Geriatrics

Question 1

Define Delirium

Answer 1

A state of mental confusion that develops quickly and fluctuates in intensity

Question 2

What are the associated features of delirium?

Answer 2

Disordered thinking/Delusions
Euphoria/depression/mood changes
Language impairment
Inattention
Reversal of sleep wake cycle
Illusions
Unawareness/disorientation
Memory defects

Question 3

What is the most common, and most frequently misdiagnosed, type of delirium?

Answer 3

Hypoactive delirium

Question 4

What would indicate an abnormal Abbreviated Mental Test Score? What is the next step?

Answer 4

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Confusion Assessment Method

Question 5

What tool can diagnose delirium?

Answer 5

Confusion Assessment method

Question 6

Name 5 1st line investigations in delirium:

Answer 6

FBC, glucose, CXR, TFT, LFT, U&E

Question 7

What are the 4 fields of management for delirium?

Answer 7

1. Find and treat underlying cause
2. Manage symptoms
3. Prevent complications
4. Explain to family

Question 8

Which sedative for delirium is contraindicated in parkinson’s?

Answer 8

Haloperidol - so lorazepam is used instead

Question 9

Name a drug that causes overflow incontinence?

Answer 9

Amitriptyline

Question 10

Name a simple investigation of incontinence

Answer 10

Frequency volume charts

Question 11

What is it called if 1/3 of urine is excreted at night?

Answer 11

Nocturnal polyuria

Question 12

How many mls a day is the maximum to urinate?

Answer 12

2500, any more is polyuria

Question 13

What are the causes of incontinence? (DIAPPERS)

Answer 13

Delirium
Infection
Atrophy
Psychological
Pharmacalogical
Excess urine out put
Restricted mobility
Stool impaction in constipation

Question 14

What are the patient education methods of managing incontinence?

Answer 14

Smoking cessation and weight loss advice
Reduce caffeine and alcohol intake
Manage constipation

Question 15

What drugs are used in overactive bladders?

Answer 15

Antimuscarinic drugs

Question 16

Name 3 medical treatments of over active bladder?

Answer 16

Antimuscarinic drug
Botox
Intravaginal oestrogen

Question 17

Name 2 drugs used to treat BPH in men

Answer 17

Alpha 5 reductase inhibitors

Alpha blockers e.g. sdoxazocin

Question 18

Define falls

Answer 18

When a person comes inadvertantly to the floor or to a lower level

Question 19

Name some intrinsic risk factors to falls

Answer 19

Cataracts, muscle strength, CI

Question 20

Name some extrinsic risk factors to falls

Answer 20

Home hazards, medications, walking aids

Question 21

Name the 4 important factors in the medical assessment of falls:

Answer 21

1. Medication review
2. DEXA scan
3. Find medical reason for falls
4. Manage conditions which cause the falls

Question 22

Name an exercise which can reduce falls risk

Answer 22

Tai Chi

Question 23

Why are old people more likely to be inappropriately prescribed?

Answer 23

• more chronic illness
• more polypharmacy
• physiological changes due to age

Question 24

How should you alter the dose of hepatic-route drugs in older patients?

Answer 24

Lower the dose, increase the dose interval

Question 25

What are the consequences of inappropriate prescribing?

Answer 25

Longer hosptal stays, death, drug reactions, poor compliance

Question 26

What are the 4 criteria for assessing a patient's capacity?

Answer 26

1. Are they able to understand the information needed to make the decision? 2. Are they able to retain this information long enough to make the decision? 3. Are they able to weigh up the pros and cons of a decision? 4. Are they able to communicate their decision?

Question 27

If a patient lacks capacity, can they make any decisions?

Answer 27

Yes e.g. what to have for dinner

Question 28

When can you restrain someone who lacks capacity?

Answer 28

Only when not doing so would cause harm to the patient

Question 29

What is unusual about the presentation of depression in older adults?

Answer 29

Physical symptoms may be more prominent | May present as confusion and memory loss

Question 30

Give 3 medications that may worsen depression

Answer 30

beta blockers, parkinson's medications and CCB

Question 31

Where are pressure ulcers most likely to occur?

Answer 31

Bony prominences e.g. buttocks, heels, between the shoulder blades

Question 32

What may predispose an ulcer?

Answer 32

Skin feeling warmer or cooler on one area, colour or texture change

Question 33

What are 3 risk factors for developing a pressure sore?

Answer 33

Immobility Sensory loss Vascular problems/insufficiency poor nutrition and hydration

Question 34

What surgery can be used to treat a pressure ulcer?

Answer 34

Surgical flap reconstruction

Question 35

What is advanced care planning?

Answer 35

Discussing care plans for patients when they are still competent, about future treatment preferences when they lose the ability to make decisions

Question 36

What are the 2 ways of having an advanced care plan?

Answer 36

1. Living will | 2. Power of attorney