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Phase 3A > Care of the Elderly > Flashcards

Care of the Elderly Flashcards

1
Q

Define dementia

A

Progressive global cognitive impairment with normal consciousness

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2
Q

Common types of dementia

A 
Alzheimers
Lewy body 
Frontotemporal 
Vascular
Parkinsons
Normal pressure hydrocephalus
Depression
Korsakoffs
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3
Q

Rare types of dementia

A 
HIV
CJD
Syphilis
Space occupying lesions
Hypothyroid
B12 deficiency
Malnutrition
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4
Q

What to ask about for dementia

A 
Age
Onset 
Progression
Memory
Personality
Thinking
Planning
Judgement 
Language
Visuospatial skills
Concentration
Social behaviour
Confusion
Wandering
Falls
Head injury
Tremor
Mood
Sleep
Delusions
Hearing
Sight
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5
Q

PMH for Dementia

A

Seizures

CVA/TIA

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6
Q

DH for Dementia

A

Regular medications
Sleeping tablets
Anticholinergics

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7
Q

FH for Dementia

A

Dementia

Neurological problems

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8
Q

SH for Dementia

A

Effect on work, relationships and social activities
ADLs
Finances
Support at home

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9
Q

What tests would you do for Dementia

A

MMSE, Abbreviated mental test score, full exam

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10
Q

Investigations for Dementia

A

Full bloods
CXR, CT Brain
EEG, LP, ECG

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11
Q

Initial management for Dementia

A

Refer to neuro, rule out reversible/treatable causes, ensure MDT to support patient’s needs

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12
Q

Describe Alzheimers Dementia

A

Slowly progressive loss of memory, with later loss of language, executive or visuospatial functions

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13
Q

Which drug may benefit moderate AD

A

Anticholinesterase inhibitors (Donepezil)

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14
Q

Describe Vascular Dementia

A

Impairment of memory and at least one other cognitive domain. IN THE PRESENCE OF VASCULAR RISK FACTRS/ ISCHAEMIA ON IMAGING

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15
Q

Describe Lewy Body Dementia

A

Early loss of executive function with HALLUCINATIONS and fluctuating levels of consciousness. Memory loss is a later feature.

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16
Q

Describe Frontotemporal dementia

A

Prominent and early LANGUAGE LOSS and also loss of social functioning/disinhibition. May be a younger age group

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17
Q

Name three reversible causes of dementia

A

Sub dural haematoma
Normal pressure hydrocephalus
Korsakoff syndrom

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18
Q

What are the categories of the Mini Mental State Exam

A 
Orientation
Registration
Attention and arithmetic
Recall
Language
Executive function
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19
Q

Describe subdural haematoma dementia

A

Dementia and focal neurology. Elderly, atrophic brains. Trauma in history. Ix CT. Tx Evacuate

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20
Q

Describe normal pressure hydrocephalus dementia

A

Dementia, gait disturbance and urinary incontinence with hydrocephalus on CT and normal CSF opening pressure

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21
Q

Causes of normal pressure hydrocephalus

A

Idiopathic (50%)
Meningitis
Trauma
Subarachnoid haemorrhage

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22
Q

Normal pressure hydrocephalus treatment

A

ventriculo peritoneal shunt

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23
Q

Describe Korsakoffs syndrome dementia

A

Amnesia and confabulation seen in thiamine deficiency (eg alcoholism). Treatment thiamine (B1) replacement

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24
Q

Define delerium

A

Acute onset of disordered cognition with attentional deficits typically involvalves changes in arousal and may be associated with hallucinations

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25
Q

Clinical features of delerium

A

Globally impaired cognition, perception and consciousness
Marked memory
Disordered/ disorientated thinking
Sleep/wake cycle reversal

26
Q

Describe hyperactive delerium

A

Restlessness
Mood lability
Agitation
Aggression

27
Q

Describe hypoactive delerium

A

Patient becomes slow and withdrawn

28
Q

What is the third type of delerium

A

Mixed

29
Q

Risk factors for delerium

A

> 65yo, dementia, hip fracture, acute illness, psychological agitation eg pain

30
Q

Causes of delerium

A 
Sugery
Systemic infection
Intracranial infection or head injury
Drug withdrawal
Alcohol withdrawal
Metabolic
Hypoxia
Vascular event
Thiamine, B12 deficiency
31
Q

Which drugs’ withdrawal causes delerium

A

Opiates
Levodopa
Sedatives
Recreational

32
Q

Delerium differentials

A

Dementia
Anxiety
Epilepsy
Primary mental illness- schizophrenia

33
Q

Delerium investigations

A

Bloods, ABG, Septic screen. ECG EEG LP CT

34
Q

Delerium treatment

A 
Reorientate
Encourage visitors
Monitor fluid balance and oral intake
Sleep hygeine
Avoid catheters
Watch out for discomfort 
Review medications
35
Q

Dementia vs delerium

A

Delerium is more inattention, distractability and disogranised thinking. Key thing is if there has been an acute decline from baseline

36
Q

Define depression

A

Low mood that is not usual and persists for over 2 weeks

37
Q

Symptoms of depression

A 
Low mood
Low energy
Feeling worthless or guilty
Poor concentration
Recurrent thoughts of suicide or death
Low self esteem
Tearfulness
Loss of interests
Anhedonia
38
Q

Somatic symptoms of depression

A 
Weight/ appetite loss
Sleep problems (early morning waking, insomnia or over sleeping)
Loss of libido
Psychomotor agitation or retardation
Change in mood with time of day
39
Q

Pyschotic symptoms of depression

A

Delusions

Hallucinations

40
Q

Signs of depression

A

Neglect, agitation, slowed speech or movement, poor eye contact

41
Q

Bereavement and depression

A

Dont diagnose depression within 2 months of bereavement. Be aware of cultural variations of grief. Depression likely if prolonged, sever functional impairment or psychomotor retardation

42
Q

Treatment options for Depression

A

Psychotherapy- CBT
Antidepressants
Electroconvulsive therapy

43
Q

When would you give electroconvulsive therapy

A

High risk (not eating or drinking) and or has failed to respond to medications

44
Q

First line antidepressants

A

SSRIs citalopram or fluoxetine

45
Q

Second line antidepressants

A

Venlafaxine

46
Q

Complications of depression

A 
Deliberate self harm
Unemployment
Relationship break down
Recurrence
Suicide
47
Q

Antidepressant advice

A

2-3wks to start. up to 6 wks
Suicide risk may increase in first few weeks
Treatment should continue for 6 months after symptoms have stopped.
Should be weaned not stopped suddenly

48
Q

Name 4 types of incontinence

A

Stress
Urge
Overflow
Functional

49
Q

Define stress incontinence

A

Leakage on exercise/ coughing/ laughing

50
Q

Define urge incontinence

A

Severe and sudden urgency (often due to detrusor instability)

51
Q

Define overflow incontinence

A

Urine volume exceeds bladder capacity (e.g. in chronic retention)

52
Q

Define functional incontinence

A

Restricted mobility so unable to get to the toilet in time

53
Q

Causes of urinary incontinence

A

UTI, detrusor instability, MS, DM, diuretics + reduced mobility
F- uterine prolapse, weak pelvic muscles, pelvic mass
M- post prostate surgery

54
Q

Investigations for incontinence

A

MSU, BM, Urinary diary, PSA

55
Q

Treatment for general incontinence

A

Weight loss
Less caffeine
Stop smoking
Treat prolapse

56
Q

Treatment for stress incontinence

A

Fluid restriction, pelvic floor exercises, transvaginal tape

57
Q

Treatment for detrusor instablity

A

Bladder drill, tolterodine

58
Q

Treatment for functional incontinence

A

Aid mobility

59
Q

Treatment for overflow incontinence (chronic urinary retention)

A

TURP, Finasteride (5-alpha reductase inhibitor), Tamsulosin (alpha blocker)

60
Q

Treatment for glaucoma

A

Prostaglandin eye drops

Phase 3A (25 decks)

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