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1. 4th year > Ageing > Flashcards

Ageing Flashcards

1
Q

what is the criteria of the 4AT

A 
alertness
AMT4
- age, DOB, location, year
attention
acute change/fluctuating course
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2
Q

when is delirium typically worse

A

at night

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3
Q

what bloods are done in a confusion screen

A 
normal bloods - FBC, U+E, LFT
also 
- B12/folate
- TFT
- glucose
- Bone profile (calcium)
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4
Q

how could you modify the environment of someone with delirium

A

quiet side room
familiar staff
visible clocks and calendars

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5
Q

1st line treatment of acute confusional state

A

Haloperidol

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6
Q

2nd line treatment of acute confusional state

A

lorazepam

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7
Q

acute confusional state in patient with parkinsons

A

lorazepam

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8
Q

2nd line acute confusional state in patient with parkinsons

A

quetiapine or clozapine

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9
Q

some medications that cause postural hypotension

A 
Nitrates
Diuretics
Anticholinergic medications
Antidepressants
Beta-blockers
L-Dopa
ACEI
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10
Q

bedside tests for falls

A 
basic obs 
LSBP
ECG
turn 180 test
timed up and go test
visual fields
hearing test
look at shoes
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11
Q

criteria of orthostatic hypotension

A

fall of SBP > 20 or DBP > 10 after 3 mins of standing

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12
Q

what are blood pressures taken in a LSBP

A

1st BP lying for 5 minutes
2nd BP standing for 1 minute
3rd BP standing for 3 minutes

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13
Q

what should you record in a LSBP aswell as blood pressure

A

any symptoms of light headed, palpitations, weakness, vision changes, pallor etc

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14
Q

what are some drugs to consider stopping in elderly in peptic ulcer disease

A

NSAIDs,warfarin and aspirin

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15
Q

what drug should be given in long term steroid treatment

A

bisphosphonates

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16
Q

when should a pressure ulcer be swabbed

A

only if evidence of surrounding cellulitis

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17
Q

how long does dementia have to be going on for in order to diagnose

A

6 months

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18
Q

most common dementia

A

alzheimers

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19
Q

dementia with stepwise progression and CVS risk factors

A

vascular

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20
Q

do people with vascular dementia tend to lose insight?

A

no vascular dementia insight usually spared

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21
Q

what can be used to differentiate Alzheimers from vascular

A

hackinski score

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22
Q

dementia with fluctuating symptoms with lucid periods and recurrent visual hallucinations

A

lewy body

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23
Q

dementia associated with parkinsons

A

lewy body

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24
Q

how do parkinsons and lewy body differ

A

parkinsons - parkinson symptoms first, cognitive at least a year after
lewy body - cognitive symptoms first or at same time as parkinsonism

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25
Q

tx lewy body dementia

A

low dose levodopa

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26
Q

dementia with younger onset and personality changes and change in eating habits

A

frontotemporal

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27
Q

is insight spared in frontotemporal dementia

A

no tends to be lost early

28
Q

inheritance of huntingtons

A

autosomal dominant

29
Q

tx severe alzheimers

A

memantine

30
Q

tx mild - moderate alzheimers

A

Rivastigmine, Donepazil, Galantamine

31
Q

what kind of drugs are Rivastigmine, Donepazil, Galantamine

A

ACh esterase inhibitors

32
Q

what kind of drug is memantine

A

NMDA antagonist

33
Q

what is the triad of huntingtons

A

emotional, cognitive and motor disturbance

34
Q

what is the motor disturbance in huntingtons

A

choreiform movements

35
Q

potentially reversible cause of dementia with urinary incontinence, ataxia and cognitive impairment

A

normal pressure hydrocephalus

36
Q

tx of normal pressure hydrocephalus

A

VP shunt

37
Q

rapid onset of dementia in < 50s with ataxia, seizures, myoclonic jerks

A

mad cow disease

38
Q

cognitive assessment in dementia (3)

A

MMSE
MOCA
ACE III

39
Q

agitation and confusion treatment in terminal phase

A

midazolam

40
Q

hiccups treatment in terminal phase

A

chlorpromazine

41
Q

secretions treatment in terminal phase

A

hyoscine hydrobromide/butylbromide

42
Q

sore mouth treatment in terminal phase

A

benzydamine hydrochloride

43
Q

1st line nausea and vomiting treatment due to reduced gastric motility

A

metoclopramide - if not risk of SEs

domperidone

44
Q

nausea and vomiting that is chemically mediated e.g. post chemo

A

metoclopramide - if not at risk of SEs

ondansetron

45
Q

what GI situation should you avoid metoclopramide

A 
post-gastric surgery 
bowel obstruction (but helpful in paralytic ileus)
46
Q

what side effect of metoclopramide is particularly apparent in children and young people

A

EPSEs - oculogyric crisis

47
Q

Nausea and vomiting due to intracranial disease treatment

A

cyclizine

48
Q

headache/raised ICP from intracranial disease treatment

A

dexamethasone

49
Q

vestibular causes of nausea and vomiting treatment

A

cyclizine

50
Q

breakthrough dose of morphine calculation

A

1/6 daily dose

51
Q

oral codeine to oral morphine

A

/ 10

52
Q

oral morphine to SC morphine

A

/ 2

53
Q

oral morphine to SC diamorphine

A

/ 3

54
Q

how much should opiate be increased if increasing dose

A

by 30-50%

55
Q

opioid of choice in mild- moderate renal disease

A

oxycodone

56
Q

opioid of choice in severe renal disease

A

buprenorphine or fentanyl

57
Q

oral morphine to oral oxycodone

A

divide by 1.5 - 2

58
Q

oral oxycodone to SC diamorphine

A

divide by 1/5

59
Q

max number of medications in a syringe driver

A

3

60
Q

commonly used N+V drug in syringe driver

A

levomepromazine

61
Q

tx bowel colic in end of life care

A

hyoscine butylbromide

62
Q

4 main anticipatory drugs in end of life care

A

levomepromazine
hyoscine butylbromide
midazolam
diamorphine

63
Q

death verification - 6 steps

A
  • Check for spontaneous movement, including respiratory effect
  • Check for reaction to voice and pain – sternal rub or supraorbital nerve
  • Palpate at least 2 major pulses for one minute
  • Inspect the eyes looking for dryness, fixed dilated pupils, absence of corneal reflexes and clouding of the cornea
  • Auscultate the heart and lungs for one minute
  • Remember to note if pacemaker/implantable device is present
64
Q

reversal of opioid toxicity

A

naloxone

65
Q

s/s opioid toxicity

A 
jerky movements, myoclonus
pin point pupils
reduced resp rate
drowsy 
hallucinations
66
Q

tx breathlessness in palliative care

A

oral opioid

67
Q

tx anxiety related breathlessness

A

lorazepam

1. 4th year (23 decks)

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