Old Age Medicine

Question 1

What are the 4 measurements of Fried’s phenotype of frailty?

Answer 1

Grip strength
Fatigue
Walking speed
Activity levels

Question 2

What components are needed in falls history?

Answer 2

Previous falls
Circumstances surrounding the fall
Preceding symptoms
Vision, cognition and continence
Osteoporosis risk factorsl

Question 3

What are the causes of falls grouped into?

Answer 3

D- drugs
A- aging
M- medical causes
E-environmental

Question 4

Define sarcopenia

Answer 4

Decreased muscle mass

Question 5

Define delerium

Answer 5

An acute onset of confusion with a change in alertness (agitated or hyperalert)

Question 6

What are the two validated tools for assesing confusion

Answer 6

Confusion assesnent method (CAM) ( is ICD 10 for delerium)

The 4AT

Question 7

What is CAM positive?

Answer 7

Acute onset and fluctuating course
PLUS
Inattention
And EITHER
Disorganised thinking (disorganised speech)
OR
altered level of consiousness (hyperalert/hypoalert)

Question 8

If delerium is not remedied by de-escelation techniques what medicatuons may be used?

Answer 8

Short term haloperidol or olanzapine (1 week)

Question 9

What conditions contraindicate the use of antipsychotics for treatment of delerium?

Answer 9

Parkinsons/ lewy body dementia

Use lorazepam instead

Question 10

What is the prognosis for patients with delerium?

Answer 10

1/3 recover quickly
1/3 recover slowly
1/3 do not completely recover

Question 11

What blood test must you always do for delerium

Answer 11

Serum calcium

Question 12

What are the 4 components of the 4 AT exam?

Answer 12

Alertness
AMT4 (age, date of birth, current year and location)
Attention (count months backwards from december)
Acute and fluctuating course

Question 13

Define the triad of parkinsonism

Answer 13

Resting tremour
Bradykinesia
Rigidity
(Postural and gait instability)

Question 14

Define essential tremor

Answer 14

A tremor that is worse on movement, may be present in legs and jaw and is usually familial. No bradykinesia or gait disorder

Question 15

What is the treatment for essential tremor?

Answer 15

A non specific beta-blocker - PROPRANOLOL

Question 16

What type of tremors are worse on movement?

Answer 16

Essential tremor
Dystonic tremor
Exaggerated physiological tremor
Hyperthyroidism
Drug induced

Question 17

What conditions have intention tremors?

Answer 17

Cerebellar disorders

Question 18

What is the average age of onset for parkinsons disease?

Answer 18

60 yrs, more common in males

Question 19

What are the stages of parkinsons?

Answer 19

Pre-diagnosis
Diagnosis/maintenance- no motor complications
Complex- on/off motor and cognitive problems
Palliative- poor drig response, may need PEG tube, dementia common

Question 20

What are the first line treatments for parkinsons?

Answer 20

Ropinirole 250mg TDS
Co-Beneldopa (Modpar) 62.5mg TDS
Rasagaline 1mg daily

Question 21

What type of medication is ropinirole?

Answer 21

A non-ergot derived dopamine agonist.

Others are Pramipexole and rotigotine (transdermal patch)

Question 22

What type of medication is co-Beneldopa (Madopar)

Answer 22

A combination of levodopa a prodrug and DOPA decarboxylase inhibitor

Question 23

What type of drug is rasagaline?

Answer 23

A monoamine-oxidase-B inhibitor.

Not as good as dopamine agonists and levodopa

Question 24

Common side effects of levodopa are?

Answer 24

Postural hypotension
Nausea and vomiting
Dyskinesia
Impulsive and compulsive behaviour

Question 25

What is the main hallmark of idiopathic parkinson’s disease?

Answer 25

Hemiparkinsonism. Early stages have asymmetrical symptoms

Question 26

What are the grades of pressure ulcers?

Answer 26

Grade 1- non blanchable erythema with intact skin Grade 2- partial skin loss presenting as abrasion or blister Grade 3- full thickness skin loss and damage to subcutaneous tissue Grade 4- extensive destruction with involvement of underlying structure muscle, bone etc

Question 27

What are recognized complications of thrombolysis in acute stroke?

Answer 27

6% risk of haemorrhage (2-3% considered life threatening) | 7% risk of angioedema

Question 28

How is stroke diagnosed?

Answer 28

Clinically! In early stages CT is normal

Question 29

What medication is the only licensed treatment for acute stroke?

Answer 29

Alteplase a recombinant tissue plasminogen activator 0.9mg per kg in IV infusion over 1 hour Requires close monitoring for physiological/ neurological change

Question 30

How long do you have to thrombalyse someone post stroke?

Answer 30

4.5 hours, if uncertain backdate to when patient knew he was well

Question 31

What must happen before patient diagnosed with stroke is given thrombolysis?

Answer 31

Blood test (do BMs), CT, Specialist review and final decision

Question 32

Define stroke

Answer 32

A clinical syndrome when blood supply to a part of the brain is restricted, either by blockage aka ischaemic stroke 85% or by haemorrhagic stroke 15%

Question 33

What is the most common system for stroke classification?

Answer 33

The Oxford stroke classification AKA Bamford classification

Question 34

How is a total anterior circulation stroke (TACS) diagnosed?

Answer 34

Three of: Unilateral weakness/ sensory deficit of face, arm and leg Homonymous hemianopia Higher cerebral dysfunction (dysphasia, visuospatial fisorder)

Question 35

How is partial anterior circulation stroke (PACS) diagnosed?

Answer 35

Two of: Unilateral weakness/ sensory deficit of face, arm and leg Homonymous hemianopia Higher cerebral dysfunction (dysphasia, visuospatial fisorder)

Question 36

How is posterior circulation syndrome (POCS) diagnosed?

Answer 36

One of: Cerebellar or brain stem syndromes Loss of consciousness Isolated homonymous hemianopia

Question 37

How is lacunar syndrome (LACS) diagnosed?

Answer 37

No evidence of higher cerebellar dysfunction and One of: Unilateral weakness/ sensory deficit of face and arm, arm and leg or all three. Pure sensory stroke Ataxic hemiparesis

Question 38

What is the algorithm for assessing risk of stroke following TIA?

Answer 38

A- age >60 =1 B- BP > 140/90mmHg =1 C- Clinical features unilateral weakness=2 speech disturbance =1 D1- Duration of symptoms >60=2 10-59=1 <10min=0 D2- Diagnosed with diabetes = 1

Question 39

What is ABCD2 scoring meaning?

Answer 39

``` 0-3 = 1% at 2 days 4-5= 4% at 2 days 6-7= 8% at 2 days ```

Question 40

What is the pneumonic for causes of delirium?

Answer 40

PINCH ME Pain​
INfection​
Constipation and urinary retention​
Hydration​
Medication (medications taken and mediation withdrawal including alcohol)​
Environment