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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
Q

What type of drugs do older people absorb more? why?

A

basic
less acid in stomach
more alpha 1 acid glycoprotein > albumin

26
Q

What does a high Vd indicate?

A

very lipophilic

27
Q

Name a side-effect of

a) opiods
b) steroids
c) calcium
d) NSAIDs
e) benzodiazepines

A

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
Q

Which drugs increase risk of falls?

A 
benzodiazepines
neuroleptics
antihypertensives
antidepressants
anticholinergics
digoxin
antiepileptics
diuretics
parkinson's drugs 
antihistamines
29
Q

calculate the therapeutic index

A

lethal dose 50 / effective dose 50

30
Q

delirium + profound hypoxia

A

silent MI/PE

31
Q

How many people over 80 fall every year?

A

50%

32
Q

Which drugs can cause constipation?

A 
opiates
anticholinergics eg TCAs
iron
antacids 
diuretics eg furosemide
CCBs
33
Q

What is overflow diarrhoea?

A

when constipation blocks the bowel so watery stool from higher up the bowel leaks out

34
Q

How can constipation be managed orally?

A
  1. osmotic agents eg. laxido/laculose
  2. softener laxative eg. docusate
  3. stimulating laxatives eg. senna/bisocdyl
  4. bulk forming agents eg fybogel
35
Q

How can constipation be managed rectally?

A

glycerine suppositories

microenemas eg. microlette

phosphate enemas

36
Q

What questions should assess constipation?

A

freq of stools + what is normal?

consistency of stools

difficulty evacuating/ feel incomplete

fluid intake, diet + exercise

37
Q

Which drugs can cause postural hypotension?

A
  • Nitrates
  • ACE-Inhibitors
  • Diuretics
  • Anticholinergics
  • L dopa
  • Anti-platelet agents
  • Anticholinergics
  • SSRIs
38
Q

What factors can precipitate delirium?

A 
drugs like anticholinergics, antidepressants, sedatives, opiates, L dopa...
urinary retention
constipation
infection
MI
Pain
Change in environment
Inability to hear/see clearly
39
Q

What are risk factors for osteoporosis and fracture?

A 
older age
female
prolonged corticosteroid use
smoking
low BMI
fhx of osteoporosis
thyrotoxicosis
chronic kidney failure
liver failure
40
Q

Can calcium and vitamin D supplementation reduce the risk of fracture?

A

no only bisphosphonates

41
Q

What drugs can cause hyponatraemia?

A 
SSRI
PPI
loop and thiazide diuretic
ACE-inhibitors
NSAIDS
42
Q

What are the signs and symptoms of cerebellar disease?

A 
normal/reduced muscle tone
normal deep tendon reflexes
broad gait
nystagmus
ataxia but rhomberg negative
43
Q

Which drugs can increase vit D?

A

atorvastatin

44
Q

Which drugs decrease vit D?

A

phenytoin

45
Q

Can low vitamin D predispose to falls?

A

yes as it can cause nerve and muscle dysfunction

46
Q

Is delirium benign and always reversible?

A

no it is a serious condition with significant morbidity and mortality

47
Q

What are the non drug causes of postural hypotension?

A

Parkinsons
Diabetes
Cessation of longterm corticosteroids

48
Q

What is the most likely cause of anaemia with low MCV (<80)?

A

iron deficiency anaemia

49
Q

What is the most likely cause of anaemia with high MCV (>100)?

A

folate and vit B12 deficiency

50
Q

When should discharge planning start?

A

immediately after admission

51
Q

How does Parkinson’s present?

A

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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