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Geriatrics 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

What does the mnemonic THINK DELIRIUM stand for?

A

Trauma, Hypoxia, Increasing age, NOF fracture, smoKer
Drugs, Environment, Lack of sleep, Imbalanced electrolytes, Retention, Infection, Uncontrolled pain, Medical conditions (dementia)

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11
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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12
Q

What is SQiD?

A

Single question indicating delirium

Is this patient more confused than before?

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13
Q

Give 5 ways to manage Delirium

A 
Reorientate the patient
Encourage friends/family visitation
Encourage physical activity 
Sleep hygiene
Remove catheters/cannulas
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14
Q

What is the link between dementia and delirium?

A

Delirium increases your chances of developing Dementia, but Dementia is a risk factor for Delirium

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15
Q

Define Dementia

A

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

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16
Q

Give 3 cognitive impairments of Dementia

A

Memory impairment
Reduced orientation
Reduced learning capacity

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17
Q

What are the three non cognitive presentations of Dementia? Give examples

A

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

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18
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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19
Q

Give 2 features of Vascular Dementia

A

Stepwise presentation

Focal neurological symptoms

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20
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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21
Q

Give 3 features of DLB

A

Fluctuating cognition and alertness
Visual hallucinations
Spontaneous features of Parkinsons

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22
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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23
Q

What is Frontotemporal Dementia?

A

Atrophy of the frontal and temporal lobes

Symptoms are lobe dependent

24
Q

Describe the pathophysiology of AIDs Dementia

A

HIV infested macrophages enter CNS and damage neurones

Insiduous onset and rapid progression

25
What are 2 pharmacological managements of Dementia?
Donepazil - AChEsterase inhibitor | Memantine - NMDA Antagonist (blocks glutamate)
26
What is functional incontinence?
The patient is unable to reach the toilet in time due to cognitive/physical problems
27
Give a conservative, pharmacological and surgical management of stress incontinence
C - Lose weight P - Duloxetine (increases sphincter contraction) S - Urethral bulking
28
Give a conservative, pharmacological and surgical management of urge incontinence
C - Absorbent pad/Sheath catheter P - Mirabegron (B3 Agonists) S - Ileocystoplasty
29
Give 3 causes of faecal incontinence
Faecal impaction Sphincter Dysfunction (haemorrhoids, tears from vaginal delivery) Impaired Sensation
30
Give 2 complications of Faecal Incontinence
Urinary Retention | Stercoral Perforation
31
What is the 'Break and Accelerate' method
Constipate then evacuate, i.e give small intermittent doses of Loperamide
32
Define TIA
Focal neurological deficits lasting less than 24hrs due to blockage of blood supply to part of brain
33
What is Amaurosis Fugax?
Central retinal artery occlusion/reduced perfusion of optic nerve causing unilateral or bilateral vision loss (like a curtain descending down)
34
Give 4 causes of TIA
Atherothromboembolism from Carotids Cardioembolism Hyperviscocity Vasculitis
35
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
36
What are the pharmacological management options of TIA?
Control CVS risk factors | Initial 300mg Aspirin for 2/52 before switching to Clopidogrel 75mg
37
What is a potential surgical management of TIA?
Carotid Endarterectomy
38
Define Stroke
Sudden onset of focal neurological deficit due to infarction/haemorrhage lasting more than 24hrs
39
Describe the features of the Bramford Classification: TACS
Unilateral weakness and sensory deficit Homonymous Hemianopia Higher cerebral dysfunction
40
Describe the features of the Bramford Classification: PACS
Two of the TACS criteria
41
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
42
Describe the features of the Bramford Classification: LAC
Pure sensory, Pure motor or Sensorimotor
43
Give two PRIMARY causes of a haemorrhagic stroke
Hypertension | Amyloid Angiopathy
44
Give two SECONDARY causes of a haemorrhagic stroke
Trauma | Anticoagulants
45
What is Thrombolysis and when would you carry it out?
Clot dissolution with Alteplase | If the onset was less than 4.5hrs ago (best results within 90 minutes)
46
Apart from Thrombolysis what other medical management would you give someone for an Ischaemic Stroke?
300mg Aspirin OD for 2/52
47
What is Malignant MCA Syndrome
Cerebral Oedema surrounding an infarct in MCA | Treated with decompressive hemicraniotomy
48
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
49
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
50
Give four arguments against the use of Enteral Feeding
Still an aspiration risk Decreased enjoyment of food Costly May never be able to return to normal feeding again
51
What is Palliative Care?
Switching to a more holistic approach when a cure is no longer viable. Different to EOL care
52
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 Secretions
53
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
54
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
55
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
56
What are J waves?
Positive deflection occuring between QRS complex and ST segment Normally due to Hypothermia

Dan Medicine (10 decks)

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