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Phase 3a - Arun&Erin > COTE > Flashcards

COTE Flashcards

1
Q

Name the 2 types of cerebrovascular accidents

A
  • Ischaemic stroke
  • Haemorrhagic stroke
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2
Q

Name 4 things that can disrupt the blood supply to the brain

A
  • Thrombus/embolus
  • Atherosclerosis
  • Shock
  • Vasculitis
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3
Q

What is a TIA?

A

Temporary (< 24hrs) neurological dysfunction caused by ischaemia without infarction

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4
Q

Name 6 symptoms of stroke

A
  • Limb weakness
  • Facial weakness
  • Dysphasia
  • Visual field defects
  • Sensory loss
  • Ataxia
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5
Q

Name 5 risk factors for stroke

A
  • Previous stroke or TIA
  • Atrial Fibrillation
  • Carotid artery stenosis
  • Hypertension
  • Diabetes
  • Raised cholesterol
  • Family Hx
  • Smoking
  • Obesity
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6
Q

What is the FAST tool for stroke?

A

Face
Arm
Speech
Time

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7
Q

Tx: What is the management of a TIA?

A
  • Aspirin 300mg daily
  • Referral for specialist assessment
  • Diffusion-weighted MRI scan
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8
Q

Tx: What is the immediate management of a stroke?

A
  • Immediate CT brain (to exclude haemorrhage)
  • Aspirin 300mg daily for 2 weeks + clopidogrel
  • Admission to a specialist stroke centre
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9
Q

Tx: What management is considered once haemorrhage is excluded?

A

Thrombolysis with alteplase

  • Alteplase is a tissue plasminogen activator that rapidly breaks down clots
  • It may be given within 4.5hrs of symptom onset

Thrombectomy
* Considered in patients with a confirmed blockage of the proximal anterior/posterior circulation
* It may be considered within 24hrs of symptom onset and alongside IV thrombolysis

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10
Q

Ix: Name 2 things that are always investigated for in patients who have had a TIA or stroke

A
  • Carotid artery stenosis: carotid imaging
  • Atrial fibrillation: ECG

Anticoagulation is initiated for AF (after excluding haemorrhage and finishing 2 weeks of aspirin)
Surgical interventions are considered for significant CAS (carotid endarterectomy or angioplasty and stenting)

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11
Q

Tx: What is the secondary prevention of a stroke?

A
  • Clopidogrel 75mg once daily
  • Atorvastatin 20-80mg (not started immediately, usually delayed by at least 48hrs)
  • Blood pressure and diabetes control
  • Addressing modifiable risk factors (smoking, obesity, exercise)
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12
Q

Name 5 members involved in the MTD for stroke patients’ rehabilitation?

A
  • Stroke physicians
  • Nurses
  • Speech and Language therapists
  • Physiotherapy
  • Dieticians
  • Occupational therapy
  • Social services
  • Optometry and ophthalmology
  • Psychology
  • Orthotics
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13
Q

Definition: Parkinson’s disease

A

Condition where there is a progressive reduction in dopamine in the basal ganglia leading to disorders of movement

Sx are asymmetrical

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14
Q

What is the classic triad of Parkinson’s disease features?

A
  • Resting tremor: worse at rest
  • Rigidity: resisting passive movement
  • Bradykinesia: slow movement
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15
Q

Name 5 clinical features of Parkinson’s disease (8)

A
  • Pin-rolling tremor
  • Cogwheel rigidity
  • Bradykinesia: shuffling gait, micrographia, festinating gait, difficulty initiating movement, difficulty turning around, reduced facial movements/expressions
  • Depression
  • Insomnia
  • Anosmia
  • Postural instability
  • Cognitive impairment/ memory problems
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16
Q

Tx: What are the 4 medical treatment options for Parkinson’s disease?

A
  • Levodopa + peripheral decarboxylase inhibitor (e.g. carbidopa, benserazide)
  • COMT inhibitors
  • Dopamine agonists
  • Monoamine oxidase-B inhibitors
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17
Q

What is Levodopa?

A
  • Synthetic dopamine
  • Combined with a peripheral decarboxylase inhibitor which stops it from being metabolised before it reaches the brain
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18
Q

Name 2 combination drugs to treat Parkinson’s

A
  • Co-beneldopa (levodopa + benserazide)
  • Co-careldopa (levodopa + carbidopa)
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19
Q

What is the main SE of Levodopa and it’s Tx?

A

SE: Dyskinesia
Tx: Amantadine (glutamate antagonist)

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20
Q

Definition: Dyskinesia

A

Abnormal movements associated with excessive motor activity:

  • Dystonia: excessive muscle contraction leads to abnormal postures/exaggerated movements
  • Chorea: abnormal involuntary movements, jerking
  • Athetosis: involuntary twisting/writhing movements, usually in fingers/hands/feet
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21
Q

What are COMT inhibitors?

A

e.g. entacapone

  • Inhibits catechol-o-methyltransferase which metabolises levodopa
  • Taken with Levodopa to slow breakdown in the brain
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22
Q

What are dopamine agonists?

A
  • Mimic action of dopamine in the basal ganglia, stimulating dopamine receptors
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23
Q

Name 3 dopamine agonists

A
  • Bromocriptine
  • Cabergoline
  • Pergolide
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24
Q

What is the main SE of prolonged dopamine agonist use?

A

Pulmonary fibrosis

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25
Q

What are monoamine oxidase-B inhibitors?

A
  • Block the action of monoamine oxidase-B enzymes which break down the neurotransmitter dopamine

Monoamine oxidase enzymes break down other neurotransmitters such as serotonin and adrenaline, but monoamine oxidase-B is specific to dopamine

26
Q

Name 2 examples of monoamine oxidase-B inhibitors

A
  • Selegiline
  • Rasagiline
27
Q

What information should be gathered in a fall history?

A
  • Who?
  • When?
  • Where?
  • What happened before/after fall?
  • Why do they think they fell?
  • How many times have they fallen in the last 6 months?
28
Q

What are 7 things you would ask in a systems enquiry in a fall Hx

A
  • General: wt loss, fatigue
  • Cardio: chest pain, palpitations
  • Resp: SOB, cough
  • Neuro: loss of consciousness, seizures, motor/sensory disturbance
  • GU: incontinence, urgency, dysuria
  • GI: abdo pain, diarrhoea, constipation
  • MSK: joint pain, muscle weakness
29
Q

What 7 things would you ask in PMH for a fall?

A
  • General: visual/hearing impairment, diabetes, anaemia
  • Cardio: CVD, arrhythmias
  • Resp: COPD
  • Neuro: parkinson’s, peripheral neuropathy, stroke, dementia
  • GU: recurrent UTI, incontinence
  • GI: diverticulitis, chronic diarrhoea, alcoholic LD
  • MSK: arthritis, chronic pain, fractures
30
Q

Name 5 medications which can cause falls

A
  • Beta-blockers (bradycardia)
  • anti epileptics (sedative)
  • Antihypertensives (hypotension)
  • Benzodiazepines (sedation)
  • Antibiotics (intercurrent infection)
  • diabetic medication (hypoglycaemia)
31
Q

Name 4 investigations for falls

A
  • Bedside: vital signs, lying/standing BP, urine dipstick, ECG, blood glucose
  • Bloods: FBC, U&E, LFT, bone profile
  • Imaging: chest x-ray, CT head, ECHO
  • Specialist: tilt table test, Dix-Hallpike test, 48hr tape cardiac monitoring
32
Q

Name 6 differentials for a fall

A
  • Mechanical: poor footwear, visual impairment
  • Polypharmacy
  • Stroke
  • Peripheral neuropathy
  • Hypoglycaemia
  • BPPV
33
Q

Tx: Name 5 possible interventions to stop a fall? (10)

A
  • Gait = physiotherapy
  • Visual/ hearing problems = eye/hearing test
  • Reduce unneccessary meds
  • Alcohol cessation
  • Cognitive impairment = refer to psychiatric team
  • Postural hypotension = review meds, imrove hydration
  • Treat/rule out infections
  • Ensure good fitting footwear
  • Environmental hazards = turn on lights, take up rugs
34
Q

Definition: Urinary incontinence

A

Loss of control of urination
Two types:
* Urge (overactivity of detrusor muscle)
* Stress (weak pelvic floor and sphincter muscles - leakage)

35
Q

Name 5 risk factors for urinary incontinence (8)

A
  • Increased age
  • Postmenopause
  • Increased BMI
  • previous pregnancy
  • Pelvic organ prolapse
  • Pelvic floor surgery
  • Neuro conditions e.g. MS
  • Cognitive impairment & dementia
36
Q

Name 4 investigations for urinary incontinence

A
  • Bladder diary
  • Urine dipstick
  • Post-void residual bladder volume
  • Urodynamic testing
37
Q

Tx: What is the management of stress incontinence?

A
  • Avoid caffeine, diuretics, excessive fluid intake
  • Weight loss
  • Pelvic floor exercises
  • Surgery
  • Duloxetine - 2nd line
38
Q

Tx: What is the management of urge incontinence?

A
  • Bladder training for at least 6 weeks
  • Anticholinergic meds (oxybutynin, tolterodine, solifenacin)
  • Mirabegron (alternative to anticholinergic)
  • Invasive procedures when medical Tx fails e.g sacral nerve stimulation/ Botox
39
Q

Definition: Osteoporosis

A
  • Significant reduction in bone density
  • T-score of < -2.5
40
Q

What is a DEXA scan?

A
  • Dual-energy x-ray absorptiometry
  • Measures how much raditaion is absorbed by the bones
  • Used to measure bone mineral density (BMD)
41
Q

Name 5 risk factors for osteoporosis (10)

A
  • Older
  • Post-menopausal
  • Reduced mobility/activity
  • Low BMI
  • Low calcium/vit D
  • Alcohol & smoking
  • Personal/Family Hx of fractures
  • Chronic diseases - e.g coeliac, diabetes
  • Long-term corticosteroids
  • Certain meds (SSRI, PPI, anti-epileptics, anti-oestrogens)
42
Q

What are QFracture tool and FRAX tool used for?

A

Calculating the 10 year risk of a major osteoporotic fracture and a hip fracture

43
Q

Tx: What is the management of osteoporosis?

A
  • Address reversible risk factors - e.g excercise, weight, stop smoking
  • Address insufficient intake of calcium & vit D e.g supplements
  • Bisphosphonates
44
Q

Name 4 side effects of bisphosphonates

A
  • Reflux / oesophageal erosions
  • Atypical fractures
  • Osteonecrosis of the jaw
  • Osteonecrosis of the external auditory canal
45
Q

How should oral bisphosphonates be taken?

A
  • On an empty stomach with a full glass of water
  • Afterwards pt should sit upright for 30 mins before moving/eating
46
Q

Name 3 examples of bisphosphonates

A
  • Alendronate
  • Risedronate
  • Zoledronic acid
47
Q

What is the Waterlow Score used for?

A

Risk assessment tool for estimating a pt’s risk of developing a pressure ulcer

48
Q

Definition: Pressure ulcer

A

Areas of skin necrosis due to pressure-induced ischaemia

49
Q

Name 5 risk factors for developing a pressure ulcer (9)

A
  • Age
  • Immobility
  • Low/high body weight
  • Malnutrition
  • Dehydration
  • Incontinence
  • Neurological damage
  • Sedative drugs
  • Vascular impairment
50
Q

Name the 4 mechanisms of pressure ulcers

A
  • Pressure
  • Shear: where skin is pulled away from skeleton small blood vessels can be kinked/torn
  • Friction: rubbing the skin decreases its integrity
  • Moisture: sweat, urine, faeces cause maceration adn decrease integrity
51
Q

Tx: What is the management of pressure ulcers?

A
  • Prevention
  • Turning & handling
  • Pressure-relieving devices
  • Debridement: dead tissue should be removed
  • Manage nutrition, incontinence, glycaemic control, correct anaemia
  • Dressings
  • Antibiotics
52
Q

Name 4 administration challenges when prescribing for the elderly

A
  • Labels too small to read / packaging hard to access / easy to muddle up tablets
  • Distribution: low lean body mass means dose should be adjusted if drug has a narrow therapeutic index
  • Hepatic metabolism
  • Renal excretion declines with age
53
Q

Definition: Deprivation of Liberty Safeguards

A

DoLS protect people in care homes/hospitals from being inappropriately deprived of their liberty if they cannot consent to their care arrangements.

54
Q

Definition: Power of Attorney

A

A legal document that allows an adult to nominate another person to conduct financial affairs/ health and welfare on their behalf

55
Q

Definition: Advance directive

A

A patient-led medical decision made when the pt is competent, which comes into force if the pt becomes incompetent

56
Q

Drugs that can cause postural HTN

A

Nitrates
Diuretics
Anticholinergic medications
Antidepressants
Beta-blockers
L-Dopa
Angiotensin-converting enzyme inhibitors - (ACE) inhibitors

57
Q

Medications that can cause falls other than due to postural hypotension

A

Codeine
Benzodiazepines
Digoxin
Antipsychotics

58
Q

FRIED phenotype for frailty

A

Fatigue
Low physical activity
Exhaustion
Weakness
Unintentional weight loss
Slowness in walking speed

59
Q

Risk factors for a fall

A
  • +65 years old
  • arthritis in lower limbs
  • postural hypotension
  • polypharmacy
  • peripheral neuropathy
  • vision problems
  • incontinence - constantly needing to get up
  • MS/GBS
    -hazardous environment e.g not clean
    -delirium and dementia
60
Q

Tests for falls

A

Turn 180 test

Timed up and go test more than 12 seconds

Phase 3a - Arun&Erin (15 decks)

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