Miscellaneous

Question 1

What are 3 key considerations when a patient presents following a fall?

Answer 1

1. Injuries sustained
2. Circumstance of fall
3. Falls risk factors

Question 2

What is a basic management plan for an elderly patient that has sustained a fall?

Answer 2

• Pain relief
• Review anti-hypertensive medication
• Optometry review
• Physiotherapy for balance training
• Footwear review
• Consider treating ‘fear of falling’
• Consider environmental modification

Question 3

What is a ‘hot fall’?

Answer 3

Patient is acutely unwell but presents with a fall as a non-specific marker of ill-health

Question 4

What is a ‘cold fall’?

Answer 4

Generally occurs in older, frail people with multiple contributing factors

Question 5

What are 3 common balance tests?

Answer 5

1. Romberg’s test
2. Timed up and go
3. Sternal push or shoulder tug

Question 6

What is the timed up and go test?

Answer 6

How long it takes a patient to stand up from a standard chair, walk 3 metres, turn around, walk back to chair & sit down

Question 7

What is an average timed up and go speed for a 70 year old?

Answer 7

9 seconds

Question 8

What are some differential diagnoses in a 23 year-old presenting with psychosis?

Answer 8

• Schizophrenia
• Drug-induced psychosis
• Schizoaffective disorder
• Delusional disorder
• Schizo-phreniform psychosis
• Brief psychotic disorders

Question 9

What are some of the symptom clusters seen in schizophrenia?

Answer 9

• Positive symptoms
• Negative symptoms
• Cognitive symptoms
• Functional symptoms
• Impaired insight

Question 10

What are the 2 main types of delirium?

Answer 10

• Hyperactive delirium

- Hypoactive delirium

Question 11

What are features of hyperactive delirium?

Answer 11

• Repetitive behaviours
• Wandering
• Hallucinations
• Verbal or physical aggression

Question 12

What are features of hypoactive delirium?

Answer 12

Patients appear quiet & withdrawn

Question 13

What is the CAM diagnosis of delirium?

Answer 13

1. Acute onset & fluctuating course
2. Inattention
3. Disorganised thinking
4. Altered conscious state

Presence of 1 and 2 and either 3 or 4.

Question 14

What are some clinical features of dementia?

Answer 14

• Agitation
• Psychosis
• Mood disorders
• Sexual disinhibition
• Eating problems
• Abnormal or inappropriate vocalisations

Question 15

What is the differential diagnosis of dementia?

Answer 15

• Alzheimer’s disease
• Dementia with Lewy bodies
• Vascular dementia
• Frontal lobe dementia

Question 16

What are the giants of geriatric medicine (4 starting with I)?

Answer 16

• Instability
• Immobility
• Incontinence
• Intellectual decline

Question 17

What is Fried’s criteria of fraily?

Answer 17

1. Unintentional weight loss
2. Weakness
3. Exhaustion
4. Slow walking speed
5. Low physical activity

Frail is 3 or more criteria

Question 18

Which patients will benefit from a comprehensive geriatric assessment (CGA)?

Answer 18

• Recent onset of physical and/or cognitive impairment
• Changing physical and/or cognitive status
• Multiple interacting problems that are amenable to treatment
• Patients with fragmented specialty medical care
• Disorders that require rehabilitation therapy
• Consideration of change in living situation
• Evaluating patient competency/capacity
• Dealing with medico-legal issues