CofE Flashcards
1
Q
What are 5 functional tests done for Dementia?
A
MMSE ACE III AMT 6- CIT GPCOG
2
Q
What score on an MMSE indicates dementia?
A
<25/30
Cut-offs are <10 for severe
10-20 moderate
21-24 mild
3
Q
What are characteristics of an Essential tremor?
A
Better at rest
Intention tremor
Better with alcohol and BBs
4
Q
Describe the Parkinsonian Gait
A
Pedestal turning Broad based Shuffling Forward flexed Reduced arm swing
5
Q
What are causes of Parkinsonism?
A
Idiopathic Drugs- METOCLOPRAMIDE Trauma Wilson's HIV Parkinsons Plus syndromes
6
Q
What are the 5 Parkinson’s plus syndromes?
A
MSA = Multiple System Atrophy PSP = Progressive Supranuclear Palsy LBD = Lewy Body Dementia CBD = Corticobasilar Degeneration VP = Vascular Parkinsons
7
Q
What are non motor features of Parkinsons?
A
Depression Dementia Nausea and loss of smell Diarrhoea and Constipation Visual Hallucinations Frequency/Urgency REM Sleep Disorder Dribbling Prosody Poor Executive Funtioning
8
Q
Who is on an MDT for Parkinsons?
A
GP NEuro Specialist Nurses Social Worker OT Physio Carers SALT Patient Support Groups Pharmacist Nutritionist
9
Q
What is the only thing that causes megaloblastic microcytic anaemia?
A
B12/ folate deficiency
10
Q
What is involved in a comprehensive geriatric assessment?
A
Physical Psychiological Functional Social Psychological Med Review
11
Q
What is involved in a physical geriatric assessment?
A
Falls risk Heart disease Dentition Weight Nutrition Continence Vision and hearing Pain Cancer
12
Q
What is involved in a psychiological geriatric review
A
Mood disorders Cognition Depression Agitation Delirium ISOLATION
13
Q
What is assessed around functional capacity in a geriatric assessment?
A
Bathing Dressing Toileting Continence Feeding Grooming Transferring Shopping and ADLs Transport Telephone and contant Handles Finances
14
Q
What is involved in a social and environmental geriatric review?
A
Home Family Advanced care preferences Help needed? Social support Partner health Groups Spirituality
15
Q
Why are old people prone to pressure sores?
A
Lack of mobility Loss of sensation DM Topical steroids Malnourishment Cognitive Impairment
16
Q
How can pressure sores be prevented?
A
4 hourly nurse checks Regular turning Air matresses Risk assessment Barrier creams
17
Q
What are the 3 systematic determinants of continence?
A
- Parasympathetic S2-4 Contract the detrusor
- Sympathetic T12-L2 - Upper sphincter and ureter
- Somatic NS External sphincter
18
Q
What are 4 causes of incontinence (DRIP)?
A
Delirium
Retention
Infection/Information/Impacted stool
Polyuria (drugs)
19
Q
What is the first line treatment for stress incontinence?
A
Duloxetine
20
Q
What is the first line treatment for urge incontinence?
A
Oxybutynin
21
Q
Why are antimuscarinics contratindicated in the elderly?
A
Cause confusion and blurred vision
22
Q
What are risk factors for incontinence?
A
Immobility Chronic disease DM Medications (diuretics) Parity Obesity Smoking Delirium COPD (stress)
23
Q
What affects geriatric food intake in hospital?
A
Environement Meal times Food temp/smell Unfamiliar foods Pain Poor apetite Infection Burns Medication
24
Q
What 3 factors contribute to geriatric malnutrition?
A
Reduced intake Increased requirements (liver disease, surgery, chemo) Greater losses (vomiting, diarrhoea, chemo etc)
25
What does MUST stand for?
Malnutrition Universal Screening Tool
26
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
27
What bloods do you need to do in refeeding syndrome?
Calcium
Phosphate
Mg
K
28
What is needed to prevent refeeding syndrome?
Thiamine
Vit B
Multivitamin
29
Why are thiazide like diuretics contraindicated in the elderly?
Gout
30
What is the metabolic imbalance caused by loop diuretics?
Metabolic alkalosis as H and K are excreted
31
What are risk factors for falls?
```
Infection
Cognitive impairment
Visual impairment
Slow relflexes
Frailty
AF
Isolation
Parkinsons
TIA/stroke
ANTICHOLINERGICS
Benzos
ANTIHYPERTENSIVES
```
32
What is osteoporosis?
Loss of bone mass and structural deterioration of bone tissue
33
What scan is used to assess osteoporosis?
DEXA
34
What score is used to assess osteoporosis risk?
FRAX
35
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
```
36
How is osteoporosis treated?
Bisphosphonates: ALENDRONATE
Calcium and vit D supplements
Raloxifine (similar to HRT but lower cancer risk)
Denosumab -monoclonal AB to RANKL
37
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
38
What are the side effects of bisphosphonates?
GI irritation
Ulcers
Bone/joint pain
39
What indicates a NOF fracture?
External rotation
| Abducted shortened leg
40
When should you aim to operate on a NOF fracture?
Same day or next day to avoid wasting
41
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
42
What are the 4 components of capacity?
1. Understand Options
2. Retain information
3. Weigh up options
4. Communicate a decision
43
When should DoLs be used?
Only when it is the least restrictive method to keep a person safe
44
How long are DoLs for?
12 months max but renewable
45
Who is permission for DoLs needed from?
Local Authority
46
What does DoLs enforce?
Kept locked in care home/ward and not free to go out without close supervision and always supervised.
47
What are the 6 criteria that must be considered in DoLs?
1. Age <18
2. Mental Health Assessment for mental illness
3. Mental Capacity Assessment
4. Best Interest Assessment- look at advanced directive, family/friends/progfessional opinion and values and beleifs
5. Eligibility- confirm not already under the MHA
6. "No refusals" assessment- check not going against an advanced directive they or their lasting power of attorney made.
48
What does DoLs need to be to be valid?
In writing
| Include the purpose
49
What 2 kinds of Lasting power of attorney are there?
Property and financial
| Health and welfare
50
What are the risks of PEG feeding?
```
Perforation
Peritonitis
Infection
Abscess
Poor wound healing
Aspiration
```
51
Who appoints deputies to make LPA decisions?
Court of Protection
52
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
