Brainscape's Knowledge GenomeTM

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


See full index

Phase 3a > COTE > Flashcards

COTE Flashcards

1
Q

Define frailty

A

State of increased vulnerability resulting from age-associated decline in functional reserve

across multiple systems

resulting in compromised ability to cope with everyday or acute stressors

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

What are the 4 geriatric giants?

A
  1. instability (falls)
  2. immobility
  3. intellectual impairment
  4. incontinence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is a comprehensive geriatric assessment?

A

MDT diagnostic process

Identifies health problems and establishes management plans in older patients with frailty

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

What are the 4 components of the comprehensive geriatric assessment?

A
  1. medical assessment
  2. functional assessment
  3. psychological assessment
  4. social and environmental assessment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How do the onset, features and causes of delirium and dementia differ?

A

acute onset + fluctuating course
inattention + altered level of consciousness
usually reversible
associated with underlying medical cause

chronic illness + progressive course
no clouding of consciousness
no underlying/reversible cause

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

What assessment tool is used for delirium?

A

4-AT

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

What causes delirium?

A

Drugs - changing dose/introducing new ones/polypharmacy
Electrolyte imbalances
Lack of drugs - withdrawal
Infection
Reduced sensory input - blind, deaf, changing environment
IC problems - stroke, seizures, haemorrhage
Urinary retention + faecal impaction
Myocardial problems - MI, arrhythmia

dehydration, B12

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

How is delirium managed?

A

treat underlying cause
manage the environment

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

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

How is confusion investigated?

A

bloods (FBC, U&Es, LFTs, TFTs, CRP/ESR, folate/B12, HbA1C) - possible causes of infection/delirium

ECG - exclude MI
urine dipstick - exclude UTI
CXR - exclude pneumonia
sputum culture

stool chart - constipation?
nutrition/hydration
maximise orientation

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

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

A

pressure ulcers
dehydration
rhabdomyolysis
hypothermia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How do you investigate pressure ulcers?

A

CRP, ESR
WCC
swabs
blood cultures
x-ray for bone involvement

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

How are pressure ulcers managed?

A

antibiotics
wound dressing
pain relief
debridement if grade 3/4

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

What is osteoporosis?

A

decreased bone mineral density due to imbalance between remodelling and resorption
> increases bone fragility and susceptibility to fracture

T score

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Most common fracture sites?

A

spine
hip
NOF

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

RFs for osteoporosis?

A

SHATTERED
Steroids
Hyperthyroidism
Alcohol/smoking
Thin (BMI<22)
Testosterone deficiency
Early menopause
Renal/liver failure
Erosive or inflammatory bone disease (RA, Ank spond)
Dietary Ca2+ deficiency

all elderly!

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

How is osteoporosis managed?

A

bisphosphonates - zoledronate, alendronate

can be given IV once/yr or oral once/wk

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

What are the issues with real bisphosphonates? What is there a risk of?

A

have to have them on an empty stomach (first thing in morning) and stay upright for half an hr after taking them
due to risk of oesophagitis

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

What tool is used to assess nutritional status?

A

MUST (malnutrition universal screening tool)

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

What is re-feeding syndrome?

A

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

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

What are the biochemical consequences of re-feeding syndrome?

A

hypophosphataemia
hypokalaemia
thiamine deficiency
abnormal glucose metabolism

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

What are the potential consequences of re-feeding syndrome?

A

4C’s:
cardiac arrhythmias
coma
convulsions
cardiac failure

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

How is re-feeding syndrome treated?

A

monitor electrolytes/glucose
commence re-feeding with guidelines

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

RFs for pressure ulcers?

A

age
immobility for long periods e.g. fracture, hospital stay
peripheral vascular diseases
dehydration
malnourishment
obesity

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

How can pressure ulcers be prevented?

A

mobilise
change position
pressure redistributing mattresses
barrier creams
regular skin assessment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Name 3 treatments to improve bone health?

A

bisphosphonates
vitamin D + Ca supplements
exercise - impact e.g. walking, not swimming

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Causes of falls in elderly people?

A
  • Drugs - medications, alcohol
  • MSK - OA, MS, previous fall and decreased confidence, muscle weakness due to inactivity
  • CVS - syncope (vasovagal, situational), postural hypotension, MI, arrhythmia, dehydration
  • Neurological - stroke, PD, gait disturbance, visual impairment, peripheral neuropathy, myopathy, vertigo
  • Infection/sepsis
  • Hypoglycaemia
  • Dementia/delirium
  • Incontinence
  • Poor environment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What medications can increase the risk of falls in the elderly?

A

benzos (sedative), ADs, antipsychotics

anti-hypertensives - ACEi, CCB, beta-blockers + diuretics

polypharmacy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

3 main features of Parkinson’s?

A

bradykinesia
rigidity - lead-pipe, cog-wheel
resting tremor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Differentiating features of a parkinsonian tremor?

A

Pill rolling
Worse at rest but reduced on distraction or movement
Worse on one side (asymmetrical)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the underlying pathophysiology of Parkinson’s?

A

Loss of dopaminergic neurones in the substantia nigra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What class of drug is normally combined with L-dopa therapy to prevent peripheral side-effects in Parkinson’s?

A

Carbidopa – a dopa-decarboxylase inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Complications of L-dopa therapy?

A

Dyskinesia
End-dose deterioration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What cardiac conditions can cause an embolic CVA?

A

AF
IE
atrial-septal defect/patent foramen ovale
aortic/mitral valve disease, valve replacement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

How does an ischaemic stroke compare to a haemorrhage stroke on CT?

A

ischaemic = black
haemorrhage = white

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

How is a CVA investigated?

A

ECG + CT head

consider:
carotid artery doppler
lipid profile
clotting screen
echo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

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

A

4+ = high risk

Aspirin – 300mg daily – started immediately
Specialist referral within 24 hours of onset of symptoms
Secondary prevention measures (statins, antihypertensives)

38
Q

What are crescendo TIAs? How should they be treated?

A

2+ episodes in a week
treated as high risk regardless of ABCD2 score

39
Q

What should be done for someone with an ABCD2 score of ≤ 3?

A

Specialist referral within 1 week of symptom onset, including decision or brain imaging

40
Q

What are the components of the GCS?

A

best eye opening response
best verbal response
best motor repose - how well they localise pain

41
Q

Causes of hyponatraemia?

A

Dilutional effect – HF, SIADH, hypervolaemia, NSAIDS, oliguria, renal failure

Sodium loss – Addison’s disease, D&V, osmotic diuresis (DM, diuretic excess), severe burns, diuretic stage of acute renal failure

42
Q

Sx of hypocalcaemia?

A

Muscle cramps/spasms
Tetany - carpopedal spasm, laryngospasm, bronchospasm
Seizures
Parasthesia

43
Q

Sx of hypercalcaemia?

A

BONES - bone pain, fractures, muscle weakness
STONES - renal stones/colic, polyuria, polydipsia, dehydration
PSYCHIATRIC MOANS - depression, drowsiness/coma
ABDOMINAL GROANS - N&V, weight loss, anorexia, constipation, abdominal pain

44
Q

What cognitive assessments are often used?

A

GP-COG
Addenbrooke’s
6-CIT
AMT
MOCA

45
Q

Name the 4 types of dementia and their key features?

A

Alzheimer’s - agnosia, apraxia, amnesia, aphasia

vascular - stepwise progression following ischaemic brain injury

LBD - sleep disorder, falls, impaired consciousness, visual hallucinations, parkinonism

Frontotemporal – memory fairly preserved, extreme personality changes and disinhibition

46
Q

What are the key blood test to exclude treatable causes of dementia?

A

vitamin B12, thiamine, folate
TFTs
FBC - anaemia
syphilis serology
LFTs - hepatic encephalopathy, alcoholism

47
Q

How is Alzheimer’s treated?

A

AChEi - donepezil, rivastigmine, galatamine
= only for alzheimer’s

alternative: NMDA-receptor antagonist (blocks glutamate) > memantine

48
Q

2 subtypes of delirium?

A

Hyperactive > agitated, inappropriate behaviour, hallucinations

Hypoactive > lethargy, reduced concentration = often missed

49
Q

RFs for delirium?

A

old age
CI, sensory impairment

frailty, multiple comorbities
significant injuries e.g. hip #
functional impairment
terminal phase of illness

hx of alcohol excess
poor nutrition
lack of stimulation

50
Q

How does delirium present?

A

Acute behavioural change
Disorganised thinking/altered perception
Altered level of consciousness
Falling
Loss of appetite

51
Q

What factors indicate a patient is at high risk of # and need to be treated with bisphosphonates?

A

on steroids
age >75
previous hip/vertebral fractures
further fractures on treatment
high risk on FRAX score
DEXA scan T score

52
Q

What is the action of bisphosphonates?

A

inhibition of osteoclasts

53
Q

3 adverse affects of bisphosphonates?

A

Oesophagitis
Osteonecrosis of the jaw

Increased risk of atypical stress fractures of the proximal femoral shaft (alendronate)

54
Q

How are DEXA scan scores interpreted?

A

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

55
Q

What are the components of the FRAX scoring system?

A

Parent hip fracture
Height and weight (BMI)
Smoking
Alcohol >3 units a day
Steroids
Previous hip fracture
Femoral neck bone mineral density
Female gender
Age
RA
Secondary osteoporosis

56
Q

How is malnutrition diagnosed?

A

BMI < 18.5 kg/m2

Unintentional weight loss >10% in the last 3-6 months

BMI < 20kg/m2 plus unintentional weight loss >5% within the last 3-6months

57
Q

Causes of malnutrition?

A

Inadequate nutritional intake (starvation)
Increased nutrient requirements (cancer, sepsis, injury)
Inability to utilise ingested nutrients (malabsorption)
Increased loss (vomiting, diarrhoea)

58
Q

What tests should be done before commencing feeds in a patient who is malnourished?

A

U&Es, LFTs
ECG

59
Q

Clinical features of re-feeding syndrome?

A

CVS – arrythymias
GI – abdo pain, constipation, vomiting, anorexia
MSK – weakness, myalgia, rhabdomyelosis, osteomalacia
Resp - SOB, ventilator dependence, respiratory muscle weakness
Neuro – weakness, paraesthesia, ataxia
Metabolic – infections, thrombocytopenia, haemolysis, anaemia
Other – liver failure, Wernicke’s encephalopathy

60
Q

When looking at best interests in a pt without capacity, what needs to be considered?

A

Whether the person is likely to regain capacity and can the decision wait
How to encourage and optimise the participation of the person in the decision
The past and present wishes, feelings, beliefs and values of the person and any other relevant factors
Views of other relevant people (family members etc.)

61
Q

What is the role of an advanced directive?

A

Allows people who understand the implications of their choices to state their treatment wishes in advance

They can authorise specific procedures or refuse treatment in a predefined future situation

62
Q

What makes an advanced refusal of treatment legally binding?

A

The person is an adult
The person was competent and fully informed when making the decision
The decision is clearly applicable to current circumstances
There is no reason to believe that they have since changed their mind

63
Q

What factors make an advanced directive less legally binding?

A

an advanced REQUEST for treatment - does not have same legal binding as a refusal
but if it’s pt’s known wishes to be kept alive then reasonable efforts should be made

64
Q

What is deprivation of liberty?

A

Occurs when a person does not consent to care or treatment
e.g. pt with dementia who is not free to leave a care home and lacks capacity to consent to this

65
Q

What is a LPoA?

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

Can be financial/about estate, or medical/health decisions

To be valid – needs to be registered with the Office of the Public Guardian

66
Q

What is the role of an independent mental capacity advocate?

A

Commissioned from independent organisations by the NHS/local authorities to ensure the MCA is being followed

Support/represent its who lack capacity and do not have anyone else to represent them in decisions

67
Q

Definition of postural hypotension?

A

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

68
Q

Causes of postural hypotension?

A

Medications – diuretics, antihypertensives, antidepressants, polypharmacy
Cardiac – aortic stenosis, arrythmias, MI, cardiomyopathy, CHF, anaemia
Endocrine – diabetes insipidus, hypoadrenalism, hypothyroid, hypo anything..
Neuro – PD and PD+ syndromes
Blood loss, dehydration, shock

69
Q

How does postural hypotension present?

A

Asymptomatic

Falls/syncope
Dizziness, light-headedness
Blurred vision
Weakness, fatigue
Palpitations
Headache

70
Q

How is postural hypotension investigated?

A

Lying and standing blood pressure

Investigate for medical causes – medication review, blood tests

71
Q

How is postural hypotension managed?

A

drink lots of water, avoid large meals and alcohol
exercises
stand slowly, sleep with head raised

fludrocortisone, midodrine (autonomic dysfunction only)

72
Q

How are pressure ulcers classified?

A

Grade 1 – non-blanching erythema with intact skin
Grade 2 – partial thickness skin loss involving epidermis, dermis or both (abrasion/blister)
Grade 3 – full-thickness skin loss involving damage/necrosis of sub-cut tissue
Grade 4 – extensive loss, destruction/necrosis of muscle, bone or support structures
Unstageable – depth unknown, base of ulcer covered by debris

73
Q

What are the 2 major metabolic components of Ca homeostasis?

A

vitamin D
PTH

74
Q

What is the role of vit D?

A

increased Ca absorption in the gut
increase Ca release from bone

75
Q

Where is PTH realised and by what trigger?

A

Secreted from the chief cells of the PT gland

In response to low serum Ca2+ levels (detected by calcium sensor cells in the PT glands)

76
Q

What are the actions of PTH?

A

= increases Ca levels

increases osteoclast activity
increases intestinal Ca absorption
increases vit D activation
increases renal tubule re-absorption of Ca

77
Q

4 common sites for osteoporosis related fractures?

A

thoracic vertebrae > kyphosis, loss of height
lumbar vertebrae
proximal femur
distal radius - Colle’s fracture

78
Q

How would you investigate someone with suspected osteoporosis?

A

DEXA scan: T value

79
Q

Why does urinary incontinence happen in old age?

A

urethral atrophy
pelvic floor atrophy
prostatic hypertrophy

80
Q

What are the reversible and treatable causes of urinary incontinence?

A

reversible:
- UTI
- delirium
- DMT2
- diuretics

Treatable:
- BPH
- overactive bladder
- stress incontinence

81
Q

How should urinary incontinence be managed?

A

Depends on cause
- overactive bladder > antimuscarinics + bladder retraining
- dementia > regular toileting
- stress incont. > pelvic floor exercises
- BPH > antiandrogens, surgery
- hypotonic bladder - intermittent catheter

catheters

82
Q

What can be given to treat nocturia?

A

desmopressin (careful in >65 > hypoNa+)
drainage sheath

83
Q

How should faecal incontinence caused by constipation/bowel obstruction be managed?

A

rehydration
small + regular meals
enema 2x daily until empty
colonic washout
laxatives - lactulose, senn, movicol

84
Q

How is neurogenic faecal incontinence managed?

A

planned evacuation - loperamide then phosphate enema 2x/wk
regular toileting + suppository

85
Q

What is Paget’s disease? What is the pathophysiology?

A

excessive bone turnover due to excessive activity of osteoblasts + clasts
> patchy areas of high density (sclerosis) and low density (lysis) > enlarged and misshapen bones with structural problems mostly in axial skeleton

86
Q

How does Paget’s disease present?

A

bone pain + deformity
fractures
hearing loss

87
Q

How does Paget’s present on x-ray?

A

bone enlargement and deformity
OP circumscripta - osteolytic lesions that appear less dense
cotton wool appearance of skull - patchy areas of sclerosis and lysis
v shaped defects in long bones - v shaped osteolytic bone lesions within healthy bone

88
Q

How is Paget’s detected on blood results?

A

raised ALP
but normal LFTs
normal Ca + P

89
Q

How is Paget’s managed?

A

bisphosphonates

NSAIDs
Ca + Vit D

90
Q

What are the 2 key complications of paget’s?

A

osteogenic sarcoma

spinal stenosis + spinal cord compression - deformity in spine leads to narrowing + presses on nerves

91
Q

Which tool can be used to assess frailty status?

A

PRISMA-7

Phase 3a (11 decks)

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