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Y4 OPIC > general older medicine > Flashcards

general older medicine Flashcards

1
Q

what are some risk factors for falls ?

A

previous falls
lower limb weakness
balance /gait disturbance
polypharmacy ( +4)
incontinence
over 65
depression
postural hypotension

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2
Q

what are some key questions to ask someone who has fallen ?

A

where was it the patient fell ?
when did they fall ?
did anyone else see the person fall ( collateral )
what happened ? associated features
why do they think they fell ?
have they fallen before ?
PMH
SH
systems review

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3
Q

what are some medications that cause postural hypotension and therefore lead to falls ?

A

nitrates
diuretics
anticholinergic
antidepressants
beta blockers
L-DOPA
ACEi

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4
Q

what are some medications associated with falls that don’t cause postural hypotension ?

A

benzodiazepines
antipsychotics
opiates
anticonvulsants
codeine
digoxin

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5
Q

what approach should be used in a falls patient ?

A

A to E assessment

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6
Q

what are some investigations for a falls patient ?

A

bedside - basic obs, BP, blood glucose, urine dip, ECG

bloods - FBC, U&E’s, LFTs, bone profile

imaging - CXR, limbs, CT head and cardiac echo

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7
Q

what are some risk factors for urinary incontinence ?

A

advancing age
previous pregnancy and childbirth
high BMI
hysterectomy
FH

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8
Q

who is the most affected by urinary incontinence ?

A

elderly females

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9
Q

what is urge incontinence ?

A

the urge to urinate is quickly followed by uncontrollable leakage due to detrusor over activity

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10
Q

what is stress incontinence ?

A

leaking small amounts of urine when straining like coughing or laughing

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11
Q

what is the pathophysiology of stress incontinence ?

A

weakness of the pelvic floor and sphincter muscles. this allows urine to leak at times of increased pressure on the bladder

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12
Q

what is mixed incontinence ?

A

a combination of urge and stress incontinence

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13
Q

what is overflow incontinence ?

A

occurs when there is chronic urinary retention due to an obstruction to the outflow of urine. this results in an overflow of urine and incontinence occurs without the urge to pass urine.

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14
Q

what can cause overflow incontinence ?

A

anticholinergic medications
fibroids
pelvic tumours
neurological conditions - MS, diabetic neuropathy and spinal cord injuries

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15
Q

who is mostly affected by overflow incontinence ?

A

elderly men

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16
Q

what is functional incontinence ?

A

comorbid physical conditions impair the patient’s ability to get to a bathroom in time

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17
Q

what are some causes of functional incontinence ?

A

dementia
sedating medication
injury / illness resulting in decreased ambulation

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18
Q

what are some risk factors for urinary incontinence ?

A

increased age
postmenopausal status
increased BMI
previous pregnancies and vaginal deliveries
pelvic organ prolapse
pelvic floor surgery
neurological conditions - MS
cognitive impairment and dementia

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19
Q

what are some modifiable lifestyle factors that contribute to urinary incontinence ?

A

caffeine consumption
alcohol consumption
medications
BMI

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20
Q

what are some investigations for urinary incontinence ?

A

bladder diary
urine dip
post-void residual bladder volume
urodynamic testing

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21
Q

what medications should be stopped before performing urodynamic testing ?

A

anticholinergics
bladder related medications

around 5 days before the tests

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22
Q

how are urodynamic tests performed ?

A

a thin catheter is inserted into the bladder and another into the rectum.
these 2 catheters can measure the pressures in the bladder and rectum for comparison. the bladder is filled with liquid and various measurements are taken.

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23
Q

what are some of the measurements taken from a urodynamic test ?

A

cystometry - measures the detrusor muscle contraction and pressure
uroflowmetry - flow rate
leak point pressure - the point at which the bladder pressure results in leakage of urine - assesses stress incontinence
post-void residual bladder volume
video urodynamic testing

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24
Q

what is the management of stress incontinence ?

A

avoid caffeine, diuretics and overfilling the bladder
weight loss if appropriate
supervised pelvic floor exercises
surgery
duloxetine - second line if surgery not prefered

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25
Q

what are some surgical options for stress incontinence ?

A

tension-free vaginal tape - mesh sling
autologous sling procedure - strip of fascia
colposuspension - stitches to connect the anterior vaginal walla and pubic symphysis
intramural urethral bulking

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26
Q

what is the management of urge incontinence ?

A

bladder retraining
anticholinergic medication - oxybutynin
mirabegron
invasive procedures - where medical treatment has failed

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27
Q

what are some side effects of anticholinergics ?

A

dry mouth
dry eyes
urinary retention
constipation
postural hypotension

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28
Q

what is mirabegron contraindicated in ?

A

uncontrolled hypertension

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29
Q

what does mirabegron act on ?

A

beta 3 agonist stimulating the sympathetic NS

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30
Q

what are some invasive options for managing urge incontinence in medical management has failed ?

A

botulinum toxin type A injection into the bladder wall
percutaneous sacral nerve stimulation
augmentation cystoplasty
urinary diversion

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31
Q

what is the difference between osteoporosis and osteopenia ?

A

osteoporosis - significant reduction in bone density
osteopenia - less severe decrease in bone density

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32
Q

on a DEXA scan what t score is considered normal ?

A

more than -1

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33
Q

on a DEXA scan what t score is considered as osteopenia ?

A

-1 to - 2.5

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34
Q

on a DEXA scan what t score is considered as osteoporosis ?

A

less than - 2.5

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35
Q

on a DEXA scan what t score is considered as severe osteoporosis ?

A

less than -2.5 plus a fracture

36
Q

how is bone mineral density measured ?

A

using a DEXA scan

37
Q

what is a DEXA scan ?

A

a type of x ray that measures how much radiation is absorbed by the bones indicating how dense the bone is

38
Q

what is a z score in bone density ?

A

the number of standard deviations the patient is from the average for their age, sex and ethnicity

39
Q

what is the T score in relation to bone density ?

A

the number of standard deviations the patient is from an average healthy young adult.

40
Q

what are some risk factors for osteoporosis ?

A

older age
post-menopausal women
reduced mobility and activity
low BMI
low calcium or vitamin D intake
alcohol and smoking
chronic diseases - hyperthyroid, CKD
long term corticosteroids
certain medications

41
Q

what is the management of osteoporosis ?

A

address reversible risk factors
address insufficient intake of calcium and vitamin D

bisphosphonates

42
Q

how do bisphosphonates work in osteoporosis ?

A

interfere with the way osteoclasts attach to bone, reducing their activity ad the reabsorption of bone.

43
Q

what are some important side effects of bisphosphonates ?

A

reflux and oesophageal erosions
Atypical fractures
osteonecrosis of the jaw and external auditory canal

44
Q

how should bisphosphonates be taken ?

A

orally on an empty stomach with a full glass of water.
afterwards the patient should sit upright for 30 minutes before moving or eating

45
Q

what are some other specialist options for treating osteoporosis ?

A

denosumab - monoclonal antibody that targets osteoclasts

46
Q

how do pressure ulcers occur ?

A

in patients with reduced mobility where there has been prolonged pressure on particular areas leading to the skin breaking down.

47
Q

how should pressure ulcers be prevented ?

A

individual risk assessments
regular repositioning
special inflating mattresses
regular skin checks
protective dressings and creams

48
Q

what is the assessment tool for estimating the risk of pressure ulcers ?

A

waterflow score

49
Q

what are the 2 types of cerebrovascular accidents ?

A

ischaemia or infarction of the brain - ischaemic stroke
intracranial haemorrhage - haemorrhagic stroke

50
Q

what is ischaemia and infarction ?

A

ischaemia - inadequate blood supply
infarction - tissue death due to ischaemia

51
Q

how can blood supply to the brain be disrupted ?

A

a thrombus or embolus
atherosclerosis
shock
vasculitis

52
Q

what is a TIA ?

A

temporary neurological dysfunction ( lasting less than 24 hours ) caused by ischaemia but without infarction.

53
Q

how does a stroke present ?

A

asymmetrical -
limb weakness
facial weakness
dysphasia
visual field defects
sensory loss
ataxia and vertigo

54
Q

what is a risk factor for strokes ?

A

previous stroke or TIA
AF
carotid artery stenosis
HTN
DM
raised cholesterol
FH
smoking
obesity
vasculitis
COCP

55
Q

what is the initial management of a TIA ?

A

aspirin 300mg daily
referral for specialist assessment within 24 hours
diffusion weighted MRI scan

56
Q

what is the immediate management of a stroke ?

A

exclude hypoglycaemia
immediate CT brain ( to exclude haemorrhage )
aspirin 300 mg daily for 2 weeks

57
Q

what is the definitive management of a stroke ?

A

thrombolysis with alteplase when haemorrhage is excluded
thrombectomy ( 24 hours )

58
Q

what is alteplase ?

A

a tissue plasminogen activator that rapidly breaks down clots.
given within 4.5 hours of symptom onset

59
Q

what is the management of carotid artert stenosis ?

A

carotid endarterectomy
angioplasty and stenting

60
Q

what is the secondary prevention for a stroke ?

A

clopidogrel 75mg
atorvastatin 20-80mg
blood pressure and diabetic control
address modifiable risk factors - smoking, obesity and exercise

61
Q

what is the criteria for determining the type of stroke in the oxford stroke classification ?

A

unilateral hemiparesis and/or hemisensory loss of face, arm and leg
homonymous hemianopia
higher cognitive dysfunction - dysphasia

62
Q

what arteries are affected in a TACs infarct ?

A

middle and anterior cerebral arteries

63
Q

what criteria needs to be met for a TACs stroke ?

A

all 3 of the oxford classification
- unilateral hemiparesis and/or hemisensory loss
- homonymous hemianopia
- higher cognitive dysfunction

64
Q

what arteries are involved in a PACs infarct ?

A

smaller arteries of the anterior circulation
- upper or lower division of the middle cerebral artery

65
Q

what criteria needs to be met in a PACs infarct ?

A

2 of the following from the oxford stroke classification :
- unilateral hemiparesis and/or hemisensory loss
- homonymous hemianopia
- higher cognitive dysfunction

66
Q

what arteries are involved in a lacunar infarct ?

A

perforating arteries around the internal capsule, thalamus and basal ganglia

67
Q

how does a lacunar infarct present ?

A

presents with one of the following :
- unilateral weakness ( and / or sensory deficit )
- pure sensory stroke
- ataxic hemiparesis

68
Q

what arteries are affected in a POCs infarct ?

A

vertebrobasilar arteries

69
Q

how does a POCs infarct present ?

A

cerebellar or brainstem syndrome
loss of consciousness
isolated homonymous hemianopia

70
Q

how does a retinal / ophthalmic artery occlusion present ?

A

amaurosis fugax

71
Q

how does a basilar artery occlusion present ?

A

locked in syndrome

72
Q

what is the most common cause of faecal incontinence ?

A

faecal impaction

73
Q

what should be performed in a patient with faecal incontinence ?

A

PR - rectum, prostate, anal tone and sensation

74
Q

what is the management of chronic diarrhoea ?

A

regular toileting and dietary review
low dose loperamide can be trialled

75
Q

what is malnutrition ?

A
  • BMI less than 18.5
  • unintentional weight loss greater than 10 % within the last 3-6 months
  • BMI of less than 20 and unintentional weight loss greater than 5% within the last 3-6 months
76
Q

what is the screening tool for malnutrition ?

A

MUST

77
Q

what is the management of malnutrition ?

A

dietician support if high risk on MUST
food first approach rather than prescribing oral nutritional supplements

78
Q

what are some cases of malnutrition ?

A

reduced dietary intake
malabsorption
increases losses or altered requirements
energy expenditure

79
Q

what are some consequences of malnutrition ?

A

altered muscle function
altered cardio-resp function
altered GI function
poor immunity and wound healing
psychosocial effects

80
Q

what are the 4 stages of wound stages ?

A

haemostasis
inflammation
proliferation
remodelling

81
Q

what are some local factors that effect wound healing ?

A

infection
oxygenation
foreign body
venous insufficiency

82
Q

what are some systemic factors that effect wound healing ?

A

age
gender
stress
ischaemia
DM
obesity
medications such as steroids, NSAIDs, chemotherapy
immunocompromised
nutrition

83
Q
A
84
Q

What is a residential home ?

A

They provide accommodation and personal care such as help with washing and dressing, taking medications and going to the toilet.

85
Q

What is a nursing home ?

A

They provide personal care but there is always 1 or more qualified nurses on duty

Y4 OPIC (7 decks)

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