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3a > COTE > Flashcards

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
Q

in which conditions is donezepil useful?

A

Alzheimer’s LBD- it is CI in frontotemporal

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26
Q

what happens to the pharmacodynamics of drugs in the elderly?

A

increased concentrations, this means BDZs are more likely to cause respiratory complications and alpha blockers to cause postural hypotension

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27
Q

how and what drugs are likely to cause falls?

A

hypotensives like alpha blockers for prostate hypertrophy

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28
Q

what drugs are likely to cause confusion?

A

BDZs, opioids, psychiatry drugs

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29
Q

what drugs are likely to cause a change in bowel habit in the elderly?

A

NSAIDs and opioids

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30
Q

what does PS U BR stand for?

A 
presumed
support
unwise
best interests
restrictive (least)
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31
Q

what is the NMDA receptor?

A

glutamate receptor

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32
Q

what is the best drug to use for aggression in a delirious patient?

A

risperidone

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33
Q

give some opthalmic conditions that commonly affect the elderly

A

age related macular degeneration
diabetic retinopathy
cataracts

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34
Q

how is postural hypotension defined?

A

in the 3-5 mins after standing, drop in systolic by 20 or 10 diastolic

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35
Q

what investigations should you do in someone with pressure ulcers?

A

Bedside: swabs
Bloods: ESR/CRP, blood cultures, WCC
Imaging: XR for bone involvement

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36
Q

what is the difference between DEXA and FRAX?

A

DEXA-diagnosis

FRAX-risk assessment for 10 yr fracture

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37
Q

what are the symptoms of scurvy?

A

bleeding from gums, bruising, slow healing, dry eyes and mouth, irritability, SOB, arthalgia, myalgia

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38
Q

what is the max capacity of the bladder?

A

600ml but desire to void is at 250

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39
Q

what nerve carries signals for storage?

A

pudendal from Onuf’s

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40
Q

what is urge incontinence a problem with?

A

too much detrusor contraction

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41
Q

which sphincter can be consciously controlled?

A

external urethral, internal is a continuation of smooth muscle

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42
Q

how many times counts as frequency of urination?

A

8+

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43
Q

what is nocturnal polyuria

A

passing>1/3 volume during the night

44
Q

how many days are urinary charts done for?

A

3

45
Q

what electrolytes are disturbed in refeeding syndrome?

A

hypophosphataemia
hypokalaemia
Ca
hypomagnesia

46
Q

what are the complications of refeeding syndrome?

A

arrythmias
coma
convulsions
cardiac failure

47
Q

what kind of drugs could cause postural hypotension?

A

dopinergic, antihypertensives

48
Q

what is the triad in menieres disease?

A

vertigo
sensineural hearing loss
tinnitus

49
Q

how can menieres be treated?

A

buccal prochlorperazine

50
Q

name 2 dopa decarboxylase inhibitors

A

carbidopa

benserazide

51
Q

what might you need to co-prescribe with aspirin?

A

PPI

52
Q

what is the management of a TIA?

A

lifestyle change, aspirin 300mg for 2w then clopidogrel
advise on driving for 1 month
anticoagulate if cardiac emboli and consider carotid doppler

53
Q

what do you need to do before putting someone on a dopamine agonist?

A

creatinine and ESR
CXR
ECG
for fibrosis

54
Q

what are the 4 domains of a CGA?

A

medical, mental health, functional, social+environment

55
Q

what are bisphophonates used for?

A

pain from bone mets
prevent osteoporosis
hypercalcaemia (keep it in the bones)
Paget’s disease

56
Q

what can be used as a marker or nutrition

A

serum albumin

57
Q

what are the consequences of malnutrition

A

healing-less effective and loss of muscle mass, impaired recovery, reduced skin integrity
more healthcare needs and admissions
respiratory and cardiac function decline

58
Q

what 3 groups cause malnutrition?

A

insufficient intake, increased requirements, malabsorption

59
Q

why does refeeding syndrome happen?

A

insulin drives carbohydrates and electrolytes into cells

60
Q

what needs to happen for an LPA to be legally binding?

A

registered with Office of Public Guardian

61
Q

what is proliferated in chronic myeloid leukaemia?

A

eosinophils, basophils, neutrophils

62
Q

which kind of leukaemia is the Ph chromosome associated with?

A

CML

63
Q

in which kind of leukaemia do you get gum hypertrophy?

A

AML-more adults than elderly

64
Q

what drug can you give for stress incontinence?

A

duloxetine

65
Q

what are the 4 aspects of a comprehensive geriatric assessment?

A

functional capacity
mental health
medical health
social and environmental assessment

66
Q

what does a DEXA miss out?

A

structural deterioration in bone tissue

67
Q

what does FRAX take into account?

A 
age
sex
prev fracture
FHx of fracture
premature menopause
DEXA
68
Q

what is osteopenia on DEXA?

A

-1 and -2.5

osteoporosis includes -2.5 or more

69
Q

what is a hip fracture?

A

neck of femur fracture

70
Q

how should bisphosponates be taken

A

once a week
one hour before food with lots of water
must remain upright for 30 minutes after

71
Q

what could you offer if a patient is not tolerating bisphosphonates?

A

give IV or IV raloxifene or denosumab

72
Q

what is Colles’ fracture

A

radial fracture

73
Q

what is the treatment of a hip fracture

A

surgery the next day with early mobilisation

74
Q

what does a fractured hip look like on examination

A

external rotation, abduction, cannot weight bear, shortened leg length

75
Q

what drugs could cause parkinsonian symptoms?

A

antipsychotics
proclorperazine
metoclopramide-N&V

76
Q

what are the differentials for parkinsonianism?

A

drugs, LBD, trauma, HIV, Wilson’s

77
Q

how do you differentiate between essential tremor and parkinsonian resting tremor?

A

essential improves with alcohol and BB but Parkinsons gets worse

78
Q

list the non motor symptoms of parkinsons

A

pain, inner restless, N+V, constipation, dementia, anosmia, REM sleep disturbance, drooling

79
Q

list the parkinsons plus syndromes

A 
multiple system atrophy (incontinence)
dementia with lewy bodies
corticobasal ganglionic degeneration
progressive supranuclear palsy
parkinsons-dementia-amyotrophic complex
80
Q

how might thiamine deficiency present in the elderly?

A

Wernicke’s/Korsakoff’s
heart failure
delirium

81
Q

what is a contraindication to thiazide use

A

gout

82
Q

what 3 things do you need to warn patients about prior to starting dopamine therapy of any kind?

A

increased sleepiness
psychotic symptoms
impulse disorders

83
Q

why would you rather use pramipexole to cabergoline as a dopamine agonist?

A

ergot derived have a higher chance of serositis-retroperitoneal/cardiac/pulmonary

84
Q

what should you do before starting a dopamine agonist?

A

serositis screen so ECG, CXR and CRP

85
Q

name 2 preparations of l dopa

A

co careldopa

co bereldopa

86
Q

side effects of MAOB inhibitors

A

postural hypotension

AF

87
Q

which antiemetic can you use to counteract the side effects of l dopa

A

domperidone

D D!

88
Q

what are selegiline and rasagiline?

A

MAOB antagonists-can cause AF and postural hypotension

89
Q

what antipsychotic could be used as a last resort in parkinsons?

A

try to manage without medication but quetiapine

90
Q

what would you use in a patient who is black or over 55 and has oedema or heart failure

A

thiazide is first line because need to offload fluid but ACEi won’t really work in these patients

91
Q

what makes up digoxin toxicity?

A

hyperkalaemia, GI distress and dysrythmia (AF, VT, VF, flutter, bradycardias, block)

92
Q

how is digoxin toxicity treated?

A

Fab fragments

93
Q

list the geriatric giants

A 
incontinence
iatrogenic
impaired homeostasis
falls
confusion
94
Q

what does the MMSE not test?

A

long term memory

95
Q

what do you do if you suspect C diff?

A 
Suspect
Isolate
Gloves and apron
Hand washing
Test stool for toxin
Treat-metronidazole or vancomycin
96
Q

3 groups of causes of malnutrition

A 
inadequate intake
malabsorption
increased demand (sepsis or injury)
97
Q

consequences of malnutrition

A

impaired healing
impaired immunity
impaired skin integrity

98
Q

refeeding syndrome complications

A 
CVS: arrythmias
Resp: resp muscle weakness
GI: abdo pain, constipation
neuro: parasthesia, Wernicke's
msk: weakness
99
Q

what are the principles of the mca05?

A 
assume
maximise ability
unwise
best interests
least restrictive
100
Q

how is risk of pressure ulcers assessed?

A

Waterlow score

101
Q

what are the risk factors for pressure ulcers?

A 
female
underweight or obese
incontinent
organ failure
smoking
neurological deficit
102
Q

what are the symptoms of scurvy?

A 
patient is poor, pregnant, on odd diet
bleeding from gums, follicles, nose, into bladder or gut
listnessness
cachexia
oedema
103
Q

what are the symptoms of severe b1 deficiency?

A

wet beriberi-heart failure

dry-Wernicke’s

104
Q

what deficiency can cause dementia?

A

Pellagra- a lack of nicotinic acid, it also gives diarrhoea and dermatitis

105
Q

what drugs should you avoid in the elderly?

A

antipsychotics
anticholinergics
sedatives
TCAs

3a (11 decks)

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