the best next step?
A) Bleep the on call psychiatrist B) Prescribe haloperidol C) Try to reassure and reorientate patient D) Increase pain medication E) Do a septic screen
E) Do a septic screen
Which of the following tests would not be as useful in the investigation of a patient with suspected dementia?
A) B12/folate levels B) ESR C) TFTs D) CT head E) Digoxin levels
E) Digoxin levels
You are a rural GP and a patient recently diagnosed with mild dementia has attended to consult you about an unrelated complaint. You notice that they arrive driving their own car and you enquire about whether they have told the DVLA about their Alzheimer’s diagnosis as you suggested. They tell you that they need the car to get about and do their food shops so they haven’t. What should you do next?
A) Call the police and assess for risk-taking behavior
B) Ask again gently about informing the DVLA
C) Tell the patient that if he does not contact the DVLA himself you will have to report it
D) Tell them firmly they must report their diagnosis to the DVLA
E) Let it go for now as the dementia is mild and so the DVLA do not need to know
C) Tell the patient that if he does not contact the DVLA himself you will have to report it
