COTE Flashcards
What is a 5Q pathway?
They are discharged from hospital to home but need a greater level of care.
What treatments can you refuse in an advanced directive?
You can withdraw anything that isn’t a basic care need.
Such as food + water.
You can refuse advanced care needs in an advanced directive
Describe what a PEG tube is?
Percutaneous endoscopic gastrostomy- a procedure where you get a flexible feeding tube placed through the abdomen wall into the stomach
What is the Court of Protection ?
This is a legal court set up to help patients who are unable to make decisions about their health, financial or welfare situation.
They appoint deputies to act on behalf of the patient
What is a court appointed deputy?
This is when a patient has already lost capacity for a lasting power of attorney.
They need to make decisions on the patients behalf
What is an independent mental capacity advocate?
This is needed when a patient has a serious decision to make ie long term move or a serious medical treatment
They lack capacity and do not have a Court Appointed Deputy to make their decisions.
How is a DoLS different to when someone is sectioned under the Mental Health Act?
DoLS is when a patient has no capacity but has no mental illness.
Decisions are made in their best interests. hence why it is used in Dementia patients.
What causes OAPs to be at an increased risk of postural hypotension?
In the elderly the blood vessels become less responsive to nerve stimuli as such you get the inability to respond to a rise and fall in BP.
Do the elderly have a higher or lower fat percentage than younger patients?
What about their renal clearance?
They have a higher fat percentage so be aware of this in fat soluble drugs.
Renal clearance: reduced. Reduce dose of regally excreted drugs accordingly
Give 5 RF for falls:
- Previous Fall
- Mobility issues
- Sensory impairment.
- Pain
- CVS, diabetes or urinary incontience
Give 5 tests you would want to do on someone that comes into hospital with a fall?
CT Head
BP + lying and standing BP
ECG
BMs , FBC, CRP, U&Es etc
Rule out sepsis: CXR, urine dip etc
What is dementia?
Dementia is a condition that describes the progressive decline in cognitive function affecting ADLs and the whole cortex
Is Alzheimer’s disease more common in females or males?
Females
How would dementia with Lewy Body’s present?
How is it different to Parkinson’s plus dementia ?
Dementia w/ Lewy body’s. Tends to present with inattention and appearance of hallucinations of small animals and children.
Other Parkinsonian Symptoms: REM, constipation and tremors tend to occur a couple of years later.
How does vascular dementia present?
Step wise degenerative changes.
RF previous vascular damage i.e. TIAs, HA and Stroke
Management: statins and BP control
What age range is fronto temporal dementia common in?
How does it present?
Common in 40-50s got a genetic link
Presents with a change in personality, social disinhibition and deterioration in intellect.
How would Alzheimer’s present?
Insidious in onset.
Memory loss, Reduction in executive function Apraxia and Agnosia Behaviour changes Decline in language Loss in insight
What are the pathophysiological changes in Alzheimer’s Disease?
You get neurofibrillary tangles of Tau protein and beta amyloid plaque deposits
What cognitive screening can you do on a patient with suspected dementia?
You need to rule out reversible causes: B12, thyroid, folate, iron deficiency, do they have pseudo dementia caused by depression?
Then you may want to do a MRI head.
Tests include: Addenbrooke’s cognitive examination, Montreal Cognitive Assessment and MMSE
Give 5 RF of a fall ?
Poor mobility
Pain
Incontience (foecal or urine)
Sensory impairment
Drug use
What are 4 investigations you would like to do in someone who just had a fall?
CT head
Lying and Standing BP
ECG
BM, urine dip etc
What would you treat someone with Lewy body Dementia?
Donepezil
How many months does Lewy Body Dementia develop pre Parkinson’s?
> 12 months
What is the treatment for Alzheimer’s?
- Donepezil or Rivastigmine
2. Memantine
What are some of the symptoms of Parkinson’s Disease pre motor symptoms?
- REM sleep
- Aches and Pains
- Anosmia
- Constipation
- Depression
What are the three features of Parkinson’s ?
Rigidity
Resting Tremor
Bradykinesia
How would you treat a benign essential tremor?
Propanol
What is the 1st and 2nd line treatment of Parkinson’s Disease?
- Co carelodopa = de carboxylase inhibitor
- Dopamine Agonist: cabergoline
- MAO-B inhibitor oral rasagiline
What criteria is used to score pressure sores?
Braden and Waterlow scores
Does smoking increase the incidence of pressure sores?
YES
What is the best diagnostic method for diagnosing PD?
Positive response to dopamine
Can also use a DAT imaging scan
Give a definition of delirium
An acute onset fluctuation in consciousness that often involves perception and mood. Worse at night.
What bloods would you like to do in a patient with suspected osteoporosis?
Alkaline Phosphatase
Phosphate
Calcium
Phosphate
Give 5 different types of syncope?
Neurally mediated syncope: vasovagal
Orthostatic Hypotension: occurs on standing up
Autonomic Failure: common in DM or PD
Hypovolaemic: haemorrhage, dehydration, D + V
Cardiogenic: arrhythmias
Psychogenic
