Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

OPIC > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

Name four things in a Falls History you would want to know about pre-fall

A

Any dizziness/light headedness
Any cardiac symptoms
Any weakness
Any previous near misses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Name four examinations you could do in a falls patient

A

Functional assessment of mobility (how do they mobilise etc)
CVS exam (inc lying and standing BP immediately, at 3 minutes and at 5 minutes)
Neurological Exam
Musculoskeletal Exam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Name two specific tests involved in falls risk assessments

A

Timed Up and Go

Turn 180

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the Timed Up and Go test?

A

Time the person getting up from their chair without using their arms, walking three metres, turning around and returning to seat

Can use a walking stick if they normally mobilise with one

> 15 seconds is deemed to be a high falls risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the Turn 180 test?

A

Asked to stand and turn 180

> 4 steps taken requires further assessment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Falls risk assessments should be carried out via Nerve Centre within 6 hours of admission. Who gets a standard falls risk assessment?

A

Over 65

Under 65 with clinically judged falls risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Falls risk assessments should be carried out via Nerve Centre within 6 hours of admission. Who gets an enhanced falls risk assessment?

A

Admitted following a fall
2 or more falls in past 12 months
Previous inpatient fall at UHL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Name five causes of Syncopal Falls

A 
Vasovagal
Situational 
Postural Hypotension 
Autonomic Failure
Carotid Sinus Hypersensitivity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Name three causes of Non Syncopal Falls

A

Poor Vision
Muscle Weakness
Labyrinthitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Other than the two specific tests in a falls risk assessment, what else does it comprise of?

A

Comprehensive History and Exam
Medication Review
Psychological (fear of falling)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

FRAX is a tool used to estimate the ten year fracture probability risk. Who qualifies to be evaluated?

A

All women >65 and all men >75

If other risk factors can consider in <65

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Name some of the parameters of the FRAX tool

A 
Sex
Weight
Height
Previous #
Smoking
Alcohol 
Steroids 
Parenteral Nutrition 
T and Z Score
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Define Osteoporosis

A

Low bone mass and deterioration of architecture leading to reduced bone strength and increased fracture risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Describe the mnemonic ‘SHATTERED’ for Osteoporosis

A 
Steroids
Hyperthyroidism 
Alcohol 
Tobacco
Thin 
Early Menopause
Renal Failure 
Erosive Bone Disease
Dietary Insufficiency
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Using a DEXA scan, two scores can be produced: Z score and T Score. What is the T Score?

A

Number of standard deviations from the mean bone density of a healthy person (30y old and same sex)

> -1.5 - normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Using a DEXA scan, two scores can be produced: Z score and T Score. What is the Z Score?

A

Number of standard deviations from the mean bone density of same age and sex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Name three conservative managements for Osteoporosis

A

Quit Smoking
Increase weight bearing exercises
Calcium and Vitamin D Rich Diet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the first line medical management for Osteoporosis?

A

Bisphosphonates (Alendronic Acid)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What should you inform patients about Bisphosphonates

A

Stay upright and wait 30 minutes before food after taking one

Side effects include GI Upset and Jaw Osteonecrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Name four contraindications to Bisphosphonate therapy

A

Achalasia
Stomach Ulcers
eGFR<30
Cognitive Impairment (won’t follow instructions)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

If wanting to give a patient Bisphosphonates but unable to take orally, what could you prescribe?

A

IV Zolendronate

Yearly infusion
Requires good Creatinine Clearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Name two other medical management options for Osteoporosis

A

Teriparatide (Recombinant PTH)

Denosumab (MAB reducing bone reabsorption - subcutaneous biannually)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Name two side effects of Teriparitide

A

Dizziness

Tachycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Name two side effects of Denosumab

A

Red/Dry/Itchy Skin

Blisters

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is classed as Polypharmacy?
Taking 5 or more medications at any one time
26
What is the STOPP tool?
Screening Tool for Older Persons Prescription Aims to reduce incidence of medicine related adverse events Can be in relation to single drugs or classes (check in BNF 'caution' boxes)
27
What is the START tool?
Screening Tool to Alert the Right Treatment Prevents omissions of indicated appropriate medications
28
Name 6 other pharmacy considerations in older people's prescriptions
Forms of Medicine (is a liquid form more appropriate?) Are some symptoms just manifestations of ageing (dont require treatment?) Patients are more sensitive to medications Pharmacokinetics (clearance ability) Review regularly Simplify regimes
29
What are the four components of an incontinence history
- Defining the type of incontinence - Defining the causes and precipitants - Excluding other pathology - Assessing the severity and impact on patient's life
30
How could you determine the type of incontinence?
Any triggers? Constant vs Intermittent Leakage Amount of Urine Lost
31
What information can help determine the cause of incontinence?
Exclude UTIs/Calculi Whether frequency is worse during day or at night Factors worsening urge Reversible causes (eg look at medication list) Risk factors for stress (high parity, large babies etc)
32
What factors in an incontinence history would lead you to think of other pathological causes?
``` Haematuria Pain Acute Onset Obstructive symptoms Neurological symptoms ```
33
How can you assess the impact of incontinence on a patient?
- Standardised Pad Test (better than subjective for measuring volume) - What lifestyle changes/restrictions the patient now has - Urogenital Distress Inventory - Incontinence Impact Questionnaire
34
What features of incontinence are you looking for on an ABDO exam?
Palpable bladder after voiding
35
What features of incontinence are you looking for on an PELVIC exam?
- Atrophic Vaginal Mucosa - Stress/Cough Test - Organ Prolapse - Pelvic Floor Contraction (rated out of 5 using Oxford System) - Pelvic Mass/Tenderness
36
What features of incontinence are you looking for on a RECTAL exam?
Constipation and Tone
37
What features of incontinence are you looking for on a NEUROLOGICAL exam?
Change in Perineal Sensation/Anal Tone | Lower limb neuro exam
38
What features of incontinence are you looking for on a CARDIAC exam?
Volume Status | Signs of Heart Failure
39
Describe the normal parameters of voiding
- Number of day time voids - 3 to 5 hourly - Total urine - 1500 to 2000mls - Largest single void - 300 to 600mls
40
How can you interpret a bladder diary/frequency volume chart?
Frequent small volume - OABS, Detrusor Overactivity Frequent large volume - Polyuria Frequent small volume with low urine output - fluid restriction Nocturnal - Ageing, OSA, Cardiac Failure
41
Describe the procedure of a bladder scan
- Patient is asked to void (volume measured) - Probe placed 3cm above pubic symphysis Volume <100ml is normal Volume >200ml requires further investigations Volume >500ml requires urgent discussion
42
Describe the Bristol Stool Chart
``` 1 - Hard Lumps like nuts 2 - Sausage shaped but lumpy 3 - Sausage shaped with cracks on 4 - Smooth Sausage shaped 5 - Soft blobs with clear cut edges 6 - Fluffy with ragged edges 7 - Watery ```
43
What has to be present in a urine dip for UTI to be a possibility?
Leukocyte Esterase | Nitrates
44
Give three risk factors for Stress Incontinence
Pelvic Surgery Child Birth Oestrogen Deficient States
45
Define Stress Incontinence
Involuntary urination upon increase in intra-abdominal pressure due to weak pelvic floor
46
Describe the conservative management of Stress Incontinence
Lose Weight Pelvic Floor (8 contractions tds) Stop Smoking Reduce Caffiene
47
How can Stress Incontinence be investigated?
Exclude infection Frequency Volume Chart (normal) Urodynamics
48
Describe the medical management of Stress Incontinence
Serotonin and Noradrenaline Reuptake Inhibitor - Duloxetine (increases pudendal nerve activity and sphincter pressure)
49
Describe the surgical management of Stress Incontinence
Burch Colposuspension (sutures between coopers and paravaginal) Periurethral Bulking TVT
50
Define Urge Incontinence
Presence of urgency in the absence of other pathology Normally due to Detrusor Overactivity and associated with Nocturia/Frequency
51
Name three risk factors for Urge Incontinence
MS Spina Bifida Pelvic Surgery
52
Name three investigations of Urge Incontinence
Exclude infection Frequency Volume (increased) Urodynamic (Detrusor Overactivity)
53
Describe the conservative management of Urge Incontinence
Avoid Caffiene and Alcohol | Bladder Retraining
54
Describe the medical management of Urge Incontinence
- Oxybutinin (Antimuscarinic preventing bladder contraction) - Solifenacin (Antimuscarinic) - Mirabegron (B3 Agonist promoting relaxation) - Tamsulosin/Doxazosin (Promotes prostate relaxation and bladder emptying)
55
Name two contraindications to Antimuscarinic medication for Urge Incontinence
Myasthenia Gravis | Closed Angle Glaucoma
56
Name four containment products for Incontinence
- Absorbent Pads - Absorbent Bed/Chair Pads - Penile Sheaths - Catheterisation (short term, long term, suprapubic, intermittent)
57
Define Functional Incontinence
Unable to reach the toilet in time due to cognitive/physical problems
58
Name three causes of Faecal Incontinence
Faecal Impaction (and overflow diarrhoea) Sphincter dysfunction (haemorrhoids, obstetric tears) Impaired sensation
59
What is Faecal loading?
Smearing Small amounts of type 1 stool or copious amounts of 6/7
60
Name two complications of Faecal Loading
Urinary Retention | Stercoral Perforation
61
How is Faecal Incontinence Managed?
Enemas, Stool Softeners, Stimulants Manual Evacuation (perforation risk vs benefit) Always coprescribe constipating drugs with laxatives
62
How would you investigate Chronic Diarrhoea?
Bowel Imaging Stool Culture Exclude Impaction/Causative Medication Dietary Review
63
How would you manage Chronic Diarrhoea?
Consider low dose loperamide (if not then break and accelerate)
64
What are Pressure Sores?
Persistently red/blistered/necrotic skin that can lead to exposure of underlying structures, caused by shear pressure/forces over bony prominence (most common in immobility)
65
Name the 5 most common areas for Pressure Sores
``` Occiput Heel Malleolus Ischium Greater Trochanter ```
66
Name four risk factors for Pressure Sores
Alzheimers Diabetes Hip Fractures Parkinsons
67
What is the Braden Score for Pressure Sores?
Each item is scored between 1 and 4 The lower the score the greater their risk Sensory perception, Moisture, Activity, Mobility, Nutrition, Fraction/Shear
68
What is the Waterlow Score for Pressure Sores?
Scoring system for risk of Pressure Sores BMI, Continence Level, Skin Appearance, Mobility, Sex, Age, Tissue Malnutrition, Neurological Deficit, Major Surgery 10+ at risk 15+ high risk 20+ very high risk
69
How are Pressure Sores assessed?
Using medical photography and ruler measurements Cause of Ulcer Site/Location Dimensions
70
Describe Stage 1 Pressure Sores
Non blanchable erythema of intact skin May appear blue/purple on darker skin
71
Describe Stage 2 Pressure Sores
Partial thickness, loss of epidermis/dermis/both Normally an Abrasion/Blister
72
Describe Stage 3 Pressure Sores
Full thickness skin loss which may extend down to underlying fascia
73
Describe Stage 4 Pressure Sores
Extensive destruction/Tissue Necrosis/Damage to muscle or bone Extremely difficult to heal, high infection risk
74
Describe Stage 5 Pressure Sores
Unstageable Base of ulcer is covered by slough so depth is undetermined
75
When do Pressure Sores require specialist services?
Extensive Superficial Ulcers Grade 3/Grade 4 pressure ulcers Deteriorating
76
Name 6 mainstays of Pressure Sore management
``` Repositioning Managing other conditions which may delay healing Pressure relieving support Wound dressing Pain relief Infection Control ```
77
Why might Debridement help tissue healing?
Devitalised tissue slows tissue healing Can be autolytic/mechanical/surgical
78
What is a Comprehensive Geriatric Assessment?
Holistic approach to the elderly patient Encompasses physical/functional/social/environmental/psychological and medication review
79
Name 6 things examined in the Physical Assessment of the Elderly patient
``` Sensory Loss Feet and Footwear Gait and Balance Lying and Standing BP Joints Weight and Nutrition ```
80
What is assessed in a Psychological Assessment of the Elderly Patient?
Mood and Cognition
81
What is assessed in the Functional Assessment of the Elderly Patient?
1) What can and what does the person actually do 2) How recently has it changed Nottingham Extended ADLs Timed Up and Go Assess timescale of change
82
How is a Medication Review carried out?
Full drug history ``` For each drug: Are you good at remembering to take? Can you swallow okay? What are you most concerned about with tablets? Do you think it works? Any SE? ``` STOPP-START
83
Name four side effects of Parkinson's medication
Impulse control disorders Excess Daytime Sleepiness Excess Drooling If not taken - Neuroleptic Malignant Syndrome
84
What should you base the Clinical Frailty Scale on?
What their level of function was two weeks ago
85
Define Postural Hypotension
Systolic drop >20mmHg on standing (or drop below 90mmHg)
86
Give four causes of Postural Hypotension
Diabetes Dehydration Drugs MSA
87
How is Postural Hypotension measured?
Lying Down and Measured Standing immediately, after one minute and after three minutes
88
What is the Falls Prevention Programme?
Combination of therapy and education to help prevent and limit damage caused by falls
89
When should Osteoporosis be managed?
If score is <= -2.5 then treat If not, modify risk factors, treat underlying conditions and review in 2 years
90
What is Shared Decision Making?
Integrates patient and clinical choice ``` Seek Participation Explore and compare treatment options Assess values and preferences Reach a decision together Evaluate decision ```
91
What are the four questions of Shared Decision making?
What are the benefits? What are the risks? What are the alternatives? What if we do nothing? BRAN
92
What is an Advanced Directive?
Legal document written at time when patient is of sound mind Refers to specific treatments Must be witnessed Can refuse medication but can’t request
93
According to the Mental Capacity Act, when can Advance Directives be overruled?
- If they are withdrawn when patient is of sound mind - If three is strong belief that current situation would’ve changed wishes - Overruled by LPA
94
What happens if someone loses capacity but doesn’t have a Lasting Power of Attorney?
- Referred to the court of protection and assigned one for welfare and one for finances
95
Can an LPA overrule an advanced directive?
If the Advanced Directive was made after someone was appointed LPA - no If the Advanced Directive was made before someone was appointed LPA - yes
96
What are the four sections from Gold Standard Framework for Advanced Care Planning?
- What is important to you in your life at the moment - What WOULD you like to happen to you if you became unwell - What WOULDN’T you like to happen if you became unwell - Who would you like (if you would like) someone to speak on your behalf

OPIC (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions