Older Persons

Question 1

Features of comphrehensive geriatic assessment

Answer 1

Problem list - current and past
Medication review
Nutritional status
Mental health - cognition, mood, anxiety, fears
Functional capacity - basic activities of daily living, gait and balance, activity status
Social circumstances
Enviroment - home facilities, access to local resources

Question 2

What is polypharmacy

Answer 2

6 or more drugs prescribed at any one time

Question 3

What is delirium

Answer 3

Acute confusional state

• sudden onset and fluctuating course
• develops over 1-2 days

Question 4

Causes of delirium

Answer 4

Underlying medical problem
- infection
- electrolyte imbalance
- hypoxia
- urinary retention
- constipation
Substance intoxication
Substance withdrawal

Question 5

Types of delirium

Answer 5

Hyperactive
- agitated
- confused
Hypoactive
- withdrawn
- drowsy
Mixed

Question 6

What is dementia

Answer 6

Progressive decline in cognitive functioning usually occuring over several months

Question 7

Features of Alzheimer’s dementia

Answer 7

Insidious onset with slow progression
Behavioural problems common
Diagnosed on clinical history but brain imaging may show disporportionate hippocampal atrophy
Progression reduced by cholinesterase inhibitors

Question 8

Types of dementia

Answer 8

Alzheimer's
Vascular
Dementia with lewy body
Parkinson's disease with dementia
Frontotemporal dementia
Mixed dementia

Question 9

Features of vascular dementia

Answer 9

Vascular risk factors
Imaging of vascular disease
Step wise progression

Question 10

Features of Dementia with Lewy Body

Answer 10

Gradually progressive
Prominent auditory or visual hallucinations
Delusions well formed and persistent
Parkinsonism commonly present but not severe

Question 11

Features of parkinson’s disease with dementia

Answer 11

Typical features of parkinson’s disease are present and preced vonfusion by over a year

Question 12

Features of frontotemporal dementia

Answer 12

Early onset
Complex behavioural problems
Language dysfunction

Question 13

Types of incontience

Answer 13

Stress - small volumes during coughing/laughing
Urge - frequent voiding, cannot hold urine, noctural incontinence, detrusor overactivity and obstruction
Overflow - urinary retention, enlarged prostate
Functional - cognitive impariment of behavioural problems

Question 14

Treatment of chronic diarrhoea

Answer 14

Faecal impaction excluded
Regualr toileting and dietary review
Low dose loperamide

Question 15

What is a TIA

Answer 15

Transient Ischaemic Attack
- focal neurological deficits due to blockage of blood supply to part of the brain (focal brain dysfunction) lasting less than 24 hours

Question 16

Features of ABCD2 tool

Answer 16

Assess short term risk for stroke/TIA - >4 = higher risk

• age
• blood pressure
• clinical features
• duration of symptoms
• diabetes

Question 17

Post TIA treatement

Answer 17

Lifestyle modification
- hyprcholesterolaemia
- hypertension
Aspirin 300mg
Surgical - carotid artery disease

Question 18

What is a stroke

Answer 18

Sudden onset focal neurological deficit lasting more than 24 hours or with imaging evidence of brain damage due to either infarction or haemorrhage

Question 19

Emergency treatment of stroke

Answer 19

Thrombolysis for cerebral infarct/ acute ischaemic stroke symptoms - alteplase
Anticoagulation reversal / selective neurosurgical intervention for intracranial bleeds - aspirin

Question 20

Types of strokes

Answer 20

Total anterior circulation stroke (TACS) - worst prognosis
Partial anterior circulation stroke (PACS)
Lacunar stroke (LAC)
Posterior circulation stroke (POCS)

Question 21

Checks to certify death

Answer 21

Pupils fixed and dilater
No response to pain
No breath or heart sounds after 1 min ausculation

Question 22

Features of death certificate

Answer 22

1a - cause of death
1b - condition leading to cause of death
1c - additional condition leading to 1b
2 - any contributing factors or conditions