COOP Flashcards
1
Q
supplies ant wall + ant septum of LV
A
LADA
2
Q
LADA supplies
A
ant wall + ant septum of LV
3
Q
most commonly involved artery in MI
A
LADA > RCA > LCA
4
Q
LADA > RCA > LCA
A
most commonly involved artery in MI
5
Q
Bamford classification of stroke classes
A
TACS, PACS, POCS, LACS
6
Q
TACS, PACS, POCS, LACS
A
Banford classification fo stroke classes
7
Q
TACS
A
alll of: ux weakness (+/- sensory deficit) of face, arm + leg, HH, higher cerebral dysfunction (dysphasia, visiospatial disorder)
8
Q
alll of: ux weakness (+/- sensory deficit) of face, arm + leg, HH, higher cerebral dysfunction (dysphasia, visiospatial disorder)
A
TACS
9
Q
PACS
A
2/3 of: ux weakness (+/- sensory deficit) of face, arm + leg, HH, higher cerebral dysfunction (dysphasia, visiospatial disorder)
10
Q
2/3 of: ux weakness (+/- sensory deficit) of face, arm + leg, HH, higher cerebral dysfunction (dysphasia, visiospatial disorder)
A
PACS
11
Q
POCS
A
1/3 of: cerebellar/brainstem S, LOC, isolated HH
12
Q
1/3 of: cerebellar/brainstem S, LOC, isolated HH
A
POCS
13
Q
LACS
A
1/3 of: ux weakness (+/- sensory deficit) of face + arm/arm + leg/all 3, pure sensory, ataxic hemiparesis
14
Q
1/3 of: ux weakness (+/- sensory deficit) of face + arm/arm + leg/all 3, pure sensory, ataxic hemiparesis
A
LACS
15
Q
most common type of dementia
A
AD
16
Q
second most comon type of dementia
A
vascular
17
Q
symptoms of vascular dementia
A
cognitive impairment, functional deficits, mood disturbances, mood disorders, psychosis, delusions, hallucinations, paranoia, depression, psychomorot retatrdation, emotional lability
18
Q
cognitive impairment, functional deficits, mood disturbances, mood disorders, psychosis, delusions, hallucinations, paranoia, depression, psychomorot retatrdation, emotional lability may be symptoms of
A
vascular dementia
19
Q
ADLs to ask about in a older person Hx
A
mobility, aids, appliances, washing, dressing, eating, drinking, shoppping, cooking, cleaning
20
Q
areas to review on older person Hx
A
PMH, DH concordance, SH, cognitive funtion, mood, functional ability (ADLs), environment, economic situation, collateral Hx
21
Q
rehabilitation can be for
A
falls, arthritis, PD, stroke, chronic L DZ, fraility, long-term care home residents
22
Q
rehabilitation can be provided by
A
nurses, support staf, Drs, PTs, OTs, SALTs, social workers
23
Q
rehabilitation goals should be
A
SMART
24
Q
SMART stands for
A
specific, measureable, achievable, relevant, t limited
25
Barthel Index is used for
measuring level of dependence
26
Barthel Index categories are
feeding, bathing, grooming (face, hair, teeth), dressing, bowels, bladder, toilet, transfer from bed to chair, walking, stairs
27
gait assessment tools
timed unsupported stand, timed walk, timed get up and go
28
timed unsupported stand test includes
stand unsupported + observe for 1 min
29
timed walk test includes
walk 10m, time, repeat measurements to assess progress
30
timed get up and go test includes
rise from chair, walk 3m, turn around, sit down on chair
31
timed get up and go test assesses
functional mobility
32
timed get up + go test results
<20 seconds = adequate for independent transfers + mobility
| >30 seconds indicated higher dependence + risk of falls
33
used to measure level of dependence
Barthel Index
34
timed unsupported stand, timed walk, timed get up and go are used to assess
gait
35
stand unsupported + observe for 1 min is called
timed unsupported test
36
walk 10m, time, repeat measurements to assess progress is called
timed walk test
37
rise from chair, walk 3m, turn around, sit down on chair is called
timed get up + go test
38
functional mobility can be assessed by using the
timed get up + go test
39
risks of a long lie
dehydration, hypothermia, P sores, pneumonia, anxiety
40
fall causes in the elderly
acute illness, stroke, infection, medication, anaemia, postural hypotension, cardiac, hypo/hyperglycaemia
41
recurrent falls causes
intrinsic: m weakness, balance problems, poor vision, cognitive impairment
extrinsic: polypharmacy, environmental hazzards
42
falls risk factors categories
social + demographic, age-related changes, poor gait + balance, medical problems, medicaiton, environmental factors
43
examples of social + demographic risk factors for falls
age, living alone, previous falls, limited ADLs
44
examples of age-realted change risk factors for falls
reduced ability to discriminate edges, reduced peripheral sensation, slower reaction times, m weakness
45
medical problems risk factors for falls
cognitive impairment, PD, CVD, eye DZs that reduce acquity, arthritis, foot problems, peripheral neuropathy, incontinence
46
medications that are risk factors for falls in the elderly
antidepressants, antihypertensives, polypharmacy
47
environmental factors that are risk factors for falls in the elderly
ill fitting footwear, bi/varifocal glasses
48
falls Hx
how many times have you fallen in the last 12/12, AMTS, DH
49
falls O/E
lying + standing BP, vision (cataracts, acquity, fields), CVS, get up + go test, neuro
50
falls Ix
ECG, tilt test, carotid sinus massage
51
how to measure lying + standing BP
lie for 5 mins, measure BP, stand + measure BP at 0, 3, 5 mins
52
postural hypotension is defined as
sBP drops by >20mmHg or diastolic >10mmHg
53
types of dizziness in the elderly
vertigo - sensation that room is moving
fuzzy all the time
lightheadedness/off balance/not right - on standing
54
lightheadedness causes
postural hypotension, acute illnes, DM, Addison's
55
vertigo causes
BPPV, vestibular neuronitis, Meniere's S, decompensated vestibular disorder
56
BPPV is
brief vertigo (seconds) on turning head
57
vestibular neuronitis is
acute onset, days of vertigo, ?recent viral
58
Meniere's S is
recurrent episodes of vertigo mins - hours, HL, tinnitus, fullness of ear(s)
59
decompensated vestibular disorder is
brief vertigo on turning head, disequilibrium, unsteadiness
60
decompensated vestibular disorder is caused by
previous stroke, vestibular neuronitis, Meniere's S which has never fully recovered
61
causes of Meniere's S
idiopathic, 2' to AI DZ or hypothyroidism
62
causes of feeling fuzzy all the time
diffuse cerebrovascular DZ, medication
63
BPPV is diagnosed by
Dix-Hallpike manoeuvre
64
BPPV is treated by
Epley manoeuvre
65
dehydration, hypothermia, P sores, pneumonia, anxiety are risks of
a long lie
66
lie for 5 mins, measure BP, stand + measure BP at 0, 3, 5 mins
how to measure lying + standing BP
67
sBP drops by >20mmHg or diastolic >10mmHg
postural hypotension
68
postural hypotension, acute illnes, DM, Addison's can cause
lightheadednessq
69
BPPV, vestibular neuronitis, Meniere's S, decompensated vestibular disorder can cause
vertigo
70
brief vertigo (seconds) on turning head
BPPV
71
acute onset, days of vertigo, ?recent viral
vestibular neuronitis
72
recurrent episodes of vertigo mins - hours, HL, tinnitus, fullness of ear(s)
Meniere's DZ
73
brief vertigo on turning head, disequilibrium, unsteadiness
decompensated vestibular disorder
74
previous stroke, vestibular neuronitis, Meniere's S which has never fully recovered can cause
decompensated vestibular disorder
75
idiopathic, 2' to AI DZ or hypothyroidism can cause
Meniere's DZ
76
diffuse cerebrovascular DZ, medication can cause
a feeling of fuzziness all the time
77
Dix-Hallpike manoeuvre is used to
diagnose BPPV
78
Eplay manoeuvre is used to
treat BPPV
79
polypharmacy is
> 5 medications
80
drugs that can cause worsening confusion in dementia
BZD, antimuscarinics, some anticonvulsants, levodopa
81
drugs that can worsen symptoms in PD
antimuscarinics
82
drugs that can worsen movement disorder in PD
metoclopramide
83
drugs that can reduce seizure threashold in seizure disorder/epilepsy
ABx, analgesics, antidepressants, antipsychotics, theophylline, EtOH
84
drugs that can worsen glaucoma
antimuscarinics
85
drugs that can cause bronchospasm in COPD/asthma
B-blockers
86
drugs that can cause resp depression in COPD/asthma
BZD
87
drugs that can worsen HF
diltiazem, verapamil, NSAIDs
88
drugs that can worsen HTN
NSAIDs, pseudoephedrine
89
drugs that can cause postural hypotension
antihypertensives
90
drugs that can cause falls in orthostatic hypotension
diuretics, TCA, levodopa
91
drugs that can cause bradycardia, heart block, prolonged QTc in cardiac conduction disorders
B-blockers, digoxin, diltiazem, verapamil, amiodarone, TCA
92
drugs that can cause intermittant claudication in peripheral arterial DZ
B-blockers
93
drugs that can cause cardiac arrhythmias in hypokalaemia
digoxin
94
drugs that can cause upper GI haemorrhage in peptic ulcer DZ
NSAIDs, anticoagulants
95
drugs that can cause worsening hyponatraemia
diuretics
96
drugs that may cause/exacerbate SIADH
TCA, carbamazepine
97
drugs that can cause AKI in renal CKD
NSAIDs, ABx
98
drugs that can cause urinary retention in BOO/BPH
antimuscarinics, a-blockers
99
drugs that cause polyuria in urinary incontinence
a-blockers
100
drugs that cause worsening stress incontinence
antimuscarinics, BZD, diuretics, TCA
101
drugs that cause worsening constipation
antimuscarinics, CaCh antagonists, TCA, opioids
102
drugs that cause accelerated osteoporosis
steriods, EZ inducing drugs
103
drugs that can cause confusion/affect memory
antipsychotics, BZDs, antimuscarinics, opioids, some anticonvulsants
104
drugs with a narrow therapeutic window
digoxin, Li, phenytoin, theophylline, warfarin
105
drugs with long t1/2
long acting BZD, fluoxetine, glibenclamide
106
drugs that can cause hypothermia
antipsychotics, TCA
107
drugs that can cause PD/movement disorders
metoclopramide, antipsychotics, stemetil
108
drugs that can cause bleeding
NSAIDs, warfarin
109
drugs that predispose to falls
antipsychotics, sedatives, a-blockers, nitrates, ACEi, diuretics, antidepressants
110
information to give when starting a new medication
name, purpose, dose, when to take, common SE, how long to take for, other warnings
111
> 5 medications is
polypharmacy
112
antipsychotics, BZDs, antimuscarinics, opioids, some anticonvulsants can
cause confusion/affect memory
113
digoxin, Li, phenytoin, theophylline, warfarin all have
a narrow therapeutic window
114
long acting BZD, fluoxetine, glibenclamide all have
a long t1/2
115
antipsychotics, TCA can cause
hypothermia
116
metoclopramide, antipsychotics, stemetil can cause
movement disorder/PD
117
NSAIDs, warfarin can cause
bleeding
118
antipsychotics, sedatives, a-blockers, nitrates, ACEi, diuretics, antidepressants predispose to
falls
119
treat someone against their wishes in an emergency/life-threatening situation under
common law
120
assess someone's ability to refuse medical treatment when you have reason to believe that theIr cognition is affected
MCA
121
assess someone's ability to make decisions regarding their MH condition
MHA
122
common law is used to
treat someone against their wishes in an emergency/life-threatening situation under
123
MCA is used to
assess someone's ability to refuse medical treatment when you have reason to believe that theIr cognition is affected
124
MHA is used to
assess someone's ability to make decisions regarding their MH condition
125
delirium factors for diagnosis
acute onset, disturbance of consciousness, impaired cognition/perceptual disturbance (not due to pre-existong dementia), clinical evidence of acute general medical condition/intoxication/substance withdrawal
126
two main patterns of delirium
```
hyperactive = agitated + wandering
hypoactive = quiet + withdrawn
```
127
predisposing factors for delirium
old age, severe illness, dementia, physical frailty, admission with infection/dehydration, visual/hearing impairment, polypharmacy, Sx, EtOH excess, renal impairment
128
precipitating factors for delirium
immobility, use of physical restraint, urinary catheter, GA, malnutrition, psychoactive meds, intercurrent illness, dehydration, BZD/EtOH withdrawal
129
delirium DD
dementia, depression, hysteria, mania, schizophrenia, dysphasia, seizures
130
AMTS
1. how old are you? 2. what is your DOB? 3. what time is it? (nearest h) 4. addres for recall 5. what year is it? 6. where are we? 7. identify 2 people 8. when did WW1 start? 9. name of current Monarch? 10. count 20-1
131
N AMTS score
8+
132
tool used to screen for delirium
Confusion Assessment Method (CAM)
133
Confusion Assessment Method (CAM) components
1. presence of acute onset + fluctuating course
2. inattention (e.g. counting 20-1)
3. disorganised thinking/altered level of consciousness
134
common causes of delirium
infection (urine, chest, biliary), acute hypoxaemia, electrolyte imbalance, medication, MI, EtOH/BZD withdrawal, urinary retention, faecal impaction, stroke, subdural haematoma, seizures, post-op cognitive dysfunction
135
common drug groups causing delirium in older PTs
opioids, anticholinergics, BZD, corticosteroids
136
1st line Ix in delirium
FBC, CRP, U+E, Ca, TFT, LFT, glucose, CXR, ECG, O2 sats, urinalysis
137
2nd line delirium Ix
ABG, CT head, EEG, cultures
138
complications of delirium
falls, P sores, noscomisal infections, functional impairment, incontinence, over-sedation, malnutrition
139
acute onset, disturbance of consciousness, impaired cognition/perceptual disturbance (not due to pre-existong dementia), clinical evidence of acute general medical condition/intoxication/substance withdrawal are components required for
delirium diagnosis
140
old age, severe illness, dementia, physical frailty, admission with infection/dehydration, visual/hearing impairment, polypharmacy, Sx, EtOH excess, renal impairment are predisposing factors for
delirium
141
immobility, use of physical restraint, urinary catheter, GA, malnutrition, psychoactive meds, intercurrent illness, dehydration, BZD/EtOH withdrawal are precipitating factors for
delirium
142
Confusion Assessment Method (CAM) is used to screen for
delirium
143
opioids, anticholinergics, BZD, corticosteroids can commonly cause
delirium
144
falls, P sores, noscomisal infections, functional impairment, incontinence, over-sedation, malnutrition are complications of
delirium
145
memory imparment causes in the elderly
```
dementia = >6/12, short term memory loss
depression = global memory imparment, biological symptoms, worry RE poor memory
delirium = acute
```
146
N P hydrocephalus triad
dementia, urinary incontinence, ataxia
147
dementia, urinary incontinence, ataxia is the triad of
N P hydrocephalus
148
dementia definition
acquired, global, progressive impairment of mental function
149
higher cognitive funcitons impaired in dementia
memory, thinking, orientation, comprehension, calculation, learning capacity, language, judgement
150
indication for CT head in dementia
early onset, rapid unexplained deterioration, neuro sign/symptom, recent head injury, urinary incontinence/gait apraxia early on in illness (?N P hydrocephalus), atypical presentation
151
dementia Ix
FBC, U+E, glucose, LFT, Ca, ESR, vit B12, folate, TFT
152
acquired, global, progressive impairment of mental function is the definition of
dementia
153
medications used in LBD
donepezil = for cognitive impairment + behavioural symptoms, carbidopa/levodopa = motor symptoms, clonazepam = REM sleep behaviour disorders, sertraline = for depression in LBD
154
LBD pathology
a-synuclein (Lewy bodies) in the substantia nigra, paralimbic + neocortical regions
155
avoid in LBD
neuroleptics e.g. antipsychotics
156
features of LBD
progressive cognitive impairment, parkinsonianism, visual hallucinations
157
a-synuclein (Lewy bodies) in the substantia nigra, paralimbic + neocortical regions
LBD
158
progressive cognitive impairment, parkinsonianism, visual hallucinations
LBD
159
Alzheimer's DZ macroscopic changes
widespread cereral atrophy, involving the cortex + hippocampus
160
Alzheimer's DZ microscopic changes
cortical plaques, deposition of B-amyloid, neurofibrillary tangles, abnormal aggregation of tau-protein
161
Alzheimer's DZ biochemical changes
deficit of acetylcholine
162
Alzheimer's DZ Mx
acetylcholinesterase i (donepezil, galantamine, rivastigmine) for mild - moderate AD, memantine (NMDA R antagonist) for severe AD
163
widespread cereral atrophy, involving the cortex + hippocampus
AD
164
cortical plaques, deposition of B-amyloid, neurofibrillary tangles, abnormal aggregation of tau-protein
AD
165
deficit of acetylcholine
AD
166
acetylcholinesterase i (donepezil, galantamine, rivastigmine) for mild - moderate, memantine (NMDA R antagonist) for severe
AD
167
pellagra d's
dementia, dermatitis (sun exposed), diarrhoea, depression, death (if untreated)
168
cause of pellagra
nicotinic acid deficiency
169
pellagra may present as a consequence of
isoniazid therapy, alcoholism
170
dementia, dermatitis, diarrhoea, depression may indicate
pellagra
171
nicotinic acid deficiency causes
pellagra
172
multiple systems atrophy features
parkinsonianisms, autonomic disturbance (atonic bladder, hypotension), cerebellar signs
173
parkinsonianisms, autonomic disturbance (atonic bladder, hypotension), cerebellar signs are features of
multiple systems atrophy
174
two main types of stroke
haemorrhagic, ischaemic
175
clinical features of stroke
suden onset, focal neurological deficit
176
TIA resolves w/i
24h
177
haemodynamic contributors to haemorrhagic stroke
chronic arterial HTN, acute arteria HTN, amphetamines, cocaine, post-carotid endarterectomy
178
anatomical contributors to haemorrhagic stroke
sm vessel DZ, cerebral amyloid angiopathy, cerebral aneurysm, AVM, cerebral venous thrombosis, mycotic emboli/aneurysms
179
coagulopathic contributors to haemorrhagic stroke
anticoagulation, thrombolysis, antiplatelet drugs
180
stroke DD
seizure, sepsis, cerebral tumour, subdural haemorrhage, EtoH intoxication, migraine, inner ear DZ, transient global amnesia, cervical spondylosis + nerve entrapment, functional disorder
181
scoring system for stroke/TIA
ABCD2
182
ABCD2
age > 60, BP >140/90, clinical features: ux weakness (2), speech alone (1), duration: >60 (2), >10 (1), DM
183
ABCD2 results mean
0-3 low risk, 4-5 moderate risk, 6+ high risk
184
stroke risk factors
HTN, smoking, DM, AF, hyperlipidaemia, previous stroke/TIA, lifestyle, diet, peripheral arterial DZ, IHD, male, age
185
neuro post-stroke complications
progression/stroke completion, further stroke, haemorrhaginc transformation, cerebral oedema, seizure, hydrocephalus
186
non-neurological post-stroke complications
sepsis (urinary, aspiration pneumonia), electrolyte disturbances, hyper/hypoglycaemia, dehydration, PE, cardiac arrhythmia
187
1st lin Ix for stroke
FBC, clotting, U+E, glucose, cholesterol, ESR, ECG, CT head
188
in ischaemic stroke give
altepase
189
give altepase in ischaemic stroke w/i
4.5h
190
post-ischaemic stroke medication
aspirin 300mg for 14/7, then reduce to 75mg, anti-HTN (wait 7/7), statin, smoking cessation, diet, lifestyle
191
AF induced stroke + anticoagulation
wait until 14/7 post-stroke
192
carotid endarterectomy for stenosis >
70%
193
suden onset, focal neurological deficit
stroke
194
altepase
given w/i 4.5hrs in ischaemic stroke
