Questions Flashcards by Jacinta Lopez

What is the most common cause of urinary incontinence in the elderly?  
A. Detrusor overactivity 
B. Stress incontinence 
C. Increased bladder compliance  
D. Obstruction

A. Detrusor overactivity

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Which two proteins involved in pathology of Alzheimer's disease? 
A. Alpha-synuclein and ubiuitin 
B. Amyloid beta and tau 
C. PLA2R and SUPAR 
D. Amyloid A chain and L chains 
E. Apo E4 and tangled fibrils.

B. Amyloid beta and tau

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Rapidly progressive dementia, myoclonus and periodic tri-phasic sharp waves on EEG

Creutzfeldt- Jacob disease

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What is the strongest predictor for a poor recovery after acute onset of lumbar back pain?
	A. Age > 60yrs
	B. Obesity
	C. Poor exercise tolerance
	D. Job dissatisfaction

D. Job dissatisfaction

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Confusion secondary to meds in Parkinsons, which to stop first

MOA inhibitors - Amantadine, Segeline

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Which feature is best able to distinguish between Alzheimer's and Lewy Body Dementia 
	A. Behavioral disturbance 
	B. Abnormal speech and writing 
	C. Apathy and depression 
	D. Hallucinations and parkinsonism 
	E. Visuospatial deficits

D. Hallucinations and parkinsonism

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Med for agitation in delirium

haloperidol

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Alpha-synuclein and ubiuitin

DLB

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Apo E4 and tangled fibrils

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In which group of patients does the MMSE best predict the underlying cognitive function of the patient?
	A. Delirium
	B. Alzheimer dementia
	C. Parkinson-related dementia
	D. Lewy body dementia
	E. Depression

B. Alzheimer dementia

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Elderly people are more susceptible to sedation with Benzodiazepines compared to younger adults because of reduce in which of the following?
A. GABA receptors
B. Body fat
C. Hepatic drug metabolism
D. Protein binding
E. Renal drug excretion

C. Hepatic drug metabolism

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In clinical trials of dementia patients, acetylcholinesterase inhibitors have demonstrated most benefit in which patient group?

a. Dementia with Lewy Bodies
b. Alzheimer's dementia
c. Frontotemporal dementia
d. Parkinson's disease dementia e. Vascular dementia

a. Dementia with Lewy Bodies

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Amyloid precursor protein mutations have been associated with some subsets of Alzheimer’s dementia. On which chromosome is the amyloid precursor protein gene located?

a. 3
b. 12
c. 17
d. 18 e. 21

e. 21

APP- chromosome 21q and encodes the protein product, APP

ThePSEN1(Presenilin 1) - chromosome 14q
ThePSEN2(Presenilin 2) - chromosome 1q APOe (late onset dementia) - chromosome 19

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Marked rigidity, immobility and confusion after the administration of neuroleptic medication such as risperidone is most suggestive of which type of dementia?
	
	a. Alzheimer's dementia
	b. Dementia with Lewy Bodies
	c. Frontotemporal dementia
	d. Korsakoff's syndrome
e. Vascular dementia

b. Dementia with Lewy Bodies

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Which of the following is/are the major protein(s) that are abnormally deposited in Alzheimer’s dementia?

a. Tau protein
b. β-amyloid and tau protein
c. α-synuclein
d. α-synuclein and tau protein e. 14-3-3 protein

b. β-amyloid and tau protein

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which protein are neurofibrillary tangles composed of?

Tau protein

What is the significant effect of cholinesterase inhibitors in Alzheimer’s dementia?

a. Improvement in activities of daily living for patients with MMSE < 10
b. Improvement in neurocognitive function
c. Improved mortality
d. Longer time before entering residential care
e. Improved long term disability

b. Improvement in neurocognitive function, does not change disease progression

Atypical femoral fracture

rare cx of Bisphosphonates - due to over suppression of bone turnover
evolve over time - prodrome of aching in though over weeks
mx conservatively

Frontal bossing

Deafness

Pagets disease
-cuased by ?inherited mutations
will have high ALP

A-synuclein
Tau protein
B-amyloid
Hyaline
Ubiquitin
Huntington protein
14-3-3 protein

A-synuclein - LBD
Tau protein - neurofibrillatory tangles (AD)
B-amyloid - AD
Hyaline - normal ageing
Ubiquitin - AD, FTD
Huntington protein - Huntingtons
14-3-3 protein - CJD

The age - related pigment that most commonly accumulates in the most cell types: -
A. Amyloid.
B. Haemosiderin.
C. Lipofuscin
D. Lipoperoxide.
E. Ubiquitin.

C. Lipofuscin

The use ECT in the elderly is most associated with which if the following:
A. Delirium
B. Headache
C. Persistent cognitive impairment
D. Stroke
E. Temporary short-term impairment

headache - most common

- amnesia - usually recovers

Mx of constipation in elderly

Lifestyle + diet modification
Bulk laxatives - psyllium etc
Osmotic - lactulose, mg, macrogol
Stimulates - shouldn’t use long term ie bisacodyl/Senna
Stool softeners - doccusate - limited efficacy

Barthel index - measures of

ADLs

``` Old, dementia, NH, bed bound. Urinary incontinence + BPH mx A. Finasteride B. Oxybutanin c. Permanent IDC D. Tamsulosin E TURP ```

1. Finasteride - reduces postate size in larger prostates (30-40cm), takes 3-6m 2. Oxybutinin - urge incontinence 3. Tamsulosin - symptomatic BPH ?IDC - non medication measures are first line including intermittent or permanent IDC (but condom drainage is better)

``` A 76 year old woman has recurrent episodes of urinary tract infection. She is well between episodes but relapses quickly after treatment. An ultrasound of her urinary tract is normal and her fasting glucose level is 6.0mmol/L. Which of the following is the most likely explanation for her recurrent infections? A. Bladder diverticulum B. Impaired glucose tolerance C. Oestrogen deficiency D. HIV infection E. Resistant organism ```

A. Bladder diverticulum -recurrent UTI, frequent -dysuira, dyspareunia, post vodi dribbling more common in females than males Oestrogen deficiency - recurrent UTI but not quick relapse post treatment

80, increasing difficulty with ADLs, progressively become more withdrawn. They are not so much worried about his memory as they are his lack of self care, poor attention to personal hygiene, often overeating, and insisting on eating the same food every day. His house is in a state of disarray. What is his likely diagnosis?

FTD - behavioural variant (most common), disinhibition, compulsive behaviour, apathy/loss of empathy, hyperorality - often binge eat/cravings

What is the primary mechanism by which postural hypotension occurs in elderly persons? A. Impaired secretion of noradrenaline B. Impaired thirst C. Impaired baroreceptor reflex D. Reduced maximal heart rate

C. Impaired baroreceptor reflex

What is the cognitive domain that is most likely to be impaired in Dementia with Lewy Bodies? A. Memory recall B. Naming objects C. Clock drawing D. Verbal fluency

C. Clock drawing

80 y/o male with background history of IHD, Htn, hyperchol and BPH presenting with increasing fall. Laying BP 140/80 and standing BP 120/60. Which medication contributes significantly to his recurrent fall? ``` A. Lisonopril B. Metoprolol C. Finesteride D. Citalopram E. Tamsulosin ```

Answer: D | "orthostatic hypotension" - can have increased risk with tamsulosin*, beta blockers