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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.

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2
Q

What is Polypharmacy?

A

When 6 or more drugs are prescribed at a time

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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

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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

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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

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6
Q

Give 5 causes of Syncopal Falls

A 
Vasovagal
Situational 
Postural Hypotension 
Autonomic Failure 
Carotid Sinus Hypersensitivity
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7
Q

Give 3 causes of Non Syncopal falls

A

Poor Vision
Muscle Weakness
Labrynthitis

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8
Q

Give 3 types of drugs that contribute to Osteoporosis

A

Steroids
Tamoxifen
Anti-Epileptics

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9
Q

Define Delirium

A

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

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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

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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
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12
Q

Define Dementia

A

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

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13
Q

Give 3 cognitive impairments of Dementia

A

Memory impairment
Reduced orientation
Reduced learning capacity

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14
Q

What are the three non cognitive presentations of Dementia?

A

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

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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

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16
Q

Give 2 features of Vascular Dementia

A

Stepwise presentation

Focal neurological symptoms

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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)

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18
Q

Give 3 features of Lewy body dementia

A

Fluctuating cognition and alertness
Visual hallucinations
Spontaneous features of Parkinsons

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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)

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20
Q

What is Frontotemporal Dementia?

A

Atrophy of the frontal and temporal lobes

Symptoms are lobe dependent

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21
Q

Describe the pathophysiology of AIDs Dementia

A

HIV infested macrophages enter CNS and damage neurones

Insiduous onset and rapid progression

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22
Q

What are 2 pharmacological managements of Dementia?

A

Donepazil - AChEsterase inhibitor

Memantine - NMDA Antagonist (blocks glutamate)

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23
Q

What is functional incontinence?

A

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

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24
Q

Give a conservative, pharmacological and surgical management of stress incontinence

A

C - Lose weight

P - Duloxetine (increases sphincter contraction)

S - Urethral bulking

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25
Give a conservative, pharmacological and surgical management of urge incontinence
C - Absorbent pad/Sheath catheter P - Mirabegron (B3 Agonists) S - Ileocystoplasty
26
Give 3 causes of faecal incontinence
Faecal impaction Sphincter Dysfunction (haemorrhoids, tears from vaginal delivery) Impaired Sensation
27
Give 2 complications of Faecal Incontinence
Urinary Retention | Stercoral Perforation
28
Define TIA
Focal neurological deficits lasting less than 24hrs due to blockage of blood supply to part of brain
29
What is Amaurosis Fugax?
Central retinal artery occlusion causing unilateral vision loss (like a curtain descending down)
30
Give 4 causes of TIA
Atherothromboembolism from Carotids Cardioembolism Hyperviscocity Vasculitis
31
What is ABCD2?
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
What are the pharmacological management options of TIA?
Control CVS risk factors | Initial 300mg Aspirin for 2/52 before switching to Clopidogrel 75mg
33
What is a potential surgical management of TIA?
Carotid Endarterectomy
34
Define Stroke
sudden onset of focal neurological deficit due to infarction/haemorrhage lasting more than 24hrs
35
Describe the features of the Bramford Classification: TACS
Unilateral weakness and sensory deficit Homonymous Hemianopia Higher cerebral dysfunction
36
Describe the features of the Bramford Classification: PACS
Two of the TACS criteria
37
Describe the features of the Bramford Classification: POCS
Cranial nerve palsy AND contralateral motor/sensory deficit Conjugate eye movement disorder Cerebellar dysfunction Macular Sparing Homonymous Hemianopia
38
Describe the features of the Bramford Classification: LAC
Pure sensory, Pure motor or Sensorimotor
39
Give two PRIMARY causes of a haemorrhagic stroke
Hypertension | Amyloid Angiopathy
40
Give two SECONDARY causes of a haemorrhagic stroke
Trauma | Anticoagulants
41
Apart from Thrombolysis what other medical management would you give someone for an Ischaemic Stroke?
300mg Aspirin OD for 2 weeks
42
What is Malignant MCA Syndrome
Cerebral Oedema surrounding an infarct in MCA | Treated with decompressive hemicraniotomy
43
There are two scores used to discuss anticoagulation suitability. Describe the components of CHADS-VASc
``` CHF Hypertension Age>75 (2) Diabetes Mellitus Stroke (2) Vascular disease Aged 65-74 Sex (F) A score >2 requires anticoag ```
44
There are two scores used to discuss anticoagulation suitability. Describe the components of HAS-BLED
Hypertension, Abnormal renal/liver function, Stroke, Bleeding predisposition, Labile INR, Age>65, Drugs/alcohol
45
What is Palliative Care?
Switching to a more holistic approach when a cure is no longer viable. Different to EOL care
46
Give 4 examples of medications used in Palliative Care and what they are used for
Morphine Subcut - Pain relief Levomepromazine - N&V Midazolam - Agitation Glycoporonium - Respiratory Secretion
47
What are the features of confirming a death certificate?
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
What are the components of a death certificate?
1a - Cause of death 1b - Condition leading to cause of death 1c - Additional condition leading to 1b 2 - Any contributing factors/conditions
49
Define Capacity (in terms of the mental capacity act 2007)
Able to understand, retain, weigh up the pros and cons and come to a decision
50
Give 3 infective and pharmacological causes of a delirium?
- UTIs, pneumonia, sepsis, viral infections, meningitis, encephalitis, malaria - benzos, analgesics (morphine), anticholinergics, anticonvulsants, steroids, GTN spray, warfarin, statins, digoxin, B blockers
51
Give 5 common non infective, non pharmacological causes of a delerium?
- 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
What are the components of the CAM score?
``` - acute/ fluctuating change in mental status AND inattention (can go 20-1) AND altered level of consciousness OR disorganised thinking ```
53
How may you investigate delirium?
- 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
Give 6 causes of constipation
- low fluid intake - low fibre diet - immobility - polypharmacy - post op pain - IBS - endocrine/ metabolic disturbance - idiopathic slow transit - usually multifactoral
55
Name 4 drugs which could cause constipation
- antidepressants - anti psychotics - CCBs - diuretics - opiates - antacids - iron supplements - NSAIDs
56
Give 3 metabolic/ endocrine conditions which could cause constipation?
- hypothyroid - hypercalcaemia - hypokalaemia - lead poisoning - diabetic neuropathy
57
How do you investigate constipation?
- abdo exam and PR - FBC, U&E,TFTs - sigmoidoscopy and biopsy of normal mucosa if unknown cause - barium enema if suspected colorectal malignancy
58
What drugs are used for soft faecal impaction only?
stimulants (senna, biscodyl)
59
What drugs are used for hard faecal impaction only?
``` Softeners (arachnid oil, ducosate sodium) Osmotic agents (macrogol then lactulose) ```
60
Which drugs can be used for soft or hard impaction?
Bulk forming laxatives (isphagula)- use first before stimulants/ osmotic agents/ softeners
61
What are the 4 types of incontinence?
- 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
How should urinary incontinence be investigated?
- 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
How is incontinance managed?
- 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
What do you need to be able to do to have capacity?
- understand information - retain information - weigh up information relating to a decision - communicate a decision
65
What are the two broad categories of falls?
``` syncopal falls (Loss of consciousness with low BP) non syncopal falls (with or without LOC) ```
66
How should a fall be investigated?
- 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
What may cause orthostatic hypotension? (postural drop >20/10 mmHg)
Hypotensive drugs (BB and CCB esp), addisons, AS, Heart failure, antipsychotics, baroreceptor desensitivity with age.
68
How should strokes be managed?
- 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
How are TIA managed?
- 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
what are the domains of a CGA
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
what is the mechanism of action of cholinesterase inhibitors and so why is it useful for the treatment of Alzheimers
- 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)

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