COOP

Question 1

Name nine risk factors for stroke

Answer 1

HTN, smoking, lifestyle, alcohol, high cholesterol, AF, obesity, DM, severe carotid stenosis

Question 2

What are the two main types of ischaemic stroke?

Answer 2

Thrombotic and embolic

Question 3

Besides ischaemia and haemorragia, name three other causes of stroke

Answer 3

Arterial dissection
Venous sinus thrombosis
Vasculitis

Question 4

What scoring system is used to assess a patient’s risk of a subsequent stroke after a TIA?

Answer 4

ABCD2
Age >60 (1), BP s>140 or d>90 (1)
Clinical features - unilateral weakness (2), just speech disturbance (1)
Duration - >60mins (2), 10-59 (1)
Diabetes (1)

Question 5

What investigations should you do following a TIA?

Answer 5

Doppler of internal carotid stenosis,
Cardiac echo,
ECG and 24hr tape
CT/MRI brain including angiography

Question 6

Which scoring system is used to assess the risk of stroke in a patient with non-rheumatic AF

Answer 6

CHA2DS2-VASc

Question 7

Definition of a stroke

Answer 7

Syndrome of acute/rapid onset causing focal deficit lasting >24hrs due to a vascular cause

Question 8

What is the definition of delirium?

Answer 8

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

Question 9

What are the two types of delirium?

Answer 9

hyperactive - heightened arousal and can be restless, agitated and aggressive
hypoactive - withdrawn, quiet and sleepy

Question 10

What are the five main complications of delirium?

Answer 10

longer stay in hospital or in critical care
have an increased incidence of dementia
have more hospital-acquired complications eg falls and pressure sores
be more likely to need to be admitted to long-term care if they are in hospital
High mortality risk

Question 11

What are the main risk factors for delirium?

Answer 11

Age >65
Cognitive impairment (past or present) and/or dementia
Current hip fracture
Severe illness

Question 12

What 10 things should be addressed to reduce the chances of delirium?

Answer 12

Cognitive impairment/disorientation, dehydration/constipation, hypoxia, infection, immobility/reduced mobility, pain, medication review, poor nutrition, sensory impairments, sleep hygiene

Question 13

What are the geriatric Giants?

Answer 13

Impaired memory/cognition (delirium/dementia)
Incontinence
Immobility and instability
Iatrogenesis
Inanition (exhaustion due to lack of food and water)

Question 14

What are the main characteristics of frailty?

Answer 14

Unintentional weight loss
Weakness evidenced by poor grip strength
Self reported exhaustion
Slow walking speed
Low level of physical activity

Question 15

Main causes of delirium

Answer 15

Drugs, electrolyte imbalance, low output states, infection, retention, Ictal, under nourished/hydrated, metabolic

Question 16

How do you screen for delirium?

Answer 16

CAM - confusion assessment method - 1 + 2 + 3/4 (AIDA)
1 - A- Acute and fluctuating
2 - I- Inattention
3 - D- Disorganized thinking: incoherent, rambling
4 - A - Altered level of consciousness: drowsy, lethargic, stuporous, hyper-alert, agitated

Question 17

What three things are needed for a safe discharge for a patient with ?delirium

Answer 17

1) The delirium to be identified
2) AND a single, clear, and reversible etiology to be identified
3) AND the presence and understanding of family or friends who can observe the patient until the delirium resolves.

Question 18

What is the pharmacological management of delirium and when would you consider using it?

Answer 18

for severe agitation that prevents therapy or puts the patient or others at risk
Haloperidol but be careful in Parkinson’s patients!
Olanzapine can also be used but more anti-cholinergic side effects

Question 19

What is involved in a Mini-Cog assessment

Answer 19

3-item recall test with a clock-drawing test (CDT).

Question 20

What do you want to establish in a safe discharge of a dementia patient?

Answer 20

RISKS:
Roaming /wandering;
Imminent danger – falls or fire-setting ;
Suicidal ideation ;
Kinship and relationships (elder abuse/adequate social support) ;
Safe driving Substance misuse, Self neglect,