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Phase 3a > COTE > Flashcards

COTE Flashcards

1
Q

What medications might someone with IHD be on

A 
Aspirin
Colpodogrel
Statin
ACEi
B blocker
Nitrate 
CCB
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2
Q

Name 5 geriatric giants

A 
Falls
Incontinence 
Confusion
Urinary symps
Chest pain+ SOB
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3
Q

What is meant by deconditioning

A

Process of physiological change following a period of inactivity. It results in functional losses in areas such as mental status, abilities to accomplish ADL.

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4
Q

What are the 4 key areas of assessment in the GCA

A

Medical
Psychological
Functional
Social and environmental

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5
Q

Three drugs for OAB

A

Fesoterodine
Tolterodine
Oxybutanin

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6
Q

Tx for nocturia

A

Desmopressin

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7
Q

Tx of urgency incontinence

A

Bladder training

Avoid caffeine

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8
Q

Tx of stress incontinence

A

Wt loss
Decrease caffeine
Bladder diary
Pelvic floor exercises

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9
Q

What are the 4 types of incontinence

A
  • Stress incontinence I.e when sneezing
  • Functional (not GU)
  • overflow/ over active bladder (OAB) commonly with prostatic enlargement
  • urgency incontinence (bladder size shrinks)
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10
Q

Treatment of overflow incontinence in BPH

A

Finasteride (it raises PSA)

Tamulosin

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11
Q

Symptoms of overactive bladder

A

F- frequency
U-urgency
N- nocturia

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12
Q

Cardiovascular causes of falls

A

Carotid sinus hypersensitivity
Vasovagal hypersensitivity
Orthosatic hypoT
Arrhythmia

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13
Q

Non cardiac causes of falls in the elderly

A

Iatrogenic
Vision
Gait problems
Fear of falling

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14
Q

What medications commonly cause falls

A

Benzos, antipsychotics , antiepileptics, antidepressants, sedatices, antihypertensives, pain killers I.e. codiene.

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15
Q

What issues might older people have with exercise regimens ?

A

Cognitive impairment may hinder adherence

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16
Q

How might orthostatic hyperT be treated

A 
Medication review 
Hydration 
Salt intake 
Education / life style advice I.e. get up slow 
OT - home risk assessment I.e rugs
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17
Q

Side effects of an ACEi

A

Cough
Dizziness
Rash / red itchy skin

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18
Q

Side effects of thiazides diuretics

A

Dizziness/ lightheaded
Blurred vision
Loss of appetite
Upset tummy

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19
Q

Side effects of antibiotics

A

Diarrhoea
N&V
Bloating and indigestion

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20
Q

What blood would your order for a dementia screen

A 
LFT
TFT
Ca++
Glucose
FBC(anaemia)
B12
Folate
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21
Q

What are the different types of dementia

A

Alzheimer’s
Vascular/mixed
Dementia w/ lewybodies
Frontotemporal

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22
Q

What is the common clinical presentation of someone with vascular dementia

A

Step wise decline
Gait and balance problems +cog decline
Associated with microhaemorrhages + mini cortical strokes
Problem with retrieval not laying down memories

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23
Q

What is the common clinical presentation of Lewy body dementia

A

Parkinson plus’s syndrome
Hallucinations
Cog impairment

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24
Q

Common clinical presentation of frontotemporal dementia

A

Marked executive function decline -I.e. in planning

Often lack insight

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25
Q

Name 4 cognitive assessment tools

A

MMSE
MOCA

6cit
GPCOG

26
Q

Pathological features of Alzheimer’s

A

Cortical atrophy
Intracellular NF tangles
Extra cellular plaques
Accumulation of beta amyloid peptide (due to degradation of APP)

27
Q

Define dementia

A

Chronic progressive neurodegen’ disorder not a normal part of the aging process
irreversible changes in brain pathology
Characterised by memory loss and impairment to ADL.

28
Q

Bio markers of AD

A

Hyperphos tau in CSF

Increased A-beta42

29
Q

Diagnostic criteria for AD

A

Progressive decline in memory and functioning for 6months +

Episodic memory test provides objective evidence

30
Q

Alzheimer’s exclusion criteria

A

Gait problems (vascular)
Hallucinations (Lewy body)
Another medical condition can explain symps
Sudden onset

31
Q

AD mimics

A

Major depression.
Severe cerebrovascular disease
Metabolic disorders
Other dementias

32
Q

What speech change might you see in AD

A

Semantically empty speech
Frequent intrusions
Repetitive errors

33
Q

What staging is used in AD

A

Braak staging for spread of amyloid pathology

34
Q

What investigations would you do in AD

And what would they show

A

Bloods
MRI- cortical atrophy
PET- APP degradation and beta amyloid accumulation
CSF sample - hyperphos tau
Episodic memory test - freq intrusions + repetition errors

35
Q

Medication for dementia

A

ACEi

Rivastigmine
Donepazil
Galantamine

Protection from excess glutamate = memantine

36
Q

Two drug classes for treating Alzheimer’s

A

1) ACEI

2) NMDA receptor antagonist

37
Q

Name an NMDA receptor antagonist used to treat Alzheimer’s

A

Memantine

38
Q

Causes of behavioural and psychological symptoms of dementia (BPSD)

A

“Pinch me”

Pain
Infection
Nutrition 
Constipation 
Hydration 
Medication
Environment
39
Q

Key feature of lewybody dementia

A

Visual hallucinations

40
Q

Key features of CJD dementia

A 
Rapid progression (weeks to months)
Motor symps- eventually unable to move and speak
Mood changes
41
Q

Key features of Frontotemporal dementia

A

Personality changes I.e. Apathy, lack of empathy, reduced humour, impulsive

42
Q

Key features of Alzheimer’s

A 
Short term memory loss
Forgetting names/ events/ conversations/ appointments 
Getting lost
Losing items
Word finding difficulties

Most common over 65

43
Q

Key features of Parkinson dementia

A

Emotional liability

Must have had motor symptoms 1year prior

44
Q

Key features of vascular dementia

A

Step wise deterioration
Change in executive function I,e, planning
Vascular history

45
Q

Which two dementias should you not give antipsychotics in

A

Lewy body dementia

Parkinson dementia

46
Q

SE of thiazide diuretics in elderly

A

Hyponatremia = orthostatic hypertension

47
Q

Drug interactions to avoid

A 
ACEI and allopurinol 
Thiazide diuretics and amiodarone
Warfarin and clarithromycin 
Statins and grapefruit
Methotrexate and trimethoprim
48
Q

Complications post stroke

A 
VTE
Post stroke pain
Malignancy MCA syndrome
Seizures
Aspiration pneumonia
49
Q

What investigations might you do post stroke

A

USS Doppler carotids
Echo
ECG / 24hours tape
MRI

50
Q

What is the secondary prevention Tx for stroke in AF

A

Stop anticoagulants (doac/ warfarin) transiently, aspirin for 14 days, start back on anticoagulant

51
Q

When can you give aspirin and clopidogrel post stroke

A

After 24hour CT following thrombolysis

Or straight away if no thrombolysis

52
Q

What is the management plan for someone coming in via ambulance ? Stroke

A 
CT head
- no haemorrhage and under 4 hours = thrombolyse 
Statin
24hour CT
Aspirin and clopi
53
Q

Why is LMWH contraindicated in high risk strokes

A

Risk of haemorrhagic transformation

54
Q

What is AF caused by MV pathology called

A

Valvular AF

55
Q

treatment of ischemic stroke + DVT/PE

A

LMWH

56
Q

Example of LMWH

A

Dalteparin

57
Q

Example of DOAC

A

Apixaban / riveroxiban

58
Q

Causes of parenchymal haemorrhagic stroke

A

Trauma
Hypertension
Malignancy

59
Q

Management of parenchymal haemorrhagic stroke

A

Lower bp- labetalol
Tranexamic acid
Reverse anticoags (octaplex/ vitk)
Refer to neurosurgeon

60
Q

Cause of SAH

A

AVM

Berry aneurism

61
Q

Investigations for SAH

A

CT angiogram
LP
ECG- inverted Twaves ?ischemia

62
Q

Vasospasm tx

A

Nimlodipine

Phase 3a (7 decks)

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