Ageing Flashcards

1
Q

Which is dominant hemisphere in most people?

A

Left

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2
Q

LOC and stroke

A

Bad prognosis

Not a common presentation

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3
Q

Which drug to thrombolyse stroke?

A

Alteplase

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4
Q

Post-stroke % of patients fully independent at 6 months?

A

50% of those who do not die

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5
Q

Post-stroke % of patients dead in a month?

A

20%

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6
Q

Time cut-off for thrombolysis being useful treatment for stroke

A

4.5 hours

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7
Q

Cerebellar disease features?

A
Nystagmus
Poor balance
Negative Rhomberg's
Normal or reduced muscle tone
Normal deep tendon jerks
Broad gait
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8
Q

Proximal myopathic gait?

A

Waddling

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9
Q

Define postural hypotension

A

Drop of more than 20 mm/Hg SBP or 10 mm/Hg DBP on standing compared to sitting.

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10
Q

What % of institutionalised older people have postural hypotension?

A

40%

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11
Q

Motor features of Parkinson’s disease

A
Unilateral initially
Bradykinesia
Rigidity
Tremor
Increased tone
Normal tendon reflexes
Short stepping gait with reduced arm swing
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12
Q

Cockcroft-Golt Equation?

A

To work out actual creatinine clearance

140-age) x (weight kg) x (?
Divided by
eGFR x1.04 if female and 1.23 if male

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13
Q

Non motor-features of Parkinson’s disease

A
Speech
Swallow
Bowel movements
Sleep
Depression
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14
Q

What drugs could have tremor as a side effect?

A

Caffeine, lithium, salbutamol
Cyclosporins:
Neuroleptics: sodium valproate etc

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15
Q

Example of how disease presents differently in old age? ADD TO

A

PE - syncope?
ACS - SOB
Pneumonia - low temperature
Pain thresholds lower

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16
Q
  1. Aspirin at analgesic doses?

2. Aspirin at overdose?

A
  1. Can cause confusion

2. Can cause tinnitus

17
Q

What kind of dementia chronically fluctuates?

A

Lewy Body Dementia

18
Q

When is the only situation that laxido and lactulose would be used concurrently?

A

Hepatic encephalopathy - to reduce ascites

19
Q

Particular drug ageing red flags?

A

NSAIDs, unnecessary antibiotics, bendroflumethiazide, psycotropic drugs, PPIs

20
Q

PPIs - why so bad?

A

Infection risk
Mg/Ca reduction -> increases osteoporosis/malabsorption
Cognitive impairment

21
Q

Why is bendroflumethiazide so bad?

A

24 hours acting - do not split dose if for chronic heart failure or they just pee all the time/leads to incontinence
Reduces sodium which can increase confusion etc

22
Q

Which is superior laxido or lactulose?

A

Laxido acts quicker

23
Q

Which opioids to be avoided?

A

Tramadol/dihydrocodeine (delirium/constipation)

24
Q

Why might prostate hypertrophy be implicated in a fall?

A

alpha blockers - drop BP

25
Q

Onset of action of quetiapine

A

Slow onset of action

26
Q

Big 5 infections in Ageing?

A

Cellulitis
UTI
Gastroenteritis/diverticulitis (GI stuff due to PPIs reducing stomach acid so less bacteria are killed, c. diff risk and other infections due to use of lots of antibiotics. Other thing is cognitive impariment re hygiene/food prep)
Pneumonia
Cholecystitis - incompetent sphincter/stents/gallstones

27
Q

Volume of?
10% dextrose?
20% dextrose?
50% dextrose?

A

100ml infusion
50ml
20ml bolus

28
Q

Why might SSRIs make you confused?

A

Can cause SIADH
Can cause serotonin syndrome
Can make constipated
All centrally acting drugs can cause confusion in the elderly

29
Q

Side effect of tolterodine?

A

Urinary retention

30
Q

Reasons for elderly becoming dehydrated?

A

Cognitive impairment
Anxiety re continence/mobility issues
Reduced thirst reflex

31
Q

Common side effect of amlodipine?

A

Swollen ankles

32
Q

Explanations of raised urea without raised creatine?

A

Dehydration

Big Bleed - GI

33
Q

Lansoprazole effect on electrolytes?

A

Reduces sodium and magnesium

all PPIs and some anti-ds

34
Q

Marker of stroke severity?

A

Hypertension

35
Q

How treat hypertension in stroke?

A

If DBP over 110, or SBP over 205 - labetalol 10mg or GTN

36
Q

For stroke patients who have been thrombolysed, what % bleed?

A

6%

37
Q

What can happen if give folate without adequate B12?

A

Acute spinal cord compression