COTE Peer Teaching Flashcards
List 6 possible causes of falls in elderly people.
- Drugs (sedatives, alcohol)
- MSK eg. OA of hip
- Syncope (vasovagal, cardiogenic, arrhythmias)
- Stroke / TIA
- Hypoglycaemia
- Visual impairment
- Dementia
- Poor environment
What are the 3 main features of Parkinson’s?
- Tremor
- Bradykinesia
- Rigidity (lead-pipe; cog wheel)
List 3 differential features of a Parkinsonian tremor.
- Slow (pill-rolling)
- Worse at rest
- Asymmetrical
- Reduced on distraction
- Reduced on movement
What is the underlying pathophysiology of Parkinson’s?
Loss of dopaminergic neurons in the substantia nigra.
What class of drugs is normally combined with L-Dopa to prevent peripheral side effects? (re: Parkinson’s).
L - Dopa Decarboxylase inhibitor (Carbidopa or Benserazide)
Name 3 complications of L-dopa therapy (re: Parkinson’s patients).
- Postural hypotension on starting treatment
- Confusion
- Hallucinations
- L-dopa induced dyskinesias
- On-off effect: fluctuations in motor performance between normal function (on) and restricted mobility (off).
- Shortening duration of action of each dose (i.e. end-dose deterioration, where dyskinesias become more prominent at the end of the duration of action.
A patient presents with confusion. What should you ask about in their history?
- Premorbid personality
- PMHx
- Medications
- Social circumstances
- Any past similar episodes
Describe ‘dementia’.
- Chronic illness
- Progressive course
- Preserved attention
- Consciousness preserved
- Irreversible
- No underlying medical cause
Describe ‘delirium’.
- Acute onset
- Fluctuating course
- Inattention
- Altered level of consciousness
- Usually reversible
- Associated with underlying medical cause
What causes delirium?
‘DELIRiUM’
- Drug use (introduction, dose adjustments)
- Electrolyte and physiological abnormalities
- Lack of drug (withdrawal)
- Infection
- Reduced sensory input (blind, deaf, changing environment)
- Intracranial problems (stroke, post-octal, meningitis, subdural haemorrhage)
- Urinary retention + faecal impaction
- Myocardial (MI, Arrhythmia, HF)
How would you manage a patient with delirium?
- Treat the cause
- Manage environment
- Soft lighting
- Clocks and calendars
- Sleep hygiene (promote night time sleep)
- Avoid multiple rooms / ward moves
- Minimise provocation
Give a summary of ‘Vascular Dementia’.
- Step-wise progression
- Caused by problems with the blood supply to brain
Give a summary of ‘Alzheimer’s Dementia’.
- Most common type of dementia
- Progressive
- Loss of ability to learn, process and retain new information
What would a patient with Alzheimer’s’ brain look like on CT / MRI?
Atrophic :(
What is the pathophysiology of Alzheimer’s?
- Neurofibrillary tangles
- Loss of neurons
- Aggregation of beta-amyloid plaques
What is the management for Alzheimer’s?
- Supportive
- AChE inhibitors
- Memantine
What is a ‘Comprehensive Geriatric Assessment’ designed to do?
- Identify health problems + establish a management plan in older patients with frailty.
What domains does a ‘Comprehensive Geriatric Assessment’ take into account?
- Physical health
- Mental health
- Social aspects
- Functional aspects
- Environment
Who might be involved in the Comprehensive Geriatric Assessment team?
- Geriatrician
- Nurses
- Pharmacist
- OT
- Physio
- SALT
- Dietitian
- Social worker
etc
What are the complications of a long lie following a fall?
- Pressure ulcers
- Dehydration
- Rhabdomyolysis
What investigations should you do if you suspect / see a pressure ulcer on admission?
- CRP, ESR
- WCC
- Swabs
- Blood cultures
- X-ray for bone involvement
How would you manage a pressure ulcer?
- Antibiotics
- Wound dressing
- Pain relief
- Debridement if grade 3/4
Define ‘osteoporosis’.
Decreased bone mineral density due to imbalance between remodelling and resorption
List some risk factors for osteoporosis.
- Smoking
- Early menopause
- Steroid use
- Underweight
- Inactivity
- Alcohol
- ALL ELDERLY PEOPLE
Which fractures are most common in people with osteoporosis?
- Spinal
- Hip
- NOF
How is osteoporosis diagnosed?
DEXA scan
What does the ‘FRAX’ score assess?
The risk of a 10 year fragility fracture
How is osteoporosis managed?
Bisphosphonates
How might a patient present if they have Vitamin C deficiency?
- Bleeding from gums
- Extensive bruising on legs (unrelated to falls)
How might Vitamin C deficiency be managed?
- Correct the deficiency -> MDT approach to malnourishment
How is Nutritional Status assessed?
- Using the ‘MUST’ screening tool
- > Malnutrition Universal Screening tool
What is ‘Refeeding Syndrome’?
- Metabolic disturbances as a result of reinstating nutrition to patients who are starved / severely malnourished.
List some biochemical features of refeeding syndrome.
- Hypophosphataemia
- Hypokalaemia
- Thiamine deficiency
- Abnormal glucose metabolism
List some complications of ‘Refeeding syndrome’.
- Cardiac arrhythmias
- Convulsions
- Cardiac failure
How should you manage / treat ‘Refeeding syndrome?’
- Monitor blood biochemistry
- Commence re-feeding with guidelines
What are the four ‘I’s of Geriatric Giants?
- Immobility
- Incontinence
- Incompetence
- Impaired homeostasis
