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ACH Flashcards

1
Q

What is osteoporosis?

A
  • A condition involving a significant reduction in bone density, making bones weaker and prone to fractures.
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2
Q

What is osteopenia?

A
  • A less severe decrease in bone density compared to osteoporosis.
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3
Q

How is osteoporosis diagnosed?

A
  • Diagnosis is made using a T-score from a DEXA scan, with a T-score of less than -2.5 indicating osteoporosis.
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4
Q

What are the main risk factors for osteoporosis?

A
  • Age, post-menopausal women, low BMI, low calcium and vitamin D intake, smoking, alcohol, and chronic diseases like rheumatoid arthritis.

Note not obesity

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5
Q

What is the T-score for osteoporosis on a DEXA scan?

A
  • A T-score of less than -2.5 is diagnostic for osteoporosis.
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6
Q

What role does hormone replacement therapy (HRT) play in osteoporosis?

A
  • HRT is protective against osteoporosis, especially in post-menopausal women.
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7
Q

What is the first-line treatment for osteoporosis?

A
  • Bisphosphonates, such as alendronate, risedronate, or zoledronic acid.
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8
Q

What is the recommended calcium intake for osteoporosis management?

A
  • At least 1000mg of calcium daily.
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9
Q

What is the recommended vitamin D intake for osteoporosis management?

A
  • 400-800 IU of vitamin D daily.
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10
Q

What is the role of bisphosphonates in osteoporosis treatment?

A
  • They reduce bone resorption by inhibiting osteoclast activity, helping to strengthen bones.
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11
Q

What are common side effects of bisphosphonates?

A
  • Reflux, oesophageal erosions, atypical fractures, osteonecrosis of the jaw.
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12
Q

What is the management for patients on long-term corticosteroids?

A
  • Bisphosphonates are recommended for patients on long-term steroids, and calcium and vitamin D supplementation.
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13
Q

How often should bisphosphonate treatment be reassessed?

A
  • After 3-5 years, with a repeat DEXA scan to guide further treatment.
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14
Q

What is the FRAX tool used for?

A
  • It is used to assess the 10-year fracture risk and guide decisions on DEXA scanning and treatment.
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15
Q

What are the key lifestyle modifications for managing osteoporosis?

A
  • Increase physical activity, maintain a healthy weight, stop smoking, reduce alcohol consumption.
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16
Q

What age groups should be assessed for osteoporosis?

A
  • All women over 65, all men over 75, and anyone over 50 with risk factors or previous fractures.
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17
Q

What is the role of a DEXA scan in osteoporosis diagnosis?

A
  • DEXA scans measure bone mineral density and provide the T-score for diagnosis.
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18
Q

What is chondrocalcinosis?

A
  • Calcification in cartilage, often seen on X-ray in conditions like Pseudogout, but not specifically in osteoporosis.
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19
Q

Why are falls a major concern in the elderly?

A
  • Increased risk of fractures, hospitalisation, loss of independence, and mortality.
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20
Q

What are the common causes of falls in the elderly?

A
  • Poor balance, muscle weakness, cognitive impairment, medications, environmental hazards, and vision problems.
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21
Q

Which 5 types of medications Should you check for when doing a falls assessment.

A
  • Sedatives
  • antihypertensives
  • antidepressants
  • antipsychotics
  • opioids
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22
Q

What intrinsic factors contribute to falls?

A
  • Age-related muscle loss, cognitive decline, sensory deficits, and chronic conditions (e.g., Parkinson’s, stroke).
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23
Q

What extrinsic factors contribute to falls?

A
  • Slippery floors, poor lighting, loose rugs, clutter, and improper footwear.
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24
Q

How does vision impairment contribute to falls?

A
  • Reduced depth perception, poor contrast sensitivity, and slower adaptation to light changes.
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25
Q

How does postural hypotension contribute to falls?

A
  • A sudden drop in blood pressure on standing can cause dizziness and fainting.
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26
Q

What is the Timed Up and Go (TUG) test?

A
  • A quick test to assess mobility and fall risk by timing a patient walking a short distance.
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27
Q

What role does muscle weakness play in falls?

A
  • Weak lower limb muscles lead to poor balance and instability.
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28
Q

Which chronic conditions increase fall risk?

A
  • Parkinson’s, stroke, arthritis, diabetes (neuropathy), and dementia.
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29
Q

How can home modifications reduce falls?

A
  • Installing grab bars, improving lighting, removing trip hazards, and using non-slip mats.
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30
Q

What footwear is best to prevent falls?

A
  • Well-fitted, supportive shoes with non-slip soles.
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31
Q

What role does vitamin D play in fall prevention?

A
  • Helps improve muscle strength and bone health, reducing fall-related fractures.
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32
Q

Why is polypharmacy a risk for falls?

A
  • Increases the likelihood of drug interactions, dizziness, and sedation.
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33
Q

How can exercise help prevent falls?

A
  • Strengthens muscles, improves balance, and enhances coordination.
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34
Q

What balance exercises are recommended for fall prevention?

A
  • Tai Chi, gait training, and strength exercises (e.g., leg raises, sit-to-stand exercises).
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35
Q

How can caregivers assist in fall prevention?

A
  • Supervision, mobility aids, medication review, and encouraging physical activity.
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36
Q

What is a multifactorial falls risk assessment?

A
  • A comprehensive evaluation of medical, environmental, and functional risks for falls.
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37
Q

When should an elderly person be referred for a falls assessment?

A
  • If they have recurrent falls, difficulty walking, or risk factors such as dizziness or visual impairment.
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38
Q

What are key interventions to reduce fall-related injuries?

A
  • Hip protectors, walking aids, home modifications, medication review, and strength training.
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39
Q

What is the acronym used as a framework for a falls Hx?

A

DAME (Drugs, Ageing related, Medical causes, Environmental)

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40
Q

Dizziness differentials?

A

Vertigo, presyncopal, unsteady, mixed, transient loss of conscioussness

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41
Q

Common precipitating events to acute confusion?

A

Infection
Metabolic - hypercalcaemia, Hypo/hypergylcaemia, dehydration
Change of environment
Pain
Withdrawal
Constipation
Significant medical event

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42
Q

First line sedative for acute confusion?

A

Haloperidol 0.5mg

-care if they have parkinsons as can make symptoms worse

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43
Q

Definition of postural hypotension?

A

change in >20 mmHg on standing

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44
Q
A
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45
Q

What is the typical onset of delirium?

A
  • Acute, sudden onset (hours to days)
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46
Q

What is the typical onset of dementia?

A
  • Gradual onset over months to years
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47
Q

What is the typical onset of depression?

A
  • Gradual onset over weeks to months
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48
Q

What is the course of delirium?

A
  • Fluctuating course (waxing and waning) - Often reversible with treatment
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49
Q

What is the course of dementia?

A
  • Slowly progressive - Irreversible
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50
Q

What is the course of depression?

A
  • Variable, often episodic - Periods of normal cognition between episodes
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51
Q

How is attention affected in delirium?

A
  • Severely impaired - Difficulty focusing and maintaining attention
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52
Q

How is attention affected in dementia?

A
  • Generally preserved in early stages - Can decline in later stages
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53
Q

How is attention affected in depression?

A
  • Generally preserved - May appear distracted due to low mood
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54
Q

How is consciousness affected in delirium?

A
  • Altered level of consciousness - Can fluctuate between drowsiness and hyperalertness
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55
Q

How is consciousness affected in dementia?

A
  • Usually clear until late stages
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56
Q

How is consciousness affected in depression?

A
  • Clear consciousness
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57
Q

How does delirium affect cognition?

A
  • Global cognitive impairment - Acute changes in memory, orientation, and language
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58
Q

How does dementia affect cognition?

A
  • Memory impairment, especially recent memory - Progressive decline in executive function
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59
Q

How does depression affect cognition?

A
  • Difficulty with concentration - Slower processing - Memory intact on deeper questioning
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60
Q

What are common causes of delirium?

A
  • Infection - Medication changes - Metabolic disturbances - Dehydration - Hypoxia - Postoperative states
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61
Q

What are common causes/types of dementia?

A
  • Alzheimer’s disease - Vascular dementia - Lewy body dementia - Frontotemporal dementia
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62
Q

What are common causes of depression in the elderly?

A
  • Social isolation - Chronic illness - Loss of independence - Bereavement - Medication side effects
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63
Q

Is delirium reversible?

A
  • Yes, if the underlying cause is treated
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64
Q

Is dementia reversible?

A
  • No, but progression may be slowed with treatment
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65
Q

Is depression reversible?

A
  • Yes, with appropriate treatment (e.g., therapy, medication, lifestyle changes)
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66
Q

How is delirium managed?

A
  • Treat the underlying cause (e.g., infection, dehydration) - Optimise environment (e.g., lighting, reducing noise) - Avoid sedating medications unless necessary
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67
Q

How is dementia managed?

A
  • Cognitive enhancers (e.g., donepezil for Alzheimer’s) - Supportive care - Address behavioural symptoms - Caregiver support
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68
Q

How is depression managed?

A
  • Antidepressants (e.g., SSRIs) - Cognitive behavioural therapy (CBT) - Social support and lifestyle changes
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69
Q

New acue confusion Hx questions?

A

Danger to themselves, falls, NEWS, pain, BM, Drugs, Eating and drinking, Weeing and pooing, Hearing aids, Infection, alcohol

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70
Q

What can you ask NOK to fill out to help with delerium?

A

Hospital passport

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71
Q

Which cognitive tests can be used to asses delirium?

A

4AT, Confusion Assessment method (CAM), AMT

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72
Q

Described 4AT test?

A
  1. Alertness (0 or 4)
  2. AMT (Age, DOB, Place & Year)
  3. Attention (Months backwards)
  4. Acute and fluctuating course.

4 or above = possible delirium.

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73
Q

Describe CAM?

A

Derlirium is likely if: presence of acute confuison with fluctuation, inattention and either disorganised thinking or altered level of consiousness.

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74
Q

Pharmacological management of delirium? (Use only if needed)

A

Haloperidol, Risperidone, Lorazepam.

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75
Q

Contraindications to haloperidol?

A

Cardiac issues esp Long QT, Parkinsons, Lewy body

76
Q

Types of delirium?

A

Hypoactive, hyperactive and mixed

77
Q

Steps if ?UTI in elderly?

A
  1. Do not perform dipstick
  2. SEPSIS,
  3. NEWS,
  4. Catheter? Check
  5. Check other causes of delirium
78
Q

What score should be considered in a confused elderly patient?

A

Their anticholinergic burden

79
Q

Examples of highly anticholinergic medicines (ACB = 3)

A

-Tricyclics
-Chlorphenamine (piriton) and Diphenhydramine (Nytol)
-Antimuscarinic (oxybutynin)

80
Q

What is delirium?

A
  • Acute confusional state.
  • Acute and fluctuating course of inattention
  • Includes disorganised thinking or altered consciousness.
81
Q

How does delirium differ from dementia?

A
  • Delirium: Acute onset, fluctuating course, impairment of consciousness, worse at night, agitation, abnormal perception.
  • Dementia: Progressive, gradual onset, stable consciousness, persistent cognitive decline.
82
Q

What tool is used to assess delirium?

A
  • 4AT (Alertness, AMT4, Attention, Acute & fluctuating course).
83
Q

What are the 4AT assessment components?

A
  • Alertness: Normal = 0, Abnormal = 4.
  • AMT4 (Age, DOB, Birthplace, Year): No mistakes = 0, 1 mistake = 1, 2+ mistakes = 2.
  • Attention (months backwards): >7 correct = 0, <7 correct = 1, untestable = 2.
  • Acute & fluctuating course: No = 0, Yes = 4.
84
Q

How is 4AT scored?

A
  • 1-3: Cognitive impairment
  • 4+: Probable delirium.
85
Q

What is the mnemonic for causes of delirium?

A

PINCH ME (Pain, Infection, Constipation/urinary retention, Hydration/metabolic, Medications, Environment).

86
Q

How can infection cause delirium?

A
  • Systemic infections (UTI, pneumonia, sepsis) can trigger acute confusion.
87
Q

What metabolic disturbances can contribute to delirium?

A
  • Hypoglycaemia, hypercalcaemia, dehydration, renal/liver dysfunction.
88
Q

What medications can cause delirium?

A
  • Benzodiazepines, opioids, anticholinergics, alcohol withdrawal.
89
Q

How does the clinical presentation of delirium fluctuate?

A
  • Worse at night.
90
Q
A
  • Periods of lucidity followed by confusion.
91
Q

What are common perceptual disturbances in delirium?

A
  • Illusions and hallucinations.
92
Q

What is a key attention deficit in delirium?

A
  • Poor attention and distractibility.
93
Q

What bedside tests are useful in delirium?

A
  • U&E, FBC, LFTs (dehydration, liver/renal function, infection).
94
Q

What imaging may be required in delirium?

A
  • CT head (to rule out brain pathology).
95
Q

What is the first-line management of delirium?

A
  • Treat the underlying cause.
96
Q

When should sedatives be used in delirium?

A
  • If patient remains severely agitated or distressed despite treatment.
97
Q

What is the first-line sedative for delirium?

A
  • Haloperidol 0.5mg (except in Parkinson’s).
98
Q

What sedative is used in Parkinson’s disease?

A
  • Lorazepam (avoid haloperidol).
99
Q

What is the first-line treatment for constipation in delirium?

A
  • Lifestyle changes (fluids, fibre).
100
Q

What is the first-line laxative for constipation?

A
  • Bulk-forming laxatives (ispaghula husk).
101
Q

What is the second-line laxative for constipation?

A
  • Osmotic laxatives (macrogol).
102
Q

What laxative is preferred for opioid-induced constipation?

A
  • Macrogol
  • Senna
103
Q

What red flag symptoms should be considered in constipation?

A
  • Blood in stool, weight loss, persistent symptoms.
104
Q

What are pressure ulcers?

A
  • Ulcers that develop in patients who are unable to move certain body parts due to illness, paralysis, or old age.
  • Often occur over bony prominences (sacrum/heel).
105
Q

What are the risk factors for pressure ulcers?

A
  • Malnourishment
  • Incontinence
  • Lack of mobility
  • Pain
  • Diabetes
  • Thin skin
106
Q

How are high-risk patients for pressure ulcers identified?

A
  • Screened using the WATERLOW score.
107
Q

How are pressure ulcers managed?

A
  • Avoid soap.
  • Use moist wound dressings with hydrogels.
  • Only use antibiotics if there are surrounding signs of cellulitis.
108
Q

What is urinary incontinence?

A
  • Loss of bladder control leading to involuntary leakage of urine.
  • Common in elderly females.
109
Q

What are the main types of urinary incontinence?

A
  • Overactive Bladder/Urge Incontinence – Sudden urge to urinate followed by leakage. - Stress Incontinence
    – Leaking small amounts when stressed (e.g., coughing, sneezing).
  • Overflow Incontinence
    – Due to bladder obstruction (e.g., adhesions, BPH, cancer).
  • Functional Incontinence
    – Unable to reach the bathroom due to conditions like dementia, frailty, or sedatives.
110
Q

What are the initial investigations for urinary incontinence?

A
  • Urine dipstick to rule out infection.
  • Bladder diaries to track voiding patterns. - Rule out diabetes/infection.
111
Q

How is urge incontinence managed?

A
  • Bladder retraining.
  • Antimuscarinics (e.g., oxybutynin).
  • If confusion risk present → beta-3 agonist (mirabegron) preferred.
112
Q

How is stress incontinence managed?

A
  • Pelvic floor training.
  • If ineffective, consider surgical intervention.
  • If surgery unsuitable → duloxetine.
113
Q

What is Parkinson’s disease?

A

A progressive neurodegenerative condition characterized by asymmetrical tremor, rigidity, and bradykinesia. Average onset is 65 years.

114
Q

What is the pathophysiology of Parkinson’s disease?

A

Degeneration of dopaminergic neurons in the substantia nigra and basal ganglia.

115
Q

What are the risk factors for Parkinson’s disease?

A

Family history, male sex.

116
Q

How does Parkinson’s disease typically present?

A

Unilateral symptoms:
-Fine resting tremor (improves with voluntary movement) -Bradykinesia (slow movements, difficulty initiating)
-Rigidity (cogwheel)
- Psychiatric symptoms (depression, psychosis, dementia),
-shuffling gait with reduced arm movement, hypophonia, hypomimia, micrographia, REM sleep disorder, impaired olfaction.

117
Q

What postural finding is seen in Parkinson’s disease?

A

Postural hypotension (>20 mmHg fall in BP on standing). Managed with fludrocortisone.

118
Q

What are some important differential diagnoses for Parkinson’s disease? aka parkinsons plus conditions

A
  • Progressive Supranuclear Palsy (Parkinsonism + postural instability)
  • Drug-induced Parkinsonism → Caused by antipsychotics,
  • Multi-System Atrophy → Parkinsonism + autonomic dysfunction
  • Lewy Body Dementia → Triad of visual hallucinations, fluctuating cognition, parkinsonism
119
Q

How is Parkinson’s disease diagnosed?

A

Clinical diagnosis. If unclear, SPECT scan can be used.

120
Q

What is the first-line treatment for Parkinson’s disease?

A

Levodopa (taken with a decarboxylase inhibitor e.g., carbidopa or benserazide). Example: Co-beneldopa = levodopa + benserazide.

121
Q

When might dopamine agonists or MAO-B inhibitors be used first-line instead?

A

If motor symptoms are not the main problem.

122
Q

What are the side effects of levodopa?

A
  • Time-sensitive dosing
  • Common: Dry mouth, weight loss, palpitations, psychosis. BP hypotension.
  • Less common: Dyskinesia (involuntary movements), end-of-dose wearing off, on-off phenomenon (fluctuations in motor response).
123
Q

What are second-line treatment options if symptoms persist or dyskinesia develops?

A
  • Dopamine Agonists (e.g., bromocriptine, ropinirole) → Can cause excessive sleepiness, hallucinations, impulse control disorder.
  • MAO-B Inhibitors (e.g., selegiline) → Inhibits dopamine breakdown.
  • COMT Inhibitors (e.g., entacapone) → Inhibits dopamine breakdown enzyme.
124
Q

How are other Parkinson’s symptoms managed?

A
  • Excessive daytime sleepiness → Adjust medication +/- modafinil.
  • Orthostatic hypotension → Midodrine or fludrocortisone.
  • Drooling → Glycopyrronium.
  • Acute dystonia + stiffness → Dopamine agonist patch.
125
Q

What is a cerebrovascular accident (CVA)?

A

A CVA is a sudden interruption of blood supply to brain tissue, leading to motor weakness, sensory deficit, dysphasia, dysphagia, and ataxia.

126
Q

What are the two main types of CVA?

A
  1. Ischaemic (85%): Thrombotic (from carotid) or Embolic (due to AF).
  2. Haemorrhagic (15%): Includes ICH or SAH, more likely to present with LOC, headache, nausea, and vomiting.
127
Q

What are the specific risk factors for ischaemic CVA?

A

Atrial Fibrillation (AF)

128
Q

What are the specific risk factors for haemorrhagic CVA?

A

AVM, Aneurysm, and Anticoagulation

129
Q

What are the three criteria in the Oxford Stroke Classification?

A

Criteria:

  1. Unilateral hemiparesis and/or hemisensory loss of face, arm & leg
  2. homonymous hemianopia
  3. higher cognitive dysfunction (i.e dysphasia, neglect)
130
Q

Which arteries are involved in a TACI (Total Anterior Circulation Infarct) and which of the three oxford criteria are present ?

A

middle and anterior cerebral arteries.

all 3

  1. Unilateral hemiparesis and/or hemisensory loss of face, arm & leg
  2. homonymous hemianopia
  3. higher cognitive dysfunction (i.e dysphasia, neglect)
131
Q

What is the definition of LACI (Lacunar Infarct)?

A

LACI involves perforating arteries supplying structures like the internal capsule, thalamus, and basal ganglia.
It is associated with hypertension

It presents with 1 of the following:
unilateral weakness
sensory deficit
ataxic hemiparesis.

132
Q

What are common clinical features of a stroke in the ACA (Anterior Cerebral Artery) territory?

A

Contralateral hemiparesis and sensory loss, with lower extremity > upper extremity involvement.

133
Q

What are common clinical features of a stroke in the MCA (Middle Cerebral Artery) territory?

A

Contralateral hemiparesis and sensory loss, with upper extremity > lower extremity involvement, aphasia, and contralateral homonymous hemianopia.

134
Q

What are common clinical features of a stroke in the PCA (Posterior Cerebral Artery) territory?

A

Contralateral homonymous hemianopia with macular sparing and visual agnosia.

135
Q

What are the clinical features of Weber’s syndrome? (midbrain supplying branches (paramedian) of PCA)

A
  • Ipsilateral
  • CN III palsy (ptosis, dilated/mydriasis, fixed pupil, down gaze)
  • Contralateral
  • face/limb weakness.
136
Q

What is Wallenberg syndrome (lateral medullary syndrome)?

A

It is caused by a stroke in the Posterior Inferior Cerebellar Artery (PICA)

Ipsilateral
* nystagmus
* ataxia
* facial pain
* temperature loss
* Horner’s syndrome

Contralateral
* limb pain
* temp loss

Dysphagia

137
Q

What is the most common initial imaging for a suspected stroke?

A

CT head non-contrast to rule out haemorrhage.

138
Q

How does an ischaemic stroke appear on a CT scan?

A

Hypodense areas (dark) and hyperdense artery.

139
Q

What is the first-line management for ischaemic stroke within 4.5 hours?

A

Aspirin 300mg for 2 weeks

Thrombectomy and thrombolysis (IV alteplase) within 4.5 hours

<6 hours thrombectomy

140
Q

What are some contraindications for thrombolysis in ischaemic stroke?

A

Contraindications include:

INR > 1.7
uncontrolled hypertension
intracranial neoplasm
previous intracranial bleed
surgery within 2 weeks
pregnancy
active bleeding
GI hemorrhage within the last 3 weeks.

141
Q

What secondary prevention strategies are used for stroke?

A
  • Clopidogrel 75mg or aspirin + MR dipyridamole
  • Statins if cholesterol > 3.5
  • Anticoagulation for AF after 2 weeks with warfarin, dabigatran, or apixaban
  • Carotid endarterectomy for stenosis > 70%.
142
Q

What is the Barthel Index used for in stroke management?

A

The Barthel Index is used to assess disability and functional independence after a stroke.

143
Q

What is the role of SALT assessment after a stroke?

A

The SALT assessment is used to evaluate swallowing and speech functions after a stroke.

144
Q

Symtoms that make haemorrhagic stroke more likely to present ?

A

LOC, headache, N+V

145
Q

Partial anterior circulation infarct (PACI) involves which arteries and how many oxford criteria present?

A

smaller anterior circulation arteries

2 criteria present

146
Q

Posterior circulation infarct (POCI) involves which arteries and how many oxford criteria present?

A

PCA, Pontine arteries, Cerebellar arteries, Vertebrobasilar

1 + of following syndromes
-cerebellar
-brainstem
-homonymos hemianopia
-loc

147
Q

anterior inferior cerebellar artery stroke
called pontine syndrome

A

ipsilateral
* CNVII (facial weakness)
* CNVIII (hearing loss, nystagmus)
* facial sensory loss

Contralateral
* limb and temp loss
* vertigo

148
Q

basilar stroke symptoms?

A

locked in syndrome
quadriplegia with consiousness and eye movment

149
Q

cerebellar stroke symptoms?

A
  • if in vermis → little/no limb involvement
  • if in hemisphere → limb involvement
    Dysdiadokinesia
    Ataxia
    Nystagmus
    Intention Tremor
    Slurred Speech
    Hypotonia
  • Lacunar → either:
    • isolated hemiparesis
    • hemisensory loss
    • hemiparesis with ataxia
150
Q

what do you need to rule out if ?stroke

A

hypoglycaemia

151
Q

which scores used to determine likelihood of stroke?

152
Q

secondary prevention of stroke if AF present?

A

anticoag after 2 weeks with
-warfarin
-dabigatran
-DOAC

153
Q

mx of haemorrhagic stroke?

A

neurosurgical consult
bp control

154
Q

haemorragic stroke
pt on warfarin
what do u give?

A

Phytomenadione (vitamin K)

155
Q

identifying features of parkinsons plus conditons?

A

Multiple system atrophy
Early autonomic dysfunction –> postural hypotension, urinary incontience

Progressive supra nuclear palsy –> vertical gaze palsy, poor response to L dopa

Corticobasal degeneration –> rigidity with apraxia (unable to perform tasks when asked).

Dementia with Lew Body –> early cognitive impairment with prominent hallucinations and REM sleep disorder.

156
Q

Score used to asses frailty?

157
Q

Parkinsons vs LBD - how to distinguish in a Q?

A

How long have symptoms been going on for - if a long time then hallucinating likely PDD

if all happened recently - LBD
If psych happened before movement - LBD

158
Q

Which drugs do we not give pts with dementia?

A

antipsychotics

159
Q

What sort of drug is haliperidol?

A

antipsychotic

160
Q

If an elderly person is hallucinating in the question - awnser is likely

A

Lewy body

(unless this comes AFTER PDD symptoms)

161
Q

Breakthrough (PRN) doses are usually what fraction of the 24 hour dose?

A

1/6-1/10 of the 24

162
Q

If you need to reverse warfarin ASAP - what do you give?

A

Vit K and 4-factor prothrombin

163
Q

What is a subdural haematoma?

A

A subdural haematoma is characterised by the accumulation of venous blood in the potential space between the dura mater and arachnoid mater of the brain.

164
Q

Which anti-emetic do you give pts with Parkinsons?

A

Domperidone

they deserve champgne

165
Q

What ant-emetic makes Parkinson’s symptoms worse?

A

Metoclopramide

Metoclopramide Makes Parkinson’s Move Poorly
(its a dopamine antagonist)

166
Q

What changes to vision occur with temporal vs parietal lobe strokes?

A

Temporal - superior homonymous hemianopia

Parietal - inferior homonymous quadrantanopia

167
Q

What is Broca’s dysarthria?

A

Broca’s dysphasia is also known as expressive dysphagia and is characterised by difficulties in expressing and producing language.

Usually patients will exhibit making great effort when speaking

Broca broken speech

168
Q

What does Charles Bonnet syndrome presents with?

A

vivid visual hallucinations

169
Q

Expressive aphasia is characterised by?
It isis strongly associated with damage to where??

A

difficulty producing meaningful speech

dominant left frontal lobe.

170
Q

Clumsy hand syndrome is due to a lesion where?

A

internal capsule

171
Q

Meds we give to treat postural hypotension?

A

Fludrocortisone

a corticosteroid used to treat PH and addisons
Helps retain sodium

172
Q

Which laxative do you give for opiod induced constipation?

A

docusate

senna

movicol

173
Q

Broca’s area, responsible for fluent speech production, is located where?

A

the inferior frontal gyrus

174
Q

RF for haemorrhagic stroke?

A

haemorrhagic stroke include hypertension, anticoagulation, and sympathomimetic

175
Q

CT scan findings haemorrhagic vs ischaemic stroke?

A

haemorrhagic - hyperdense

ischaemic - hypodense

176
Q

Patient is having a haemorrhagic stroke - which medication do you check if they are on?

A

Warfarin

consider Vit K

177
Q

which cranial nerve is not contralateral?

178
Q

What is DOLS?

A

A means to protect the rights of patients who lack capacity who are detained in a hospital or care home

–> For patients lacking capacity in a hospital or care home who wish to leave but present a risk to themselves or others

179
Q

hallucinations but pt knows they are not real?

A

charles-bonnet syndrome

180
Q

drugs that reduce seizure threshold?

A
  • antipsychotics (haloperidol)
  • abx (penicillin, cephalosporins, isoniazid, metronidazole)
  • antidepressants - tricyclics, venlafaxine, bupropion
  • tramadol
  • fentanyl
  • ketamine
  • lidocaine
  • lithium
  • antihistamines
181
Q

commmon drugs causes of delerium?

A

benzo
opiates
antiparkinsonian
TCA
digoxin
BB
steroids
antihistamines - chlorphenamine

182
Q

confusion screen

A

MSU
FBC, ESR, CRP (anaemia)
TFT
Calcium
Renal function (AKI)
B12 and folate
LFT

then more specialist
CT/MRI
LP
EEG

183
Q

if you see pancytopaenia in elderly pt, consider?

A

myelofibrosis

you can get hepatosplenomegaly

poikilocytes (tear shaped rbc) on blood film

dry tap on bone marrow aspirate (dry due to fibrosis)

184
Q

AKA in pt just taken trimethoprim?

A

can cause a pseudo AKI - dont panic

185
Q

which abx for aspiration pneumonia?

A

IV beta lactam (co amox) + IV metrondiazole

186
Q

pt is restless and has a suprapubic mass - what are you thinking?

A

urinary retention

maybe amityptilline
oxybutynin

187
Q

ECG for hypOthermia?

Year 4 (9 decks)

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