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RACP > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

Intervention with highest benefit to reduce risk falls

A

Exercise (in a patient at home not RACF)

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2
Q

CAM

A

Confusion assessment method- Delirium screen

Must have both Acute Onset and inattention plus one of disorganised thinking or altered consciousness

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3
Q

Multi-factorial interventions to prevent progression of dementia

A

Diet
Exercise
Cognitive training
Vascular risk reduction

FINGER STUDY

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4
Q

Most common type of urinary incontinence in elderly

A

Urge incontinence

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5
Q

Definition of frailty

A

Three or more of;
- Unintentional weight loss
- Self reported exhaustion
- Decreased grip strength
- Slow walking pace
- Low physical activity

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6
Q

Clinical frailty score

A
  1. Very fit - regular exercise, motivated, robust, no medical problems
  2. Well - occasional exercise, no medical problems
  3. Managing Well - Seasonal exercise, medical problems well controlled
  4. Vulnerable.- Symptoms limit ADLs but not yet reliant on others
  5. Mildly Frail - require assistance with higher order ADLs - transport, bills, shopping, cooking
  6. Moderately frail - require stand-by assist for all ADLs
  7. Severely frail - completely dependent on others
  8. Very severely frail - EOL care and likely to die of even a mild illness
  9. Terminal ill - < 6 months to live but are otherwise not evidently frail
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7
Q

Only intervention proven to reduce frailty

A

Exercise

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8
Q

Test of the benefits of exercise in elderly

A

6 minute walk test

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9
Q

Affects on sleep in elderly

A

NOT DECREASED need for sleep
- Increased nocturnal awaking or arousal
- Decreased Non-REM sleep (preserved REM sleep)
- Fragmented sleep-wake cycle

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10
Q

Definition of dementia

A

Chronic > 6 months, impairing personal or occupational activities with 2 or more impairment in

  • Memory
  • Executive function
  • Attention
  • Language
  • Social cognition and judgement
  • Psychomotor speed
  • Visioperceptual or vsiospatial abilities

MUST have neuroimaging to make diagnosis
MMSE < 24

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11
Q

Side effects of Donepezil

A

Cholinergic side-effects
- Diarrhoea and GI upset is most common!
- Urinary frequancy
- Asymptomatic bradycardia
- Vivid dreams
- Headache
- Long QT
- Lowers seizure threshold

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12
Q

CADASIL

A

Cerebral Autosomal Dominant Arteriopathy with Subcortical infarcts and Leukoencephalopathy
Recurrent strokes/TIA in young patents 40 - 50 without risk factors, due to smooth muscle atrophy in blood vessels
Causes Vascular dementia
Notch 3 gene on Chromosome 19
Muscle biopsy will show arterioles with dense bodies
No treatment

Complicated by migraines, urinary incontinence, pseudobulbar palsy

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13
Q

Anti-psychotics for use in dementia/delirium

A

Respiridone in dementia
Haloperidol in delirium (does not sedate patients)

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14
Q

Drugs contributing to falls

A

Anti-depressants - SSRI (highest)
Anti psychotics
Benzos
Sedatives
Some Anti-HTN’s (highest shortly after commencement)
NSAIDs
Diuretics
Beta blockers and digoxin

Perindopril and indapamide protective!

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15
Q

Drugs contributing to falls

A

Anti-depressants - SSRI (highest)
Neuroleptics
Benzos
Sedatives
Some Anti-HTN’s (highest shortly after commencement)
NSAIDs
Diuretics
Beta blockers ad digoxin

Perindopril and indapamide protective!

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16
Q

Which medication is protective against falls?

A

Perindopril and indapamide

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17
Q

Medications associated with weight loss in elderly

A

Digoxin
Theophylline
Antipsychotics
SSRIs (Citalopram, Fluoxetine, Paroxetine) -> Amitryptaline causes weight gain!
Frusemide
Metformin

18
Q

Cardiovascular changes in elderly

A
  • Decrease in maximum heart rate
  • Increase in end diastolic and end systolic volume
  • Increase in stroke volume
  • Reliance on Frank Starling mechanism
19
Q

Weight re-distribution in elderly

A

Decrease in Subcut and appendicular fat
Increase in Visceral and Truncal fat

20
Q

Changes in muscle fibres with ageing

A

Decreased Type 2 muscle fibres for gross, sustained movements
Preserved Type 1 muscle fibres for fine and precise movements

i.e. can knit but can’t run!

21
Q

Changes in respiration with ageing

A

Increased Residual capacity and functional residual capacity
Decreased FEV1 > FVC
Decreased DLCO
Reduced respiratory drive to hypoxia and hypercapnia
Stable total lung capacity

22
Q

Cause of Nocturia in elderly

A

Increased ANP in response to fluid retention

23
Q

Visual impairment

A
24
Q

Visual impairment

A
25
Q

Visual impairment

A
26
Q

Visual impairment

A
27
Q

Strongest risk factor for fall

A

Prior falls

28
Q

Strongest risk factor for delirium

A

Restraint Use
Malnutrition with BMI < 20
INCREASE BY FOUR-FOLD

29
Q

HELP Model of delirium management

A

Orientation
Vision and Hearing aids
Early mobilisation
Non-drug approaches to sleep and anxiety
Fluid Replacement
Noise reduction

30
Q

Drugs with reduced incidence of dementia

A

Perindopril and Indapamide

31
Q

Barthol Score

A

For ADLs
- Feeding
- Bathing
- Dressing
- Grooming
- Toileting
- Bowels
- Bladder
- Mobility on flat surface
- Stairs
- Transfer bed to chair
The need for supervision renders the patient not independent

32
Q

Worst Parkinsons Meds for side effect of psychotic symptoms

A

In order;
Anticholinergics (Amantadine, Selegiline)
Dopamine agonists (Pramipexole, Ritigotine)
Dopamine replacement (L.Dopa)

33
Q

NH patient Vs community dweller risk of falling each year

A

Around 50% Vs. 30% (but increases to 50% > 80 years even in community dwellers)

34
Q

Time to up and Go test

A

> 13.5 seconds indicates increased risk of falls

35
Q

Visual aid interventions that improve falls risks

A

Cataracts
Singles lens help with outside falls only

36
Q

Interventions to reduce falls in NH patients

A

Vitamin D supplementation for deplete patients (otherwise nothing)

37
Q

Types of Fronto-temporal dementia

A

Behavioural - disinhibited, apathetic

Progressive Non-fluent Aphasia - slowed speech and problems understanding speech

Semantic - Problems recognising people or items, trouble finding the right word for objects

38
Q

Types of Fronto-temporal dementia

A

Behavioural - disinhibited, apathetic

Progressive Non-fluent Aphasia - slowed speech and problems understanding speech

Semantic - Problems recognising people or items, trouble finding the right work for objects

39
Q

Genes associated with Alzheimers

A

APOe4 - Late onset alzheimers and cardiovascular disease
Presenilin 1
Presenilin 2
Amyloid precursor proteins

Protective: APOe2

40
Q

Types of Fronto-temporal dementia

A

Behavioural - disinhibited, apathetic

Progressive Non-fluent Aphasia - slowed speech and problems understanding speech

Semantic - Problems recognising people or items, trouble finding the right work for objects

41
Q

Protein deposition and types of dementia

A

Alzheimers - Extracellular Beta Amyloid and intracellular Tau proteins forming Neurofibillary tangles
Lewy body dementia - intracellular Alpha-synuclein
Vascular dementia/Picks disease - Intracellular Tau proteins
FTD - Intracellular Tau and TDP-43
PSP - Intracellular Tau
CBD - Intracellular Tau
MSA - Alpha-synuclein
Mixed (LATE neuropathology) - Tau, Beta amyloid, alpha-synuclein, TDP-43

RACP (17 decks)

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