Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

3a > COTE > Flashcards

COTE Flashcards

1
Q

What is anticholinergic burden?

A

(ACB) - Scoring system to measure cumulative effect of taking multiple medications with anticholinergic activity (not just anticholinergic drugs). A predictor of frailty. A score of 3+ is associated with increased cognitive impairment and mortality.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Give 3 anticholinergic side effects.

A

Urinary retention/incontinence, constipation, dry eyes, dry mouth, blurred vision, dizziness, unsteadiness, confusion.
Think of Alice in a hot, dry, confusing wonderland.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Give 3 drugs which have an ACB score of 1. What does this mean?

A 
ACB score is 1-3 for each drug, so if you were on 3 of the following drugs then the ACB score is 3, which indicates increased cognitive impairment and mortality.
Atenolol
Codeine
Diazepam
Digoxin
Furosemide
Haloperidol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Give 2 drugs with have an ACB score of 2.

A

Amantadine

Carbamazepine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Give 3 drugs with which have an ACB score of 3. What is the significance of this?

A

ACB score of 3 means increased risk of cognitive impairment and mortality, so any of these drugs on their own is enough to cause this.
Antidepressants: amitriptyline, paroxetine
Antipsychotics: clozapine, quetiapine
Antimuscarinics: Darifenacin, trospium, oxybutynin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

In an elderly lady with urinary incontinence due to prolapse, which drug would you prescribe?

A

Solifenacin.
Oxybutynin has high anticholinergic burden score, proven to reduce cognition and increase progression of dementia, NOT for frail old ladies.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the side effects of atenolol?

A

Indications - used to be used for htn but is now 6th line.
CI - just avoid it as much as possible especially in old people. It is not cardiac selective so more side effects – breathing worsens (asthma, COPD), worsens postural hypotension (falls)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How would you treat hypertension in someone over 55?

A

1st line: CCB eg amlodipine.
2nd line: Add ACEi/ARB/thiazide-like diuretic (eg indapamide - worsens gout though)
3rd line: as above but never ACEi and ARB together. Only one thing beginning with A at any one time!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How is dementia treated?

A

Alzheimers - Cholinergics - rivastigmine, donepezil
PD/LBD - balance cognitive impairment with parkinsonian sx
VD - no licensed medications, control RFs to prevent deterioration.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are BPSD and how do you treat?

A

Behavioural and psychological symptoms of dementia (BPSD)
Treat with haloperidol (anti-dope, causes extrapyramidal SEs, avoid in PD)
Risperidone (esp in AD)
Quetiapine
Low mood - antidepressants rarely work if the mood difficulty is due to brain matter loss in dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How can delirium be prevented on the ward?

A
  • Ward design – bright colours, good signage, eg purple bay, orange bay.
  • ‘toilet’ written in large letters, large M/F/disabled signs.
  • Continuity of staff
  • Talking to patients
  • Introducing self
  • Using people’s names to provide familiarity.
  • Adequate lighting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Give 3 signs that indicate delirium rather than dementia.

A

Alertness - impairment of conscious level.
AMT4 low score
Attention
Acute change or fluctuating course

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is multimorbidity? What are the complications of multimorbidity?

A

2+ long term health conditions, including LDs, substance misuse, mental health conditions.
Higher prevalence in women, socioeconomic deprivation, increasing age, tobacco and alcohol usage, lack of physical activity, poor nutrition and obesity.
Complications - decreased QoL and LE, increased treatment burden, polypharmacy, negative impact on carers welfare.
[NICE 2017, passmed]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the PRISMA-7?

A

Patient Questionnaire, score of 3+ indicates frailty.

  1. Age >85
  2. sex Male
  3. Health problems that require you to limit your activities
  4. Require help regularly
  5. Health problems that require you to stay home
  6. If you need help can you count on someone close to you
  7. Do you regularly use a cane/walker/wheelchair?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the STOPP/START tool?

A

STOPP = Screening Tool of Older Persons potentially inappropriate Prescriptions
Identifies medication where the risk outweighs benefits. Eg, atenolol, TCAs in dementia.

START = Screening Tool to Alert to Right Treatment
Suggests medications that may provide additional benefits ie PPIs for gastroprotection in patients on medications increasing bleeding risk.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the MUST tool?

A

Malnutrition Universal Screening Tool: for assessing malnutrition in adults.

BMI - <18.5 = 2, <20 = 1.
Wt loss unplanned in <6 months. >5% = 1, >10%= 2
Acute illness/no nutritional intake for >5 days? =2

1 or more = medium risk - observe and monitor
2 or more = high risk - treat.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the Waterlow score?

A

Score used to estimate risk of pressure sores in patients.

think water –> pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the indications and side-effects of digoxin?

A

Used for: 2nd line for rate control in AF (NOT paroxysmal AF!), mild positive inotrope sometimes used in heart failure.
MEASURE levels regularly to avoid
DIGOXIN TOXICITY:
- confusion, nausea, vomiting, arrhythmias, visual haloes (‘yellow vision’), dizziness, drowsiness.
-ECG - reversed tick/ST depression and inverted T wave.
- HYPOKALAEMIA predisposes so monitor K (should be >4) and supplement if needed. Eg gastroenteritis could precipitate.
-Treatment: stop digoxin, rehydrate and correct hypokalaemia.
[oxford]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the indications and side-effects of thiazide-like diuretics?

A

Used for: hypertension 2nd/3rd line. Less commonly, oedema.
Eg indapamide, Bendroflumethiazide
Work by increasing urinary excretion of Na and Cl, and subsequently water, to lower BP.
SEs:
Decreases serum Cl, Na, K
Increases serum glucose (especially in diabetes); ca, and uric acid–> makes gout worse.
Dehydration –> AKI, postural hypotension (esp in elderly/frail)
[ztf]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the indications and contraindications of loop diuretics?

A

Used for: Mainly oedema, resistant htn. Also CCF, pulmonary or peripheral oedema, renal failure.
Eg: Furosemide, bumetanide
Work by: Powerful diuretics, inhibit active transport in the loop of Henle in the nephron of the kidney so less water is reabsorbed into the blood and more is excreted in the urine. Oral - work in 1hr, IV - work in 5 mins.
SEs:
Pissing all the time. Give in the morning so the patient isn’t getting up in the night to wee - this is especially important in elderly people at risk of falls.
Hypokalaemia, hypotension, AKI, urinary retention- outflow restricted because can’t pass quick enough, hyperglycaemia, exacerbate gout, ototoxicity (damage to inner ear)
CIs: Hepatic encephalopathy, hypokalaemia, hyponatraemia, dehydrated/hypovolaemia, lithium - increases the lithium level.
[ztf]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

List 5 causes of falls in elderly people.

A

Drugs (e.g. sedatives, alcohol)
MSK (e.g. OA of hip)
Syncope (e.g. vasovagal, cardiogenic, arrhythmias)
Stroke/TIA
Postural hypotension (secondary to antihypertensives, hypovolaemia, dopaminergic drugs)
Vertigo (e.g. BPV, meniere’s disease)
Neurological: peripheral neuropathy, Parkinson’s
Hypoglycaemia
Poor environment (e.g. poor lighting, loose rugs)
Visual impairment
Dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

If someone has a TIA, when should they be seen by a specialist?

A

ABCD2 4 or more OR crescendo TIAs = high risk –> aspirin, referral within 24h, secondary prevention measures
ABCD2 3 or less = low risk. –> referral within 1 week, decision on brain imaging

(Should be seen within 24h of sx or ASAP after, but if >1 wk ago, only need to be seen within 1 week.)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the long term management of stroke?

A

Lifestyle mod
Clopidogrel 75mg daily
Statins, antihypertensives if necessary
Warfarin/NOACs if AF, Mitral stenosis, dilated cardiomyopathy, recent big septal MI.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Give 2 ways pressure sores are prevented.

A

Repositioning every 6h if normal risk, every 4h if high risk.
Distribution of weight to decrease pressure and friction eg heel support, foam mattress
Regular assessment of skin, pain and discomfort
Barrier creams

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Name 3 cardiac conditions that may cause an embolic CVA.

A 
MI causing mural thrombus
Infective endocarditis
Patent foramen ovale
Mitral or aortic valve disease/stenosis/regurgitation
Atrial fibrillation
26
Q

After a deterioration in symptoms, you are considering starting your patient on Parkinsons disease medication. What do you need to monitor/be aware of and why?

A 
Dopamine receptor agonists (1st line)
CRAB: Cabergoline, Ropinirole, Apomorphine, Bromocriptine.
Risk of Pulmonary, retroperitoneal and cardiac fibrosis with C and B. Do echocardiogram, ESR, creatinine and chest X ray prior to treatment and monitor patient closely.
Other effects:
Impulse control disorders
Excessive daytime somnolence
Hallucinations
Nasal congestion
Postural hypotension

If they are elderly you might start with levodopa/2nd line.
+ decarboxylase inhibitor eg carbidopa.
reduced effectiveness with time (2 yrs), dyskinesia, drowsiness, delirium/psychosis, dry mouth

27
Q

What are the components of the GCS and what is the score for each?

A

Eyes 1-4
Verbal 1-5
Motor 1-6
Total = min 3, max 15.

28
Q

Give 3 causes of hyponatraemia.

A

Sodium loss - AddIson’s (aldosterone insufficiency), D+V, DM/diuresis, burns
Dilutional effect - hypervolaemia, heart failure, hypoproteinaemia, SIADH, NSAIDs (promote water retention)
Renal failure

29
Q

How can hypocalcaemia present?

A 
NEURO:
Paraesthesia (fingers, toes, mouth)
Tetany
Seizures
Muscle cramps
Carpopedal spasm

Cardiac: Long QT

30
Q

How does hypercalcaemia present?

A

Bones - fractures, bone pain
Stones - kidney stones, polyuria, polydipsia, dehydration (nephrogenic diabetes insipidus)
Groans - constipation, abdo pain, vomiting, nausea
Moans - delirium, depression

Cardiac: Htn, short QT, arrhythmias.

31
Q

What MMSE score supports a diagnosis of dementia?

A 
<25/30 = dementia
25-27 = borderline
21-24 = mild
10-20 = moderate
<10 = severe
32
Q

Give 3 tools used to assess cognition.

A 
GPCOG
MoCA
ACE-III
AMT
6CIT
33
Q

List 4 blood tests you would to do exclude treatable causes of dementia.

A

Thyroid function tests
Syphilis serology
Liver function tests - hepatic encephalopathy; alcoholism
Vitamin B12, thiamine (B1) and folate levels

34
Q

What does the comprehensive geriatric assessment entail?

A

4 domains.

1) MEDICAL - problem list, comorbid conditions, disease severity, meds, nutrition
2) MENTAL HEALTH - cognition, mood, anxiety, fears
3) FUNCTIONAL CAPACITY - ADLs, gait and balance, activity/exercise status
4) SOCIAL AND ENVIRONMENTAL - support, social network, care resource eligibility, home safety and facilities, transport facilities

35
Q

How would you investigate a fracture after a fall in an elderly person?

A

DEXA scan -> generates a T score.

36
Q

How do you treat osteoporosis?

A

(AdCal if needed?)
PO Bisphosphonates eg alendronic acid for 5 years then re-assess with FRAX and DEXA

High risk –> continue.
High risk = Score of 75, GC therapy, prev hip/vertebral fractures, further fractures on treatment, high FRAX score

Consider stopping if patient <75 years, T score >-2.5, low risk on FRAX/NOGG.

37
Q

How do bisphosphonates work?

A

Analogues of pyrophosphate, a molecule with decreases demineralisation in bone. They inhibit osteoClasts (which Chip away at home) by reducing recruitment and promoting apoptosis.
Used for: prevention and treatment of osteoporosis; hypercalcaemia; Paget’s disease, and pain from bone mets.

38
Q

List 3 adverse effects of bisphosphonates.

A

Oesophageal reactions:
oesophagitis,
oesophageal ulcers (especially alendronate),
osteonecrosis of the jaw,
increased risk of atypical stress fractures of the proximal femoral shaft.

39
Q

What is malnutrition and what are the causes?

A

State in which deficiency of energy, protein and/or other nutrients causes measurable adverse effects on the body’s form, composition, function and clinical outcome (NICE 2006)
Diagnosis:
BMI <18.5
Or unintentional wt loss >10% last 3-6 months
or BMI <20 and unintential wt loss >5% last 3-6 months
Causes:
Decreased nutrient intake (starvation)
Increased nutrient requirements (sepsis, injury)
Inability to utilise ingested nutrients (malabsorption)

40
Q

What are the consequences of malnutrition? Give 5.

A 
Impaired immunity
Impaired wound healing
Muscle mass loss
Resp function loss
Cardiac function loss
Impaired skin integrity
Impaired recovery from illness
Worsening prognosis
low quality of life
Prolonged hosp stay
More hosp admissions
Greater healthcare needs
41
Q

What should you consider when prescribing erythromycin?

A

Erythromycin is a very potent enzyme inhibitor and will inhibit metabolism of many drugs –> build up of levels in the blood.
So find out is the person on any other meds? Esp ones with a narrow therapeutic index so high risk of toxicity?
Eg digoxin–> digoxin toxicity.
lithium –> lithium toxicity
Warfarin
Theophylline

42
Q

How does warfarin affect the body? How is it administered?

A

Oral only.
Antagonises vit K –> reversible with oral or IV Vit K. Interferes with EXTRINSIC coagulation pathway which is measured by INR. Metabolised predominantly by P450 CYP2C9.
Used for: Treatment of DVT/PE, prevention of VTE after insertion of prosthetic heart valve, prevention of recurrent TIA/stroke in patient who have suffered a stroke and have AF.

43
Q

How are DVTs and PEs prevented in post-surgical patients?

A

Low molecular weight heparin eg enoxaparin, tinzaparin, at licensed prophylactic dose.
[capsule]

44
Q

What does the APTT tell you?

A

Measurement of the INTRINSIC coagulation pathway, which is affected by heparin.
Regularly monitored in patients on IV heparin

45
Q

In chronic liver disease, what happens to the INR?

A

If liver sufficiently damaged to reduce synthesis of vit K dependent coagulation factors –> longer time to clot –> INR increases.

46
Q

How do you determine the target INR?

A

Normal people; 1-2
People with AF + stroke prevention, treatment of DVT/PE: 2-3.
People with prosthetic heart valves and some patients with recurrent DVT/PE = 3-4.

47
Q

What advice should you give to patients on warfarin?

A

Don’t take OTC NSAIDs - use paracetamol based products instead. (nb NSAIDs dont affect the INR)
Abx eg erythromycin inhibit hepatic enzymes –> increase INR.
Take at the same time every day preferably in evening
Avoid cranberry juice as can enhance effects of warfarin - inhibits cytochrome P450 enzymes.

48
Q

What would you do in a patient with AF at risk of stroke and falls? How would you decide whether to anticoagulate?

A

HASBLED tool to identify those at high risk of bleeding
DON’T withhold anticoag including warfarin due to risk of falls (NICE 2014)
Offer modification and monitoring of the RFs - htn, INR, concurrent meds eg aspirin/NSAIDs, alcohol.

49
Q

Aspirin - mechanism of action, indications, contraindications?

A

Used for: Analgesia, stroke prevention 3rd line
Mechanism: Prevents prostaglandin production –> reduces inflammation and clotting.
Problems:
Fluid retention, htn, cardiac failure, renal toxicity, peptic ulceration and GI bleeding esp with older age.
CIs: 2 NSAIDs together
When prescribed with many other drugs needs PPI eg omeprazole.
Avoid ACEis and NSAIDs together - opposing effects on fluid handling, renal toxicity.
(Used to be used for stroke prevention until NICE 2014 advised against aspirin as monotherapy, because risks outweigh benefits. Use clopidogrel 75mg instead)

50
Q

Give 5 things which precipitate delirium.

A 
Nb precipitate is different to predisposing to age would not count. 
Alcohol
Codeine
Constipation
Malnutrition
Sepsis
51
Q

Give 5 risk factors/predisposing factors for delirium.

A 
Older age
Cognitive impairment
Frailty/multiple comorbidities
significant injuries
Functional impairment
Alcohol hx
Sensory impairment 
Poor nutrition
Lack of stimulation
Terminal phase of illness
52
Q

What is SIADH and how does it occur?

A

Syndrome of Inappropriate ADH is characterised by hyponatraemia in a euvolaemic patient (normal ECF), with no other cause.
Urine osmolality > plasma osmolality.

Normal ADH:
ADH (vasopressin) stimulates production of aquaporin II channels which allow water reabsorption in principle cells of the kidney.
SIADH:
Too much ADH produced so too much water reabsorbed –> chronic hypervolaemc hypo-osmolarity state.
Kidneys adapt by decreasing the number of aquaporin II channels = more water and sodium excreted in the urine. ECF volume is now fine but excess sodium is lost.

53
Q

Give 5 causes of SIADH (hint: car dish)

A 
Medications:
Chemotherapy
Antidepressants
Recreational drugs
Diuretics
Inhibitors - ACEI, SSRI
Sulfonylurea
Hormones (desmopressin)
Other: trauma, surgery, CNS infection, stroke, small cell carcinoma, pancreatic cancer (increase ADH)
Nephrogenic - AQP2 mutation causing the channels to remain open causing h2o retention.
54
Q

How is SIADH managed?

A

Restrict fluid intake –> increase aldosterone –> increase sodium retention.
Hypertonic saline slowly. Contains Na which will increase fluid volume.
Furosemide - increases excretion of water, Na+, K+, Cl-
Demeclocycline - chronic hyponatraemia. Inhibits ADH binding to its receptors.
RAPID correct can lead to CENTRAL PONTINE MYELINOSIS.

55
Q

How do you correct hyponatraemia?

A

Give hypertonic saline slowly.
Remember water follows sodium. So the risk if that you will cause water to leave the tissues and go into the ECF, causing shrivelling of the cells, damage to the myelin sheath –> quadraparesis, pseudobulbar palsy, emotional lability.

56
Q

Give 5 risk factors of urinary retention.

A

Anticholinergic drugs - Amitriptyline, oxybutynin, codeine.
Prostate problems
Autonomic neuropathy eg end stage PD, diabetes
Constipation

57
Q

Give 5 causative organisms of UTIs in elderly people.

A 
E Coli
Staphylococci
Proteus spp
Klebsiella
Enterococcus
Enterobacter
58
Q

How are pressure ulcers managed?

A

Always: wound dressing, appropriate analgesia, nutritional assessment (as malnourishment is a potential cause)
Abx if: sepsis, spreading cellulitis (eg purulent discharge), or osteomyelitis.
Waterlow score to screen for risk of pressure sores.
[NICE, passmed]

59
Q

What is the MELD tool for?

A

Model for End-stage Liver disease: stratifies severity of end-stage liver disease when planning for a transplant.

60
Q

What is the PERC tool for?

A

Pulmonary Embolism Rule-out Criteria, an initial screening tool to assess if the patient could be having a PE.

61
Q

What tests are commonly performed as part of the ‘confusion screen’?

A 
B12/folate - macrocytic anaemia, deficiency worsens confusion
TFTs - hypothyroidism
Glucose - hypoglycaemia
Bone profile - hypercalcaemia
[passmed]

3a (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions