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Medicine > COOP > Flashcards

COOP Flashcards

1
Q

supplies ant wall + ant septum of LV

A

LADA

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2
Q

LADA supplies

A

ant wall + ant septum of LV

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3
Q

most commonly involved artery in MI

A

LADA > RCA > LCA

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4
Q

LADA > RCA > LCA

A

most commonly involved artery in MI

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5
Q

Bamford classification of stroke classes

A

TACS, PACS, POCS, LACS

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6
Q

TACS, PACS, POCS, LACS

A

Banford classification fo stroke classes

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7
Q

TACS

A

alll of: ux weakness (+/- sensory deficit) of face, arm + leg, HH, higher cerebral dysfunction (dysphasia, visiospatial disorder)

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8
Q

alll of: ux weakness (+/- sensory deficit) of face, arm + leg, HH, higher cerebral dysfunction (dysphasia, visiospatial disorder)

A

TACS

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9
Q

PACS

A

2/3 of: ux weakness (+/- sensory deficit) of face, arm + leg, HH, higher cerebral dysfunction (dysphasia, visiospatial disorder)

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10
Q

2/3 of: ux weakness (+/- sensory deficit) of face, arm + leg, HH, higher cerebral dysfunction (dysphasia, visiospatial disorder)

A

PACS

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11
Q

POCS

A

1/3 of: cerebellar/brainstem S, LOC, isolated HH

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12
Q

1/3 of: cerebellar/brainstem S, LOC, isolated HH

A

POCS

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13
Q

LACS

A

1/3 of: ux weakness (+/- sensory deficit) of face + arm/arm + leg/all 3, pure sensory, ataxic hemiparesis

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14
Q

1/3 of: ux weakness (+/- sensory deficit) of face + arm/arm + leg/all 3, pure sensory, ataxic hemiparesis

A

LACS

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15
Q

most common type of dementia

A

AD

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16
Q

second most comon type of dementia

A

vascular

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17
Q

symptoms of vascular dementia

A

cognitive impairment, functional deficits, mood disturbances, mood disorders, psychosis, delusions, hallucinations, paranoia, depression, psychomorot retatrdation, emotional lability

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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

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19
Q

ADLs to ask about in a older person Hx

A

mobility, aids, appliances, washing, dressing, eating, drinking, shoppping, cooking, cleaning

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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

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21
Q

rehabilitation can be for

A

falls, arthritis, PD, stroke, chronic L DZ, fraility, long-term care home residents

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22
Q

rehabilitation can be provided by

A

nurses, support staf, Drs, PTs, OTs, SALTs, social workers

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23
Q

rehabilitation goals should be

A

SMART

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24
Q

SMART stands for

A

specific, measureable, achievable, relevant, t limited

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25
Q

Barthel Index is used for

A

measuring level of dependence

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26
Q

Barthel Index categories are

A

feeding, bathing, grooming (face, hair, teeth), dressing, bowels, bladder, toilet, transfer from bed to chair, walking, stairs

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27
Q

gait assessment tools

A

timed unsupported stand, timed walk, timed get up and go

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28
Q

timed unsupported stand test includes

A

stand unsupported + observe for 1 min

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29
Q

timed walk test includes

A

walk 10m, time, repeat measurements to assess progress

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30
Q

timed get up and go test includes

A

rise from chair, walk 3m, turn around, sit down on chair

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31
Q

timed get up and go test assesses

A

functional mobility

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32
Q

timed get up + go test results

A

<20 seconds = adequate for independent transfers + mobility

>30 seconds indicated higher dependence + risk of falls

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33
Q

used to measure level of dependence

A

Barthel Index

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34
Q

timed unsupported stand, timed walk, timed get up and go are used to assess

A

gait

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35
Q

stand unsupported + observe for 1 min is called

A

timed unsupported test

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36
Q

walk 10m, time, repeat measurements to assess progress is called

A

timed walk test

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37
Q

rise from chair, walk 3m, turn around, sit down on chair is called

A

timed get up + go test

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38
Q

functional mobility can be assessed by using the

A

timed get up + go test

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39
Q

risks of a long lie

A

dehydration, hypothermia, P sores, pneumonia, anxiety

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40
Q

fall causes in the elderly

A

acute illness, stroke, infection, medication, anaemia, postural hypotension, cardiac, hypo/hyperglycaemia

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41
Q

recurrent falls causes

A

intrinsic: m weakness, balance problems, poor vision, cognitive impairment
extrinsic: polypharmacy, environmental hazzards

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42
Q

falls risk factors categories

A

social + demographic, age-related changes, poor gait + balance, medical problems, medicaiton, environmental factors

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43
Q

examples of social + demographic risk factors for falls

A

age, living alone, previous falls, limited ADLs

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44
Q

examples of age-realted change risk factors for falls

A

reduced ability to discriminate edges, reduced peripheral sensation, slower reaction times, m weakness

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45
Q

medical problems risk factors for falls

A

cognitive impairment, PD, CVD, eye DZs that reduce acquity, arthritis, foot problems, peripheral neuropathy, incontinence

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46
Q

medications that are risk factors for falls in the elderly

A

antidepressants, antihypertensives, polypharmacy

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47
Q

environmental factors that are risk factors for falls in the elderly

A

ill fitting footwear, bi/varifocal glasses

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48
Q

falls Hx

A

how many times have you fallen in the last 12/12, AMTS, DH

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49
Q

falls O/E

A

lying + standing BP, vision (cataracts, acquity, fields), CVS, get up + go test, neuro

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50
Q

falls Ix

A

ECG, tilt test, carotid sinus massage

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51
Q

how to measure lying + standing BP

A

lie for 5 mins, measure BP, stand + measure BP at 0, 3, 5 mins

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52
Q

postural hypotension is defined as

A

sBP drops by >20mmHg or diastolic >10mmHg

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53
Q

types of dizziness in the elderly

A

vertigo - sensation that room is moving
fuzzy all the time
lightheadedness/off balance/not right - on standing

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54
Q

lightheadedness causes

A

postural hypotension, acute illnes, DM, Addison’s

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55
Q

vertigo causes

A

BPPV, vestibular neuronitis, Meniere’s S, decompensated vestibular disorder

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56
Q

BPPV is

A

brief vertigo (seconds) on turning head

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57
Q

vestibular neuronitis is

A

acute onset, days of vertigo, ?recent viral

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58
Q

Meniere’s S is

A

recurrent episodes of vertigo mins - hours, HL, tinnitus, fullness of ear(s)

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59
Q

decompensated vestibular disorder is

A

brief vertigo on turning head, disequilibrium, unsteadiness

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60
Q

decompensated vestibular disorder is caused by

A

previous stroke, vestibular neuronitis, Meniere’s S which has never fully recovered

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61
Q

causes of Meniere’s S

A

idiopathic, 2’ to AI DZ or hypothyroidism

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62
Q

causes of feeling fuzzy all the time

A

diffuse cerebrovascular DZ, medication

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63
Q

BPPV is diagnosed by

A

Dix-Hallpike manoeuvre

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64
Q

BPPV is treated by

A

Epley manoeuvre

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65
Q

dehydration, hypothermia, P sores, pneumonia, anxiety are risks of

A

a long lie

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66
Q

lie for 5 mins, measure BP, stand + measure BP at 0, 3, 5 mins

A

how to measure lying + standing BP

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67
Q

sBP drops by >20mmHg or diastolic >10mmHg

A

postural hypotension

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68
Q

postural hypotension, acute illnes, DM, Addison’s can cause

A

lightheadednessq

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69
Q

BPPV, vestibular neuronitis, Meniere’s S, decompensated vestibular disorder can cause

A

vertigo

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70
Q

brief vertigo (seconds) on turning head

A

BPPV

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71
Q

acute onset, days of vertigo, ?recent viral

A

vestibular neuronitis

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72
Q

recurrent episodes of vertigo mins - hours, HL, tinnitus, fullness of ear(s)

A

Meniere’s DZ

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73
Q

brief vertigo on turning head, disequilibrium, unsteadiness

A

decompensated vestibular disorder

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74
Q

previous stroke, vestibular neuronitis, Meniere’s S which has never fully recovered can cause

A

decompensated vestibular disorder

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75
Q

idiopathic, 2’ to AI DZ or hypothyroidism can cause

A

Meniere’s DZ

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76
Q

diffuse cerebrovascular DZ, medication can cause

A

a feeling of fuzziness all the time

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77
Q

Dix-Hallpike manoeuvre is used to

A

diagnose BPPV

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78
Q

Eplay manoeuvre is used to

A

treat BPPV

79
Q

polypharmacy is

A

> 5 medications

80
Q

drugs that can cause worsening confusion in dementia

A

BZD, antimuscarinics, some anticonvulsants, levodopa

81
Q

drugs that can worsen symptoms in PD

A

antimuscarinics

82
Q

drugs that can worsen movement disorder in PD

A

metoclopramide

83
Q

drugs that can reduce seizure threashold in seizure disorder/epilepsy

A

ABx, analgesics, antidepressants, antipsychotics, theophylline, EtOH

84
Q

drugs that can worsen glaucoma

A

antimuscarinics

85
Q

drugs that can cause bronchospasm in COPD/asthma

A

B-blockers

86
Q

drugs that can cause resp depression in COPD/asthma

A

BZD

87
Q

drugs that can worsen HF

A

diltiazem, verapamil, NSAIDs

88
Q

drugs that can worsen HTN

A

NSAIDs, pseudoephedrine

89
Q

drugs that can cause postural hypotension

A

antihypertensives

90
Q

drugs that can cause falls in orthostatic hypotension

A

diuretics, TCA, levodopa

91
Q

drugs that can cause bradycardia, heart block, prolonged QTc in cardiac conduction disorders

A

B-blockers, digoxin, diltiazem, verapamil, amiodarone, TCA

92
Q

drugs that can cause intermittant claudication in peripheral arterial DZ

A

B-blockers

93
Q

drugs that can cause cardiac arrhythmias in hypokalaemia

A

digoxin

94
Q

drugs that can cause upper GI haemorrhage in peptic ulcer DZ

A

NSAIDs, anticoagulants

95
Q

drugs that can cause worsening hyponatraemia

A

diuretics

96
Q

drugs that may cause/exacerbate SIADH

A

TCA, carbamazepine

97
Q

drugs that can cause AKI in renal CKD

A

NSAIDs, ABx

98
Q

drugs that can cause urinary retention in BOO/BPH

A

antimuscarinics, a-blockers

99
Q

drugs that cause polyuria in urinary incontinence

A

a-blockers

100
Q

drugs that cause worsening stress incontinence

A

antimuscarinics, BZD, diuretics, TCA

101
Q

drugs that cause worsening constipation

A

antimuscarinics, CaCh antagonists, TCA, opioids

102
Q

drugs that cause accelerated osteoporosis

A

steriods, EZ inducing drugs

103
Q

drugs that can cause confusion/affect memory

A

antipsychotics, BZDs, antimuscarinics, opioids, some anticonvulsants

104
Q

drugs with a narrow therapeutic window

A

digoxin, Li, phenytoin, theophylline, warfarin

105
Q

drugs with long t1/2

A

long acting BZD, fluoxetine, glibenclamide

106
Q

drugs that can cause hypothermia

A

antipsychotics, TCA

107
Q

drugs that can cause PD/movement disorders

A

metoclopramide, antipsychotics, stemetil

108
Q

drugs that can cause bleeding

A

NSAIDs, warfarin

109
Q

drugs that predispose to falls

A

antipsychotics, sedatives, a-blockers, nitrates, ACEi, diuretics, antidepressants

110
Q

information to give when starting a new medication

A

name, purpose, dose, when to take, common SE, how long to take for, other warnings

111
Q

> 5 medications is

A

polypharmacy

112
Q

antipsychotics, BZDs, antimuscarinics, opioids, some anticonvulsants can

A

cause confusion/affect memory

113
Q

digoxin, Li, phenytoin, theophylline, warfarin all have

A

a narrow therapeutic window

114
Q

long acting BZD, fluoxetine, glibenclamide all have

A

a long t1/2

115
Q

antipsychotics, TCA can cause

A

hypothermia

116
Q

metoclopramide, antipsychotics, stemetil can cause

A

movement disorder/PD

117
Q

NSAIDs, warfarin can cause

A

bleeding

118
Q

antipsychotics, sedatives, a-blockers, nitrates, ACEi, diuretics, antidepressants predispose to

A

falls

119
Q

treat someone against their wishes in an emergency/life-threatening situation under

A

common law

120
Q

assess someone’s ability to refuse medical treatment when you have reason to believe that theIr cognition is affected

A

MCA

121
Q

assess someone’s ability to make decisions regarding their MH condition

A

MHA

122
Q

common law is used to

A

treat someone against their wishes in an emergency/life-threatening situation under

123
Q

MCA is used to

A

assess someone’s ability to refuse medical treatment when you have reason to believe that theIr cognition is affected

124
Q

MHA is used to

A

assess someone’s ability to make decisions regarding their MH condition

125
Q

delirium factors for diagnosis

A

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
Q

two main patterns of delirium

A 
hyperactive = agitated + wandering
hypoactive = quiet + withdrawn
127
Q

predisposing factors for delirium

A

old age, severe illness, dementia, physical frailty, admission with infection/dehydration, visual/hearing impairment, polypharmacy, Sx, EtOH excess, renal impairment

128
Q

precipitating factors for delirium

A

immobility, use of physical restraint, urinary catheter, GA, malnutrition, psychoactive meds, intercurrent illness, dehydration, BZD/EtOH withdrawal

129
Q

delirium DD

A

dementia, depression, hysteria, mania, schizophrenia, dysphasia, seizures

130
Q

AMTS

A
  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
Q

N AMTS score

A

8+

132
Q

tool used to screen for delirium

A

Confusion Assessment Method (CAM)

133
Q

Confusion Assessment Method (CAM) components

A
  1. presence of acute onset + fluctuating course
  2. inattention (e.g. counting 20-1)
  3. disorganised thinking/altered level of consciousness
134
Q

common causes of delirium

A

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
Q

common drug groups causing delirium in older PTs

A

opioids, anticholinergics, BZD, corticosteroids

136
Q

1st line Ix in delirium

A

FBC, CRP, U+E, Ca, TFT, LFT, glucose, CXR, ECG, O2 sats, urinalysis

137
Q

2nd line delirium Ix

A

ABG, CT head, EEG, cultures

138
Q

complications of delirium

A

falls, P sores, noscomisal infections, functional impairment, incontinence, over-sedation, malnutrition

139
Q

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

A

delirium diagnosis

140
Q

old age, severe illness, dementia, physical frailty, admission with infection/dehydration, visual/hearing impairment, polypharmacy, Sx, EtOH excess, renal impairment are predisposing factors for

A

delirium

141
Q

immobility, use of physical restraint, urinary catheter, GA, malnutrition, psychoactive meds, intercurrent illness, dehydration, BZD/EtOH withdrawal are precipitating factors for

A

delirium

142
Q

Confusion Assessment Method (CAM) is used to screen for

A

delirium

143
Q

opioids, anticholinergics, BZD, corticosteroids can commonly cause

A

delirium

144
Q

falls, P sores, noscomisal infections, functional impairment, incontinence, over-sedation, malnutrition are complications of

A

delirium

145
Q

memory imparment causes in the elderly

A 
dementia = >6/12, short term memory loss
depression = global memory imparment, biological symptoms, worry RE poor memory
delirium = acute
146
Q

N P hydrocephalus triad

A

dementia, urinary incontinence, ataxia

147
Q

dementia, urinary incontinence, ataxia is the triad of

A

N P hydrocephalus

148
Q

dementia definition

A

acquired, global, progressive impairment of mental function

149
Q

higher cognitive funcitons impaired in dementia

A

memory, thinking, orientation, comprehension, calculation, learning capacity, language, judgement

150
Q

indication for CT head in dementia

A

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
Q

dementia Ix

A

FBC, U+E, glucose, LFT, Ca, ESR, vit B12, folate, TFT

152
Q

acquired, global, progressive impairment of mental function is the definition of

A

dementia

153
Q

medications used in LBD

A

donepezil = for cognitive impairment + behavioural symptoms, carbidopa/levodopa = motor symptoms, clonazepam = REM sleep behaviour disorders, sertraline = for depression in LBD

154
Q

LBD pathology

A

a-synuclein (Lewy bodies) in the substantia nigra, paralimbic + neocortical regions

155
Q

avoid in LBD

A

neuroleptics e.g. antipsychotics

156
Q

features of LBD

A

progressive cognitive impairment, parkinsonianism, visual hallucinations

157
Q

a-synuclein (Lewy bodies) in the substantia nigra, paralimbic + neocortical regions

A

LBD

158
Q

progressive cognitive impairment, parkinsonianism, visual hallucinations

A

LBD

159
Q

Alzheimer’s DZ macroscopic changes

A

widespread cereral atrophy, involving the cortex + hippocampus

160
Q

Alzheimer’s DZ microscopic changes

A

cortical plaques, deposition of B-amyloid, neurofibrillary tangles, abnormal aggregation of tau-protein

161
Q

Alzheimer’s DZ biochemical changes

A

deficit of acetylcholine

162
Q

Alzheimer’s DZ Mx

A

acetylcholinesterase i (donepezil, galantamine, rivastigmine) for mild - moderate AD, memantine (NMDA R antagonist) for severe AD

163
Q

widespread cereral atrophy, involving the cortex + hippocampus

A

AD

164
Q

cortical plaques, deposition of B-amyloid, neurofibrillary tangles, abnormal aggregation of tau-protein

A

AD

165
Q

deficit of acetylcholine

A

AD

166
Q

acetylcholinesterase i (donepezil, galantamine, rivastigmine) for mild - moderate, memantine (NMDA R antagonist) for severe

A

AD

167
Q

pellagra d’s

A

dementia, dermatitis (sun exposed), diarrhoea, depression, death (if untreated)

168
Q

cause of pellagra

A

nicotinic acid deficiency

169
Q

pellagra may present as a consequence of

A

isoniazid therapy, alcoholism

170
Q

dementia, dermatitis, diarrhoea, depression may indicate

A

pellagra

171
Q

nicotinic acid deficiency causes

A

pellagra

172
Q

multiple systems atrophy features

A

parkinsonianisms, autonomic disturbance (atonic bladder, hypotension), cerebellar signs

173
Q

parkinsonianisms, autonomic disturbance (atonic bladder, hypotension), cerebellar signs are features of

A

multiple systems atrophy

174
Q

two main types of stroke

A

haemorrhagic, ischaemic

175
Q

clinical features of stroke

A

suden onset, focal neurological deficit

176
Q

TIA resolves w/i

A

24h

177
Q

haemodynamic contributors to haemorrhagic stroke

A

chronic arterial HTN, acute arteria HTN, amphetamines, cocaine, post-carotid endarterectomy

178
Q

anatomical contributors to haemorrhagic stroke

A

sm vessel DZ, cerebral amyloid angiopathy, cerebral aneurysm, AVM, cerebral venous thrombosis, mycotic emboli/aneurysms

179
Q

coagulopathic contributors to haemorrhagic stroke

A

anticoagulation, thrombolysis, antiplatelet drugs

180
Q

stroke DD

A

seizure, sepsis, cerebral tumour, subdural haemorrhage, EtoH intoxication, migraine, inner ear DZ, transient global amnesia, cervical spondylosis + nerve entrapment, functional disorder

181
Q

scoring system for stroke/TIA

A

ABCD2

182
Q

ABCD2

A

age > 60, BP >140/90, clinical features: ux weakness (2), speech alone (1), duration: >60 (2), >10 (1), DM

183
Q

ABCD2 results mean

A

0-3 low risk, 4-5 moderate risk, 6+ high risk

184
Q

stroke risk factors

A

HTN, smoking, DM, AF, hyperlipidaemia, previous stroke/TIA, lifestyle, diet, peripheral arterial DZ, IHD, male, age

185
Q

neuro post-stroke complications

A

progression/stroke completion, further stroke, haemorrhaginc transformation, cerebral oedema, seizure, hydrocephalus

186
Q

non-neurological post-stroke complications

A

sepsis (urinary, aspiration pneumonia), electrolyte disturbances, hyper/hypoglycaemia, dehydration, PE, cardiac arrhythmia

187
Q

1st lin Ix for stroke

A

FBC, clotting, U+E, glucose, cholesterol, ESR, ECG, CT head

188
Q

in ischaemic stroke give

A

altepase

189
Q

give altepase in ischaemic stroke w/i

A

4.5h

190
Q

post-ischaemic stroke medication

A

aspirin 300mg for 14/7, then reduce to 75mg, anti-HTN (wait 7/7), statin, smoking cessation, diet, lifestyle

191
Q

AF induced stroke + anticoagulation

A

wait until 14/7 post-stroke

192
Q

carotid endarterectomy for stenosis >

A

70%

193
Q

suden onset, focal neurological deficit

A

stroke

194
Q

altepase

A

given w/i 4.5hrs in ischaemic stroke

Medicine (30 decks)

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