COTE peer teaching Flashcards
what things do you need to establish in the history if you suspect confusion
premorbid personality
past medical history
medications
social circumstances
any past similar episodes
differences between dementia and delirium
what causes delirium
Drug use
Electrolyteand physiological abnormalities
Lack of drug (withdrawal)
Infection
Reduced sensory input (blind, deaf, changing environment)
Intracranial problems (stroke, post ictal, meningitis, subdural)
Urinary retention and faecal impaction (or even just constipation)
Myocardial (MI, arrhythmia, HF)
managing delirium
treat the cause
manage the environment
soft lighting
clocks and calendars
sleep hygiene i.e. promote night time sleep
avoid multiple rooms/ward moves
minimise provocation
management of alzheimers
suppotive
acetylcholinesterase inhibitors such as donepezil
memantine
what are the 5 domains of the comprehensive geriatric assessment
physical health
mental health
social
function
environment
what are the complications of remaining on the floor for a long time following a fall
pressure ulcers
dehydration
rhabdomyolysis
how to investigate pressure ulcers
- CRP
- ESR
- Swabs
- Blood cultures
- X-ray for bone involvement
management of pressure ulcers
antibiotics
wound dressing
pain relief
debridement if grade 3/4
what is osteoporosis
decreased bone mineral density due to imbalance between remodelling and resorption
risk factors for osteoporosis
smoking
early menopause
steroid use
being underweight
inactivity
alcohol use
age
how do you assess nutritional status
MUST screening tool
what does frax check for
10 yr fragility fracture risk
management of osteoporosis
bisphosphinates like alendronic acid and vitamin d and calcium supplementation if needed with adcal
biochemical features of refeeding syndrome
- hypophosphataemia
- hypokalaemia
- thiamine deficiency
- abnormal glucose metabolism
complications of refeeding syndrome
cardiac arrhythmias
coma
convulsions
cardiac failure
what are the 3 main features of parkinsons
resting tremor
bradykinesia
rigidity
differentiating features of a parkinsonian tremor
slow (pill rolling)
worse at rest
asymmetrical
reduced on distraction
reduced on movement
what is the usual pharmacological management of parkinsons
L-dopa given with a dopa decarboxylase inhibitor like carbidopa
combined drug like co careldopa
complications of l-dopa therapy
postural hypotension
confusion
hallucinations
dyskinesias
shortening duration of action of each dose
4 elements of pressure sore prevention
- barrier creams
- pressure redistrobution and friction reduction
- repositioning (every 6 hrs in normal risk, every 4 hrs in high risk)
- regular skin assessment
- check for areas of pain and discomfort
- skin integrity at pressure areas
- colour changes
- variations in heat, firmness and moisture
name 4 cardiac conditions that may cause an embolic CVA
- atrial fibrillation
- MI causing thrombus
- infective endocarditis
- aortic or mitral valve disease
- patent foramen ovale
what colour does haemorrhage appear on CT
WHITE
Is parkinsons more common in men or women
twice as common in men
what is the mean age of diagnosis of parkinsons
65 years
management for parkinson’s
- at diagnosis if they have significant impact of motor symptoms of ADLs then treat with co-careldopa
- if they don’t have significant impact of motor symptoms of ADLs then treat with a choice of either dopamine agonists, co-careldopa or MAO-BI
- can also give anti-muscarinics which help with tremor and rigidity
- can also give amantidine which increases dopamine release and prevents reuptake in the synapses
what are the pros and cons of dopamine agonists and give an example
- can be used in early disease
- fewer motor complications than co-careldopa
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what are the pros and cons of MAO-B inhibitors?
give an example of one
- it’s less effective in reduction of motor symptoms and improving ADLs but has fewer complications
- an example is selegiline or rasagiline
how do MAO-B inhibitors work
inhibit dopamine breakdown
when to image in suspected stroke
- CT within one hour if
- indications for thrombolysis or thrombectomy
- on anticoagulation
- known bleeder
- GCS<13
- severe headache at onset of stroke symptoms
- CT as soon as possible and within 24 hours of symptom onset in everyone with suspected acute stroke without indications for immediate brain imaging.
acute ischaemic stroke initial assessment and treatment
- thrombolysis with alteplase if
- within 4.5 hours of onset of stroke symptoms
- intracranial haemorrhage has been excluded
- for everyone presenting with acute stroke who has had haemorrhage excluded by CT
- give 300mg aspirin asap and continue for two weeks
- give PPI
- after 2 weeks start definitive long-term anti-thrombotic treatment
- give 300mg aspirin asap and continue for two weeks
- thrombectomy if occlusion demonstratef by CTA or MRA
causes of hyponatraemia
- dilutional
- heart failure
- hypopoteinaemia
- SIADH
- fluid loss
- NSAIDs (promote water retention)
- oliguric renal failure
- sodium loss
- addison’s diseae
- diarrhoea and vomiting
- osmotic diuresis
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symptoms of hypocalcaemia
paraesthesia
tetany
carpopedal spasm (wrist flexion and fingers drawn together)
muscle cramps
seizures
prolonged QT
bronchospasm