Passmedicine + Quesmed Geriatrics Flashcards
Causes for delirium?
U PINCH ME
Urinary Retention
Pain
Infection
Nutrition: Hypercalcaemia, Hypoglycaemia, Hyperglycaemia
Constipation
Hydration/Hypoxia
Medication: Opioids
Environment
Delirium features?
Memory loss (Short term > Long term)
Agitation/Withdrawn
Disorientation
Mood change
Visual hallucination
Disturbed sleep cycle
Poor attention
Delirium management?
Remove cause
Haloperidol (Orally if refused then IM)
In Parkinson’s atypical antipsychotics like quetiapine/clozapine preferred
Alternatively, Benzodiazepines
What are the three subtypes of delirium?
Hyperactive, Hypoactive, Mixed
What is hypoactive delirium?
Withdrawn, lethargic, slow to respond
What are first line medications for mild/moderate alzheimer?
Acetylcholinesterase inhibitors:
Donepezil
Rivastigmine
Galantamine
What is second line for alzheimers?
NMDA Receptor antagonists - (N-Methyl-D-Aspartate):
Memantine (add on to 1st line drugs)
Monotherapy in severe Alzheimer’s
Donepezil contraindications and side effect?
Contraindicated in bradycardia, adverse effects of insomnia
MMSE Scores?
For MMSE,
20-24 is mild, 13-20 is moderate, 0-12 is severe.
What drug is associated with a significant increase in mortality in dementia patients
Antipsychotics
Which part of the brain is affected by Alzheimer’s disease?
Cortex and hippocampus
What are risk factors for Alzheimer’s disease?
Increased age
Family History
5% are inherited in Autosomal Dominant trait
Caucasian
Down’s syndrome
Pathological changes in Alzheimer’s?
Macroscopic: Widespread cerebral atrophy particularly cortex and hippocampus
Microscopic: Cortical plaques due to deposition of type A-Beta-amyloid protein and intraneuronal neurofibrillary tangles
Delirium features vs. dementia?
Acute onset
Impairment of consciousness
Fluctuation of symptoms: worse at night, periods of normality
Abnormal perception (e.g. illusions and hallucinations)
Agitation, fear
Delusions
Who works in memory clinics?
Old-age psychiatrists
Dementia assessment tools recommended by NICE for the non-specialist setting?
10-point cognitive screener (10-CS)
6-Item cognitive impairment test (6CIT)
What MMSE score indicates dementia?
A MMSE score of 24 or less out of 30 suggests dementia
Management of suspected dementia?
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
Features of digoxin toxicitiy?
Symptoms of acute digoxin toxicity include gastrointestinal disturbance (nausea, vomiting, abdominal pain), dizziness, confusion, blurry or yellow vision, and arrhythmias.
What drugs can cause postural hypotension?
ACE-i, Nitrates, Diuretics
Anticholinergic medications
Antidepressants
Beta-Blockers
L-Dopa
NICE guidelines for investigations of falls?
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’.
What are the three subtypes of Frontotemporal lobar degeneration?
Frontotemporal dementia (Pick’s Disease)
Progressive non fluent aphasia
Semantic dementia
Features of FTLD?
Onset before 65
Insidious onset
Relatively preserved memory and visuospatial skills
Personality change and social conduct problems
What sign is characteristic of Pick’s disease?
Focal gyral atrophy with a knife blade appearance
What pathological signs are seen in Pick’s disease?
Macroscopic: Atrophy of frontal and temporal lobes
Microscopic: Pick bodies, Gliosis, Neurofibrillary tangles, Senile Plaques
