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ADELE-Noodles of Neurology > Ageing > Flashcards

Ageing Flashcards

1
Q

What is delirium?

A

An acute confusional state that can lasts for 4-6 weeks

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2
Q

What are the 4 components of delirium?

A

Disturbance in attention
Change in cognition
Over a short period
Fluctuates during the day

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3
Q

What are the other DDx with delirium?

A

Anxiety

Depression

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4
Q

What are the two pathophysiological reasons for delirium?

A

Direct toxic insults e.g. drugs, hypoxia, low Na, low glucose
Aberrant stress response e.g. cortisol

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5
Q

What are the 4 predisposing factors to delirium?

A
  1. Dementia/Stroke/Learning difficulties
  2. Post-op (esp Hip)
  3. Elderly
  4. Co-morbidity
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6
Q

Precipitating factors for delirium

A

P-Pain
I-Infection
N-Nutrition and neurological insults
C-Constipation and catheterisation (due to urinary retention)
H-Hypoglycaemia, hypoxia, hydration, hypo/hyperthyroidism

M-Medication (polypharmacy)
E-Environment

ALCOHOL

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7
Q

What does hypoactive delirium look like?

A

Withdrawn, Apothetic, Sleepy

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8
Q

What does hyperactive delirium look like?

A

Agitated, aggressive, wandering, insomnia

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9
Q

What is used to diagnose delirium?

A

4AT, CAM

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10
Q

What are the components fo 4AT?

A

Alertness
Abbreviated mental test
Attention
Acute change or fluctuating course

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11
Q

What are the components of CAM

A

1+2 + 3 OR 4

1- Acute onset and fluctuations
2- Inattention
3-Disorganised thinking
4-Altered level of consciousness

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12
Q

Management for delirium?

A

Nurse in a well lit quiet room with the same nursing team present
Check they have hearing aids and glasses with them
Minimise medication when possible

Haloperidol if v agitated

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13
Q

What word described the body reaction to the drugs

A

Pharmokinetics

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14
Q

What word describes the drug action on the body?

A

Pharmodynamics

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15
Q

What does DOACs stand for?

A

Direct Oral anticoagulant

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16
Q

3 examples of acidic drugs

A

Phenytoin
Aspirin
Peniclillin

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17
Q

3 examples of basic drugs

A

Diazepam
Morphine
Pethidine

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18
Q

What is the basic principle for absorption?

A

Acidic drugs need an acidic environment

Basic drugs need a basic environment

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19
Q

In older people there is a much more basic environment. Why is this?

A

Less gastric parietal cells therefore they absorb they absorb more of basic drugs

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20
Q

TRUE/FALSE

There is decreased small bowel surface area in elderly people

A

TRUE

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21
Q

What protein binds to acidic drugs?

A

Albumin

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22
Q

What protein binds to basic drugs?

A

a-1 acid glycoprotein

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23
Q

TRUE/FASLE

Elderly tend to have low albumin but higher a-1 AG

A

TRUE

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24
Q

Why is there an increase in volume of distribution (and therefore longer half-lives) of lipophilic drugs in elderly patients?

A

As elderly people in proportion to muscle mass have more fat

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25
Q

What is the most important change in terms of distribution of drugs?

A

Decreased body water (10-15%)

Therefore lower volume fo distribution of lipophilic drugs

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26
Q

With all these changes why is the t1/12 usually unchanged in the elderly?

A

the Volume of distribution and CrCL are both lower

27
Q

What does it mean if there is a huge volume of distribution?

A

Very lipophilic, very little in plasma

28
Q

Why are drugs that have a high volume of distribution potentially dangerous?

A

Sit in fatty tissues for a long time

If then become cachexia this will start to be released

29
Q

Why do older patients have longer half-lives?

A

Poorer renal and hepatic functions

30
Q

What is the equation for calculating the half-life?

A

CL R+L

31
Q

What is the equation to calculate CrCL?

A

Serum Creatinine

x1.23 men OR x1.04 women

32
Q

SE of opioids

A

Constipation

33
Q

What is the worrying SE of Steroids in elderly?

A

Osteoporosis

34
Q

What does calcium interfere with the absorption of?

A

Levothyroxine

35
Q

NSAIDs pose a big risk in elderly, what should you use instead if possible?

A

Paracetamol

36
Q

What can opioids and benzodiazepines have as side effects?

A

Impair psychomotor function, falls and confusion

37
Q

What is Beers Criteria?

A

Potentially Inappropriate Medication Use in Older Adults

38
Q

TRUE/FALSE

Once the diagnosis is confirmed dementia patients no longer are classed as having capacity

A

FALSE

Dementia patients do have capacity

39
Q

Elderly patients often have atypical presentations of typical diseases e.g. in MI what percentage of people do not have chest pain?

A

1/3 (eey not a percentage)

40
Q

Why do older people fall?

A

Physiology of ageing

Pathology commonly associated with ageing

41
Q

What fraction of patients who fall fear falling again?

A

1/3

42
Q

What is a common presentation of falls in 50s and 60s?

A

Osteoporotic Wrist Fractures

43
Q

What is a common presentation of calls in 60+?

A

Hip fracture (as not reaching out hand)

44
Q

What is sarcopenia?

A

age related loss of muscle mass and function

45
Q

What are 20% pf unexplained falls due to?

A

Syncope

46
Q

What is the definition of postural hypotension?

A

Fall in SBP >20mmHg or DBP >10mmHg after 3 minutes of standing

47
Q

What are the 5 causes of syncope?

A
  1. Arrythmias
  2. Postural hypotension
  3. Neurogenic (vasovagal)
  4. Carotid sinus hypertrophy
  5. Valvular heart disease (aortic stenosis)
48
Q

Why are you more likely specifically to fall if you have dementia?

A

Frontal part of the brain affected - Judgement and Visuo-spatial perception

49
Q

High stepping gait and Romberg’s positive is characteristic of which condition?

A

Cervical Myelopathy

50
Q

What is altered sensation and gait wide-based characteristic of?

A

Peripheral neuropathy

51
Q

Pain/Paraesthesia legs and wide-based gait is characteristic of which condition?

A

Lumbar stenosis

52
Q

Wide-based gait and cerebellar signs occur in which condition?

A

Cerebellar ataxia

53
Q

Shuffling gait, tremor, rigidity, bradykinesia and postural hypotension are characteristic of which disease?

A

Parkinsons disease

54
Q

How do you confirm BPPV?

A

Dix-Hallpike manouvre

55
Q

How is BPPV treated?

A

Epley manouvre

56
Q

Why are those who use bifocal or varifocal lenses at high risk of falls?

A

They have altered depth perception

57
Q

What are the 5 main reasons that people fall?

A
  1. Medication-Polypharmacy
  2. Alcohol
  3. Environmental hazards
  4. Inappropriate clothing/footwear
  5. Inappropraite walking aids
58
Q

What is the Fracture score?

A

prediction algorithm which estimates the 10 year absolute risk of osteoporotic fractures and hip fractures

59
Q

When does muscle mass and function start to decline? When is the loss accelerated?

A

Starts to decline 30 years

Loss accelerated >60 years

60
Q

What is the criteria for diagnosis of sarcopenia?

A

1 +2/3

  1. Low muscle mass
  2. Low muscle strength
  3. Low physical performance
61
Q

What is sarcopenia obesity?

A

Loss of muscle mass with an increase in fat levels

62
Q

Which group of patients is cachexia often found with?

A

Cancer patients

63
Q

TRUE/FALSE

Muscle power declines more rapidly than muscle strength

A

TRUE

therefore need resistance training

64
Q

Where is 95% of creatinine stored?

A

Skeletal muscles

ADELE-Noodles of Neurology (38 decks)

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