Passmedicine + Quesmed Geriatrics

Question 1

Causes for delirium?

Answer 1

U PINCH ME

Urinary Retention
Pain
Infection
Nutrition: Hypercalcaemia, Hypoglycaemia, Hyperglycaemia
Constipation
Hydration/Hypoxia
Medication: Opioids
Environment

Question 2

Delirium features?

Answer 2

Memory loss (Short term > Long term)
Agitation/Withdrawn
Disorientation
Mood change
Visual hallucination
Disturbed sleep cycle
Poor attention

Question 3

Delirium management?

Answer 3

Remove cause
Haloperidol (Orally if refused then IM)

In Parkinson’s atypical antipsychotics like quetiapine/clozapine preferred
Alternatively, Benzodiazepines

Question 4

What are the three subtypes of delirium?

Answer 4

Hyperactive, Hypoactive, Mixed

Question 5

What is hypoactive delirium?

Answer 5

Withdrawn, lethargic, slow to respond

Question 6

What are first line medications for mild/moderate alzheimer?

Answer 6

Acetylcholinesterase inhibitors:
Donepezil
Rivastigmine
Galantamine

Question 7

What is second line for alzheimers?

Answer 7

NMDA Receptor antagonists - (N-Methyl-D-Aspartate):
Memantine (add on to 1st line drugs)
Monotherapy in severe Alzheimer’s

Question 8

Donepezil contraindications and side effect?

Answer 8

Contraindicated in bradycardia, adverse effects of insomnia

Question 9

MMSE Scores?

Answer 9

For MMSE,
20-24 is mild, 13-20 is moderate, 0-12 is severe.

Question 10

What drug is associated with a significant increase in mortality in dementia patients

Answer 10

Antipsychotics

Question 11

Which part of the brain is affected by Alzheimer’s disease?

Answer 11

Cortex and hippocampus

Question 12

What are risk factors for Alzheimer’s disease?

Answer 12

Increased age
Family History
5% are inherited in Autosomal Dominant trait
Caucasian
Down’s syndrome

Question 13

Pathological changes in Alzheimer’s?

Answer 13

Macroscopic: Widespread cerebral atrophy particularly cortex and hippocampus
Microscopic: Cortical plaques due to deposition of type A-Beta-amyloid protein and intraneuronal neurofibrillary tangles

Question 14

Delirium features vs. dementia?

Answer 14

Acute onset
Impairment of consciousness
Fluctuation of symptoms: worse at night, periods of normality
Abnormal perception (e.g. illusions and hallucinations)
Agitation, fear
Delusions

Question 15

Who works in memory clinics?

Answer 15

Old-age psychiatrists

Question 16

Dementia assessment tools recommended by NICE for the non-specialist setting?

Answer 16

10-point cognitive screener (10-CS)
6-Item cognitive impairment test (6CIT)

Question 17

What MMSE score indicates dementia?

Answer 17

A MMSE score of 24 or less out of 30 suggests dementia

Question 18

Management of suspected dementia?

Answer 18

in primary care, a blood screen is usually sent to exclude reversible causes (e.g. Hypothyroidism). NICE recommend the following tests: FBC, U&E, LFTs, calcium, glucose, ESR/CRP, TFTs, vitamin B12 and folate levels. Patients are now commonly referred on to old-age psychiatrists (sometimes working in ‘memory clinics’).

In secondary care, neuroimaging is performed* to exclude other reversible conditions (e.g. Subdural haematoma, normal pressure hydrocephalus) and help provide information on aetiology to guide prognosis and management

Question 19

Features of digoxin toxicitiy?

Answer 19

Symptoms of acute digoxin toxicity include gastrointestinal disturbance (nausea, vomiting, abdominal pain), dizziness, confusion, blurry or yellow vision, and arrhythmias.

Question 20

What drugs can cause postural hypotension?

Answer 20

ACE-i, Nitrates, Diuretics
Anticholinergic medications
Antidepressants
Beta-Blockers
L-Dopa

Question 21

NICE guidelines for investigations of falls?

Answer 21

Identify all individuals who have fallen in the last 12 months.
Identify why they are at risk (Bedside tests, Bloods, Imaging)
For those with a falls history or at risk complete the ‘Turn 180° test’ or the ‘Timed up and Go test’.

Question 22

What are the three subtypes of Frontotemporal lobar degeneration?

Answer 22

Frontotemporal dementia (Pick’s Disease)
Progressive non fluent aphasia
Semantic dementia

Question 23

Features of FTLD?

Answer 23

Onset before 65
Insidious onset
Relatively preserved memory and visuospatial skills
Personality change and social conduct problems

Question 24

What sign is characteristic of Pick’s disease?

Answer 24

Focal gyral atrophy with a knife blade appearance

Question 25

What pathological signs are seen in Pick’s disease?

Answer 25

Macroscopic: Atrophy of frontal and temporal lobes
Microscopic: Pick bodies, Gliosis, Neurofibrillary tangles, Senile Plaques