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4th Year SB > Ageing > Flashcards

Ageing Flashcards

1
Q

anterior cerebral artery stroke

A

contralateral hemiparesis and sensory loss

lower > upper

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2
Q

middle cerebral artery stroke

A

contralateral hemiparesis and sensory loss
upper > lower

contralateral homonymous hemianopia

aphasia

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3
Q

posterior cerebral artery stroke

A

contralateral homonymous hemianopia with macular sparing

visual agnosia

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4
Q

Total anterior circulation infarcts sx

A

involves middle and anterior cerebral arteries

  1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
  2. homonymous hemianopia
  3. higher cognitive dysfunction e.g. dysphasia
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5
Q

Partial anterior circulation infarcts sx

A

involves smaller arteries of anterior circulation e.g. upper or lower division of middle cerebral artery
2 of the above criteria are present

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6
Q

Lacunar infarcts sx

A

involves perforating arteries around the internal capsule, thalamus and basal ganglia

presents with 1 of the following:

  1. unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
  2. pure sensory stroke.
  3. ataxic hemiparesis
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7
Q

Posterior circulation infarcts sx

A

involves vertebrobasilar arteries

presents with 1 of the following:

  1. cerebellar or brainstem syndromes
  2. loss of consciousness
  3. isolated homonymous hemianopia
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8
Q

basilar artery stroke Sx

A

locked in syndrome

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9
Q

what is weber syndrome

A

branches of the posterior cerebral artery that supply the midbrain

ipsilateral CN III palsy
Contralateral weakness of upper and lower extremity

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10
Q

what is lateral medullary syndrome/Wallenberg syndrome

A

posterior inferior cerebellar artery

Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus

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11
Q

70 year old taxi driver with trouble calculating change and with navigation - where is affected

A

parietal lobe

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12
Q

what is a common side effect of alpha blockers

A

postural hypotension

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13
Q

fall and syncope = DDx

A

arrthymia
orthostatic hypotension
vasovagal
valve disease i.e. aortic stenosis

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14
Q

what are common drugs that increase the risk of falls

A 
BZDs
antipsychotics 
antihypertensives 
antidepressants 
anticholinergics 
Class 1A antiarrthymias 
opiates 
diuretics 
parkisons medication
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15
Q

what is the intervention for falls with the most supportive evidence it works

A

Strength and balance training

Must be 3x week for minimum 12 weeks

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16
Q

being on how many drugs are considered a risk factor for falls

A

> 4

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17
Q

4 drugs that are frequently associated with adverse effects in the elderly

A

warfarin
digoxin
insulin
BZDs

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18
Q

side effects of NSAIDs

A

GI haemorrhage
decline in GFR
decreased effectiveness of diuretics, anti hypertensive agents

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19
Q

what anti-emetics cannot be used in parkinsons

A

prochlorperazine

metoclopramide

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20
Q

what can beta blocker not be prescribed with

A

verapamil

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21
Q

who can not get non-cardioselective beta blockers (e.g. propranolol, sotalol)

A

patients with COPD

22
Q

who should CCB be stopped in

A

people with chronic constipation

23
Q

what drugs do Potassium rich food [i.e. bananas,oranges, green leafy vegetables] interact with

A

ACEIs, ARBs, K-sparing diuretics

24
Q

what drugs do food with lots of Vit E and K [Apples, chickpeas, spinach, nuts, spinach, kiwi, broccoli] interact with

A

Warfarin

25
Q

what is important to note about these foods; Chicken, turkey, milk, soy,cheese, yogurt

A

alter PH

Interacts with: Antibiotics, thyroid meds, Digoxin, diuretics

26
Q

what is the relation of Amitrytilline and BPH

A

makes it worse

there is a risk of urinary retention

27
Q

what food/drink should you AVOID with a statin

A

grapefruit juice

28
Q

what food/drink should you AVOID with metronidazole

A

alcohol

29
Q

what food/drink should you AVOID with warfarin

A

cranberry

30
Q

what food/drink should you AVOID with thyroxine

A

calcium

get decreased absorption

31
Q

what drug should not be prescribed with warfarin

A

NSAID = risk of bleed

32
Q

what would a combination of ACEi and spironolactone cause

A

Hyperkalaemia

33
Q

what would a combination of digoxin and verapamil cause

A

digoxin toxicity

34
Q

what would a combination of fluoxetine and phenelzine cause

A

serotonin syndrome

35
Q

what conditions are Triptans contraindicated in

A

IHD
uncontrolled HTN
Lithium
SSRI

36
Q

what antibiotics can not be given to someone on a statin

A

clarithromycin

37
Q

what is the criteria for Delirium

A

Disturbance in attention
Change in cognition
Acute
Fluctuates

38
Q

how does hypoactive delirium compare to hyperactive

A

hyperactive - agitation and restless

hypoactive - sleepy and slow

39
Q

what are the hallmarks of Delirium

A

Acute and fluctuating
Inattention
Altered level of consciousness
Disorganised thinking

40
Q

what is the 4AT

A

assessment test for delirium and cognitive impairment

41
Q

what are the categories of 4AT and the points you can get in that category

A

Alertness [out of 4 points]

AMT4 [out of 2 points]
- [age, dob, place, current year]

Attention [out of 2 points]
- say months of the year backwards starting from December

Acute change or Fluctuating course [out of 4 points]

42
Q

what are the score cut-offs for 4AT

A

4 or above = possible delirium +/- cognitive impairment

1-3 = possible cognitive impairment

0 = delirium unlikely

43
Q

medication for Tx of delirium

A

Haloperidol
- 0.25-0.5mg PO, max 5mg a day

Quetipine
- for Parkinsons patients or Lewy Body Dementia

Lorazepam
- ONLY if alcohol or BZDs withdrawal

44
Q

what score is used to assess risk of stroke in AF

A

CHA2DS2-VASc

Congestive HF
Hypertension 
Age > 75 [2pts]
Diabetes 
Stroke or TIA previously [2pts]
Vascular disease
Age 65-74 [1pt]
Sex (female)

Score more than 1 = offer anti-coagulation

45
Q

what are the options for anti-coagulation for AF

A

Warfarin
- INR target 2-3

NOACS

46
Q

symptoms of opioid overdose

A

hallucinations, myoclonus, drowsiness

47
Q

what is MR and what is it used for

A

Modified release (MR)
Background pain
Twice daily tablet

48
Q

what is morphine IR and what is it used for

A 
Immediate release (IR)
Breakthrough pain

‘PRN’ tablet (sevredol) or liquid (oramorph) which is approx 1/6 of total background dose

49
Q

Patient on Codeine 60mg four times a day (total daily dose 240mg) - what is the equivalent morphine dose

A

24mg morphine

divide by 10 = weak opiate

50
Q

conversion factor for PO morphine to SC

A

Morphine is twice as potent given SC
To work out SC dose, divide PO dose by 2

Oral MST 10mg bd [20mg total] = SC morphine 10mg over 24 hours

51
Q

what is common [anticipatory] prescribing for end of life

A

Pain / SOB = Morphine 2mg scut hourly

Distress = Midazolam 2mg scut

N/V = Levomepromazine 2.5mg eight hourly

Secretions = Hyoscine butylbromide injection (Buscopan® 20mg SC hourly

4th Year SB (22 decks)

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