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OSCE > Ageing > Flashcards

Ageing Flashcards

1
Q

What questions should you ask when assessing a patient’s orientation to time/person/place during a 4AT assessment?

A

Their name and DOB, where they are, what year is it

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2
Q

How is Wernicke’s encephalopathy treated?

A

IV/IM thiamine for 2-7 days followed by oral thiamine indefinitely

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3
Q

What MMSE score is suggestive of mild cognitive impairment?

A

18-23

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4
Q

How is the orientation to time/person/place section of the 4AT scored?

A

No mistakes scores 0 points, one mistake scores 1 point, two or more mistakes score 2 points

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5
Q

What is the triad of Korsakoff’s syndrome?

A

Anterograde and retrograde amnesia, confabulation

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6
Q

What effect do drugs have for Alzheimer’s disease?

A

They can improve cognition for a few months-years

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7
Q

If all interventions for delirium fail, what medication can you prescribe?

A

0.5mg haloperidol orally

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8
Q

What are some medications that may be responsible for postural hypotension?

A

Diuretics, antihypertensives, antidepressants, sedatives, Levodopa

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9
Q

What questions should you ask in the ‘during’ section of a falls history?

A

Did they lose consciousness? Was there any tongue biting/incontinence? Did they injure themselves?

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10
Q

How is alertness ranked in the 4AT?

A

Normal or mild sleepiness for < 10 seconds after wakening scores 0 points, clearly abnormal scores 2 points

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11
Q

What are the second line drugs to be used for Alzheimer’s disease? Give an example.

A

NMDA receptor antagonist e.g. memantine

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12
Q

What are some examinations/interventions to consider after a falls history?

A

Cardio/MSK/neuro exam, blood pressure, medication review, ? visual acuity

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13
Q

What is the triad of Wernicke’s encephalopathy?

A

Ataxia, nystagmus/ophthalmoplegia, cognitive dysfunction

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14
Q

How is the attention section of the 4AT scored?

A

7 months or more correctly scores 0 points, starts but states < 7 months or refuses to start scores 1 point, not starting because they are unable to scores 2 points

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15
Q

When taking a falls history, what are some good things to clarify before moving onto the before/during/after of the fall?

A

When did it happen? Do they have any idea why it happened? Where were they when it happened? Who was there when it happened?

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16
Q

What is an important safety question to ask in a history of memory loss?

A

Have they ever put themselves at harm e.g. going out and getting lost or leaving the cooker on?

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17
Q

What drugs should you check for and stop in a patient with delirium?

A

Any neurotoxic drugs

18
Q

A 4AT score of what suggests that delirium or severe cognitive impairment is unlikely?

A

0

19
Q

What MMSE score is suggestive of no cognitive impairment?

A

24-30

20
Q

A 4AT score of what is suggestive of possible cognitive impairment?

A

1-3

21
Q

What is the management of vascular dementia?

A

Prevention of further episodes with antiplatelets, antihypertensives and lipid lowering drugs

22
Q

What are the four sections of the 4AT for diagnosing delirium?

A
  1. Alertness, 2. Orientation to time/person/place, 3. Attention, 4. Acute change/fluctuating course
23
Q

What questions should you ask in the ‘after’ section of a falls history?

A

What happened afterwards? How long did it take for them to come around? Did they get themselves up or did they need help? How did they feel afterwards?

24
Q

What are some medical things you can do to make a patient with delirium more comfortable?

A

Ensure good hydration, treat any pain/constipation

25
Q

How is the acute change/fluctuating course section of the 4AT scored?

A

If there has been an acute change or fluctuation in cognition in the last 2 weeks which is still evident in the last 24 hours, this scores 4 points. (If there is no evidence of acute change/fluctuating course, this scores 0 points)

26
Q

How is a patient’s attention tested during the 4AT assessment?

A

Ask them to state the months of the year backwards

27
Q

What is a really important thing to consider in the medication history of someone presenting with falls?

A

Has there been any changes to their medications recently?

28
Q

What are some good things to do for all patients who present with falls?

A

Medication review, ensure vision is optimised, make any necessary footwear/environmental changes, consider strength and balance training

29
Q

What are the first line drugs to be used for Alzheimer’s disease? Give examples.

A

Acetylcholinesterase inhibitors e.g. donepezil, rivastigmine, galantamine

30
Q

What MMSE score is suggestive of severe cognitive impairment?

A

0-17

31
Q

What are some investigations you should do for a patient with delirium?

A

Bloods (esp electrolytes and glucose), ECG, CXR, urine microscopy, culture and sensitivity

32
Q

Describe the confusion assessment method (CAM) for diagnosing delirium?

A

Acute change/fluctuating course of mental status + inattention + one of disorganised thinking or altered level of consciousness

33
Q

What is the definition of postural hypotension?

A

A fall in systolic BP of 20mmHg or more and/or diastolic BP of 10mmHg or more within 3 minutes of standing

34
Q

What investigations would you want to do in someone presenting with memory loss?

A

Memory testing (MMSE, MOCA, Addenbrooke’s) and imaging (CT/MRI)

35
Q

What questions should you ask in the ‘before’ section of a falls history?

A

What happened before the fall? Did they have any symptoms e.g. palpitations, dizziness, chest pain?

36
Q

What are some specific examples you should ask about in somebody presenting with memory loss?

A

Forgetting names/dates/appointments, forgetting words, activities of daily living, disorientation to time/place

37
Q

Other than medications, what are some potential causes of postural hypotension?

A

Diabetes, Parkinson’s, alcohol

38
Q

A 4AT score of what is suggestive of possible delirium +/- cognitive impairment?

A

4 or more

39
Q

What additional question should you always cover in a systemic enquiry of someone presenting with memory problems?

A

What is their mood like?

40
Q

What are the two main reasons for not giving haloperidol to a patient with delirium?

A

If the delirium is related to alcohol withdrawal or if they have Parkinsonian symptoms

OSCE (14 decks)

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