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NV - Phase 3A > COTE > Flashcards

COTE Flashcards

1
Q

Define frailty.

A

State of increased vulnerability resulting from age-ing associated decline in functional reserve, across multiple physiological systems, resulting in compromised ability to cope with everyday or acute stressors.

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2
Q

What are the 4 components of the comprehensive geriatric assessment?

A

Medical assessment
Functional assessment
Psychological assessment
Social and environmental assessment

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3
Q

What is the medical assessment comprised of?

A

Doctor, nurse, phrmacist, dietician, SALT

problem list, comorbidities, medication review, nutritional states

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4
Q

What is the functional assessment comprised of?

A

OT, PT, SALT

assesses ADLs, activity, exercise satus, gait, balance

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5
Q

What is the psychological assessment comprised of?

A

Doctor, nurse, OT, psychologist

cognitive status testing, mood/depression testing (PHQ-9 questionnaire)

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6
Q

What is the social and environmental assessment comprised of?

A

OT and social worker if needed

informal supprt needs and assets, care resource eligibility, home safety

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7
Q

What are the features of delirium?

A 
Acute onset
fluctuating course
inattention 
altered level of consciousness
usually reversible 
associated with underlying medical cause
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8
Q

What are the features of dementia?

A

Chornic illness
progressive course
no clouding of consciousness
no underlying/reversible cause

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9
Q

Name an assessment tool used for delirium.

A

4-AT

Mini Mental State Exam

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10
Q

What causes delirium?

A

PINCHES-ME

Pain
Infection
Nutrition
Constipation and urinary retention
Hydration
Endocrine and electrolytes
Stroke
Medication and alcohol 
Environmental
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11
Q

Name some ways in which the environment can be altered to help delirium.

A 
Clocks and calendars to maximise orientation
ensure hearing aids/glasses are worn
photos of family members
consistency of staff members
quiet bay/side room if possible
sleep hygiene
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12
Q

Who makes up the comprehensive geriatric assessment team?

A

geriatrician
social worker
physiotherapist
occupational therapist

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13
Q

What are the complications of a long lie following a fall?

A

pressure ulcers
dehydration
rhabdomyolysis
hypothermia

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14
Q

How are pressure ulcers managed?

A

antibiotics
wound dressing
pain relief
debridement if grade3/4

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15
Q

What is osteoporosis?

A

Decreased bone mineral density due to imbalance between remodelling and resorption.
Increased risk of fractures - esp spine, hip and NOF

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16
Q

What are the risk factors for osteoporosis?

A 
smoking
early menopause
steroid use
underweight
inactivity 
alcohol
all elderly people
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17
Q

How is osteoporosis managed?

A

bisphosphonates (zoledronate, alendronate)

can be given IV once a year
or oral once a wekk - on an empty stoach + sit upright for half an hour after as it can cause oesophagitis

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18
Q

What is a tool used to assess nutritional status?

A

MUST screening tool - malnutrition universal screening tool

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19
Q

What is re-feeing syndrome?

A

Metabolic disturbances as a result of reintroduction of nutrition to patients who are starved/severely malnourished

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20
Q

What are the biochemical features of refeeding syndrome?

A

hypophosphataemia
hypokalaemia
thiamine deficiency
abnormal glucose metabolism

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21
Q

What are some complications of re-feeding syndrome?

A

cardiac arrhythmias
coma
convulsions
cardiac failures

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22
Q

How is re-feeding syndrome treated?

A 
monitor blood biochemistry 
commence re-feeding with guidelines 
recognise electrolyte changes 
monitor glucose and Na levels 
supportive care
refer to nutritional support team/dietician
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23
Q

Name 3 treatments can that improve bone health.

A

bisphosphonates
vitamin D and calcium supplements
exercise - impact exercise like walking (not swimming)

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24
Q

What are some environmental causes of falls in elderly people?

A 
loose rugs
pets
furniture
unstable footwear
poor lighting
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25
Q

What are some power/balance causes of falls in elderly people?

A

inactivity leading to muscle weakness
dizziness/loss of balance/loss of proprioception (vertigo)
Pain/MS - osteoarthritis
previous fall leading to decreased confidence

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26
Q

What are soem cardiovascular causes of falls in elderly people?

A 
vasovagal syncope (fainting)
situational syncope - micturition (old men at night time)
postural hypotension 
myocardial infarction
arrhythmia
dehydration/shock
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27
Q

What are some neurological causes of falls in elderly people?

A 
stroke
PD
gait disturbance 
visual impairment 
peripheral neuropathy 
myopathy e.g. statin or steroid myopathy
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28
Q

What are some medications that increase risk of falls in elderly people?

A 
benzodiazepines 
diuretics
anti-hypertensives 
antidepressants
antipsychotics
polypharmacy
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29
Q

What are some other causes of falls in elderly people?

A 
infection/sepsis 
delirium
hypoglycaemia 
incontinence 
alcohol - intoxication, neuropathy, W-K
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30
Q

What are the 3 main features of Parkinson’s disease?

A

bradykinesia
rigidity
resting tremor

31
Q

List 3 differentiating features of a Parkinsonian tremor.

A 
pill rolling
worse at rest
reduced on distraction
reduced on movement
worse on one side (asymmetrical)
32
Q

What is the underlying pathophysiology of Parkinson’s?

A

loss of dopaminergic neurones in the substantia nigra

33
Q

What class of drug is normally combined with L-dopa therpay to prevent peripheral side-effects?

A

Carbidopa - a dopa-decarboxylase inhibitor.

34
Q

Name 3 complications of L-dopa therapy.

A 
choreiform movements - L-dopa induced dyskinesia 
tolerance to meds 
confusion
hallucinations
postural hypotension on starting tx
35
Q

Name 4 cardiac conditions that may cause an embolic CVA.

A 
atrial fibrillation
infective endocarditis
atrial-septal defect/patent foramen ovale 
mitral regurgitation
aortic or mitral valve disease
valve replacement
36
Q

What investigations would you undertake in someone with a suspected ischaemic stroke?

A 
CT head
ECG
Carotid artery doppler - check for carotid artery stenosis 
Lipid profile 
Clotting screen 
Echocardiogram
37
Q

What ABCD2 score is considered “high risk” for a stroke and what should be done?

A

> = is high risk

Aspirin 300mg daily stat
specialist referral within 24 hours of onset of symptoms
secondary prevention measures - statins, antihypertensives

38
Q

What are the components of the GCS?

A
  1. best eye opening response
  2. best verbal response
  3. best motor response (how well they localise pain)
39
Q

List 4 causes of hyponatraemia.

A

dilutional effect - heart failure, SIADH, hypervolaemia, NSAIDs (promote water retention), oliguira renal failure

Sodium loss - Addison’s disease, diarrhoea and vomiting, osmotic diuresis (DM, diuretic excess), severe burns, diurteic stage of acute renal failure

40
Q

Name 4 symptoms of hypocalcaemia.

A 
muscle cramps/spasms
tetany
seizures
paraesthesia 
carpopedal spasm 
laryngospasm, bronchospasm
41
Q

Name 4 symptoms of hypercalcaemia.

A

Bones, stone, moans and groans.

bone pain, fractures
renal stones colic, polyuria, polydipsia, dehydration
drowsiness/coma
muscle weakness
depression
nausea, vomiting, weight loss, anorexia
constipation, abdo pain
42
Q

What MMSE score supports a diagnosis of dementia?

A

<25

43
Q

What cognitive tools can be used to assess dementia?

A 
4AT
MMSE
GP-COG
Addenbrook'es
6-CIT
AMT
MOCA
44
Q

Name 4 different types of dementia and their key features.

A

Alzheimer’s - agnosia, apraxia, amnesia, aphasia, insidious onset and gradual progression

Vascular dementia - stepwise progression following ischaemic brain injury

Lewy Body dementia - sleep behaviour disroder, falls, impaired consciousness, visual hallucinations, Parkinsonism

Frontotemporal dementia - memory fairly preserved, extreme personality changes and disinhibition

45
Q

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

A 
vitamin B12, thiamine and folate levels
thyroid function
FBC looking for anaemia 
syphilis serology (neurosyphilis)
LFTs (hepatic encephalopathy, alcoholism)
46
Q

What is Donepezil and what types of dementia can it be used to treat?

A

Acetylcholinesterase inhibitor (other examples are rivastigmine and galantamine)

can only be used to treat Alzheimer’s

Alternative medication - NMDA-receptor antagonist - blocks glutamate (memantine)

47
Q

What are the two subtypes of delirium?

A

Hyperactive –> agitated, inappropriate behaviour, hallucinations

Hypoactive –> lethargy, reduced concentration

48
Q

What bedside tests would you do for someone with delirium?

A

O2 sats
BP
Temperature
ABG/VBG

49
Q

What investigations would you do for someone with delirium?

A 
FBC, U&amp;E, LFT
CRP/ESR
Sputum culture
Folate, B12
HbA1c
TFT
CXR, ECG, urinalysis
50
Q

What is the guidance on long-term usage of bisphosphonates?

A

Treatment should be reassessed after 5 years - updated FRAX and DEXA

Keep treating if considered high risk:
age >75
previous hip/vertebral fracture s
further fractures on treatment 
high risk on frax score
dexa scan T score
51
Q

How do bisphosphonates work?

A

inhibition of osteoclasts

52
Q

List 3 adverse effects of bisphosphonates.

A

oesophagitis
osteonecrosis of the jaw
increased risk of atypical stress fractures of the proximal femoral shaft in patients taking alendronate

53
Q

How are DEXA scan score interpreted?

A

-1 to +1 = healthy
-1 to -2.5 = osteopenia
< -2.5 = osteoporosis
< -2.5 and current fragility fracture = severe osteoporosis

54
Q

What are the components of the FRAX scoring system?

A 
parent hip fracture 
height and weight 
smoking 
alcohol >3 units a day 
steroids
previous hip fracture
femoral neck BMD
female gender
age
RA
secondary osteoporosis
55
Q

How is malnutrition diagnosed?

A

BMI<18.5
unintentional weight loss >10% in last 3-6 months
BMI<20 + unintentional weight loss >5% within 3-6 months

56
Q

What are some clinical features of re-feeding syndrome?

A

CVS - arrhythmias
GI - abdo pain, constipation, vomiting, anorexia
MSK - weakness, myalgia, rhabdomyolysis, osteomalacia
Resp - SOB, ventilator dependance, respiratory muscle weakness
Neuro - weakness, paraesthesiae, ataxia
Haematological - infections, thrombocytopenia, haemolysis, anaemia
liver failure
wernicke’s encephalopathy

57
Q

What is a lasting power of attorney?

A

A document which a person can use to nominate someone else to make certain decisions on their behalf when they are unable to do so themselves

It can be financial/about estate or medical/health decisions

To be valid it must be registered with the Office of the Public Guardian

58
Q

What is the definition of postural hypotesion?

A

a drop of >20/10 mmHg within 3 minutes of standing

59
Q

What are some causes of postural hypotension?

A

meds - diuretics, antihypertensives, antidepressants, polypharmacy

cardiac - aortic stenosis, arrhythmias, MI, cardiomyopathy, CHF, anaemia

endocrine - diabetes insipidus, hypoadrenalism, hypothyroid

Neuro - PD and PD+ syndromes
blood loss, dehydration, shock

60
Q

What is the pharmacological management of postural hypotension?

A

fludrocortisone, midodrine

61
Q

How are pressure ulcers classified?

A

Grade 1- non-blanching erythema with instact skin
Grade 2 - partial thickness skin loss involving epidermis, dermis or both
Grade 3 - extensive loss, destruction/necrosis of the muscle, bone or support structures

62
Q

What is the role of vitamin D?

A

increase Ca2+ absorption in the gut

increased Ca2+ release from the bone

basically trying to get calcium into the blood, just like PTH hormone

63
Q

Where is parathyroid hormone released from and what triggers its release?

A

Secreted from the chief cells of the parathyroid gland

in response to low serum Ca2+ levels

64
Q

What are 4 common sites for osteoporosis related fractures?

A
  1. thoracic vertebrae - lead to kyphosis and loss of height
  2. lumbar vertebrae
  3. proximal femur
  4. distal radius (Colles’ fracture)
65
Q

Give some examples of cortical and subcortical dementia.

A

cortical - Alzheimer’s disease, Lewy Body dementia, frontotemporal dementia

subcortical - PD dementia, Huntington’s disease dementia, LBD, alcohol-related dementia, AIDS dementia

66
Q

What are the typical symptoms of cortical dementia?

A

memory impairment
dysphasia - language deficit
visuospatial impairment - apraxia
problem solving and reasoning deficit

67
Q

What are the typical symptoms of subcortical dementia?

A 
psychomotor slowing 
impaired memory retrieval 
depression
apathy 
executive dysfunction 
personality change 
language preserved - unlike in cortical
68
Q

Which 3 genes have been linked to the development of early onset Alzheimer’s disease?

A
  1. APP gene
  2. Presenillin 1
  3. Presenillin 2

autosomal dominant inheritance pattern

69
Q

Which gene has been linked to late onset Alzheimer’s disease?

A

Apolipoprotein E (ApoE)

70
Q

Describe the macroscopic pathological changes seen on CT in Alzheimer’s disease?

A

shrunken brain - diffuse cerebral atrophy
increased sulcal widening
enlarged ventricles

71
Q

Describe the microscopic pathological changes seen in Alzheimer’s disease.

A

neuronal loss
neurofibrillary tangles
amyloid plaques

72
Q

Which neurotransmitters are affected in Alzheimer’s?

A

acetylcholine
noradrenaline
serotonin
somatostatin

73
Q

What are the microscopic pathological features in frontotemporal dementia?

A

ubiquitin and tau deposits

NV - Phase 3A (7 decks)

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