This document contains 28 multiple choice and short answer questions about topics in geriatric medicine including: - Benign essential tremor and Parkinson's disease - Delirium prevalence, risk factors, and treatment - Depression and dementia symptoms - Falls risk assessment tools and investigations - Medication administration and compliance - Functional scales and pneumonia severity scoring - Leg ulceration, pressure ulcers, and incontinence - Safeguarding vulnerable adults and geriatric syndromes - Pressure area risk assessment and categories - Stress incontinence and overactive bladder syndrome - Key principles of the mental capacity act

1. Geriatrics formative test
answers with explanation.
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2. Q1. Regarding Benign Essential tremor
• Worse on action
• Often inherited (autosomal dominant)
• Improved by alcohol and beta blockers
• May have head nodding (titubation)
• Can also have vocal tremor
Five marks
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3. • http://youtu.be/sf1N0Zf5IqA
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4. Q2.Regarding Parkinson’s Disease
• Tremor usually asymmetrical (but still bilateral)
• Rest tremor
• Tremor unaffected by alcohol
• Treatment should begin when the patient and clinician are ready no
danger in delaying
• MRI is not helpful in diagnosis but may sometimes be used if other
neurological disorders are suspected
Five marks
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5. Q3 Regarding Delirium
• High prevalence in hospitalised elderly (15-60%) depending on ward
type
• Fluctuation in conscious level is very common and helps diagnosis
• People with sensory impairment are more at risk
• Sedative drugs should be used as for patient and staff safety when
other methods have failed. They may well worsen the delirium
• Symptoms are often worse at night
Five marks
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6. Q4 Depression
• Memory loss more rapidly progressing
• Patient complains about poor memory
• May do well in cognitive tests or answer don’t know (apathy)
• On probing or giving clues patients may remember
• The opposite tends to be true in dementia.
• Dementia may have more behavioural features and there may be loss
of ability to self care and incontinence which would be very unlikely in
depression
One mark
6

7. Q5 Assessing delirium
• The best diagnostic tool is the CAM (confusion assessment method)
• Other cognitive tests (AMT, MMSE) may trigger you to consider
delirium
Two marks
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8. Q6 Depression
• Memory loss more rapidly progressing
• Patient complains about poor memory
• May do well in cognitive tests or answer don’t know (apathy)
• On probing or giving clues patients may remember
• The opposite tends to be true in dementia.
• Dementia may have more behavioural features and there may be loss
of ability to self care and incontinence
Two marks
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9. Q9 Falls risk assessment tools
• Get up and Go or TUG (timed up and go)
• Quick, simple bedside assessment of walking
• http://www.youtube.com/watch?v=s0nqzvt9JSs
One mark
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10. Q 10 High Ck
• Muscle necrosis (rhabdomyolysis) due to prolonged pressure releases
myoglobin which can accumulate in the renal tissues
• Creatine kinase is released by damaged muscle levels above 5 times
normal indicated rhabdomyolysis
• Patients can get renal failure, disseminated intravascular coagulation
and low calcium
Long Lie
•
•
•
•
•
•
Pressure areas,
rhabdomyolysis,
fear of not being found,
hypothermia,
stasis pneumonia
DVT
Four marks
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11. Q11 Falls Investigations
• BASIC TESTS
• Lying and standing blood pressure
• Urine Dip
• ECG
• Assessment of walking (eg Up and Go)
• Appropriate xrays may be needed
• Assess vision
CT heads, tilt table testing and 24hr ECG tapes only in specific cases
Three marks
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12. Q12 Taking an oral bisphosphonate
• May be daily or weekly preparations but weekly generally used as studies
have shown increased compliance.
•
•
•
•
Tablets swallowed whole with plenty of water
Sat upright or stood upright
On an empty stomach (including no milky drinks)
No breakfast or other medications for at least half an hour (two hours for
risedronate) after
• Remain upright for half an hour post dose.
• COMPLIANCE can be a BIG issue!
One mark
12

13. Q 14 Falls Risk factors from the case
• Increasing age and frailty level
• Living alone
• Cognitive Impairment
• Previous fall
• Visual impairment
• Home hazards
• Use of walking aid
• Fear of falling
• Acute illness
• Knee pain
• Women tend to fall more than
men
Eight marks available
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14. Q 15 Functional rating scale
• Barthel Index
• Ten item scale looking at daily functioning
• Mainly ADL and mobility
• Used as a baseline level
• Can be used to show acute deterioration (compared with Barthel a
while ago)
• Can be used to demonstrate rehabilitation success
• Higher scores more independent patients
One mark
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15. Q 16 Pneumonia Severity scoring
•
•
•
•
• Risk of death at 30 days
• You would be unlikely to be asked
Confusion
these exact figures
• New onset AMT less or equal to
8
0
0-0.7%
Urea
1
1
• Greater than 7
2
3%
Respiratory Rate
• Greater or equal to 30/min
3
17%
Blood pressure
4
41%
• Less than 90 systolic or 60 diastolic
• 65
5
57%
• Age 65 or over
One mark
15

16. Q 17 Falls intervention.
• Only way to stop falls is to stop movement!
• We may be able to reduce the frequency and possibly impact of the
fall
• Strength and Balance Training has convincing evidence
One mark
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17. Q 19 Stroke
• If present within 4 and half hours consider thrombolysis if not
contraindicated.
• Need to urgently contact the stroke team to organise this
One mark
17

18. Venous about 70% of ulcers
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19. Q21 Leg ulceration
•
•
•
•
•
•
Venous leg ulcers common in the elderly (70-90% of all leg ulcers)
Appearance of “inverted champagne bottle” legs
Generally medially located
Painless (unless infected)
Antibiotics only rarely indicated
Skin biopsy only needed if prolonged non healing or worsening with
treatment
• Treated with compression bandaging after arterial Doppler to exclude
concomitant arterial disease
One mark
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20. 20

21. Q22 Vulnerable adults
• All trusts must have a policy for safeguarding
• Generally you should refer if any index of suspicion to the Protection
of Vulnerable Adult team
• Other appropriate responses may be to speak to social services or if
more serious the police
• If in doubt about a home or nursing environment admit the patient to
hospital as a place of safety
One mark
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22. Q 24 Isaacs Geriatric Giants
• Immobility
• Instability (falls)
• Incontinence
• Impaired memory/Intellectual impairment
• Elderly patient commonly present with one, some or all of these
One mark
22

23. Q25 Pressure area Risk Assessment Tool
• Waterlow
•
•
•
•
•
•
Takes into account Nutritional status
Skin Type
Acute illnesses
Degree of immobility
Sex and Age
Continence
• Gives advice about how to manage risk
• Like all risk assessment tools there can be interater variability which
reduces reliability
One mark
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24. Q 27 Pressure areas Categories
1. Non Blanching Erythema
2. Partial thickness.
• Broken skin shallow ulcer. Not eroding deeper. Blisters generally category 2
3. Full thickness skin loss.
• Deep ulcer may see subcutaneous fat but not bone, muscle or tendon.
4. Full thickness tissue loss.
• Exposed bone, tendon or muscle
• Eschar
• May be undermining/tunnelling
One mark
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25. Q27 Stress Incontinence
• Small volumes leak during coughing, laughing
• Associated with pelvic floor weakness (obstetric history in females)
• Treatment
• Rigid adherence to pelvic floor exercises
• Duloxetine (SNRI)
• Surgery (colposuspension, tension free vaginal tape)
One mark
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26. Q 28 Overactive bladder syndrome
• Frequent and precipitant voiding
• Nocturnal incontinence
• Feeling of Urgency can leak small volume
• Treatment
• Bladder retraining
• Regular toileting
• Anti-muscarinic drugs
One mark
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27. First key principle mental capacity act
• Presumption of capacity
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28. Please take the time to fill out the
feedback.
• Https://www.surveymonkey.com/s/c3xkrkx
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