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COTE Flashcards

1
Q

which of depression, delirium and dementia will have an abnormal EEG?

A

delirium

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2
Q

what is delirium

A

abnormal function of neurones leading to fluctuating state of consciousness, cognition and attention

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3
Q

what are the clinical features of delirium?

A

fluctuation; difficulty concentrating; disorganised thinking; decreased level of consciousness; can also have psychomotor changes

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4
Q

which lobe will be damaged with the picture of short term memory difficulties, speech and attention?

A

temporal

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5
Q

which lobe will have been damaged if the patient has difficulty recognising things and ordering tasks?

A

parietal

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6
Q

what is CI in vascular dementia which may be useful in alzheimer’s?

A

memantine-an NMDA receptor antagonist

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7
Q

what genes have a role in Alzheimer’s?

A

APP, PS1, PS2

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8
Q

what is the pathology of alzheimer’s?

A

tau tangles and beta amyloid plaques, cortical and hippocampal

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9
Q

where does the degeneration occur in alzheimers?

A

cortex and hippocampus

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10
Q

what is the picutre of CJD?

A

ataxia, visual problems, dysphasia, confusion, behavioural changes

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11
Q

what part of the brain is affected in LBD

A

brainstem and neocortex

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12
Q

what age does LBD usually come on?

A

50-85

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13
Q

what type of dementia is very likely to be confused with delirium and why?

A

LBD, they both have fluctuating courses

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14
Q

what will you find on MRI of someone with LBD?

A

generalised atrophy

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15
Q

what can be given in LBD?

A

rivastigmine-acetylcholinesterase inhibitor

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16
Q

what must you investigate in someone with hallucinations?

A

whether they have LBD, antipsychotics can worsen LBD condition

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17
Q

what are Lewy bodies?

A

oesinophilic intracytoplasmic inclusion bodies

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18
Q

Jasper has been experiencing parkinsonian symptoms for the last 5 years, he reports that he has also been experiencing some memory difficulties in the last year, what is the diagnosis and what could it be confused with?

A

Parkinson’s disease, non motor symptoms come a year after the motor problems whereas they follow dementia symptoms in LBD. also onset of parkinsonian and memory problems is in the first year, they’re more together

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19
Q

in what disease do the temporal horns matter?

A

Alz when they are over 5mm

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20
Q

what diseases do you get tau tangles in?

A

frontotemporal and Alzheimer’s

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21
Q

what 2 drug types are used in Alzheimer’s

A

aceytlcholinesterase inhibitors (stigmine and donezepil) and NMDA receptor antagonists (memantine)

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22
Q

what investigation is part of the management of Pick’s?

A

MND, there is an association

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23
Q

Brian has vascular dementia and has been having persistenly low mood, adhedonia and anergia, what is the best management and what would be the worst?

A

best-citalopram

worst-tricyclics

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24
Q

in what condition are visuospatial problems early and in what are they late?

A

early-Alzheimer’s

late-frontotemporal

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25
in which conditions is donezepil useful?
Alzheimer's LBD- it is CI in frontotemporal
26
what happens to the pharmacodynamics of drugs in the elderly?
increased concentrations, this means BDZs are more likely to cause respiratory complications and alpha blockers to cause postural hypotension
27
how and what drugs are likely to cause falls?
hypotensives like alpha blockers for prostate hypertrophy
28
what drugs are likely to cause confusion?
BDZs, opioids, psychiatry drugs
29
what drugs are likely to cause a change in bowel habit in the elderly?
NSAIDs and opioids
30
what does PS U BR stand for?
``` presumed support unwise best interests restrictive (least) ```
31
what is the NMDA receptor?
glutamate receptor
32
what is the best drug to use for aggression in a delirious patient?
risperidone
33
give some opthalmic conditions that commonly affect the elderly
age related macular degeneration diabetic retinopathy cataracts
34
how is postural hypotension defined?
in the 3-5 mins after standing, drop in systolic by 20 or 10 diastolic
35
what investigations should you do in someone with pressure ulcers?
Bedside: swabs Bloods: ESR/CRP, blood cultures, WCC Imaging: XR for bone involvement
36
what is the difference between DEXA and FRAX?
DEXA-diagnosis | FRAX-risk assessment for 10 yr fracture
37
what are the symptoms of scurvy?
bleeding from gums, bruising, slow healing, dry eyes and mouth, irritability, SOB, arthalgia, myalgia
38
what is the max capacity of the bladder?
600ml but desire to void is at 250
39
what nerve carries signals for storage?
pudendal from Onuf's
40
what is urge incontinence a problem with?
too much detrusor contraction
41
which sphincter can be consciously controlled?
external urethral, internal is a continuation of smooth muscle
42
how many times counts as frequency of urination?
8+
43
what is nocturnal polyuria
passing>1/3 volume during the night
44
how many days are urinary charts done for?
3
45
what electrolytes are disturbed in refeeding syndrome?
hypophosphataemia hypokalaemia Ca hypomagnesia
46
what are the complications of refeeding syndrome?
arrythmias coma convulsions cardiac failure
47
what kind of drugs could cause postural hypotension?
dopinergic, antihypertensives
48
what is the triad in menieres disease?
vertigo sensineural hearing loss tinnitus
49
how can menieres be treated?
buccal prochlorperazine
50
name 2 dopa decarboxylase inhibitors
carbidopa | benserazide
51
what might you need to co-prescribe with aspirin?
PPI
52
what is the management of a TIA?
lifestyle change, aspirin 300mg for 2w then clopidogrel advise on driving for 1 month anticoagulate if cardiac emboli and consider carotid doppler
53
what do you need to do before putting someone on a dopamine agonist?
creatinine and ESR CXR ECG for fibrosis
54
what are the 4 domains of a CGA?
medical, mental health, functional, social+environment
55
what are bisphophonates used for?
pain from bone mets prevent osteoporosis hypercalcaemia (keep it in the bones) Paget's disease
56
what can be used as a marker or nutrition
serum albumin
57
what are the consequences of malnutrition
healing-less effective and loss of muscle mass, impaired recovery, reduced skin integrity more healthcare needs and admissions respiratory and cardiac function decline
58
what 3 groups cause malnutrition?
insufficient intake, increased requirements, malabsorption
59
why does refeeding syndrome happen?
insulin drives carbohydrates and electrolytes into cells
60
what needs to happen for an LPA to be legally binding?
registered with Office of Public Guardian
61
what is proliferated in chronic myeloid leukaemia?
eosinophils, basophils, neutrophils
62
which kind of leukaemia is the Ph chromosome associated with?
CML
63
in which kind of leukaemia do you get gum hypertrophy?
AML-more adults than elderly
64
what drug can you give for stress incontinence?
duloxetine
65
what are the 4 aspects of a comprehensive geriatric assessment?
functional capacity mental health medical health social and environmental assessment
66
what does a DEXA miss out?
structural deterioration in bone tissue
67
what does FRAX take into account?
``` age sex prev fracture FHx of fracture premature menopause DEXA ```
68
what is osteopenia on DEXA?
-1 and -2.5 | osteoporosis includes -2.5 or more
69
what is a hip fracture?
neck of femur fracture
70
how should bisphosponates be taken
once a week one hour before food with lots of water must remain upright for 30 minutes after
71
what could you offer if a patient is not tolerating bisphosphonates?
give IV or IV raloxifene or denosumab
72
what is Colles' fracture
radial fracture
73
what is the treatment of a hip fracture
surgery the next day with early mobilisation
74
what does a fractured hip look like on examination
external rotation, abduction, cannot weight bear, shortened leg length
75
what drugs could cause parkinsonian symptoms?
antipsychotics proclorperazine metoclopramide-N&V
76
what are the differentials for parkinsonianism?
drugs, LBD, trauma, HIV, Wilson's
77
how do you differentiate between essential tremor and parkinsonian resting tremor?
essential improves with alcohol and BB but Parkinsons gets worse
78
list the non motor symptoms of parkinsons
pain, inner restless, N+V, constipation, dementia, anosmia, REM sleep disturbance, drooling
79
list the parkinsons plus syndromes
``` multiple system atrophy (incontinence) dementia with lewy bodies corticobasal ganglionic degeneration progressive supranuclear palsy parkinsons-dementia-amyotrophic complex ```
80
how might thiamine deficiency present in the elderly?
Wernicke's/Korsakoff's heart failure delirium
81
what is a contraindication to thiazide use
gout
82
what 3 things do you need to warn patients about prior to starting dopamine therapy of any kind?
increased sleepiness psychotic symptoms impulse disorders
83
why would you rather use pramipexole to cabergoline as a dopamine agonist?
ergot derived have a higher chance of serositis-retroperitoneal/cardiac/pulmonary
84
what should you do before starting a dopamine agonist?
serositis screen so ECG, CXR and CRP
85
name 2 preparations of l dopa
co careldopa | co bereldopa
86
side effects of MAOB inhibitors
postural hypotension | AF
87
which antiemetic can you use to counteract the side effects of l dopa
domperidone | D D!
88
what are selegiline and rasagiline?
MAOB antagonists-can cause AF and postural hypotension
89
what antipsychotic could be used as a last resort in parkinsons?
try to manage without medication but quetiapine
90
what would you use in a patient who is black or over 55 and has oedema or heart failure
thiazide is first line because need to offload fluid but ACEi won't really work in these patients
91
what makes up digoxin toxicity?
hyperkalaemia, GI distress and dysrythmia (AF, VT, VF, flutter, bradycardias, block)
92
how is digoxin toxicity treated?
Fab fragments
93
list the geriatric giants
``` incontinence iatrogenic impaired homeostasis falls confusion ```
94
what does the MMSE not test?
long term memory
95
what do you do if you suspect C diff?
``` Suspect Isolate Gloves and apron Hand washing Test stool for toxin Treat-metronidazole or vancomycin ```
96
3 groups of causes of malnutrition
``` inadequate intake malabsorption increased demand (sepsis or injury) ```
97
consequences of malnutrition
impaired healing impaired immunity impaired skin integrity
98
refeeding syndrome complications
``` CVS: arrythmias Resp: resp muscle weakness GI: abdo pain, constipation neuro: parasthesia, Wernicke's msk: weakness ```
99
what are the principles of the mca05?
``` assume maximise ability unwise best interests least restrictive ```
100
how is risk of pressure ulcers assessed?
Waterlow score
101
what are the risk factors for pressure ulcers?
``` female underweight or obese incontinent organ failure smoking neurological deficit ```
102
what are the symptoms of scurvy?
``` patient is poor, pregnant, on odd diet bleeding from gums, follicles, nose, into bladder or gut listnessness cachexia oedema ```
103
what are the symptoms of severe b1 deficiency?
wet beriberi-heart failure | dry-Wernicke's
104
what deficiency can cause dementia?
Pellagra- a lack of nicotinic acid, it also gives diarrhoea and dermatitis
105
what drugs should you avoid in the elderly?
antipsychotics anticholinergics sedatives TCAs

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