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