Ageing Flashcards
Confusion Assessment Method
Diagnosing Delirium
Presence of…
- Acute onset and fluctuating course
- Inattention
And either of..
- Disorganised thinking
- Altered level of consciousness
Risk factors for falls
Previous falls - most predictive for future falls Impaired mobility Hazards in the home Urinary incontinence Gait and balance problems Visual impairment Fear of falling Cognitive impairment Postural hypotension
Who should be assessed for osteoporosis?
All women 65 and over
All men 75 and over
Younger if... Previous fragility fracture Current use or frequent recent use of oral or systemic glucocorticoid History of falls Other causes of secondary osteoporosis Low BMI smoking Alcohol over 14/week
DEXA scan
T score (compared with healthy adult)
Above -1 is normal
-1 and -2.5 is osteopaenia
Below -2.5 is osteoporosis
Z score (compared with someone your age) Below -2 bone density lower than should be
Secondary prevention of osteoporosis in post menopausal women
Vitamin D and calcium supplementation should be offered to all women
Alendronate first line
Can’t tolerate - risedronate
Can’t tolerate bisphosphonates - ranelate or ralofaxene
HRT - only if also vasomotor symptoms
Triad for Normal Pressure Hydrocephalus
Gait dyspraxia
Fluctuating confusion
Urinary incontinence
Wet wobbly wacky
Ix and Tx of normal pressure hydrocephalus
CT Head - hydrocephalus, relatively well preserved sulci
LP can confirm diagnosis
Treatment is insertion of a VP shunt
Wernickes
Progressive confusional state
Gait ataxia
Opthalmoplegia and eye signs (usually nystagmus and bilateral sixth nerve palsy)
Seen in thiamine deficiency
Classically alcoholics
Lewy Body Dementia
Fluctuating progression of confusion
Early phase - loss of executive function but recognition and recall preserved
Loss of concentration and attention
Visual hallucinations, systematised delusions
Parkinsonism
Low mood, depression, apathy
Vitamins D deficiency
Scurvy Muscle and joint pain Fatigue Perifollicular haemorrhages - red dots on skin Gingivitis Decreased wound healing Easy bruising
Pellagra
Serious condition
Cause = B3 niacin deficiency
Features
Diarrhoea
Dermatitis
Dementia
Restless legs syndrome
Can be secondary to iron deficiency anaemia or peripheral neuropathy
Treatment = sedative eg clonazepam
Anti epileptics eg gabapentin
Dopaminergics eg ropinirole
Dementia and related proteins
Alzheimer’s - APP and Tau
LBD and Parkinson’s - alpha synuclein
FTD and ALS - TARDBP43
FTD - Tau protein and Pick bodies
Presentation of aortic stenosis
SADDLER Syncope on exercise Angina Dyspnoea Dizziness LHF Emboli from heavily calcified valve RHF secondary to LHF
Mitral Stenosis Presentation
MALARPATCHES Malar flush AF LHF Apex beat tapping, undisplaced RHF Palpitations Auscultation - loud S1 opening snap, mid diastolic rumble - best heard when patient is on left hand side and on expiration Thromboembolism may be first symptom Cachexia/cyanosis/COPD Haemoptysis Emboli Syncope
