CLINICAL

Question 1

WHAT ARE THE GERIATRICS GIANTS?

Answer 1

instability - falls
immobility - cant walk
incontinencce
cognitive impairment

Question 2

reasons for a fall? 8

Answer 2

hypo
alcohol 
brain issues 
urinary incontinence 
medication 
footwear
joint pain 
sick

Question 3

cognitive impairment either?2

Answer 3

dementia - alzeihmers/lewy body/

delirium - haematoma/ intoxication/medication

Question 4

urinary incontinence due to? e.g.

Answer 4

diuretics, sedatives

excessive fluid intake

Question 5

geriatric medicine deals with what?

Answer 5

people of frailty

Question 6

inter-individual variability relationship with age?

Answer 6

variability increases with age - older people have more physiologically differences between them

Question 7

dyshomeostasis in elderly?

Answer 7

progressive dyshomeosis in elderly

reduction in our ability to deal with change

Question 8

evidence of drug efficacy and safety in patients elderly?

Answer 8

little evidence as trials rarely use elderly people

Question 9

multiple medications cause an increase of what two things?

Answer 9

drug-drug interactions

ADR

Question 10

medical condiitions presentation in elderly?

Answer 10

same condiitons present differently in frail - different presentation

Question 11

CGA?

Answer 11

COMPREHENSIVE GERIATRIC ASSESSMENT

process to assess and manage disruption to health in older people with frailty

Question 12

CGA?

Answer 12

COMPREHENSIVE GERIATRIC ASSESSMENT

process to assess and manage disruption to health in older people with frailty

Question 13

frailty desscirbed as state of what?

Answer 13

state of susceptibility - to acquiring disease and to functional decline in context of disease

Question 14

OLD + MUTLIMORBID = FRAIL ??

Answer 14

NO

OLD does not mean frail

but more likely to become frail as you age

Question 15

how to class someone as frail? 2

Answer 15

frailty index - each gets a point

frailty phenotype - 3 out of 5 criteria (weight loss, fatigue, slow walk, weak grip etc)

Question 16

frailty scale?

Answer 16

spectrum
1-9

1= very fit 
9 = terminally ill

Question 17

decompensated frailty syndromes? 4

Answer 17

falls
immobility
delirium
funcitonal decline

ALL SYSTEM FAILURES

Question 18

HEALTH DOMAINS? name 5

Answer 18

medical 
psychological 
functional 
behavioural 
nutritional 
social 
sexual

Question 19

iatrogenic harm?

Answer 19

harm from prescribed drugs

Question 20

hospital risks to frail people? 4

Answer 20

delirium
dependancy
iatrogenic harm
hospital acquired infection

Question 21

when is optimal discharge from hospital?

Answer 21

when risk and benefit of staying in the hospital is the same

Question 22

extrinsic factors that cause incontinence? 5

Answer 22

reduced mobility 
confusion 
drinking too. much 
medications 
co-morbiditieis

Question 22

extrinsic factors that cause incontinence? 5

Answer 22

reduced mobility 
confusion 
drinking too. much 
medications 
co-morbiditieis

Question 23

intrsinic factors that lead to incontinence?

Answer 23

bladder or outlet - too weak or strong

Question 24

stress incontinence means?

Answer 24

bladder outlet too weak urine leak on movement, coughing, laughing etc weak pelvic floor muscles

Question 25

duloxetine?

Answer 25

SSRI - anti depressant to help with stress incontinence

Question 26

urinary retention with overflow incontinence?

Answer 26

bladder outlet too strong hesitancy double voiding poor urine flow post-dribbling blockage to urethra - too narrow e/g - BPH

Question 27

URGE incontinence?

Answer 27

bladder muscle too strong detrusor contracts at low volumes sudden urge to pass urine

Question 28

type of incontinence? 3

Answer 28

overflow stress urge

Question 29

beta-3 adrenoceptor agonists do what? e/g

Answer 29

dugs that relax detrusor e/g - mirabegron

Question 30

antimuscarinics are what? e/g

Answer 30

drugs relax detrusor oxybutinin tolterodine

Question 31

neuropathic bladder is what? in who? and due to?

Answer 31

underactive b;adder usually in elderly secondary to prolonged cathetarisation

Question 32

bladder scan for what?

Answer 32

residual volume - volume left after they go to toilet

Question 33

urinary incontinence - referral for pelvic floor exercises ?

Answer 33

max 3 months referral

Question 34

dihydrocodeine can cause?

Answer 34

can lead to constipation

Question 35

delirium what is it?

Answer 35

disturbed consciousness - fluctuations in conscious level | change in cognition

Question 36

describe fluctuations of delirium?

Answer 36

from hyperactive delirium - agitated/restless to hypoactive delirium - lethargic, sedated, stupor

Question 37

who's more common to get delirium?

Answer 37

frail people - more common in old age

Question 38

what triggers delirium? name 7

Answer 38

``` infection pain drugs dehydration hypoxia changes in environment/emotional distress urinary retention ``` USUALLY MULTIPLE TRIGGERS

Question 39

delirium complication of?

Answer 39

commonest complication of hopsitalisation

Question 40

why do we care about delirium?

Answer 40

massive morbidity and mortality increased risk of death longer length of stay increased rates of hospitalisation - affect societal costs

Question 41

how to diagnose delirium?

Answer 41

4AT score for all over 65 years patients in hospital

Question 42

non-pharmocological treatment of delirium?

Answer 42

re-orientate and reassure agitated patients encourage mobility glasses, hearing aids etc put on discharge ASAP

Question 43

pharma management of delerium?

Answer 43

stop bad drugs avoid drugs!

Question 44

delirium and falls relationship?

Answer 44

4.5x more liekly to fall if you have deliriium vice versa more likely to get delirium if you have fall

Question 45

falls due to what decrease and what increase?

Answer 45

decrease - in bp, HR, awareness increase - in urine output, sedation, dizziness, hallucinations

Question 46

culprit drugs that cause falls? 6

Answer 46

``` antihypertensive beta blockers sedatives opoids alcohol anticholinegerics ```

Question 47

why look at feet when fallen patient?

Answer 47

check peripheral neuropathy

Question 48

ataxic gait?

Answer 48

cerebellar damage pathology

Question 49

arthralgia gait?

Answer 49

arthiritis patholgy

Question 50

small steps, shuffling gait?

Answer 50

parkonism vascular

Question 51

high stepping gait means?

Answer 51

peripheral neuropathy

Question 52

long lie on floor after fallen means

Answer 52

check for CK for rhabdomyolysis

Question 53

how many ADR reversible?

Answer 53

nealry 1/3

Question 54

consquences od ADRs? name 5

Answer 54

``` falls cognitive loss dehydrations incontinence depression ```

Question 55

conc of drug over use of it?

Answer 55

reduces over time

Question 56

therapeutic range of drug?

Answer 56

range where drug is actually doing something

Question 57

absorption of drug in elderly patients?

Answer 57

only slower rate - but same extent of absorption

Question 58

distribution of drug in elderly affected by what? 4 factors

Answer 58

reduced muscle mass increased fat tissue reduced water in body decreased albumin - protein binding - so more likely to get into toxic range in elderly

Question 59

metabolism of drug in elderly?

Answer 59

hepatic m affected by - decreased liver mass and liver blood flow toxicity due to reduced metabolism

Question 60

excretion of drug in elerly?

Answer 60

reduced renal function reduced clearance and increases half-life of drugs leading to toxicity

Question 60

excretion of drug in elerly?

Answer 60

reduced renal function reduced clearance and increases half-life of drugs leading to toxicity

Question 61

pharmacodynamics is what?

Answer 61

what drug does to body

Question 62

pharmacokinetics means?

Answer 62

what body does to drug

Question 63

pharmacodynamics in elderly is?

Answer 63

more sensitive to particular medicines

Question 64

what drugs to stop in elderly? 4

Answer 64

antihypertensives, diuretics, psychotropics, benzodiazepines

Question 65

what drugs most likely to be associated with ADRs? 4

Answer 65

NSAIDS diuretics Warfarin ACEI

Question 66

digoxin affect?

Answer 66

increased toxicity - SO LOW DOSE ONLY