Geriatrics Flashcards
What is a Comprehensive Geriatric Assessment?
Multidimensional diagnostic process to determine medial, psychological and functional capabilities of a frail older person to come up with an integrated plan.
What is Polypharmacy?
When 6 or more drugs are prescribed at a time
What is ‘Section 2’ when discharge planning?
A referral made to social services to assess for funding (for care home), direct payments or package of care
What is ‘Section 5’ when discharge planning?
A referral made to social services by nursing staff when a patient is medically fit for discharge
What is Frailty?
Health state where multiple body systems gradually lose their inbuilt reserves and the patient becomes more at risk of adverse outcomes
Give 5 causes of Syncopal Falls
Vasovagal Situational Postural Hypotension Autonomic Failure Carotid Sinus Hypersensitivity
Give 3 causes of Non Syncopal falls
Poor Vision
Muscle Weakness
Labrynthitis
Give 3 types of drugs that contribute to Osteoporosis
Steroids
Tamoxifen
Anti-Epileptics
Define Delirium
Acute confusional state with sudden onset and fluctuating course, developing over 1-2 days
What does the mnemonic THINK DELIRIUM stand for?
Trauma, Hypoxia, Increasing age, NOF fracture, smoKer
Drugs, Environment, Lack of sleep, Imbalanced electrolytes, Retention, Infection, Uncontrolled pain, Medical conditions (dementia)
Delirium can be either hyperactive or hypoactive, give 3 common features of both
Memory impairment/disordered thinking
Sleep wake cycle reversal
Tactile/visual hallucinations
What is SQiD?
Single question indicating delirium
Is this patient more confused than before?
Give 5 ways to manage Delirium
Reorientate the patient Encourage friends/family visitation Encourage physical activity Sleep hygiene Remove catheters/cannulas
What is the link between dementia and delirium?
Delirium increases your chances of developing Dementia, but Dementia is a risk factor for Delirium
Define Dementia
Neurodegenerative syndrome with progressive decline in various cognitive functions with clear consciousness
Give 3 cognitive impairments of Dementia
Memory impairment
Reduced orientation
Reduced learning capacity
What are the three non cognitive presentations of Dementia? Give examples
Behavioural (Aggression, Agitation)
Psychotic (Delusions)
Sleep (Insominia)
Give 2 microscopic and 2 macroscopic features of Alzheimers
Macro - Cortical atrophy, Sulcal widening
Micro - Senile plaques (aggregated AB protein from amyloid breakdown), Hyperphosphorylated Tau Proteins
Give 2 features of Vascular Dementia
Stepwise presentation
Focal neurological symptoms
Describe the difference in pathophysiology between DLB and Parkinsons
Aggregations of Lewy Bodies (a- syn nuclein proteins) are widespread across the brain (whereas in Parkinsons they are localised to Substantia Nigra)
Give 3 features of DLB
Fluctuating cognition and alertness
Visual hallucinations
Spontaneous features of Parkinsons
What is neuroleptic malignant syndrome?
Drop in dopamine when you start anti-psychotics
FEVER (Fever, Encephalopathy, Vital sign instability, Elevated enzymes, Rigidity)
What is Frontotemporal Dementia?
Atrophy of the frontal and temporal lobes
Symptoms are lobe dependent
Describe the pathophysiology of AIDs Dementia
HIV infested macrophages enter CNS and damage neurones
Insiduous onset and rapid progression
What are 2 pharmacological managements of Dementia?
Donepazil - AChEsterase inhibitor
Memantine - NMDA Antagonist (blocks glutamate)
What is functional incontinence?
The patient is unable to reach the toilet in time due to cognitive/physical problems
Give a conservative, pharmacological and surgical management of stress incontinence
C - Lose weight
P - Duloxetine (increases sphincter contraction)
S - Urethral bulking
Give a conservative, pharmacological and surgical management of urge incontinence
C - Absorbent pad/Sheath catheter
P - Mirabegron (B3 Agonists)
S - Ileocystoplasty
Give 3 causes of faecal incontinence
Faecal impaction
Sphincter Dysfunction (haemorrhoids, tears from vaginal delivery)
Impaired Sensation
Give 2 complications of Faecal Incontinence
Urinary Retention
Stercoral Perforation
What is the ‘Break and Accelerate’ method
Constipate then evacuate, i.e give small intermittent doses of Loperamide
Define TIA
Focal neurological deficits lasting less than 24hrs due to blockage of blood supply to part of brain
What is Amaurosis Fugax?
Central retinal artery occlusion/reduced perfusion of optic nerve causing unilateral or bilateral vision loss (like a curtain descending down)
Give 4 causes of TIA
Atherothromboembolism from Carotids
Cardioembolism
Hyperviscocity
Vasculitis
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
What are the pharmacological management options of TIA?
Control CVS risk factors
Initial 300mg Aspirin for 2/52 before switching to Clopidogrel 75mg
What is a potential surgical management of TIA?
Carotid Endarterectomy
Define Stroke
Sudden onset of focal neurological deficit due to infarction/haemorrhage lasting more than 24hrs
Describe the features of the Bramford Classification: TACS
Unilateral weakness and sensory deficit
Homonymous Hemianopia
Higher cerebral dysfunction
Describe the features of the Bramford Classification: PACS
Two of the TACS criteria
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
Describe the features of the Bramford Classification: LAC
Pure sensory, Pure motor or Sensorimotor
Give two PRIMARY causes of a haemorrhagic stroke
Hypertension
Amyloid Angiopathy
Give two SECONDARY causes of a haemorrhagic stroke
Trauma
Anticoagulants
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)
Apart from Thrombolysis what other medical management would you give someone for an Ischaemic Stroke?
300mg Aspirin OD for 2/52
What is Malignant MCA Syndrome
Cerebral Oedema surrounding an infarct in MCA
Treated with decompressive hemicraniotomy
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
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
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
What is Palliative Care?
Switching to a more holistic approach when a cure is no longer viable.
Different to EOL care
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
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
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
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
What are J waves?
Positive deflection occuring between QRS complex and ST segment
Normally due to Hypothermia
