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Y3 Medicine > Elderly medicine > Flashcards

Elderly medicine Flashcards

1
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
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2
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)
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3
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
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4
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)
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5
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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6
Q

How is delirium tremens treated?

A

benzodiazepams

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7
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
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8
Q

Name 4 drugs which could cause constipation

A
  • antidepressants
  • anti psychotics
  • CCBs
  • diuretics
  • opiates
  • antacids
  • iron supplements
  • NSAIDs
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9
Q

Give 3 metabolic/ endocrine conditions which could cause constipation?

A
  • hypothyroid
  • hypercalcaemia
  • hypokalaemia
  • lead poisoning
  • diabetic neuropathy
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10
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
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11
Q

What drugs are used for soft faecal impaction only? (1 type 2 examples)

A

stimulants (senna, biscodyl)

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12
Q

What drugs are used for hard faecal impaction only? (2 types, 2 of each))

A 
Softeners (arachnid oil, ducosate sodium)
Osmotic agents (macrogol then lactulose)
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13
Q

Which drugs can be used for soft or hard impaction?

A

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

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14
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)
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15
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
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16
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)
17
Q

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

A
  • understand information
  • retain information
  • weigh up information relating to a decision
  • communicate a decision
18
Q

What is a DOLs form?

A

deprivation of liberty- used in delirium for drs to make best interest decisions for pt

19
Q

Give 5 signs that a pt is approaching end of life?

A
  • bed bound
  • semi comatose
  • only able to sip flui
  • cannot take oral meds
  • frequent infections
  • treatment failure
20
Q

What end of life symptoms may palliative care staff want to help reduce?

A
  • N+V
  • Dyspnoea
  • agitation
  • confusion
  • terminal secretions
  • constipation
  • anorexia
21
Q

What drugs are commonly used in palliative care and why? (6)

A
  • morphine (pain, dyspnoea)
  • haloperidol (delirium)
  • dexamethasone (anorexia)
  • midazolam (agitation)
  • metoclopamide (N+V)
  • amitriptyline (neuropathic pain)
  • hyoscine (terminal secretions)
  • ducosate/ senna (constipation)
22
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)
23
Q

Give 5 causes of syncope

A
  • orthostatic hypotension
  • carotid sinus hypersensitivity
  • arrhythmias
  • aortic stenosis and other cardiac structural abnormalities
  • PE
  • cerebrovascular disease
  • subclavian steal syndrome
  • vasovagal
24
Q

Give 2 causes of non syncopal falls with and without LOC

A

without LOC- MSK or accidental falls

with LOC- seizures, psychogenic, intoxication, hypoglycaemia, TIA and stroke

25
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
26
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.

27
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
28
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
29
Q

What causes faecal incontinence?

A
  • 50% due to overflow diarrhoea + anal sphincter gaping and reduced tone with age
  • rest is due to neurogenic dysfunction (will have significantly reduced anal tone and sensation)

Y3 Medicine (11 decks)

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