conditions across the lifespan

Question 1

what are the physiological changes with increasing ageing

Answer 1

Physiological decline happens across all body systems
Less stable internal environment
Reduced homeostasis
Less physiological reserve
Increasing the risk of illness
Endpoint = Frailty

Question 2

what are the atypical presentations

Answer 2

Immobility
instability
intellectual impairment
incontinence
latrogenic

Question 3

what is immobility

Answer 3

Immobility is the state of not being able to move around and can include ‘Can’t get up’, ‘can’t walk’, ‘generally weak’, ‘off legs, Medication side effects, pain and lack of mobility aid

Question 4

what is instability/falls in ageing

Answer 4

⅓ adults over 65 who live at home will have at least one fall a year, and ½ of these will have more frequent falls
Acute illness
Age-related changes: sarcopenia, visual impairment, balance
Medical conditions: MSK, cardiac, neuropathy, stroke, Parkinsons
these factors can result in fractures, other injuries, fear of falling

Question 5

what is intellectual impairment delirium

Answer 5

Common clinical syndrome characterised by disturbed consciousness, cognitive function or perception, which has an acute onset and fluctuating course

Question 6

what can be the causes of delirium

Answer 6

Acute illness e.g. infection
Medication changes – newly started, omitted/withdrawal
Dehydration
Constipation
Electrolyte imbalance
Pain
Change in environment

Question 7

what is incontinence

Answer 7

Urge – sudden/intense desire to pass urine
stress – urine leaks when bladder under pressure
Overflow – with urine retention
Functional – can’t get to toilet/commode

Question 8

what are the consequences

Answer 8

Damage to skin
Infection
Embarrassment
social isolation

Question 9

what are Latrogenic - polypharmacy

Answer 9

Increased risk of adverse drug reactions
10% of older people at time of acute admission

Medication review is essential
Beware of prescribing cascade

Always consider non compliance – we may start ‘regular’ meds that the patient hasn’t been taking - can cause issues

Question 10

What are the increased risk of hypothermia

Answer 10

Impaired vasodilation and vasoconstriction (reduced SNS activity)
Reduced subcutaneous fat – less insulation from heat loss
Reduced shivering (sarcopenia)
Reduced number of cells in hypothalamus, reduced sensitivity to feedback
Chronic diseases –e.g. hypothyroid, malnutrition
Medications - Beta-blockers, sedatives
Cognitive impairment
Social isolation

Question 11

what to do with a skin tear

Answer 11

Clean wound – reduce risk of infection
Do not remove flap

Question 12

what is skin tears

Answer 12

can become complicated chronic wounds leading to prolonged healing, pain and distress.
Caused by a shear/ friction
Partial thickness (separation of epidermis from dermis) or full thickness (separation of epidermis & dermis from underlying structures)

Question 13

what is pressure sores

Answer 13

when the soft tissue gets squeezed between a firm spot and something external to your body. The area of damage is the pressure ulcer or sore

Question 14

what is mental state examination MSE

Answer 14

Appearance and Behaviour
Speech
Mood
Thoughts
Cognition
Perceptions
Insight

Question 15

what does appearance include

Answer 15

Physical characteristics of patient
Dress - appropriate for the weather?
Self care – well kempt, malodorous?

Question 16

what does behavior include

Answer 16

Eye contact
Body language
Calm or agitated?
Engaging or distracted
Reactions to you and others, eg. warm and open, hostile and guarded, frightened and avoidant
Rapport

Question 17

what does speech include

Answer 17

Volume - how loud?
Rate - how fast?
Rhythm and Tone - how the tone changes?
Quality – mention if there is stutter or stammer etc
Spontaneity - is there is need for prompting and a series of closed questions?
Appropriate speech?
Interruptions, sudden silences, frequent changes of topic

Question 18

What does mood and affect include

Answer 18

Subjective mood: how the patient describes their mood
Objective mood: what you observe their mood to be
Affect is the patient’s changing emotional tone during the interview, as the interviewer perceives it
Observing their facial expressions, body movements, posture and tone of voice
Flat
Blunted
Reactive

Question 19

What does thoughts include form vs consent

Answer 19

Form - Are thoughts structured A-B (linear and goal oriented) – normal
Scattered, illogical (Knight’s move thinking)

Consent - What are the ideas/thoughts – delusions, obsessions, repetitive/intrusive, suicidal

Question 20

what is perception

Answer 20

Hallucinations: Auditory, visual, or olfactory, gustatory or tactile
Illusions
Déjà vu and Jamais vu
Depersonalisation –person feels as if they’re ‘unreal’
Derealisation – person feels as if the world is ‘unreal’

Question 21

what is cognition

Answer 21

Memory and concentration
Simple assessment of alertness, orientation & attention
Further exploration with structured cognitive assessments may be needed
MMSE

Question 22

what is insight

Answer 22

Does patient believe they may have a mental health problem?
Patient’s understanding of any problems
Patient’s beliefs about treatment
Response to clinician’s view of diagnosis and recommended treatment
Willingness to engage with plan

Question 23

What is the physiologocial difference in bariatric care

Answer 23

Airway
Breathing
Circulation
Disability

Question 24

Airway

Answer 24

putting blankets,towels or pillows under shoulder head to get the eat to sternal notch alignment ramping

Question 25

Breathing

Answer 25

Obesity increases O2 demand and CO2 production, increases the mechanical work of breathing, increases upper airway resistance, and decreases functional reserve capacity, resulting in the closure of peripheral airways and atelectasis.

Question 26

what is hypoxemia and hypoxia

Answer 26

Hypoxemia isa below-normal level of oxygen in your blood, specifically in the arteries.

Hypoxia isa state in which oxygen is not available in sufficient amounts at the tissue level to maintain adequate homeostasis

Question 27

circulation

Answer 27

Arteries have less room to expand under pressure, which in turn adds to hypertension
Difficult to locate anatomical landmarks due to extra tissue
ECG interpretation is a speciality in morbidly obese patients, commonly see a left vector shift and ventricular hypertrophy.