Year 3: Ageing

Question 1

In elderly albumin

Answer 1

Decreases

Question 2

In elderly alpha acid glycoprotein

Answer 2

Increases

Question 3

In elderly acidic drugs

Answer 3

Work better (due to decreased albumin, as it binds acids)

Question 4

In elderly basic drugs

Answer 4

Have decreased action

Question 5

In elderly stomach acid

Answer 5

Decreases

Question 6

In elderly body water %

Answer 6

Decreases

Question 7

In elderly the GFR is

Answer 7

Decreased

Question 8

In elderly the therapeutic window for drugs is

Answer 8

Decreased

Question 9

A tool to use in elderly for prescribing

Answer 9

STOP START tool

Question 10

In elderly lipids are

Answer 10

Increased

Question 11

Lipophilic drugs have an

Answer 11

Increased half life (due to increased lipids)

Question 12

Infuenza vaccination is given to

Answer 12

• Ages 65 +
• Once per year

Question 13

Pneumococcal vaccination is given to

Answer 13

• Ages 65+
• As a once off

Question 14

Shingles vaccination is given to

Answer 14

• At age 70
• As a once off
• “Varicella zoster”

Question 15

Abdominal Aortic Aneurysm

Answer 15

• Ages 65+
• USS
• 3-4.4cm = annual screening
• 4.5-5.4cm = 3 monthly scan
• >5.4cm = refer for an operation

Question 16

Colorectal cancer (bowel) screening is for

Answer 16

• Ages 50-75
• Every 2 years

Question 17

Breast cancer screening is for

Answer 17

• Ages 50-70 (women)
• Every 3 years

Question 18

Age-related loss of muscle mass and function

Answer 18

Sarcopenia

Question 19

Muscle mass declines from

Answer 19

Age 30

Question 20

Muscle mass degradation accelerates at

Answer 20

Age 60

Question 21

Sarcopenia happens due to

Answer 21

• Decreased sex hormones (oestrogen)
• Increased apoptosis
• Increased mitochondrial dysfunction

Question 22

3 pharmacological interventions for elderly people

Answer 22

• Creatine/ protein supplements + weight exercise
• ACE Inhibitors (reduce inflammation and increase mitochondrial function)
• Ca²⁺ and Vit D (for bone strength)

Question 23

Diagnosis of postural hypotension

Answer 23

• Systolic is <90mmHg
• Systolic has reduced by >20mmHg
• Diastolic has reduced by >10mmHg

Measure after 3 mins of standing up

Question 24

Management of falls

Answer 24

• Stop medications if underlying cause
• Treat underlying cause
• Strength and balance training (3/7 for 12/52)
• Attend hobbies like Tai Chi

Question 25

Triad of Delirium

Answer 25

* Disturbance in attention "Disoriented" * Change in cognition "Disorganised thinking" * Acute and fluctuating course

Question 26

Pathophysiology of Delirium

Answer 26

* Derangement of ACh * Caused due to stress *

Question 27

Two types of Delirium

Answer 27

* Hyperactive * Hypoactive *

Question 28

Hyperactive

Answer 28

* Aggitated * Aggressive * Wandering

Question 29

Hypoactive

Answer 29

* Withdrawn * Apathetic * Sleepy

Question 30

Assessments of Delirium

Answer 30

* 4AT * CAM Assessment

Question 31

4AT

Answer 31

* Alertness * Attention: Months of the year backwards * Acute and fluctuating * AMT4 (Acute mental test): Age, DoB, Place, Year

Question 32

What should you always do in delirium

Answer 32

* Reassure * Re-orientate * Help patient with sensory aids etc

Question 33

1st line treatment for Delirium

Answer 33

Haloperidol (Typical antipsychotic)

Question 34

Haloperidol is contraindicated in

Answer 34

Patients with Parkinson's Disease and Lewy Body Dementia

Question 35

2nd line for Delirium

Answer 35

Quetiapine (Atypical antipsychotic)

Question 36

3rd line for Delirium

Answer 36

(Lorazepam) BZD

Question 37

1st line for Delirium in Parkinson's and LBD patients

Answer 37

Quetiapine

Question 38

1st line for Delirium in Alcohol Withdrawal

Answer 38

Lorazepam (BZD)

Question 39

If you prescribe Opioids

Answer 39

Prescribe Laxatives alongside this (due to side effect of constipation from opioids)

Question 40

If you prescribe Steroids

Answer 40

Prescribe * Biphosphonates * Vit D * Ca²⁺

Question 41

Side effects of bisphosphonates

Answer 41

Necrosis of jaw

Question 42

Side effects of levothyroxine

Answer 42

Hypocalcaemia

Question 43

If prescribing antiplatelets or SSRIs

Answer 43

Then prescribe PPIs * Antiplatelets can increase GI bleeds * SSRIs can increase stomach acid

Question 44

Do not prescribe Metoclopramide in

Answer 44

Parkinson's patients * Metoclopramide is a D2 receptor antagonist

Question 45

In Heart failure or post-MI prescribe

Answer 45

ACE inhibitors

Question 46

In elderly patients suffering from Osteoarthritis

Answer 46

Switch NSAIDs for Paracetamol

Question 47

The truth about statins and the elderly

Answer 47

They take years to actually work... and they area long-term prophylactic- so whats the point? They interfere with a lot of shit Not indicated for use \> age 75

Question 48

Palliative care for pain/SOB

Answer 48

Morphine

Question 49

Palliative care for distressed patients

Answer 49

Midazolam

Question 50

Palliative care for nausea

Answer 50

Levomepromazine

Question 51

Palliative care for trouble with respiratory secretions

Answer 51

Buscopan

Question 52

Morphine (oral) is

Answer 52

10 times the strength of Codeine (15mg of Codeine = 1.5mg of Morphine)

Question 53

Morphine (SC) is

Answer 53

twice the strength of Morphine (oral) (2mg of Morphine (oral) = 1mg Morphine (SC))

Question 54

Oxycodone is

Answer 54

twice the strength of Morphine (oral) 2mg of Morphine (oral) = 1mg Oxycodone

Question 55

Oramorph is

Answer 55

of similar strength to Morphine (oral) but is **immediate release**

Question 56

Oramorph is used for

Answer 56

* Breakthrough pain * It is taken PRN * Is 1/6th the dosage of background dosage

Question 57

7 steps of a death certificate

Answer 57

1. Check for spontaneous movement 2. Check for reaction to voice and pain 3. Palpate 2 major pulses for 1 min 4. Inspect eyes (fixed, dilated, absence of corneal reflex, dry) 5. Auscultate heart and lungs for 1 min 6. Check for implantable devices 7. Record date and time of death