Geriatrics

Question 1

Most common subtype of dementia

Answer 1

Alzhiemers disease

Question 2

Frailty (not complete)

Answer 2

> 3 or = to

-

Question 3

MMSE cut off for possible dementia

Answer 3

MMSE

Question 4

Hallmark feature of AD

Answer 4

Rapid forgetting + one other cortical manifestation

• no physical signs
• speech
• executive
• visuospatial

Question 5

Which molecule is responsible for 7% of dementia

Answer 5

APOE4

Question 6

Mechanism underpinning early onset of AD in Down syndrome patients

Answer 6

Extra copy of amyloid precursor gene on chromosome 21

Question 7

Probable benefit in preventing AD

Answer 7

1) Physical acigtivty
2) Cognitive stimulation
3) Social interaction

Question 8

Pathophysiology of AD

Answer 8

Accumulation of amyloid plaque + tau

PET: Increased deposition of amyloid

Question 9

Where does AD commence

Answer 9

Atrophy of medial temporal lobe/hippocompus

Cortical atrophy

Question 10

Findings on post mortem in AD (not complete)

Answer 10

1) Neurofibirrilary tangles -

2)

Question 11

Early onset autosomal dominant AD associated mutations

Answer 11

• Amyloid precursor protein (APP)
• Presenilin 1 Chromosome 14
• Presenilin 2 Chromosome 1

Collectively <1% of all adults alzheimers

Genetic screening if there appears to be a pedigree

Question 12

Late onset AD genetics

Answer 12

Apolipoprotein E on chromosome 19
- E4 allele strongest risk factor for AD

Nb: no preventive measures specific to APOE therefore no genetic screening in late onset

Question 13

A/E for anti-cholinesterase inibitors

Answer 13

1) Nausea/vomitting/diarhoea
2) Bradycardia –> cannot give to anyone with long PR/conduction deficits
3) Nightmares

C/I in asthma/gastric ulcer disease

Question 14

A/E of Memantine

Answer 14

Seizures

Question 15

MOA of memantine

Answer 15

Neuroprotective NMDA antagonist as it blocks glutamate induced excitotoxicity

Question 16

Mortality risk of operatively managed hip fracture

Answer 16

• 15-30% mortality (some study say 15-20%)

- doubled if >2 days delayed

Question 17

Treatment for urge incontinence (not complete)

Answer 17

Oxybutinin - Anti-muscarinic (cannot use in acute angle closure glaucoma)
Mirabegron - B3 adrenergic receptor agonist

Question 18

Treatment for stress incontinence (not complete)

Answer 18

First line: Physical therapy

Second line: Topical oestrogens

Question 19

Mirabegron mechanism of action and adverse effects

Answer 19

MOA: B3 agonist –> sympathetically medicated relaxation of the detrusor muscle
Adverse Effects: Hypertension, urinary tract infections and headaches

Question 20

Oxybutinin mechanism of action and adverse effects

Answer 20

MOA: Antagonist of the muscarinic receptor on the bladder –> reduction in contraction
Advers Effects: Can precipitate acute angle closure glaucoma.

Question 21

Genes associated with early onset AD

Answer 21

Amyloid Precursor Gene (Chromosome 21) 
Preselin 1 (Chromosone 14q) 
Preselin 2 (Chromosone 1q)

Question 22

Gene associated with late onset AD

Answer 22

Apolipoprotein E (Chromosome 19) 
APOE4 = Greatest risk of developing AD

Question 23

Memantine Mechanism of Action

Answer 23

MOA: NMDA receptor antagonist. Blocks glutamate induced excitotxicity.
PBS for MMSE 10-14
Adverse effects: Seizures

Question 24

Mechanism of Action of Rosozoumab

Answer 24

MOA: Inhibits sclerostin. Binds sclerostin, a regulatory factor in bone metabolism. Sclerostin inhibition increases bone formation and, to a lesser extent, decreases bone resorption

Question 25

MRI findings in Dementia with Lewy Bodies

Answer 25

typical MRI findings is that of diffuse atrophy with relative preservation of the medial temporal lobes

Question 26

Cardinal features of Dementia with Lewy Bodies

Answer 26

1) visual hallucinations 2) motor parkinsonism 3) REM sleep disorder 4) fluctuating cognition

Question 27

Differentiating features of MSA and PD

Answer 27

1) Autonomic instability 2) Early falls 3) Lack of response to LD