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3a PTS - PM - ZTF > General Med/Geriatrics > Flashcards

General Med/Geriatrics Flashcards

1
Q

Definition of postural (orthostatic) hypotension

A

Systolic drop of at least 20 mmHg or a diastolic drop of at least 10 mmHg when going from sitting/lying to standing after 3 minutes of standing

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2
Q

Treatment options for orthostatic hypotension

A

Midodrine and Fludrocortisone

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3
Q

Factors favouring a non-epileptic attack (pseudoseizure) vs syncope or epilepsy

A

Gradual onset but sudden drop to floor
Arms flexing and extending, pelvic thrusting
Prolonged seizures (often >30 minutes)
Symptoms wax and wane
Much more common in females
Crying after seizure

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4
Q

2 factors favouring true epileptic seizures vs pseudoseizures

A

Tongue biting
Raised serum prolactin

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5
Q

Aortic dissection definition

A

Tear in the tunica intima of the wall of the aorta

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6
Q

Single biggest risk factor for aortic dissection

A

Hypertension

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7
Q

Associative symptoms of type A aortic dissection vs type B aortic dissection

A

Type A (originates in ascending aorta): chest pain
Type B (descending aorta): upper back pain

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8
Q

Type of chest/back pain felt in aortic dissection

A

Typically severe and ‘sharp, ‘tearing’ in nature’
Maximal at onset (DDx from myocardial infarction which has a build in intensity)

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9
Q

Pulse featured changes in aortic dissection (2)

A
  1. weak or absent carotid, brachial or femoral pulse
  2. variation (> 20) in systolic BP between arms
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10
Q

Aortic dissection investigations

A

Chest X-ray: widened mediastinum
CT angiography (gold-standard): false lumen
TOE: useful in unstable patients

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11
Q

Risk factors for DVT / PE

A

Immobility
Recent surgery
Long-haul travel
Pregnancy
Hormone therapy with oestrogen (COC / HRT)
Malignancy

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12
Q

VTE prophylaxis options and contraindications

A
  1. LMWH e.g. enoxaparin / deltaparin
    - contraindications: warfarin / DOAC
  2. Anti-embolic compression stockings
    - contraindications: PAD

Provoked: 3 months
Unprovoked: 6 months

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13
Q

Scoring system used to assess risk of PE

A

Wells score (risk factors e.g. recent surgery and clinical findings e.g. HR above 100 + haemoptysis)

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14
Q

4 symptoms of pulmonary embolism

A

SOB
Cough
Haemoptysis
Pleuritic chest pain

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15
Q

ABG results of pulmonary embolism

A

Respiratory alkalosis: low O2 causes raised respiratory rate which blows off extra CO2 = alkalosis / type 1 respiratory failure

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16
Q

Outcome of Wells score/Management of PE

A

Likely: perform CT pulmonary angiogram
Unlikely: perform a d-dimmer and if positive perform CTPA

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17
Q

Clinical signs PE

A

Tachycardia + tachypnoea with clear chest

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18
Q

1st line treatment PE with haemodynamic instability

A

Thrombolysis

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19
Q

2 most common causes of pericarditis

A

Idiopathic
Viral infection (HIV, CSV, EBV)

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20
Q

2 key presenting features of pericarditis

A

Pleuritic chest pain (often relieved by sitting forwards)
Low grade fever

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21
Q

Key auscultation finding in pericarditis

A

Pericardial friction rub (rubbing, scratching sound)

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22
Q

Investigation findings in pericarditis (bloods, ecg, echo)

A

Blood tests: raised inflammatory markers (WCC, CRP, ESR)
ECG: saddle-shaped ST-elevation, PR depression
Echo: can be used to diagnose pericardial effusion

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23
Q

Management of pericarditis

A

1st line: NSAIDs (aspirin or ibuprofen)

+ Colchicine (taken longer term to reduce risk of recurrence or symptoms beyond 14 days)

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24
Q

Treatment of paracetamol overdose and MOA

A

N-acetylcystine replenishes glutathione stores so that NAPQI can be converted to a less toxic product, preventing hepatocyte damage

within 8 hours of ingestion
divided into 3 consecutive IV infusions

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25
Q

Time frame when activated charcoal can be used in paracetamol overdose management

A

Within 1 hour

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26
Q

Risk factors for hepatotoxicity outcome in paracetamol overdose

A

Chronic alcohol user
HIV
Anorexia
P450 inducer drugs

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27
Q

Heparin overdose management in cases such as significant haemorrhage

A

Protamine sulphate

fully effective against unfractionated heparin and partially effective against LMWH

28
Q

LMWH MOA

A

Activates antithrombin III which inhibits factor Xa

29
Q

B12 absorption

A

Binds to instrinsic factor (secreted from parietal cells in the stomach)
Actively absorbed in the terminal ileum

30
Q

3 causes of B12 deficiency

A

Pernicious anaemia (most common cause) - lack of intrinsic factor
Vegan diet
Crohn’s disease: either disease activity or following ileocaecal resection

31
Q

B12 deficiency causes which type of anaemia

A

Megaloblastic macrocytic anaemia

32
Q

Medication given in B12 deficiency

A

IM hydroxocobalamin

33
Q

What should be treated first in B12 deficiency with folate deficiency

A

Treat the B12 deficiency first - giving patients folic acid when they have B12 deficiency can lead to subacute combined degeneration of the cord

SCD of the cord = combined dorsal column and lateral corticospinal tracts affected

34
Q

Secondary prevention ACS medications

A

Block An ACS

Beta blocker
ACEi
Aspirin
Clopidogrel
Statin

35
Q

Site of iron absorption

A

Duodenum and jejunum

36
Q

Risk factors for osteoporosis

A

SHATTERED

Steroids
Hyperthyroidism
Alcohol/smoking
Thin (BMI <22)
Testosterone deficiency (female)
Early menopause
Renal/liver failure
Erosive or inflammatory disease (Rheumatoid arthritis, Ank Spond)
Dietary Ca2+ deficiency / Did mum or Dad have it?

37
Q

Gold standard investigation for diagnosing osteoporosis

A

DEXA scan T score of less than -2.5

38
Q

Osteopenia DEXA results

A

T score -1 to -2.5

39
Q

1st line treatment for osteoporosis

A

Alendronate

40
Q

Indication for diagnosis of osteoporosis / treatment without a prior DEXA scan

A

following a fragility fracture in women aged 75 years or older

41
Q

2nd line treatment for osteoporosis

25% of patients cannot tolerate alendronate due to GI problems

A

Other bisphosphonates e.g. risedronate or etidronate

42
Q

Polypharmacy definition

A

A single patient taking 5 or more medications daily

43
Q

benign prostatic hyperplasia treatment

A

Tamsulosin (alpha blocker)

Common side effects = dizziness and sexual dysfunction

44
Q

How should alendronate be taken

A

Standing/sitting upright for at least 30 minutes after taking it
Take it 30 mins before breakfast with plenty of water and on an empty stomach

45
Q

contraindications to joint aspiration in a non-theatre setting

A

Joint prosthesis
Bacteraemia
Inaccessible joints
Overlying infection in the soft tissue

46
Q

LFT investigation alcoholic liver disease

A

AST level higher than ALT liver
S > L (more soda than lime)

47
Q

Screening test for malnutrition

A

MUST (malnutrition universal screening tool)
- BMI
- recent weight change
- presence of acute disease

48
Q

Scoring system for assessing the risk of a patient developing a pressure sore

A

Waterlow score
- BMI
- nutritional status
- skin type
- mobility
- continence

49
Q

4 risk factors for developing pressure ulcers

A

Malnourishment
Incontinence
Lack of mobility
Pain (leads to reduction in mobility)

50
Q

Falls risk factors

A

Vision problems
Gait disturbances: diabetes, rheumatoid arthritis, Parkinson’s
Polypharmacy (4+ medications)
Incontinence
> 65
Fear of falling
Depression
Postural hypotension
Cognitive impairment

51
Q

Medications that cause postural hypotension

A

just recognise these and associate with falls in elderly

Nitrates
Diuretics
Anticholingeric
Antidepressants
Beta-blockers
L-dopa
ACEi

52
Q

Medications associated with falls (due to mechanisms other than postural hypotension)

A

think sedation

Benzodiazepines/Zopiclone
Antipsychotics
Opiates
Anticonvulsants
Codeine
Digoxin

53
Q

Investigations to consider after a fall

A

Bedside tests e.g. basic obs, BP, blood glucose, urine dip, ECG
Bloods e.g. FBC, U&E, LFT, bone profile
Imaging e.g. CXR, CT head, echo

54
Q

2 recommended tests from NICE to assess risk of further falls in elderly who have fallen in the last 12 months

A

Turn 180
Timed up and Go test

55
Q

Falls criteria for MDT assessment by qualified clinician in patients over 65

A

> 2 falls in last 12 months
Fall that requires medical treatment
Poor performance or failure to complete Turn 180 or Timed Up and Go test

Falls individuals who do not meet this criteria should be reviewed annually and given advice

56
Q

4 management options for falls in the elderly

A

Strength and balance training (physiotherapist)
Home hazard assessment / assessment to improve independence with ADLS (occupational therapist)
Vision assessment
Med review (pharmacist)

57
Q

Rhabdomyolysis causes

A

Seizure
Collapse/coma e.g. elderly patient who has collapsed at home and found hours later
Crush injury
McArdle’s syndrome
Statins (esp if co-prescribed with clarithromycin)
Ecstasy

58
Q

rhabdomyolysis blood results

A

Elevated creatinine kinase
Hypocalcaemia (myoglobin binds calcium)
Elevated phosphate (released from myocytes)
Hyperkalaemia (before AKI)
Metabolic acidosis

59
Q

Management of rhabdomyolysis

A

IV fluids (to maintain good urine output)

60
Q

1st line sedative in delirium

A

Haloperidol or Olanzapine

PD: if antipsychotics required urgently then use quetiapine or clozapine

61
Q

How should frailty be assessed

A
  1. Evaluation of gait speed
  2. Self-reported health status
  3. PRISMA-7 questionnaire (age, sex, health problems, assistance required and walking aid use)
62
Q

4 palliative medications prescribed in end of life care and the symptoms they treat

A

Pain: morphine
Respiratory secretions: hyoscine bromide
Nausea: haloperidol
Agitation: midazolam

63
Q

Causes of weight loss and weakness in elderly

A

Frailty
Aging
COPD
Malignancy
Depression

64
Q

Osteoporosis scoring system

A

Fraxx (BMI, smoking, alcohol, previous fracture)

65
Q

Malnutrition

A

State in which a deficiency of energy, protein or other nutrients causes measurable effects on outcome

Starvation, sepsis, malabsorption

66
Q

4 prevention of pressure sores

A

Barrier creams
Pressure redistribution
Repositioning
Regular skin assessment

67
Q

Key parts of mental capacity act (5)

A

Assumed capacity
Maximise decision making capacity
Freedom to make unwise decisions
Best interests
Least restrictive option

3a PTS - PM - ZTF (8 decks)

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