Geriatrics

Question 1

What is osteoporosis?

Answer 1

Low done density and subsequent susceptibility to fracture

Question 2

What are the risk factors for osteoporosis?

Answer 2

SHATTERED
Steroid use
Hyperthyroidism
Thin (low BMI under 22)
Low testosterone
Erosive or inflammatory bone disease
Renal or liver failure
Dietary calcium low
Early menopause before 45 years

Question 3

What is the presentation of osteoporosis?

Answer 3

Asymptomatic until fracture
Vertebral crush fracture
Thoracic fracture
Colle’s fracture of the wrist

Question 4

What is the diagnosis of osteoporosis?

Answer 4

DEXA scan - taken at the hip is gold
T-score is comparison to a healthy young adult
Z-score is comparison to an age and sex matched individual

Question 5

What is the interpretation of DEXA scan results?

Answer 5

More than -1 = normal
-1 to -2.5 = osteopenia
More than -2.5 = osteoporosis
More than -2.5 with a fracture = severe osteoporosis

Question 6

What is the management of osteoporosis?

Answer 6

Bisphosphonates such as Alendronate
Monoclonal antibodies such as Denosumab

Question 7

What is the risk scoring tool for osteoporosis?

Answer 7

FRAX - 10 year risk of fractures

Question 8

What is the management for osteopenia?

Answer 8

Lifestyle advice and repeat DEXA scan in 2 years

Question 9

What are some drugs that can increase the risk of falls?

Answer 9

Anticholinergics
ACE-i
L-DOPA
Benzodiazepines
Diuretics
Baclofen

Question 10

What are some assessment tests for falls?

Answer 10

Turn 180 test
Timed up and go test

Question 11

What is the criteria for constipation?

Answer 11

2 or more of the following for 3 months or more -
Straining or defecation
Incomplete evacuation
Less than 2 bowel movements per week
Lumpy or hard stools

Question 12

Name an osmotic laxative

Answer 12

Magnesium hydroxide 15ml

Question 13

Name a stimulant laxative

Answer 13

Senna

Question 14

What is a side effect of long term stimulant laxative use?

Answer 14

Cathartic atonic colon - anatomical change to the colon

Question 15

Give some presentations of constipation in the elderly

Answer 15

Confusion
Urinary retention
Abdominal pain
Overflow diarrhoea
Appetite loss
Nausea

Question 16

Give some causes of constipation in the elderly

Answer 16

Anticholinergics, opioids, antidepressants
Immobility
Poor toilet access
Parkinsons
Diverticular disease

Question 17

What is used for soft stool constipation?

Answer 17

bisacodyl suppositories

Question 18

What is used for hard stool constipation?

Answer 18

Glycerin suppositories

Question 19

What is used for faecal impaction?

Answer 19

Lubricant and high phosphate enema

Question 20

What is the MUST score used for?

Answer 20

Detecting protein energy undernutrition

Question 21

What are the 3 methods of tube feeding?

Answer 21

PEG
RIG
Fine bore NG

Question 22

What are pressure sores?

Answer 22

Areas of skin necrosis due to pressure induced ischaemia

Question 23

What are the mechanisms of a pressure sore?

Answer 23

Pressure
Shear
Friction
Moisture

Question 24

What is the risk assessment tool for pressure sores?

Answer 24

Waterlow score

Question 25

What is the prevention of pressure sores?

Answer 25

Barrier creams Reposition Limit sitting Pressure redistribution

Question 26

What is the management of pressure sores?

Answer 26

Hydrocolloid dressings Hydrogels Surgical debridement Antibiotics if any sign of infection

Question 27

What is a neck of femur fracture?

Answer 27

Break in the upper femur just below the ball and socket hip joint

Question 28

Which type of neck of femur fracture has a better outcome?

Answer 28

Extracapsular because intracapsular has a high risk of avascular necrosis due to disrupted blood supply to the femoral head

Question 29

What is the classification for degree of displacement for neck of femur fracture?

Answer 29

Garden classification

Question 30

What is the classification for angle of displacement for neck of femur fracture?

Answer 30

Pauwels classification

Question 31

What is a colles wrist fracture?

Answer 31

Fracture of the distal radius from FOOSH

Question 32

What is the visible deformity of a colles wrist fracture?

Answer 32

Dinner fork

Question 33

What are 2 complications of a colles wrist fracture?

Answer 33

Carpal tunnel syndrome Median nerve injury

Question 34

Name some confusion screen bloods

Answer 34

FBC - infection, anaemia U+E - hyponatraemia or hyper LFT Coagulation/ INR - bleeding TFT - hypothyroidism Calcium B12 and folate Glucose Blood cultures - sepsis

Question 35

What are some causes of delirium in the elderly?

Answer 35

UTI Infection and sepsis Opiates Hypoxia Alcohol Constipation Change in environment

Question 36

What is the diagnosis of postural hypotension?

Answer 36

A fall of 20 mmHg or more in systolic pressure on standing or fall of 10 mmHg in diastolic pressure

Question 37

What is the definition of polypharmacy?

Answer 37

4 or more medications

Question 38

What tool is used to suggest medications?

Answer 38

START

Question 39

Used to assess which drugs can potentially be discontinued in elderly patients undergoing polypharmacy

Answer 39

STOPP tool

Question 40

What is the temperature of hypothermia?

Answer 40

Under 35 degrees

Question 41

What is the gold standard diagnosis of hypothermia?

Answer 41

Rectal temperature

Question 42

What does poikilothermic mean?

Answer 42

Older people are generally less able to manage their core body temperature which is prone to fluctuation

Question 43

What is the temperature of hyperthermia?

Answer 43

Over 35

Question 44

What is miliaria and the treatment?

Answer 44

Prickly heat Cool, wash and give antihistamines

Question 45

What are some presentations of heat exhaustion?

Answer 45

Collapse Weakness Vomiting Dizziness Headache

Question 46

What are some presentations of heat stroke?

Answer 46

Core temperature over 40 Mental state alteration Absent sweating Coma

Question 47

What is a squamous cell carcinoma?

Answer 47

2nd most common skin cancer Malignant tumour of epidermal keratinocytes

Question 48

What is the presentation of SCC?

Answer 48

Hyperkeratotic and scaly May ulcerate Pain Tenderness Bleeding

Question 49

What is the diagnosis of SCC?

Answer 49

Excision biopsy with 4mm margins Punch biopsy

Question 50

What is the management of SCC?

Answer 50

Removal with 5mm margins Radiotherapy