Brainscape's Knowledge GenomeTM

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


See full index

taz- year 3 med > elderly medicine > Flashcards

elderly medicine Flashcards

1
Q

What is a Comprehensive Geriatric Assessment?

A

Multidimensional diagnostic process to determine medial, psychological and functional capabilities of a frail older person to come up with an integrated plan.

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

What is Polypharmacy?

A

When 6 or more drugs are prescribed at a time

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

What is ‘Section 2’ when discharge planning?

A

A referral made to social services to assess for funding (for care home), direct payments or package of care

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

What is ‘Section 5’ when discharge planning?

A

A referral made to social services by nursing staff when a patient is medically fit for discharge

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

What is Frailty?

A

Health state where multiple body systems gradually lose their inbuilt reserves and the patient becomes more at risk of adverse outcomes

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

Give 5 causes of Syncopal Falls

A 
Vasovagal
Situational 
Postural Hypotension 
Autonomic Failure 
Carotid Sinus Hypersensitivity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Give 3 causes of Non Syncopal falls

A

Poor Vision
Muscle Weakness
Labrynthitis

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

Give 3 types of drugs that contribute to Osteoporosis

A

Steroids
Tamoxifen
Anti-Epileptics

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

Define Delirium

A

Acute confusional state with sudden onset and fluctuating course, developing over 1-2 days

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

Delirium can be either hyperactive or hypoactive, give 3 common features of both

A

Memory impairment/disordered thinking
Sleep wake cycle reversal
Tactile/visual hallucinations

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

How would you manage a delirium?

A
  • TREAT CAUSE
  • support symptoms
  • make surrounds familiar (photos, encourage fam visits, early discharge)
  • allow supervised wandering- think about why wandering (need toilet?)
  • anti psychotics (haloperidol) used in aggressive pts who dont respond to de- escalation techniques
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Define Dementia

A

Neurodegenerative syndrome with progressive decline in various cognitive functions with clear consciousness

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

Give 3 cognitive impairments of Dementia

A

Memory impairment
Reduced orientation
Reduced learning capacity

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

What are the three non cognitive presentations of Dementia?

A

Behavioural (Aggression, Agitation)
Psychotic (Delusions)
Sleep (Insominia)

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

Give 2 microscopic and 2 macroscopic features of Alzheimers

A

Macro - Cortical atrophy, Sulcal widening

Micro - Senile plaques (aggregated AB protein from amyloid breakdown), Hyperphosphorylated Tau Proteins

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

Give 2 features of Vascular Dementia

A

Stepwise presentation

Focal neurological symptoms

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

Describe the difference in pathophysiology between DLB and Parkinsons

A

Aggregations of Lewy Bodies (a- syn nuclein proteins) are widespread across the brain (whereas in Parkinsons they are localised to Substantia Nigra)

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

Give 3 features of Lewy body dementia

A

Fluctuating cognition and alertness
Visual hallucinations
Spontaneous features of Parkinsons

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

What is neuroleptic malignant syndrome?

A

Drop in dopamine when you start anti-psychotics

FEVER (Fever, Encephalopathy, Vital sign instability, Elevated enzymes, Rigidity)

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

What is Frontotemporal Dementia?

A

Atrophy of the frontal and temporal lobes

Symptoms are lobe dependent

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

Describe the pathophysiology of AIDs Dementia

A

HIV infested macrophages enter CNS and damage neurones

Insiduous onset and rapid progression

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

What are 2 pharmacological managements of Dementia?

A

Donepazil - AChEsterase inhibitor

Memantine - NMDA Antagonist (blocks glutamate)

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

What is functional incontinence?

A

The patient is unable to reach the toilet in time due to cognitive/physical problems

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

Give a conservative, pharmacological and surgical management of stress incontinence

A

C - Lose weight

P - Duloxetine (increases sphincter contraction)

S - Urethral bulking

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

Give a conservative, pharmacological and surgical management of urge incontinence

A

C - Absorbent pad/Sheath catheter

P - Mirabegron (B3 Agonists)

S - Ileocystoplasty

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

Give 3 causes of faecal incontinence

A

Faecal impaction
Sphincter Dysfunction (haemorrhoids, tears from vaginal delivery)
Impaired Sensation

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

Give 2 complications of Faecal Incontinence

A

Urinary Retention

Stercoral Perforation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Define TIA

A

Focal neurological deficits lasting less than 24hrs due to blockage of blood supply to part of brain

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

What is Amaurosis Fugax?

A

Central retinal artery occlusion causing unilateral vision loss (like a curtain descending down)

30
Q

Give 4 causes of TIA

A

Atherothromboembolism from Carotids
Cardioembolism
Hyperviscocity
Vasculitis

31
Q

What is ABCD2?

A

Risk assessment of patient having a stroke after having a TIA
Age, Blood pressure, Clinical features, Duration of symptoms, Diabetes
Greater than or equal to four indicates high risk

32
Q

What are the pharmacological management options of TIA?

A

Control CVS risk factors

Initial 300mg Aspirin for 2/52 before switching to Clopidogrel 75mg

33
Q

What is a potential surgical management of TIA?

A

Carotid Endarterectomy

34
Q

Define Stroke

A

sudden onset of focal neurological deficit due to infarction/haemorrhage lasting more than 24hrs

35
Q

Describe the features of the Bramford Classification: TACS

A

Unilateral weakness and sensory deficit
Homonymous Hemianopia
Higher cerebral dysfunction

36
Q

Describe the features of the Bramford Classification: PACS

A

Two of the TACS criteria

37
Q

Describe the features of the Bramford Classification: POCS

A

Cranial nerve palsy AND contralateral motor/sensory deficit
Conjugate eye movement disorder
Cerebellar dysfunction
Macular Sparing Homonymous Hemianopia

38
Q

Describe the features of the Bramford Classification: LAC

A

Pure sensory, Pure motor or Sensorimotor

39
Q

Give two PRIMARY causes of a haemorrhagic stroke

A

Hypertension

Amyloid Angiopathy

40
Q

Give two SECONDARY causes of a haemorrhagic stroke

A

Trauma

Anticoagulants

41
Q

Apart from Thrombolysis what other medical management would you give someone for an Ischaemic Stroke?

A

300mg Aspirin OD for 2 weeks

42
Q

What is Malignant MCA Syndrome

A

Cerebral Oedema surrounding an infarct in MCA

Treated with decompressive hemicraniotomy

43
Q

There are two scores used to discuss anticoagulation suitability. Describe the components of CHADS-VASc

A 
CHF
Hypertension
Age>75 (2)
Diabetes Mellitus
Stroke (2)
Vascular disease
Aged 65-74
Sex (F)
A score >2 requires anticoag
44
Q

There are two scores used to discuss anticoagulation suitability. Describe the components of HAS-BLED

A

Hypertension, Abnormal renal/liver function, Stroke, Bleeding predisposition, Labile INR, Age>65, Drugs/alcohol

45
Q

What is Palliative Care?

A

Switching to a more holistic approach when a cure is no longer viable.
Different to EOL care

46
Q

Give 4 examples of medications used in Palliative Care and what they are used for

A

Morphine Subcut - Pain relief
Levomepromazine - N&V
Midazolam - Agitation
Glycoporonium - Respiratory Secretion

47
Q

What are the features of confirming a death certificate?

A

Pupils fixed and dilated
No response to pain
No breath/heart sounds after one minute of auscultation
Completed by a doctor who has cared for the patient in the last 2 weeks

48
Q

What are the components of a death certificate?

A

1a - Cause of death
1b - Condition leading to cause of death
1c - Additional condition leading to 1b
2 - Any contributing factors/conditions

49
Q

Define Capacity (in terms of the mental capacity act 2007)

A

Able to understand, retain, weigh up the pros and cons and come to a decision

50
Q

Give 3 infective and pharmacological causes of a delirium?

A
  • UTIs, pneumonia, sepsis, viral infections, meningitis, encephalitis, malaria
  • benzos, analgesics (morphine), anticholinergics, anticonvulsants, steroids, GTN spray, warfarin, statins, digoxin, B blockers
51
Q

Give 5 common non infective, non pharmacological causes of a delerium?

A
  • post op
  • constipation, incontinance
  • trauma (head injury)
  • neoplasms (paraneoplastci syndromes/ brain mets)
  • toxins (alcohol, CO)
  • vascular (ischaemia, infarction)
  • metabolic (hypoxia, electrolyte imbalance)
  • vit deficiency (B12, thiamine)
  • endocrine disorders (thyroid, hypopituitaryism, cushings)
52
Q

What are the components of the CAM score?

A 
- acute/ fluctuating change in mental status
AND inattention (can go 20-1) 
AND altered level of consciousness OR disorganised thinking
53
Q

How may you investigate delirium?

A
  • ABCDE
  • urine dip, PR, blood glucose, blood cultures depending on suspected problem
  • FBC, U&E, LFT. TFT, calcium, Mg, cardiac enzymes, haematinics,, PSA
  • ECG
  • CXR
  • CT of brain (rarely useful)
54
Q

Give 6 causes of constipation

A
  • low fluid intake
  • low fibre diet
  • immobility
  • polypharmacy
  • post op pain
  • IBS
  • endocrine/ metabolic disturbance
  • idiopathic slow transit
  • usually multifactoral
55
Q

Name 4 drugs which could cause constipation

A
  • antidepressants
  • anti psychotics
  • CCBs
  • diuretics
  • opiates
  • antacids
  • iron supplements
  • NSAIDs
56
Q

Give 3 metabolic/ endocrine conditions which could cause constipation?

A
  • hypothyroid
  • hypercalcaemia
  • hypokalaemia
  • lead poisoning
  • diabetic neuropathy
57
Q

How do you investigate constipation?

A
  • abdo exam and PR
  • FBC, U&E,TFTs
  • sigmoidoscopy and biopsy of normal mucosa if unknown cause
  • barium enema if suspected colorectal malignancy
58
Q

What drugs are used for soft faecal impaction only?

A

stimulants (senna, biscodyl)

59
Q

What drugs are used for hard faecal impaction only?

A 
Softeners (arachnid oil, ducosate sodium)
Osmotic agents (macrogol then lactulose)
60
Q

Which drugs can be used for soft or hard impaction?

A

Bulk forming laxatives (isphagula)- use first before stimulants/ osmotic agents/ softeners

61
Q

What are the 4 types of incontinence?

A
  • stress (small volumes leak on coughing/ laughing)
  • urge (frequent voiding, usually seen in destrusor overactivity)
  • overflow (due to urinary retention, often seen in obstructions and BPH)
  • functional (often due to cognitive or physical impairment)
62
Q

How should urinary incontinence be investigated?

A
  • review or bladder and bowel diary
  • abdo exam
  • urine dip and MSU
  • PR exam inc prostate in male
  • external genitalia review esp looking for atrophic vaginitis in females
  • post void bladder USS
63
Q

How is incontinance managed?

A
  • stress= pelvic floor exercises
  • urge= bladder training
  • urge = reduce cafffine, treat cause etc
  • functional= improve ability to toilet
  • pads and long term catheters
  • pharmacological used last (oxybutanine- anticholinergics, anti- muscarinics etc)
64
Q

What do you need to be able to do to have capacity?

A
  • understand information
  • retain information
  • weigh up information relating to a decision
  • communicate a decision
65
Q

What are the two broad categories of falls?

A 
syncopal falls (Loss of consciousness with low BP)
non syncopal falls (with or without LOC)
66
Q

How should a fall be investigated?

A
  • lying and standing BP
  • CVS and resp exam
  • ECG
  • neuro and msk exam
  • bloods
  • further investigations as required eg xray, CTPA, EEG, head CT etc
  • look for cause and consequence
67
Q

What may cause orthostatic hypotension? (postural drop >20/10 mmHg)

A

Hypotensive drugs (BB and CCB esp), addisons, AS, Heart failure, antipsychotics, baroreceptor desensitivity with age.

68
Q

How should strokes be managed?

A
  • urgent CT or MRI head to determine haemorrhagic or ischaemic
  • if embolic: alteplase if present within 4 hrs and no contraindications, then aspirin for 2 weeks and decide on new antiplatelet later
  • if ischaemic: BP lowering drugs and surgery
  • DVT prophylaxis
  • CVS risk reduction
  • carotid doppler
  • PT, OT and SALT input
69
Q

How are TIA managed?

A
  • aspirin 300mg daily
  • high risk= urgent TIA clinic
  • lifestyle mod
  • CVS risk reduction
  • carotid doppler and intervention if appropriate
  • no driving for 1 month
70
Q

what are the domains of a CGA

A

problem list – current and past
◦ Medication review
◦ Nutritionalstatus
◦ Mental health – cognition, mood and anxiety, fears
◦ Functional capacity - basic activities of daily living , gait and balance, activity/exercise status, instrumental activities of daily living
◦ Social circumstances - informal support available from family or friends, social network such a visitors or daytime activities, eligibility for being offered care resources
◦ Environment - home environment, facilities and safety within the home environment, transport facilities ,accessibility to local resources

71
Q

what is the mechanism of action of cholinesterase inhibitors and so why is it useful for the treatment of Alzheimers

A
  • acetylcholine is released from the nucleus basalis to the cortex and hippocampus and therefore involved in memory and motor control
  • nucleus basalis dies in Alzheimers and therefore cholinesterase inhibitors used to treat it

taz- year 3 med (10 decks)

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