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NMF: Year 3 > Ageing > Flashcards

Ageing Flashcards

1
Q

Compare the cardiac output of an 80 year old to a 20 year old

A

about half

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2
Q

How much bone mass is lost by
a) women
b) men
per decade?

A

a) 5-10%

b) 5%

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3
Q

What tools can help us to

a) identify delirium?
b) diagnose delirium?

A

a) CAM score

b) 4AT

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4
Q

What makes up the CAM assessment?

A 
acute onset
fluctuating course
inattention
disorganised course
altered level of consciousness
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5
Q

Which 4AT score is suggestive of delirium?

A

above 4

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6
Q

How do you assess inattention?

A

get patient to count the months backwards

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7
Q

What are the parts of 4 AT?

A

Alertness
AMT4
Attention
Acute change or fluctuating course

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8
Q

What is AMT4?

A

age
DOB
place
year

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9
Q

Give examples of cephalosporins

A

cefixime

ceftriaxone

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10
Q

Which type of antibiotic is ciprofloxacin?

A

a quinolone

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11
Q

What can help to identify a stroke?

A

ROSIER score: greater than 0 means stroke is likely

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12
Q

Which signs would make stroke less likely?

A

loss of consciousness/syncope

seizure

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13
Q

Difference between dominant and non-dominant parietal lobe

A

dominant = calculations, planned movement, language, appreciation of size shape weight texture

non-dominant = spatial orientation, constructional skills

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14
Q

Difference between dominant and non-dominant temporal lobe

A

dominant = sound, speech, smell, verbal memory

non-dominant = sound, music, smell, non-verbal memory

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15
Q

4C

A
  • cephlasporins
  • co-amoxiclav
  • ciprofloxacin
  • clindamycin
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16
Q

treat falls

A

review drugs
strength and balance training
calcium/vit D supplements

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17
Q

What is affected in delirium other than cognition?

A

attentiveness

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18
Q

Which condition that causes cognitive impairment is worse in the morning?

A

depression

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19
Q

What environment should delirious patients be in?

A

quiet

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20
Q

Should you give benzodiazepams in delirium?

A

no they make it worse unless it is precipitated by alcohol withdrawal

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21
Q

What medication can be given to control delirium in a patient with parkinson’s ?

A

quetiapine

22
Q

What is the carrier for

a) basic drugs
b) acidic drugs

A

a) alpha 1 acid glycoprotein

b) albumin

23
Q

How do plasma levels of drugs change with age?

A

older patients have higher plasma levels of drug on the same dose as younger patients

24
Q

Does the
a) protein binder
b) environment
need to be the same or different for drugs?

A

a) different

b) same

25
What type of drugs do older people absorb more? why?
basic less acid in stomach more alpha 1 acid glycoprotein > albumin
26
What does a high Vd indicate?
very lipophilic
27
Name a side-effect of a) opiods b) steroids c) calcium d) NSAIDs e) benzodiazepines
a) constipation b) osteoporosis and diabetes c) 25% get nausea or GI upset, interferes with levothyroxine d) interferes with diuretics and anti-hypertensives e) impaired psychomotor function --> falls
28
Which drugs increase risk of falls?
``` benzodiazepines neuroleptics antihypertensives antidepressants anticholinergics digoxin antiepileptics diuretics parkinson's drugs antihistamines ```
29
calculate the therapeutic index
lethal dose 50 / effective dose 50
30
delirium + profound hypoxia
silent MI/PE
31
How many people over 80 fall every year?
50%
32
Which drugs can cause constipation?
``` opiates anticholinergics eg TCAs iron antacids diuretics eg furosemide CCBs ```
33
What is overflow diarrhoea?
when constipation blocks the bowel so watery stool from higher up the bowel leaks out
34
How can constipation be managed orally?
1. osmotic agents eg. laxido/laculose 2. softener laxative eg. docusate 3. stimulating laxatives eg. senna/bisocdyl 4. bulk forming agents eg fybogel
35
How can constipation be managed rectally?
glycerine suppositories microenemas eg. microlette phosphate enemas
36
What questions should assess constipation?
freq of stools + what is normal? consistency of stools difficulty evacuating/ feel incomplete fluid intake, diet + exercise
37
Which drugs can cause postural hypotension?
* Nitrates * ACE-Inhibitors * Diuretics * Anticholinergics * L dopa * Anti-platelet agents * Anticholinergics * SSRIs
38
What factors can precipitate delirium?
``` drugs like anticholinergics, antidepressants, sedatives, opiates, L dopa... urinary retention constipation infection MI Pain Change in environment Inability to hear/see clearly ```
39
What are risk factors for osteoporosis and fracture?
``` older age female prolonged corticosteroid use smoking low BMI fhx of osteoporosis thyrotoxicosis chronic kidney failure liver failure ```
40
Can calcium and vitamin D supplementation reduce the risk of fracture?
no only bisphosphonates
41
What drugs can cause hyponatraemia?
``` SSRI PPI loop and thiazide diuretic ACE-inhibitors NSAIDS ```
42
What are the signs and symptoms of cerebellar disease?
``` normal/reduced muscle tone normal deep tendon reflexes broad gait nystagmus ataxia but rhomberg negative ```
43
Which drugs can increase vit D?
atorvastatin
44
Which drugs decrease vit D?
phenytoin
45
Can low vitamin D predispose to falls?
yes as it can cause nerve and muscle dysfunction
46
Is delirium benign and always reversible?
no it is a serious condition with significant morbidity and mortality
47
What are the non drug causes of postural hypotension?
Parkinsons Diabetes Cessation of longterm corticosteroids
48
What is the most likely cause of anaemia with low MCV (<80)?
iron deficiency anaemia
49
What is the most likely cause of anaemia with high MCV (>100)?
folate and vit B12 deficiency
50
When should discharge planning start?
immediately after admission
51
How does Parkinson's present?
bradykinesia, resting tremor, rigidity increased tone, normal reflexes short stepping gait with reduced arm swinging soft speech

NMF: Year 3 (10 decks)

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