COTE Flashcards
How is the diagnosis of postural hypotension made?
Drop in systolic of 20 or diastolic of 10 after standing
3 medications that can cause postural hypotension
Furosemide, bendroflumethiazide
Tamsulosin
Calcium channel blockers, ACE inhibitors
Other than medication, give 2 possible causes of postural hypotension
Parkinsons
T2DM
Aortic stenosis
Give 2 non-pharmacological management options for postural hypotension
Increasing salt and fluid intake
Avoiding sudden sitting to standing, prolonged standing etc
Compression stockings or abdominal binder (to reduce venous pooling)
Physical activity (to reduce venous pooling)
Give 2 drugs used to manage postural hypotension
Fludrocortisone
Midodrine
Other than postural hypotension, give 2 factors that may increase the risk of falls in the elderly
Polypharmacy
Arthritis
Reduced cognition
Reduced vision
Define delirium
an acute onset of cognitive deficit where the perception of reality is distorted
What tool can differentiate delirium from dementia
4AT
Alertness
A short test of orientation (cognition)
Attention (recitation of the months in backwards order)
Acute change or fluctuating course
Other than infection, give 3 possible causes of delirium
Urinary retention
Dehydration
Hypothermia
Hypoxia
Insomnia
Hepatic or renal impairment
Environmental changes / visual disturbance / hearing disturbance
Drugs (opioids / corticosteroids / anticholinergics / benzodiazepines)
Alcohol withdrawal
Which organisms are most commonly responsible for UTIs
e.coli
staph aureus
What is the mechanism of action of penicillin-based antibiotics?
Inhibit cell wall synthesis
How may bacteria develop resistance to penicillin-based antibiotics
Beta-lactamase production (break down the beta-lactam ring)
How do combination penicillin drugs work e.g. co-amoxiclav or tazocin
Beta-lactamase inhibitors
Other than memory loss, give 2 ways dementia may present
Irritability
Mood changes
Personality changes
Anorexia
Other than Alzheimer’s disease, give the 2 commonest causes of dementia
Lewy body dementia
Vascular dementia
Give 2 common reversible causes of dementia
Normal pressure hydrocephaly
B12 deficiency
Thiamine deficiency
Uraemia
Name 2 abnormalities seen on an MRI brain of a patient with Alzheimer’s disease
Frontal lobe atrophy
Hippocampal atrophy
Ventricular enlargement
What class of medication may be given to a patient with alzheimer’s disease and briefly explain its mechanism of action
Anticholinergics e.g. donepezil, rivastigmine
Inhibition of acetylcholinesterase (less ACh broken down and more available at the synapse)
Which group of muscles are commonly weak in women with stress incontinence
Pelvic floor muscles
Name one drug that precipitates urinary incontinence
Diuretics (furosemide, bendroflumethiazide)
Sedatives (opiates, antipsychotics)
Give 2 reasons for pelvic floor weakness
Pregnancy
Childbirth
Obesity
Chronic constipation
Name one drug that may cause urinary retention
Anti-cholinergics
Give 2 pieces of advice for stress incontinence
Drink less fluids
How does duloxetine work for stress incontinence
tightens the urethral sphincter
A pt has recently started a new tablet, as her BP was not controlled on amlodipine, and her urinary incontinence has got worse - what is the tablet?
ACEi
What scoring system can be used to determine the risk of stroke in the days following a TIA
ABCD2
Name the parameters of the ABCD2 scoring system
Age (65 - 1, 70 -2)
Blood pressure
Clinical features
Duration (> 60)
Diabetes
What operation may be performed on someone with carotid artery stenosis?
Carotid arterectomy
Name 3 risk factors for ischaemic stroke
Smoking
Obesity
Hypertension
What is the mechanism of action of warfarin
Vitamin K antagonist
What is the mechanism of action of apixaban
Direct inhibitor of factor X
What is the mechanism of action of dabigatran
Indirect inhibitor of factor X
What is the mechanism of action of dalteparin
LMWH -
What is the mechanism of action of heparin
From which artery does the middle cerebral artery arise
Internal carotids
Facial droop, slurred speech, expressive dysphasia, right-sided facial palsy, right-sided weakness and right homonymous hemianopia
Using the OCSP, what is the diagnosis?
What drug is commonly used for stroke thrombolysis?
alteplase
Give 4 absolute or relative contraindications to thrombolysis
Previous intracranial haemorrhage
Active bleeding
Severe uncontrolled hypertension
Significant head injury within 3 months
Recent intracranial surgery
Ischaemic stroke within 3 months
Name 4 risk factors for osteoporosis
Steroids
Hyperthyroidism
Alcohol and smoking
Thin (BMI <18.5)
Testosterone
Early menopause
Renal/liver
Erosive bone disease (myeloma, RA)
Dietary low calcium/malabsorption
Fractured right pubic ramus (common site for osteoporotic fractures)
Name 3 other sites where osteoporotic fractures often occur
NOF
Elbow?
Knee?
on a DEXA scan, what is meant by a) T score b) Z score
a) Against healthy young person
b) Against matched for sex, age, ethnicity
Give 2 pieces of advice on how to take bisphosphonates e.g. alendronate
Sit up
30 mins before eating and drinking
In the morning
Give 2 common side effects of bisphosphonates and 2 serious side effects
Diarrhoea, reflux
Oesophageal ulcers, atypical fractures
What 2 investigations are requested in a myeloma screen
Urinary proteins
Serum proteins
What characteristic abnormality may be seen on X-ray in myeloma
punched out lesions
Myeloma pt with difficulty passing urine and constipation, no sensation below T10
Diagnosis?
spinal cord compression
What drug should be started immediately in spinal cord compression
dexamethasone
What urgent investigation would you request for spinal cord compression
CT?
Give 2 management options for spinal cord compression
surgical decompression
Other than spinal cord compression, name 2 other possible complications of myeloma
Hypercalcaemia
Acute kidney injury
Anaemia
What is parkinsons disease
Destruction of dopaminergic neurones in the substania nigra causing motor defects
Give the 3 classical features of PD
Bradykinesia
Cogwheel rigidity
Unilateral tremor
Other than the classical triad, give 2 other features of PD
Hypomimica
Hypoarthria
Name 2 other causes of PD
Drugs
Lewy body
Why is levodepa often used in combination with another durg e.g. carbidopa
stops levodopa being broken down peripherally so it has a longer affect in the CNS
Features of benign essential tremor
improves with alcohol
bilateral tremor
worse with movement
Other than prostate cancer, give 2 other causes of a raised PSA
DRI
BPH
What abnormality would you expect to see on LFTs in bone cancer
raised ALP
Give 2 management options for hypercalcaemia
Fluids
Bisphosphonates
Name the 4 distressing end-of-life symptoms and name a drug for each
Agitation - haloperidol
Respiratory secretions - hyoscene
Constipation - laxatives
Pain - morphine
Mechanism of action of memantine
NMDA receptor antagonist
Donepezil and rivastigmine mechanism of action
Acetylcholinesterase inhibitors
1 non-pharmacological interventions used in prevention and treatment of delirium
Reduce polypharmacy
Promote good sleep hygiene
Avoid dehydration
Encourage early mobilisation
Encourage family to visit
Reorient patient
Maintain environment
Document to make DNACPR legally binding
Advance decision to refuse treatment
Give two appropriate points for metastatic bone cancer discussion (aims)
- Manage symptoms e.g. analgesia
- Slow progression e.g. chemo
- Improve quality of life e.g. end of life discussions such as DNACPR, ceiling of care, wishes for home or hospital
What is one area of palliative care that you cannot offer support or advice
Anything which would assist suicide
