CofE Flashcards
What are 5 functional tests done for Dementia?
MMSE ACE III AMT 6- CIT GPCOG
What score on an MMSE indicates dementia?
<25/30
Cut-offs are <10 for severe
10-20 moderate
21-24 mild
What are characteristics of an Essential tremor?
Better at rest
Intention tremor
Better with alcohol and BBs
Describe the Parkinsonian Gait
Pedestal turning Broad based Shuffling Forward flexed Reduced arm swing
What are causes of Parkinsonism?
Idiopathic Drugs- METOCLOPRAMIDE Trauma Wilson's HIV Parkinsons Plus syndromes
What are the 5 Parkinson’s plus syndromes?
MSA = Multiple System Atrophy PSP = Progressive Supranuclear Palsy LBD = Lewy Body Dementia CBD = Corticobasilar Degeneration VP = Vascular Parkinsons
What are non motor features of Parkinsons?
Depression Dementia Nausea and loss of smell Diarrhoea and Constipation Visual Hallucinations Frequency/Urgency REM Sleep Disorder Dribbling Prosody Poor Executive Funtioning
Who is on an MDT for Parkinsons?
GP NEuro Specialist Nurses Social Worker OT Physio Carers SALT Patient Support Groups Pharmacist Nutritionist
What is the only thing that causes megaloblastic microcytic anaemia?
B12/ folate deficiency
What is involved in a comprehensive geriatric assessment?
Physical Psychiological Functional Social Psychological Med Review
What is involved in a physical geriatric assessment?
Falls risk Heart disease Dentition Weight Nutrition Continence Vision and hearing Pain Cancer
What is involved in a psychiological geriatric review
Mood disorders Cognition Depression Agitation Delirium ISOLATION
What is assessed around functional capacity in a geriatric assessment?
Bathing Dressing Toileting Continence Feeding Grooming Transferring Shopping and ADLs Transport Telephone and contant Handles Finances
What is involved in a social and environmental geriatric review?
Home Family Advanced care preferences Help needed? Social support Partner health Groups Spirituality
Why are old people prone to pressure sores?
Lack of mobility Loss of sensation DM Topical steroids Malnourishment Cognitive Impairment
How can pressure sores be prevented?
4 hourly nurse checks Regular turning Air matresses Risk assessment Barrier creams
What are the 3 systematic determinants of continence?
- Parasympathetic S2-4 Contract the detrusor
- Sympathetic T12-L2 - Upper sphincter and ureter
- Somatic NS External sphincter
What are 4 causes of incontinence (DRIP)?
Delirium
Retention
Infection/Information/Impacted stool
Polyuria (drugs)
What is the first line treatment for stress incontinence?
Duloxetine
What is the first line treatment for urge incontinence?
Oxybutynin
Why are antimuscarinics contratindicated in the elderly?
Cause confusion and blurred vision
What are risk factors for incontinence?
Immobility Chronic disease DM Medications (diuretics) Parity Obesity Smoking Delirium COPD (stress)
What affects geriatric food intake in hospital?
Environement Meal times Food temp/smell Unfamiliar foods Pain Poor apetite Infection Burns Medication
What 3 factors contribute to geriatric malnutrition?
Reduced intake Increased requirements (liver disease, surgery, chemo) Greater losses (vomiting, diarrhoea, chemo etc)
What does MUST stand for?
Malnutrition Universal Screening Tool
Descrive refeeding syndrome
Starvation/Chronic malnutrition causes:
1. decreased glucose, increased glucagon and cortisol
2. This causes gluconeogenesis, glycogenesis and protiin catabolism
3. This causes vitamin depletion and salt and water intolerance
4. When refed, insulin is secreted
5. This causes increased protein and glycogen synthesis, increased glucose uptake, increased thiamine USE, and increased potassium, magnesium and phosphate USE
6. The result is HYPOKALAEMIA, HYPOMAGNESIA, HYPOPHOSPHATEAMIA, THIAMINE DEFICIENCY, SODIUM + WATER Retention
= oedema
What bloods do you need to do in refeeding syndrome?
Calcium
Phosphate
Mg
K
What is needed to prevent refeeding syndrome?
Thiamine
Vit B
Multivitamin
Why are thiazide like diuretics contraindicated in the elderly?
Gout
What is the metabolic imbalance caused by loop diuretics?
Metabolic alkalosis as H and K are excreted
What are risk factors for falls?
Infection Cognitive impairment Visual impairment Slow relflexes Frailty AF Isolation Parkinsons TIA/stroke ANTICHOLINERGICS Benzos ANTIHYPERTENSIVES
What is osteoporosis?
Loss of bone mass and structural deterioration of bone tissue
What scan is used to assess osteoporosis?
DEXA
What score is used to assess osteoporosis risk?
FRAX
What is included in the FRAX score?
Age/ Sex/ BMI Previous fracture or parent fracture Current smoker and alcohol use RA GLucocorticoids 2dry osteoporosis due to: T1DM, Hypergonadism, Perimenopausal, Malnourished, Chronic liver disease
How is osteoporosis treated?
Bisphosphonates: ALENDRONATE
Calcium and vit D supplements
Raloxifine (similar to HRT but lower cancer risk)
Denosumab -monoclonal AB to RANKL
What are the conditions necessary to take bisphosphonates in?
1 hour before food
Once weekly
With lots of water
Sit upright 1/2 an hour after and no food for an hour
What are the side effects of bisphosphonates?
GI irritation
Ulcers
Bone/joint pain
What indicates a NOF fracture?
External rotation
Abducted shortened leg
When should you aim to operate on a NOF fracture?
Same day or next day to avoid wasting
What are teh 5 principes of the Mental Capacity Act?
Presume Capacity
Individuals should be supported to make their own decisions
Individuals allowed to make unwise decisions
Best Interests
Least Restrictive Option should be taken
What are the 4 components of capacity?
- Understand Options
- Retain information
- Weigh up options
- Communicate a decision
When should DoLs be used?
Only when it is the least restrictive method to keep a person safe
How long are DoLs for?
12 months max but renewable
Who is permission for DoLs needed from?
Local Authority
What does DoLs enforce?
Kept locked in care home/ward and not free to go out without close supervision and always supervised.
What are the 6 criteria that must be considered in DoLs?
- Age <18
- Mental Health Assessment for mental illness
- Mental Capacity Assessment
- Best Interest Assessment- look at advanced directive, family/friends/progfessional opinion and values and beleifs
- Eligibility- confirm not already under the MHA
- “No refusals” assessment- check not going against an advanced directive they or their lasting power of attorney made.
What does DoLs need to be to be valid?
In writing
Include the purpose
What 2 kinds of Lasting power of attorney are there?
Property and financial
Health and welfare
What are the risks of PEG feeding?
Perforation Peritonitis Infection Abscess Poor wound healing Aspiration
Who appoints deputies to make LPA decisions?
Court of Protection
What is the role of an IMCA?
Make decisions on behalf of people who lack capacity if there is no one but paid staff willing or able to do so, and no one to consult to as about best interests and advanced directive
