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Ageing and Complex Health > ACH Flashcards > Flashcards

ACH Flashcards

1
Q

What does NIHSS stand for?

A

National Institute of Health Stroke Scale

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2
Q

What is the NIHSS used for?

A

It is used to help a doctor determine the extent of neurological deficit in a patient with a suspected stroke.

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3
Q

How much do you have to score on the NIHSS to be susected of a very severe stroke?

A

> 25

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4
Q

How much do you have to score on the NIHSS to be suspected of a severe stroke?

A

15 - 24

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5
Q

How much do you have to score on the NIHSS to be considered to have a moderate stroke?

A

5 - 14

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6
Q

How much do you have to score on the NIHSS to be considered to have a mild stroke?

A

1 - 5

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7
Q

How many sections are there in the NIHSS?

A

11 (but some sections have subsections)

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8
Q

What does Dysarthria mean?

A

Slurred speech or difficult speaking (because of the muscles)

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9
Q

What percentage of strokes are made by an ischaemic stroke?

A

85%

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10
Q

What percentage of strokes are made by a haemorrhagic stroke?

A

10-15%

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11
Q

How many segments is the Middle Cerebral Artery split into?

A

4 segments (M1 - M4)

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12
Q

What is included in the Inclusion Checklist for Thrombolysis Treatment?

A

Symptoms of scute stroke

Onset within 4.5 hours

Measurable deficit on NIHSS

Absence of Haemorrhage on CT scan

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13
Q

What does tPA stand for ad what does it do?

A

Tissue Plasminogen Activator - this activates tissue plasminogen which converts it to plasmin. Plasmin goes on to break down Fibrin clots.

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14
Q

What is the only licensed synthetic tPA for Ischaemic stroke?

A

Alteplase

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15
Q

What is the risk associated with using Alteplase for thrombolytic treatment of ischaemic stroke?

A

6% risk of haemorrhage (2-3% of which are considered major/life-threatening)

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16
Q

What is the treatment for someone presenting with an ischaemic stroke, more than 4.5 hours after symptom onset?

A

Aspirin 300 mg stat dose.

Then Aspirin 300mg OD for 2 weeks, followed by clopidogrel 75mg OD life long

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17
Q

If Clopidogrel is contraindicated in stroke prophylaxis, which drug should be used instead?

A

Dipyridamole - this is a phosphodiesterase inhibitor

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18
Q

What does TACS stand for in stroke?

A

Total Anterior Circulation Stroke

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19
Q

What is the criteria for a TACS?

A

All (3) of the following symptoms:

  • unilateral hemiparesis
  • homonymous hemianopia/quadrananopia
  • higher cortical dysfunction (dysphasia, visuospatial disorder)
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20
Q

What does PACS stand for?

A

Partial Anterior Circulation Stroke

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21
Q

What is the criteria for a PACS?

A

Two of the following symptoms:

  • unilateral hemiparesis
  • homonymous hemianopia/quadrananopia
  • higher cortical dysfunction (dysphasia, visuospatial disorder)
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22
Q

What does LACS stand for?

A

LACunar Stroke

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23
Q

What is the criteria for a LACS?

A

One of the following symptoms:

  • unilateral hemiparesis
  • homonymous hemianopia/quadrananopia
  • higher cortical dysfunction (dysphasia, visuospatial disorder)
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24
Q

What does POCS stand for?

A

Posterior Circulation Stroke

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25
Q

What is the criteria for a POCS?

A

One of the following:

  • Cerebellar or brainstem syndrome (DANISH)
  • Loss of consciousness
  • Isolated homonymous hemianopia
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26
Q

What does DANISH stand for and what is it?

A

It is a checklist of some of the symptoms that can be seen in cerebellar and brainstem syndrome.

D - Dysdiadochokinesia

A - Ataxia

N - Nystagmus

I - Intention tremor

S - Scanning Dysarthria

H - Heel-shin test positivity (lack of coordination)

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27
Q

Which artery supplies the largest part of the brain?

A

Middle Cerebral Artery

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28
Q

Which part of the body is more commonly affect in Arterior Cerebral Artery occlusion?

A

The legs (lower limbs)

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29
Q

What of the body is most commonly affected when there is an occlusion in the Middle Cerebral Artery?

A

The face

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30
Q

What are some differentials for a TIA?

A

Syncope

Atypical Seizures

Migraine

Temporal Arteritis

Hypoglycaemia

Labyrinthe disorders (sometime mistaken for POCS TIAs)

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31
Q

What 5 factors are included in Fried’s Phenotype of Frailty?

A

Grip Strength

Walking Speed

Fatigue

Weight loss

Activity levels

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32
Q

How many steps (Severities) are on the Clinical Frailty Scale?

A

9 steps, with 9 being terminally ill and 1 being fit and well.

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33
Q

What should be specifically considered in a falls history?

A

What happened before, during and after the fall?

What is the home environment like? (for rehab purposes and understanding their baseline usually)

PMH - parkinsons, dementia (declining cognition), osteoporosis or osteoarthritis

DH - loads

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34
Q

What is the Acronym for remembering majority of the falls in the elderly population?

A

DAME

D - Drugs

A - Ageing

M - Medical conditions

E - Environment

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35
Q

What should you think about in the Drugs section of DAME, for causes of falls?

A

Beta blockers

ACE inhibitors

Diuretics

Sedatives

Opioids

Psychotropics

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36
Q

What should you think about in the Ageing section of DAME, for causes of falls?

A

Presbyopia

Cognitive decline

Gait changes

Reduced postural sway

Slower reflexes (i.e. putting hands out in front of you when falling)

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37
Q

What should you think about in the Medical Conditions section of DAME, for causes of falls?

A

Parkinson’s Disease

Osteoporosis

Osteoarthritis

Strokes, Dementia and other neuro conditions

Hypotension, Arrythmias

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38
Q

What should you think about in the Environment section of DAME, for causes of falls?

A

Walking aids (zimmer frames, walking sticks etc)

Glasses (varifocals)

Home hazards - carpets, stools/ottomans etc

Footwear

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39
Q

What is the most important question to ask when a patiet says they feel dizzy?

A

“Can you tell me what you mean when you say dizzy?”

40
Q

What are some of the symptoms that can be seen when a patient says they feel “dizzy”?

A

Vertigo

Syncope (lightheadedness)

Unsteadiness

Psychogenic dizziness

41
Q

What are some causes of Vertigo?

A

Benign Paroxysmal Position Vertigo (BPPV)

Meniere’s Disease

Acoustic Neuroma

Migraine

Cerebellar Stroke

Multiple Sclerosis

42
Q

What is the diagnostic procedure for BPPV?

A

Dix-Hallpike Manoeuvre

turn head 45 degrees towards you (on either side), looking at the eyes for any nystagmus. Then drop the head to roughly 30 degrees of the end of couch (still looking for nystagmus).

Do the same on the other side.

Start on the unaffected side.

43
Q

What is the treatment for BPPV?

A

Epley Manoeuvre

44
Q

What is the commest cause for syncopal symptoms?

A

Postural hypotension

45
Q

How is postural hypotension investigated?

A

Using lying and standing blood pressure

Lying for 5 mins - measure bp

Standing - at 1 and 3 mins, measure bp

46
Q

What are some reasons for a patient to feel unsteady?

A

Parkinson’s Disease

Osteoporosis

Osteoarthritis

Reduced muscle mass

47
Q

What are the main investigations of a fall?

A

FBC

U&Es

TFTs

Folate/B12 - peripheral neuropathy

ECG

Bone profile

Vitamin D

Lying and Standing BP

48
Q

What is the Tinetti Score?

A

An assessment of a patients likelihood of falling.

The Tinetti Assessment Tool is a simple, easily administered test that measures a resident’s gait and balance. The test is scored on the resident’s ability to perform specific tasks.

The maximum score for the gait component is 12 points. The maximum score for the balance component is 16 points. The maximum total score is 28 points. The higher the score, the less likely a patient is to have a fall.

49
Q

Name some types of Gait

A

Hemiplegic

Ataxic

Parkinsonian

Antalgic

Choreiform

Diplegic

Neuropathic

50
Q

What tool is used to help determine a patients likelihood of having a fracture?

A

FRAX tool

51
Q

What is a DEXA scan?

A

Scan that is used to assess a patient Bone Mineral Density (BMD)

52
Q

How frequently are bisphosphonates taken as regular medication?

A

Weekly

53
Q

What is the first line Bisphosphonate?

A

Alendronic acid (Alendronate)

Oral, 70 mg, weekly

54
Q

If someone is in Vitamin D deficiency and found to have osteoporosis what is their management plan baseline?

A

Vitamin D supplements (high dose to get them back to normal, for 4 days)

Adcal3 - Vitamin D and Calium supplements as level maintenance

Bisphosphonates - alendronic acid

55
Q

What is a Colles Fracture?

A

Radial fracture causing displacement of the radius bone and obvious deformity.

56
Q

Where are venous ulcers usually located?

A

Medial ankle

57
Q

Where are arterial ulcers usually located?

A

Points of trauma or pressure

58
Q

What is an Aphthous ulcer?

A

They are small, shallow lesions that develop on the soft tissues in your mouth or at the base of your gums

59
Q

What is the 4AT test?

A

It is a test for delirium - it is the quickest method of assessment

60
Q

What are the 4 A’s in the 4AT test?

A

Alertness

AMT4

Attention

Acute course

61
Q

What does CAM stand for?

A

Confusion Assessment Method

62
Q

What is the criteria for the CAM assessment?

A

To be positive, patient must have features 1 & 2, plus either 3 or 4

The presence of acute confusion, with fluctuation

AND

Inattention (difficulty concentrating)

AND, EITHER

Disorganised thinking

OR

Altered level of consciousness (either heightened arousal/agitation or drowsy)

63
Q

What are the risk factors for Delirium?

(PINCH ME)

A

P - Pain

I - Infection

N - Nutrition

C - Constipation

H - Hydration

M - Medication

E - Environment

64
Q

What are some of the medications that can contribute to delirium?

A

Anticholinergics

Promethazine

Codeine

Amitryptilline

Diuretics

ACE Inhibitors

Beta Blockers

65
Q

How do you manage delirium?

A

Descalation Techniques:

Reassurance, Encourage mobility, Keep familar items around, Promote a normal sleep-wake cycle, Encourage oral intake and fluids

and Sedation if needed

66
Q

What are some types of laxatives?

A

Bulk-forming laxatives

Osmotic laxatives

Stimulant laxatives

Faecal softeners

67
Q

How do bulk forming laxatives work?

And what is one example?

A

Increases fluid retention within the stool, thus increasing the faecal mass.

ispaghula husk and methylcellulose

68
Q

How do osmotic laxatives work?

and what is one example?

A

Increases the amount of ffluid within the large bowel

Macrogols and Lactulose

69
Q

How do stimulant laxatives work?

and what is one example?

A

Stimulating peristalsis

Senna, bisacodyl and sodium picosulphate

70
Q

How do faecal softeners work?

And what is one example?

A

Increases fluid content of the stool which reduces surface tension (ad makes it easier to excrete)

Glycerol and sodium docusate

71
Q

What are the 5 pillars of the Mental Capacity Act?

A

Person must be assumed to have capacity

Use all practicable steps to help the person make the decision

Persons are allowed to make unwise decisions

Decisions must be made in the best interests of the person

Least restrictive option

72
Q

What is an Essential Tremor?

A

A tremor that is made worse by carrying out actions such as tryig to carry a cup or reaching for something

73
Q

What is the triad of symptoms for Parkinson’s?

A

Resting tremor

Bradykiesia

Rigidity

(postural instability is an additional factor)

74
Q

What type of gait would you see in Parkinson’s Disease?

A

Shuffling Gait

75
Q

What are some differentials of Parkinson’s Disease?

A

Lewy-body dementia

Drug-induced parkinsons

Vascular Parkinsonism

Multi-systems atrophy

76
Q

What is the main (principle) treatment of Idiopathic Parkinson’s Disease?

A

Levodopa or a dopamine agonist

77
Q

What are some clinical features of Parkinson’s Disease (other than the parkinson’s triad)?

A

Hypomimia

Hypotonia

Micrographia

Reduced rate of blinking

Reduced arm swing

78
Q

How is Parkinson’s Disease diagnosed?

A

By referral to a specialist neurologist - who will make the diagnosis based on knowledge, investigation and deduction.

79
Q

Which gender is more affected by Parkinson’s?

A

Men

80
Q

What are the approved (and researched) medications for Parkinson’s Disease?

A

Levodopa (synthetic dopamine, which is able to cross the blood-brain barrier)

Dopamine Agonist

Monoamine Oxidase B Inhibitors (MOBI)

81
Q

What are the main side effects of Levodopa, that make them more risky for treatment?

A

Increased risk of motor complications (fluctuations, dyskinesias, and dystonia)

82
Q

There are three types of therapists involved with Parkinson’s Management. Who are they are what is their role?

A

Physiotherapists

Gait management, rehabilitation of movement ability, helping to achieve functional independence, improving movement initiation

Occupational Therapists

Maintaining personal and work activites, maintaining patients ability to care for self, environmental education, cognitive assessment

Speech and Language Therapists (SALT)

Improving vocal loudness and pitch range

83
Q

What are some examples of Dopamine Agonists?

A

Pramipexole, ropinirole, rotigotine and apomorphine

Amantidine

84
Q

What are some examples of Monoamine Oxidase Inhibitors?

A

Selegiline and rasagiline

85
Q

Which part of the basal ganglia is affected in Parkinson’s Disease?

A

Substantia Nigra

86
Q

What are the 4 groups of risk factors for Elder Abuse?

A

Factors relating to the older person

Factors relating to the perpetrator

Relationship between perpetrator and abused

Environmental factors

87
Q

What factors relating to the abuse person can increase the risk of elder abuse?

A

Cognitive impairment

Shared living

Functional dependency

Low income

88
Q

What factors relating to the perpetrator can increase the risk of elder abuse?

A

Psychiatric illness (including dementia)

Drug and alcohol dependency

Caregiver burden and stress

89
Q

What relationship factors between the abused and the perpetrator can increase the risk of elder abuse?

A

Family disharmony

Conflicted relationships

90
Q

What environmental factors can increase the risk of elder abuse?

A

Low social support

Shared living

91
Q

What is a grade 1 pressure ulcer?

A

Non-blanchable erythema of intact skin. Discoloration, warmth, induration, or hardness of skin may also be used as indicators, particularly in people with darker skin

92
Q

What is a grade 2 pressure ulcer?

A

Partial-thickness skin loss, involving epidermis and/or dermis. The ulcer is superficial and presents clinically as an abrasion or blister

93
Q

What is a grade 3 pressure ulcer?

A

Full-thickness skin loss involving damage to or necrosis of subcutaneous tissue that may extend down to, but not through, underlying fascia

94
Q

What is a grade 4 pressure ulcer?

A

Extensive destruction, tissue necrosis or damage to muscle, bone, or supporting structures, with or without full-thickness skin loss

95
Q

What is the SSKIN mneumonic for preventing pressure ulcers?

A

Support surface

Skin inspection

Keep moving

Incontinence checks

Nutrition

Ageing and Complex Health (2 decks)

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