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Medicine for the elderly > Conditions > Flashcards

Conditions Flashcards

1
Q

What is delirium?

A
  • Acute deterioation in mental function
  • arises over hours or days
  • can last days-months
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2
Q

Delirium triggers?

A
  • acute medical illness
  • trauma
  • drugs
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3
Q

Pathophysiology of delirium?

A
  • direct toxic insult to brain

- stress response

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4
Q

Stress response releases ____ which may trigger delirium?

A
  • cortisol
  • prostaglandins
  • cytokines
  • cholinesterase activity
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5
Q

Risk factors for delirium?

A
  • elderly
  • pre-existing cognitive impairment
  • post-operative
  • sensory impairment
  • previous delirium
  • polypharmacy
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6
Q

Causes of delirium?

A
  • infection
  • polypharmacy
  • constipation
  • fluid overload
  • hip fracture
  • new environment
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7
Q

Symptoms of delirium?

A
  • sudden
  • short, fluctuating
  • reversible
  • agitation
  • distorted illusions and hallucination
  • inattention / decreased awareness
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8
Q

Types of delirium?

A
  • hyperactive

- hypoactive

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9
Q

Screening for delirium?

A
  • all aged > 65yrs screened

- 4AT screening score > 4 = may indicate delirium

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10
Q

What is the 4-AT score

A
  • used to screen for delirium
  • alertness
  • AMT 4 (age, place, year, DOB)
  • Attention
  • acute change
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11
Q

What is the TIME bundle in delirium?

A
  • Think about and treat
  • Investigate and intervene
  • Management plan
  • Engage and Explore
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12
Q

Investigations for delirium?

A
  • History (4 AT)
  • Full exam + neuro examination
  • basic obstruction + BG
  • Medications review
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13
Q

Management of delirium?

A
  • treat underlying cause
  • management agitation
  • TIME bundle
  • Haloperidol (or lorazepam in Parkinson or Lewy body)
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14
Q

When should haloperidol not be used in the treatment of non-pharmacological responding delirium?

A
  • when the patient has Parkinsons or Lewy body dementia
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15
Q

3 broad reasons for fall?

A
  • motor co-ordination
  • sensory inputs
  • biomechanicals
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16
Q

Cautious gait risk

A
  • decrease walking speed and step length

- increased time that both feet are on the ground

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17
Q

Name some drugs that contribute to falls

A
  • antidepressants, antipsychotics
  • antiarrhythmics
  • benzodiazepines
  • diuretics
  • anticonvulsants
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18
Q

What is the falls risk associated with psychotropic drugs?

A
  • doubles risk of falling
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19
Q

What is the falls risk associated with anti-hypertensives?

A
  • a systolic bp < 110 increases risk of falls

- risk of orthostatic hypotension

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20
Q

What test can be performed to assess gait disturbances?

A
  • Romberrg’s test
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21
Q

Commonest cause of syncope in the elderly?

A
  • orthostatic hypotension

- differentials: arrhythmias, carotid sinus syndrome

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22
Q

What makes a diagnosis of orthostatic hypotension?

A
  • lying and standing BP (0mins, 1 min, 3mins)

- drop in systolic > 20mmHg, drop in diastolic > 10mmHg

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23
Q

Causes of orthostatic hypotension?

A
  • decreased autonomic buffering
  • medications - alpha blockers
  • volume depletion (diuretics or dehydration)
  • peripheral neuropathy
  • parkinsons/lewy body
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24
Q

Management of orthostatic hypotension?

A
  • education

- fludrocortisone

25
Q

Investigations into falls?

A
  • history
  • ECG
  • BG
  • Postural BP
  • Timed get up and go
  • Echocardiogram (if required)
  • Brain CT (if required)
26
Q

Requirements for a brain CT?

A
  • GCS< 13
  • GCS <15 after 2hrs
  • new focal neurological deficit
  • suspected open or decompressed fracture
  • suspected base of skull fracture
  • vomited > 2 times
  • post-traumatic seizure
27
Q

Explain the role of the carotid sinus?

A
  • area in ICA with many baroreceptors for homeostasis

- sensed increase in pressure = peripheral vasodilation and drop in heart rate

28
Q

What is carotid sinus syndrome

A
  • abnormal activation of carotid sinus

- cerebral hypoperfusion = drop attack

29
Q

Types of carotid sinus syndrome on carotid massage?

A
  • cardio-inhibitory
  • vasodepressor
  • mixed
30
Q

Explain cardio-inhibitory CSS

A
  • Pause in heart rate > 3seconds
31
Q

Explain vasodepressor CSS

A
  • Drop in systolic BP > 50mmHg
32
Q

If suspected CSS but no signs on carotid massage what investigation should be performed?

A
  • tilt table test
33
Q

Two main categories of stroke?

A
  • haemorrhagic

- infarction (most common)

34
Q

Causes of a haemorrhagic stroke

A

primary

  • hypertension
  • amyloid angiopathy

secondary

  • arteriovenous malformations
  • tumour
35
Q

Causes of infarction haemorrhage?

A
  • small vessel
  • cardioembolic
  • atheroembolic
36
Q

Bamford classification of stroke?

A
  • Total anterior circualtion
  • partial anterior circulation
  • lacunar
  • posterior circulation
37
Q

Symptoms of a partial anterior circulation syndrome?

A
  • 2/3 TACS crietria
  • hempiplegia
  • homonomous hemianopia
  • cortical signs
38
Q

Symptoms of total anterior circulation stroke?

A
  • hempiplegia
  • homonomous hemianopia
  • cortical signs
39
Q

Symptoms of a posterior circulation stroke?

A
  • cranial nerve palsies
  • isolated homonomous hemianopia
  • ipsilateral cerebellar deficits
40
Q

Investigations for a stroke?

A
  • carotid doppler
  • ct angiogram
  • MRI
41
Q

What is associated with atrial fibrillation?

A
  • cardioembolism

- infarction stroke

42
Q

Why is there increased stroke risk in patent foramen ovale

A
  • clots from venous circulation can enter the arterial circulation
43
Q

Potential intervention for significant stenosis of the carotid artery?

A
  • carotid endarterectomy
44
Q

Ageing consequences on the bladder?

A
  • decrease in bladder capacity
  • decrease in urethral closure pressure
  • increase in post void residual volume
  • increase in detrusor overactivity
45
Q

Transient causes of incontinence

A

(DIAPERS)

  • Delirium
  • Infection
  • Atrophic vaginitis
  • Psychological
  • Pharmacological
  • Endocrine
  • Restricted mobility
  • Stool impaction
46
Q

Define urge incontinence?

A
  • involuntary leakage associated with urgency
47
Q

Define stress incontinence

A
  • involuntary leakage on effort
48
Q

Define mixed incontinence

A
  • involuntary leakage associated with urgency and esertion
49
Q

Define overflow incontinence

A
  • leakage owing to bladder outflow obstruction resulting in large post-void volume
  • constipation
50
Q

Define functional incontinence

A
  • incontinence resulting from an inability to reach the toilet in time
  • poor mobility
  • cognitive impairment
51
Q

Taking a history of incontience should include

A
  • voiding symptoms
  • storage symptoms
  • precipitants
  • red flags
  • bowel symptoms
  • fluid intake
52
Q

Red flags in incontinence?

A
  • haematuria

- recurrent UTI

53
Q

When should urinalysis be performed in incontience?

A
  • only if result will change the management plan
54
Q

Investigations for incontinence

A
  • bladder diary
  • bladder scanning
  • urodynamic studies
55
Q

Non-pharma management of incontinence

A
  • lifestyle (caffeine, alcohol, weight)
  • pelvic floor exercises
  • bladder training
56
Q

Pharmacological management of incontinence?

A
  • tolterodine (antimuscarinic)
  • solifenacin
  • mirabegron
57
Q

Consider what drug for nocturia?

A
  • desmopressin

- check sodium

58
Q

What can be prescribed for incontinence associated with atrophic vaginitis?

A
  • vaginal oestrogens

Medicine for the elderly (4 decks)

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