GERIATRICS

Question 1

Renal changes with ageing?

Answer 1

Global sclerosis
Reduced eGFR
Detrusor overactivity
High EPO
Low vitamin D: can’t activate
Reduces cortex mass and kidney size

Question 2

Immune changes with ageing?

Answer 2

Adaptive more affected > innate
Increased inflammation

Question 3

Hepatic changes with ageing?

Answer 3

Type 1 > type 2
Red size

Question 4

Endocrine changes with ageing?

Answer 4

Less GH, sex steroids
Incr insulin sensitivity
Slow cortisol response
Red T3, normal T4

Question 5

Resp changes with ageing?

Answer 5

Reduced
- elastic recoil
- VQ mismatch
- VC
- chest compliance

Incr
- lung compliance
- Aa gradient

Question 6

CV changes with ageing?

Answer 6

Shortened telomeres
Red HR, dependence on SV
Red pacemaker cells

Question 7

Sleep changes with ageing?

Answer 7

Less total sleep
REM preserved
More arousals at night
Increased sleep latency
Shorter SWS
Early morning awakening

Question 8

Neuro changes with ageing?

Answer 8

General
- frontotemporal, hippocampal atrophy

Preserved:
- procedural memory
- semantic memory
- attention
- recognition
- familiar material

Worse
- unfamiliar material

Question 9

CJD changes on imaging?

Answer 9

Caudate, putamen hyperintensity
Diffusion restriction DWI

Question 10

Imaging changing and pathology of dementia?
- AD
- DLB
- Parkinsons
- FTD

Answer 10

Check notes

Question 11

AD risk factors?

Answer 11

INCR RISK
- APOE4 gene 19
- APP on chr 21
- PSEN1 on cha 14/ PSEN 2 on chr 1: earlier onset
- Age
- Family history
- Education
- Vascular disease
- Trauma
- Hearing loss GREATEST MODIFIABLE

PROTECTIVE
- APOE2

Question 12

Treatment for AD + effect?

Answer 12

Acetylcholinesterase inhibitors
- Donepezil + rivastigmine: improved performance in cognitive tests
- Galantamine: slows decline, for mod dementia

NMDA antagonists
- Memantine
- moderate dementia; small effect on cognitive function

Amyloid Ab
- Aducanumab
- Mild Alzheimers

Question 13

FTD genetic risk factors?

Answer 13

c9orf72: link with MND
MAPT: fam association with Parkinson’s
GRN: late onset

Question 14

CBD features?

Answer 14

Parkinsonism
Sensory Loss
Alien Limb

Question 15

Vascular dementia features?

Answer 15

Executive dysfunction
Episodic memory preserved
UMN signs
Gait disturbances
Slower speed of processing

Question 16

Non medication risk factors for falls?

Answer 16

Vision
Slow reaction time
History falls
Age
ADL limitations
Stroke
Parkinsons
Impaired stability when reaching
Muscle weakness
reduced peripheral sensation

Question 17

Medication risk factors for falls?

Answer 17

Antipsychotics
Type I antiarrhytmics
Antidepressants
Sedatives/hypnotics
Neuroleptics

Question 18

Stress incontinence symptoms and treatment

Answer 18

Peeing with increased intra-abdominal pressure

Tx: strengthening, pads

Question 19

Urge incontinence symptoms and treatment?

Answer 19

Can’t hold it

Tx:
- Anticholinergic: (oxybutynin/ tolterodine/solifenacin/darifenacin)
- Beta 3 agonist: mirabegron (no anticholinergic SE’s)
- Botox injections

Question 20

AD genes correlated with incr risk?

Answer 20

• APOE4 gene 19
• APP on chr 21
• PSEN1 on cha 14/ PSEN 2 on chr 1: earlier onset

Question 21

AD pathology?

Answer 21

tau proteins + neurofibrillary tangles
beta amyloid

Question 22

What does the MMSE test

Answer 22

Orientation
Recall
Language
Copying
Attention
Registration

Question 23

1st and 2nd most common causes of dementia?

Answer 23

Alzheimers
LBD