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Phase 3a > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

What is frailty?

A

Diminished strength, endurance and physiological function that increases an individuals vulnerability for developing increased dependency or death

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2
Q

Frailty phenotype model?

A

Unintentional weight loss
Weakness evident by poor grip strength
Self-reported exhaustion
Low levels of physical activity

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3
Q

How is degree of frailty assessed?

A

Rockwood frailty Index

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4
Q

Physiological markers of frailty?

A 
Increased inflammatory markers 
Elevated insulin and glucose in fasting state 
Low albumin 
Raised D-dimer + Alpha Antitrypsin 
Low Vit D
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5
Q

What is included in the comprehensive geriatric assessment?

A 
Physical health 
Mental health 
Functional ability 
Social circumstances 
Environment
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6
Q

What is the comprehensive geriatric assessment?

A

Evidence based approach to identify health problem and establish management plans in older frail patients

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7
Q

4 physical assessment scales?

A

Barthel Index
Berg Balance test
Nottingham Extended ADL
Timed up and go test

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8
Q

5 mental assessment scales?

A 
Abbreviated mental test 
Montreal Cognitive Assessment 
Mini mental state exam 
Geriatric depression scale 
Confusion Assessment Method
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9
Q

How do you assess malnutrition in the elderly?

A

BMI + Malnutrition Universal Screening Tool

BMI, Unexpected weight loss, acutely ill or no food for >5 days

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10
Q

What is re-feeding syndrome?

A

Metabolic abnormalities that occur when a patient begins eating again after a period of starvation or limited intake
- In particular low levels of phosphorus

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11
Q

Mechanism of re-feeding syndrome?

A

When eating after starvation, insulin is increased and so is BMR using up all the electrolytes such as phosphates, magnesium and potassium + intracellular movement of electrolytes causes further depletion

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12
Q

Cardiogenic causes of falls?

A

Arrhythmia

Structural Heart Disease

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13
Q

What is orthostatic hypotension?

A

When standing for 3 mins SBP drops by 20 or DBP drops by 10. Failure of compensatory mechanisms

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14
Q

Pharmacological management of orthostatic hypotension?

A

Fludrocortisone or Midodrine

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15
Q

Reflex syncope?

A

Inappropriate cardiovascular response of vasodilation or bradycardia leading to cerebral hypoperfusion
e.g. Vasovagal, Situational, Carotid sinus syndrome

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16
Q

Causes of postural hypotension?

A

Diuretics
Alpha/ Beta blocks
Aortic stenosis
Heart Failure

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17
Q

Complications of the long lie?

A

Loss of independence, Decreased confidence, Internal bleeding, Rhabdomyolysis, Hypothermia, Pneumonia, Pressure Sores

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18
Q

Pressure ulcer?

A

Injuries to the skin or underlying tissue primarily caused by prolonged pressure on the skin

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19
Q

Mechanism of a pressure ulcer?

A

Localised external pressure on skin causes occlusion of the arteries and tissue compression

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20
Q

Stage 1 pressure ulcer?

A

Non-blanching Erythema

Skin is intact and non-blanchable redness is localised to a bony prominence

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21
Q

Stage 2 pressure ulcer?

A

Loss of dermis appearing as a shallow open ulcer or fluid filled blister

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22
Q

Difference between stage 3 + stage 4 full-thickness?

A

Loss of SC fat but in stage 4 the bone, tendon or muscles may be exposed and has a greater risk of osteomyelitis

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23
Q

Suspected deep tissue injury?

A

Deep blood-filled blister with intact skin

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24
Q

Moisture lesion

A

Redness/ partial thickness involving the dermis/epidermis caused by excessive moisture from urine, faeces or sweat

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25
Q

Risk assessment tools for pressure ulcers?

A

Waterlow Pressure Ulcer Policy

Braden Pressure Ulcer Risk Assessment

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26
Q

SSKIN?

A 
Surface support 
Skin
Keep Moving 
Incontinence 
Nutrition + Hydration
27
Q

When are systemic abx prescribed in a patient with pressure ulcers?

A

Sepsis
Cellulitis
Osteomyelitis

28
Q

Common cause of community-acquired pneumonia?

A

Strep Pneumonia
Mycoplasma pneumonia
Influenzae A

29
Q

Common cause of pneumonia in COPD?

A

Haemophilus Influenzae

30
Q

Common cause of pneumonia in IVDU?

A

Staphy Aureus

Mycobacterium Tubercluosis

31
Q

Common cause of hospital-acquired pneumonia?

A

Pseduomondas Aeruginosa or MRSA

32
Q

How do you assess the severity of CAP?

A 
CURB-65
Confusion 
Urea >7
RR>30
BP <90/60
>65 
1 or less - Outpatient treatment 
2 - admit
3 - ITU
33
Q

Complications of pneumonia?

A

Lung abscess
Empyema
Sepsis
ARDS

34
Q

Basal ganglia?

A

Collection of nerve cells located at the base of the cerebrum deep in the brain that smooth out, coordinate and initiate movement

35
Q

Complications of Parkinson’s?

A 
Autonomic dysfunction 
Motor involuntary movements
On-off phenomenon
Freezing of gait 
Falls
Aspiration pneumonia 
Pain
sleep disturbances 
Pressure ulcers 
Daytime sleepiness 
Behaviour change - Gambiling, hypersexuality
36
Q

Early signs of Parkinson’s?

A

Mood changes
Ansomia
Acting out dreams during their sleep
Visual/ Auditory hallucinations

37
Q

Diagnosis of Parkinson’s?

A

MRI

DAT scan

38
Q

MOA of levodopa?

A

Combines with DOPA decarboxylase and cross the BBB. Then is converted to Dopamine to stimulate dopaminergic receptors

39
Q

MOBI?

A

Inhibits the enzyme that normally breaks down dopamine

e.g. Selegiline, Rasagiline, Safinamide

40
Q

Why is cabergoline not recommended as a dopamine agonist for Parkinson’s?

A

Risk of cardiac Fibrosis

41
Q

What group of medications are more effective for managing excessive sleepiness, hallucinations and impulse control in Parkinson’s disease?

A

Dopamine agonists
Pramipexole
Ropinirole
Rotigotine

42
Q

Symptoms of Parkinson’s?

A 
Tremor 
Rigidity 
Akinesia 
Postural Instability 
Bradykinesia
43
Q

Osteoporosis?

A

When BMD is >2.5SD below the peak mass. Increased risk of fragility fracture due to increase osteoclast activity

44
Q

Risk factors of osteoporosis?

A 
Female 
Menopause
Corticosteroid use 
Rheumatoid arthritis 
IBD
Chronic liver disease 
BMI<18.5
45
Q

FRAX score?

A

Risk of fracture over a period of 10 years in a patient with osteoporosis

46
Q

What specialist test can be used to estimate bone turnover?

A

Serum C telopeptide

47
Q

Management of osteoporosis?

A

Bisphosphonates
Calcium + Vit D
HRT in premenopausal women
Lifestyle changes

48
Q

SE of bisphosphonates?

A

Nausea, Gastritis, Oesophageal bleeds, Osteonecrosis of the Jaw, Bone/ Muscle/ Joint Pain, Atypical stress fracture

49
Q

Types of incontinence?

A 
Stress
Urge 
Mixed 
Bladder outlet obstruction (Overflow)
Fistula 
Functional incontinence
50
Q

Stress incontinence?

A

Weakness of the urinary outlet

51
Q

Urge incontinence?

A

Failure of the bladder to store urine due to high bladder pressure

52
Q

Functional incontinence?

A

Incontinence due to general impairment e.g. cognitive, functional, affective

53
Q

Examination of a patient presenting with incontinence?

A

Mental - cognitive assessment
Cardioresp - Signs of chronic respiratory disease or HF
Abdo - kidneys or bladder enlarge, PR exam
Pelvis - Vaginal atrophy or prolapse, pelvic floor strength, cough
Neuro - Gait, sensation of lower limbs and pelvis

54
Q

Medication and Urinary incontinence

A 
Alcohol - Polyuria
ACEi - Cough + stress incontinence 
Anticholinergic - Retention + overflow 
Diuretic - polyuria, frequency, urgency
Opiate - Retention, constipation, sedation 
TCA - Retention + Overflow
55
Q

Investigation of incontinence?

A

Urinalysis
Mid stream urine for culture, microscopy + sensititivity
Post-void bladder scan
Bladder diary

56
Q

Causes of stress incontinence?

A

Instrumentation during birth or Pelvic floor damage
Vaginal prolapse
Post-prostectomy in men

57
Q

Management f stress incontinence?

A

Lifestyle changes
Pelvic floor exercises
Duloxetine - SNRI
Mid-urethral sling insertion (Tension free vaginal tape)

58
Q

What is polypharmacy?

A

Being prescribed more than 4 medications

59
Q

Consequences of polypharmacy?

A

Increased morbidity + mortality
Increased hospital admission length
Reduced compliance
Increased risk of adverse drug reactions

60
Q

Types of constipation?

A

Hard stool in the rectum - faecal impaction which can lead to overflow diarrhoea

Whole distal colon - loaded with soft putty like faeces

High Impaction - Caused by obstructive lesion

61
Q

The effect of ageing on the bowel?

A

Decreased motility
Decreased peristaltic speed and strength
Weak connective tissue - Diverticula
Increased sensory threshold - urge to open bowels

62
Q

Investigations of constipation?

A

PR exam
Bloods - FBC, U+E, TFT
Abdo X-ray
Other - colonscopy, CT abdomen, Barium enema

63
Q

Management of constipation?

A 
Rehydration, Mobilisation, High fibre, Med Review 
Docusate 
Macrogol/ Lactulose (softening)
Senna
Enema or Manual evacuation

Phase 3a (8 decks)

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