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bookmarked qns medicine > geriatric medicine > Flashcards

geriatric medicine Flashcards

1
Q

What are some important points in a geriatric history you need to cover in addition to a normal history?

A
  • Falls history
  • Assessment of cognition (check with collaterals if change)
  • Continence assessment
  • Social and functional history (where do they live, do they have carers, do they have adaptations in home)
  • Further systemic enquiry
  • Advanced care planning
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2
Q

what is involved in a cognitive geriatric assessment?

A

Problem list (current and past)
Medication review
Nutritional status
Mental health
Functional assessment: basic ADL, gait, functional ADLs
Social circumstances
Environment

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3
Q

What do you need to sort out before a patient can be discharged?

A

TTO (medication to take home)
Transport
Therapy assessment (physio and OT)
Outpatient appointments
Restarting package of care
Transfer back letter for residential residents

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4
Q

What is frailty and some examples of frailty syndromes?

A

Distinctive health state related to the aging process inwhich multiple body systems gradually lose their inbuilt reserve

Use Rockwood clinical frailty score

Frailty syndromes: falls, immobility, delirium, incontinence, susceptibility to side effects of medications

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5
Q

What are some causes of falls in the elderly?

A

Non-Syncopal

Impaired vision
Home hazards
Drug side effects affecting balance and BP
Dizziness
Syncopal

  • Cardiac syncope: ACS, Aortic stenosis, Dysarrhythmias
  • Postural Hypotension
  • Neurally mediated: vasovagal
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6
Q

what are some causes of cardiac syncope?

A

arrthymias
valvular disease eg aortic stenosis
cardiomyopathy
PE
aortic dissection

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7
Q

what is postural hypotension?

A

In first 3 min of standing:

Systolic BP fall > 20 mmHg or
Diastolic BP fall > 10 mmHg

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8
Q

What are some causes of hypovolaemia?

A

Hypovolaemia (Dehydration, Haemorrhage, Addison’s)
Autonomic failure (Diabetes)
Prolonged bed rest
Drugs eg antihypertensives, anti-anginals, antidepressants,
Alcohol

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9
Q

what is delirium and some causes of it?

A

Acute confusion state with sudden onset over 1-2 days and fluctuating course. It has a change in consciousness and hyper or hypoalert.

Causes: infections, substance intoxication, substance withdrawal, electrolyte imbalance, hypoxia, constipation, urinary retention

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10
Q

how is delirium screened?

A

AMT4
AMT10
CAM (confusion assessment method)

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11
Q

What patients are at increased risk of developing delirium and what are the complications of delirium?

A

Increased risk: cognitive impairment, sensory impairment, surgical patients, hip fracture patients as risk of infection, dementia

Complications: increased mortality, prolonged hospital admission, increased risk of developing dementia

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12
Q

how do you manage delirium?

A

Supportive care: treat underlying cause, orientate patient to time and place. stop offending medication, resolve infection

Pharmacological treatment (Lorazepam and Haloperidol): only if patient is a harm to themselves or others.

Prevention for those at risk!!!!

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13
Q

How do you assess for dementia?

A

Collateral history from relatives

Clear history of declining memory over several months
Exclude delirium and depression
- Exclude reversible causes

  • Screening tools e.g AMT, MMSE, MOCA

Brain imaging e.g hippocampul atrophy
- Refer to memory clinic

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14
Q

What examinations should you perform for a patient presenting with urinary incontinence?

A

Abdo exam
PR exam
External genitalia
Urine dipsick and MSU
Post micturition bladder scan
Review of bladder and bowel diary

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15
Q

What are some of the causes of faecal incontinence in the elderly?

A
  • Faecal impaction with overflow diarrhoea
  • Neurogenic dysfunction
  • Gaping anal sphincter due to haemorrhoids or chronic constipation
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16
Q

What should raise your suspicion of faecal impaction? (rectum full of soft or hard stool)

A

Smearing
Small amount of type 1 stool
Lots of type 6/7 stool
Mass palpated on abdominal exam
Urinary retention (must always due PR with this to check for impacted rectum and large prostate)

17
Q

How is faecal impaction managed?

A

_Hard stool: G_ive stool softener like macrogol then a few days later give stimulant like glycerol or use enema docusate sodium.

Can also give Ispaghula Husk if cannot increase fibre in diet

Soft Stool: Give stimulant or enema

Difficult cases: manual evacuation (risk of perforation outweighed by benefits of improving patient’s symptoms and wellbeing)

Give laxatives prophylactically if elderly and taking another drug that has constipation as a side effect. Always encourage fluids, fibre and exercise!

18
Q

What is the ABCD2 score?

A

A tool used to calculate the short term risk of a stroke after a TIA

Calculate by summing up and if 4 or more indicates a high risk:

Age
Blood pressure
Clinical features
Duration of symptoms
Presence of diabetes

19
Q

how do you manage someone with a suspected stroke?

A

Immediate 300mg aspirin then take daily
If high risk of stroke (ABCD2 4 or more) then prioritised to be seen in TIA clinic straight away
Ix: carotid doppler, CT or MRI of brain

20
Q

What are the screening tools for the rapid assessment of a patient presenting with a suspected stroke?

A

FAST:

Facial drooping
Arm weakness
Speech slurred
Time to call 999
ROSIER:

Determines difference between stroke and stroke mimic in A and E

21
Q

How is a ischaemic stroke managed in general terms?

A

Stop/reverse any anticoagulants
Send for CT
Once confirmed ischaemic give alteplase if <4.5 hours since onset
- Also give 300mg aspirin (orally or rectally) and continue this for 2 weeks after stroke, then long term anticoagulation

Rehabilitation
Modify stroke risk factors

22
Q

what are some stroke mimics?

A

Seizures
Space occupying lesions
Hemiplegic migraine
MS
Sepsis

23
Q

What does the CHADVASC score calculate?

A

The risk of someone with AF developing a stroke

24
Q

what are some milestones that help you recognise a patient is towards end of life care

A

Bed bound
Semicomatose
Only able to sip fluid
Unable to take oral medication

25
Q

what are some types of laxatives and give an example

A

Bulk-forming laxatives
Bulk-forming laxatives work by increasing the “bulk” or weight of poo, which in turn stimulates your bowel. eg ispaghula husk
Osmotic laxatives
Osmotic laxatives draw water from the rest of the body into your bowel to soften poo and make it easier to pass eg marcogol, lactulose
Stimulant laxatives
These stimulate the muscles that line your gut, helping them to move poo along to your back passage eg senna
in faecal enema consider an enema

26
Q

what are some examples of drugs that cause constipation?

A

Opioids
TCA
CCBs
Anti-Parkinson’s (dopaminergic)

27
Q

What laxatives should be given to someone with the following types of constipation:

Short duration
Chronic
Opioid induced

A

Short (not responded to increased fibre): Bulk forming laxative with adeqaute fluid intake. If still hard give osmotic laxative. If soft just give stimulant

Chronic: Same as above then slowly withdraw when regular bowel habits. If using 2 then withdraw stimulant first. If 2 laxatives still not working at highest dose for 6 months, give prucalopride, reassess if not working after 4 weeks

Opioid induced: Osmotic and Stimulant. AVOID bulk forming

28
Q

What are some medications that can contribute to urinary incontinence and urinary retention?

A

Urinary retention: alpha agonists, CCBs, TCA, antipsychotics, benzodiazepines, opioids, NSAIDs

Urinary incontinence: diuretics, alpha blockers, any drugs causing retention as will cause overflow

29
Q

why may someone in a nursing home have poor oral intake?

A

Difficulty chewing and swallowing
Constipated
Drug side effects
Anorexia from dementia
Not physically active

30
Q

Should dementia patients be fed with enteral feeding e.g NG/PEG?

A

No

Higher risk of aspiration with NG than swallow in dementia
Does not improve nutrition and survival
Unpleasant procedure and patient may try to pull it out

31
Q

What is an advanced care plan?

A

A conversation between a patient and their family/carers/GP outlining their future wishes and priorities for care/treatment

This is made whilst the patient still has capacity

32
Q

what are some causes of confusion in the elderly?

A

Infection
Stroke/TIA
Hypoglycaemia
Head injury
Alcohol
CO poisoning

33
Q

how should you manage a patient with acute confusion?

A

Withdraw or reduce any drugs causing confusion
Correct biochemical derangements
If high likelihood of infection treat promptly with antibiotics
Relieve exacerbating symptoms (pain, urinary retention, constipation, thirst)
Avoid major tranquillisers where possible
Monitor AMTS
Communicate with the relatives

34
Q

What does feeding at risk mean and what do you have to tell the patient’s family with this?

A

Patient continues to eat and drink despite a significant risk of aspiration/choking

Tell family it helps them to maintain quality of life, that other options (e.g NG) may also not reduce risk of aspiration, ask them how they want to treat further aspiration pneumonias e.g ?no hospitalisation

bookmarked qns medicine (7 decks)

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