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Phase 3a > Care of the Elderly Peer Teachings > Flashcards

Care of the Elderly Peer Teachings Flashcards

1
Q

Key features for Alzheimers in history

A 
12 month history
Progressive
Memroy
Gets lost
MMSE
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2
Q

What is brocas aphasia

A

Expressive

-difficulty producing language

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3
Q

What is wernickes aphasia

A

Receptive

Difficulty comprehending

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4
Q

What is apraxia

A

Deficit in voluntary motor skills

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5
Q

What is agnosia

A

Difficulty recognising things or faces

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6
Q

What is apathy

A

Lack of motivation

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7
Q

Rank common causes of dementia

A
  1. Alzheimers
  2. Vascular
  3. Lewy body
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8
Q

What are the signs of Alzhiemers on imaging

A
  • Global atrophy
  • Intracellular neurofibrillary tangles
  • extracellular beta amyloid plaques
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9
Q

What are neurofibrillary tangles made out of

A

Tau protein

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10
Q

What action do neurofibrillary tangles have

A

They disrupt the microtubules in nerves

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11
Q

What action do beta amyloid plaques have

A

They disrupt nerve communication at synapses causing nerve degeneration

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12
Q

What are the 5As of Alzheimers

A 
Amnesia
Aphasia
Apraxia
Agnosia
Apathy
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13
Q

Treatment for Dementia

A

Anticholinesterase inhibitors

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14
Q

Examples of anticholinesterase inhibitors

A

Donepezil
Rivastigmine
Galantine

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15
Q

What will you see on imaging for vascular dementia

A

Multiple cerebral infarcts

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16
Q

Describe the history for Lewy body dementia

A

Day to day fluctuating cognition, visual hallucinations, sleep disturbed, falls, parkinsonism

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17
Q

Which drugs should you not prescribe in lewy body dementia

A

Antipsychotics as increased risk of SE

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18
Q

Describe the history for vascular dementia

A

No atherosclerotic risk factors, step wise deterioration in cognition, can get focal neurology, fits, nocturnal confusion

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19
Q

Describe the history for picks disease

A

Frontotemporal dementia- disinhibition, antisocial, personality changes, knide blade atrophy

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20
Q

What is knife blade atrophy

A

Extreme and global thinning of the gyri of the frontotemporal lobes

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21
Q

Describe the history in normal pressure hydrocephalus

A

Wet, wacky, wobbly. Incontinence, dementia, gait disturbance

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22
Q

What happens in normal pressure hydrocephalus

A

Increased CSF but ventricles dilate

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23
Q

What is mild cognitive impairment

A

Cognitive impairment but minimal impairment of ADLs

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24
Q

What is the main cognitive tool

A

MMSE

mini mental state exam

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25
Q

Name 5 more cognitive tools

A 
ACE-111
MoCA
AMT
6CIT
GPCOG
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26
Q

What does ACE-III stand for

A

Addenbrookes cognitive examination- III

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27
Q

What does MoCA stand for

A

Montreal cognitive assessment

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28
Q

What does AMT stand for

A

Abbreviated mental test score

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29
Q

What does 6CIT stand for

A

6 iten cognitive impairment test

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30
Q

What does GPCOG stand for

A

General Practicioner Assessment of cogntion

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31
Q

Define delerium

A

Acute, transient, reversible state of fluctuating impairment of consciousness, cognition and perception

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32
Q

Define delusion

A

A fixed belief, held with conviction, cannot be altered with evidence/proof, is inappropriate according to the social/ cultural norm

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33
Q

Describe hyperactive delerium

A

Agitation, innapropriate behaviour, hallucinations

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34
Q

Describe hypoactive delerium

A

Lethargy, reduced concentration

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35
Q

What is the acronym for delerium causes

A

DELERIUM

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36
Q

What does the acronym for the delerium causes stand for

A 
Drug
Electrolyte
Lack of drug (withdrawal)
Infection
Reduced sensory input 
Intracranial problems
Urinary retention and constipation
Malnutrition
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37
Q

Which drugs cause delirium

A

Anticholinergics, opioids, steroids, benzos

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38
Q

Which electrolyte abnormalities cause delirium

A

High or low Na, High Ca, Low Glucose, high Urea

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39
Q

Which infections often cause delerium

A

UTI or pneumonia

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40
Q

Which reduced sensory inputs can cause delerium

A

Blind, Deaf

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41
Q

Which intracranial problems can cause delerium

A

Stroke, post ictal, meningitis, subdural haematoma

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42
Q

Which types of malnutrition can cause delirium

A

Thiamine (B1), B3, B12

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43
Q

Delerium screen bloods

A

FBC, U&Es, LFT, TFTs,

Ca, Haematinics, INR

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44
Q

Hypercalcaemia symptoms

A

Bones, stones, groans, psychic moans

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45
Q

Septic screen

A

Urine dipstick
Chest XRay
Blood cultures

46
Q

Delerium screen investigations

A 
ECG
Malaria films
LP
EEG
CT/MRI
47
Q

Delerium supportive management aim

A

Alter environment to help with reorientation

48
Q

Delerium supportive

A 
Clocks and calenders
Side room
Sleep hygeine
Adequate lighting
Continuity of care
Access to hearing aids/glasses
49
Q

Medical treatment of delerium

A

IM Haloperidol

Benzos

50
Q

Assessment for delerium

A

Complete a full CGA- Comprehensive Geriatric Assessment for discharge planning

51
Q

What are the components of the Comprehensive Geriatric Assessment

A 
Medical
Functional
Psychological
Social
Environmental
52
Q

What forms the medical assessment in the GCA

A

Problem list (diagnosis and treatment), comorbid conditions and disease severity, medication review

53
Q

What forms the functional assessment in the GCA

A

ADL, Gait, Balance

OT, Physio

54
Q

What forms the psychological assessment in the GCA

A

Cognition, mood

Nurse or psychiatrist

55
Q

What forms the social assessment in the GCA

A

Care resources, finances

Social worker

56
Q

What forms the environmental assessment in the GCA

A

Home safety

57
Q

Which investigation is best for severity of osteoporosis in an old woman

A

DEXA scan

58
Q

What is osteoporosis

A

Where a reduced bone mineral density increases bone fragility and risk of fractures

59
Q

What is osteopenia

A

Precursor to osteoporosis

60
Q

What is osteomalacia

A

Softening of bones, due to impaired bone metabolism from inadequate levels of calcium, phosphate and vitamin D

61
Q

What does DEXA stand for

A

Dual Energy XRay Absorptiometry

62
Q

What is a T score

A

Number of standard deviations the patients’ bone mineral density differs from eh population average for a gender matched 30 year old.

63
Q

What is a Tscore of more than 1

A

Better than reference

64
Q

What is a Tscore of 0 to -1

A

Normal

65
Q

What is a Tscore of -1 to -2.5

A

Osteopenia- give lifestyle measures

66
Q

What is a Tscore below -2.5

A

Osteoporosis

67
Q

When would you spinal Xray an osteoporotic patient

A

Vertebral crush factors. Cant assess osteoporosis. Low sensitivity and specificity

68
Q

When are MRIs used for osteoporosis

A

Never

69
Q

When are bloods used for osteoporosis

A

Identify cause and risks. Bone profile normal (calcium, phosphate, alk phos)

70
Q

Are vitamin D levels helpful for osteoporosis montiroing

A

Low contribute but cant assess

71
Q

Acronym for osteoporosis risk factors

A

SHATTERED

72
Q

What does the osteoporosis risk factors acronym stand for

A 
Steroids
Hyperthryoid, hyperparathyroid, hypocalcaemia
Alcohol, tobacco
Thin (BMI <22)
Testosterone low
Early menopause
Renal or liver failure
Erosive/ IBD
Dietary (low Ca, malbsorption, DMT2)
73
Q

Which drugs can cause Osteoporosis

A 
Steroids
PPI omeprazole (reduces stomach acid and reduces calcium absorption from the stomach)
74
Q

What is renal osteodystrophy

A

Damaged kidneys=

  • hyperparathyroid
  • low activated D3
  • high fibroblast growth factor 23
75
Q

What is the response of the parathyroid to low calcium concentrations

A

Release parathyroid hormone

76
Q

Parathyroid hormone effects

A

Increases osteoclast activity
Increases calcium reabsorption but decreases phosphate reabsorption at kidneys
Active VitD production is increased

77
Q

How does PTH increase activated VitD

A

More 1 hydroxylase=

more 1,25 hydroxyvitamin D and therefore more calcium absorption from gut

78
Q

Life style changes for osteoporosis

A

Reduce risk factors
Weight bearing exercises
Fall prevention- balance exercises
Home assessment

79
Q

How to reduce risk factors for osteoporosis

A

Stop smoking, alcohol, weight, calcium vitamin D supplements

80
Q

Medical treatment of osteoporosis

A 
Bisphosphonates (alendronate)
Strontium ranelate (similar structure to Ca)
Raloxifene
Calcitonin
Denosumab (mab to Rank Ligand)
81
Q

Instructions for taking alendronate

A

Swallow pills with pint of water, remain upright, 30 mins before eating

82
Q

Side effects of alendronate

A

Oesophageal ulcers, jaw osteonecrosis, photosensitivity, GI upset

83
Q

What does rank ligand do

A

Activates osteoclasts

84
Q

Define syncope

A

Transient loss of consciousness characterised by

  • fast onset
  • short duration
  • spontaneous recovery
85
Q

Collapse

A

http://oscestop.com/Common%20acute%20-%20collapse.pdf

86
Q

What causes syncope

A

Hypoperfusion of the brain

87
Q

Falls risk factors categories

A 
Motor problems
Sensory impairment
Cognitive or mood impairment
Orthostatic hypotension
Polypharmacy
Alcohol/ drugs
Environmental hazards
Incontinence
Fear of falling
88
Q

Motor problems which increase risk fo falls

A

Gait or balance impairment

Muscle weakness

89
Q

Sensory impairment which increases risk to falls

A

Vision problems
Peripheral neuropathy
Vestibular dysfunction

90
Q

Cognition or mood impairment which increases risk to falls

A

Dementia
Delerium
Depression

91
Q

Medications which increase your chance of falls

A

Benzodiazepines
Antipsychotics
Antihypertensives
NSAIDs

92
Q

Enviromental hazards for falls

A

Poor lighting
Loose rugs
Clutter

93
Q

What is rhabdomyolysis

A

Skeletal muscle breakdown, due to traumatic chemical or metabolic injury

94
Q

Causes of rhabdomyolysis

A

Crush injuries, prolonged immobilisation following a fall, prolonged seizure activity, hyperthermia

95
Q

Muscle breakdown results in

A

Increased potassium, phosphate, myoglobin and creatine kinase

96
Q

What is the result of raised myoglobin

A

Acute tubular necrosis

97
Q

What is the risk of raised potassium

A

Arrythmias therefore do ECG

98
Q

Management for rhabdomyolysis

A

Supportive, IV fluids, correction of electrolytes, renal replacement therapy

99
Q

Hyperkalaemia ECG changes

A

Peaked T waves
Loss of P waves
Sine wave pattern

100
Q

Acronym for hyperkalaemia management

A

C BIG K DRop

101
Q

What does the acronym for hyperkalaemia management stand for

A

Calcium gluconate

Bicarbonates
Insulin
Glucose

Kayexalate

Diuretics (if kidneys ok)
Renal dialysis (if kidneys gone)
102
Q

Why do you give calcium gluconate in hyperkalaemia

A

Cardioprotective

103
Q

Why do you give insulin in hyperkalaemia

A

Drives pottasium intracellularly

104
Q

Why do you give kayexalate in hyperkalaemia

A

Binds pottasium in the GI tract

105
Q

Define ulcer

A

Break in the skin or mucous membrane which fails to heal

106
Q

Risk factors for pressure ulcers

A

Stroke victims
Quadriplegia
Comatose patients
Immobility, obesity

107
Q

What is bad about pressure ulcers

A

Cause pain and infection and therefore maybe sepsis

108
Q

How to prevent pressure ulcers

A

Barrier creams
Pressure redistribution and friction reduction
Repositioning
Regular skin assessment

109
Q

How do you do pressure redistribution and friction reduction

A

Special foam mattresses, heel support, cushions

110
Q

How often do you reposition patients

A

6hours, 4 if high risk

111
Q

How do you do a skin assessment for pressure ulcers

A

Check for areas of pain or discomfort
Skin integrity at pressure areas
Colour changes
Variation in heat, firmness and moisture

Phase 3a (9 decks)

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