Geriatrics

Question 1

Presentation of Dementia with Lewy Bodies

Answer 1

2 of 3 core features:
–> Fluctuating cognition, parkinsonism and visual hallucinations

Question 2

Diagnosis of Postural hypertension

Answer 2

A fall of >=20mmHg in systolic BP or a fall of >=10mmHg in diastolic BP

Question 3

Management of Postural Hypertension

Answer 3

Adequate hydration
Fall alarms, soft flooring
Rise from sitting slowly
Compression stockings

Pharma: Fludrocortisone, Midodrine

Question 4

Management of Delirium

Answer 4

Treat underlying cause
Maintain environment w/ good lighting and frequent reassurance
In extremely agitated patients –> small doses of haloperidol or olanzapine

Question 5

Causes of Delirium

Answer 5

D - drugs and alcohol
E - Eyes, ears and emotional
L - Low output state (MI, ARDS, PE, CHF, COPD)
I - Infection
R - Retention
I - Ictal
U - Under-hydration/Under-nutrition
M - Metabolic
S - Subdural, Sleep deprivation

Question 6

Causes of iron deficiency anaemia

Answer 6

Increased loss: Menorrhagia, GI bleeding, hookworm
Reduced intake: Poor diet
Malabsorption: e.g. Coeliac disease and IBD

Question 7

Features of iron deficiency anaemia

Answer 7

Lethargy, tiredness, weakness, jaundice, heavy periods, change in bowel habit

Question 8

Iron deficiency treatment

Answer 8

Ferrous sulphate

Question 9

How to convert oral morphine to subcutaneous morphine?

Answer 9

Oral morphine:Subcutaneous morphine
2:1

Half oral morphine to find subcutaneous

Question 10

Treatment for erectile dysfunction

Answer 10

Sildenafil (viagra)

Question 11

Mechanism of sildenafil (viagra)

Answer 11

Phosphodiesterase 5 (PDE5) inhibitor which enhances the effect of nitric oxide causing smooth muscle relaxation and subsequent penile erection due to inflow of blood

Question 12

Side effects of sildenafil (viagra)

Answer 12

Flushing, headache, dyspepsia, nasal congestion, dizziness, diarrhoea, rashes, and UTIs

Question 13

Contra-indications for sildenafil (viagra)

Answer 13

Patients taking organic nitrates due to risk of hypertension

Question 14

What is Charles Bonnet syndrome?

Answer 14

Associated with visual loss, these patients often describe smaller versions of real life objects commonly people, animals, etc.
They realise these hallucinations are not real.

Question 15

Features of pseudodementia

Answer 15

–> primarily associated w/ cognitive deficits in older patients with depression

Short duration of dementia
Equal effect on long and short term memory
Amnesia concerning specific events (often events that are emotionally charged)
Loss of social skills early in the illness
Patient’s will often answer ‘don’t know’ to closed questions rather than guessing the answer
Make little effort in performing tasks

Question 16

4 As of Alzheimer’s

Answer 16

Amnesia
Aphasia (word-finding problems, speech muddles & disjointed)
Agnosia (recognition problems)
Apraxia (inability to carry out skilled tasks despite normal motor function)

Question 17

Rome IV criteria constipation

Answer 17

Fewer than three bowel movements per week

Hard stool in >25% of bowel movements

Tenesmus (sense of incomplete evacuation) in >25% of bowel movements

Excessive straining in >25% of bowel movements

A need for digital evacuation of bowel movements

Primary constipation: no organic cause, thought to be due to dysregulation of the function of the colon or anorectal muscles

Secondary constipation: due to e.g diet, drugs, metabolic, endocrine or neurological disorder or obstruction

Question 18

Alarm features of constipation

Answer 18

–> may indicate GI malignancy

Weight loss
Loss of appetite
Abdo mass
Dark stool

Question 19

Subdural haemorrhage definition

Answer 19

Collection of venous blood accumulating in the potential space between the dura mater and arachnoid mater

Question 20

Risk factors for subdural haemorrhage

Answer 20

Advancing age (>65)
Bleeding disorders or anticoag therapy
Chronic alcohol use
Recent trauma

Question 21

Presentation of subdural haemorrhage

Answer 21

headache, N&V, confusion and diminished GCS

May be focal neurological signs indicative of haematoma site

Episodes of being alert and well

May present a few days after injury

Question 22

CT scan appearance of subdural haemorrhage

Answer 22

Crescent-shaped

Question 23

Presentation of vascular dementia

Answer 23

Progressive stepwise deterioration in cognition

Hx of cerebrovascular disease