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Academic days > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

What is a key tool in geriatric history/exam?

A

collateral history…paramedics, carers, family, GP

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2
Q

What are key aspects of social history that you must inquire about in geriatric history?

A

social support- carers, family support?

activities of daily living- requires assistance or independent?

continence

cognition

mobility- falls, walking aids, mobility around house

exercise tolerance

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3
Q

What aspects of physical examination are important in a geriatric exam?

A

vision and hearing
swallow, nutrition, hydration
bladder and bowel
injury
skin

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4
Q

Name two other allied professionals who are involved in the care of geriatric patients?

A

occupational therapist- improving every day life, prevent falls, memory rehab, home modifications, help with vision loss

Social worker- connecting to appropriate services, community resources

dietitian

speech and language therapist

physio

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5
Q

What criteria is used to assess frailty?

A

fried frailty criteria

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6
Q

Name two components of the fried frailty criteria

A

weight loss, exhaustion, low physical activity, slowness and weakness (measured by grip strength)

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7
Q

A patient has a score of 3 on fried frailty criteria. Are they frail?

A

> 3 = frail
1-2= pre-frail

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8
Q

Name one frailty index/scoring system

A

ROckwood’s frailty index- the more things you have wrong the more likely you are going to be frail

fried frailty criteria

Edmonton frail scale

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9
Q

List three common problems in frailty

A

falls
cognitive impairment
continence
mobility
nutrition
polypharmacy
mood
loneliness
alcohol
vision
hearing

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10
Q

Which is the most helpful tool for frailty for medical students?

A

Health improvement Scotland frailty score

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11
Q

Name one key thing that can be done to improve health outcomes for frail people when they first begin to show evidence of physical and mental decline

A

comprehensive geriatric assessment CGA- specialist care

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12
Q

What is a bedside frailty score?

A

FRAIL acronym

Functional decline- self care
Residential care
Acute or chronic confusion
Immobility
Living with support at home

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13
Q

Which tests should you do to rule out delirium and depression?

A

4AT
GDS- geriatric depression scale

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14
Q

How does pharmacokinetics change with age?

A

absorption- low HCL secretions
Less body water and more body fat- impact on half life
Elimination- high first pass metabolism, reduction in doses e.g. morphine
Reduction in creatinine- impairment of renal excretion

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15
Q

How does pharmacodynamics change with age?

A

increased sensitivity to medication due to changes in receptor numbers and response

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16
Q

What is risperidone?

A

antipsychotic

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17
Q

What is the impact of risperidone on dementia?

A

increased risk of stroke and roles, caution in elderly

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18
Q

List two contributing factors to polypharmacy

A

seeing multiple doctors
failure to review
severe chronic disease
care home
admission
failure to recognise non concordance= not actually taking the medications

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19
Q

What is number needed to treat?

A

The Number Needed to Treat (NNT) is the number of patients you need to treat to prevent one additional bad outcome (death, stroke, etc.). For example, if a drug has an NNT of 5, it means you have to treat 5 people with the drug to prevent one additional bad outcome.

The lower the number the better

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20
Q

List three classes of drugs that should be stopped in person who is unwell

A

ACEi
ARBs
NSAIDs
Diuretics
Metformin

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21
Q

How do water and fat content change with increasing age?

A

increase in total body fat
decrease in total body water

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22
Q

List three causes of weight loss?

A

poor dentition
swallowing difficulties
cognitive impairment
access/environment
poor appetite
low mood

chronic disease
acute illness/injury –> inflammation

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23
Q

List two risk factors for pressure ulcers

A

sarcopenia
malnutrition
immobility
neurological damage
medical conditions
incontinence

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24
Q

List two medical conditions that increase the risk of pressure sores

A

COPD
dementia
CVA
fracture/surgery
malignancy

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25
Q

List the grades of pressure ulcers

A

Grade 1- non blanching erythema
Grade 2- Partial thickness skin loss
Grade 3- Full thickness skin loss
Grade 4- Full thickness tissue loss

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26
Q

List two strategies to improve outcome of skin ulcers

A

keep repositioning
incontinence and moisture
skin inspection
surface- redistribute body weight
nutrition and hydration

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27
Q

List three types of incontinence

A

Passive/functional
Overactive bladder/urge
Stress incontinence
Overflow

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28
Q

Two causes of stress incontinence?

A

child birth
chronic cough
obesity

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29
Q

Management of stress UI?

A

lifestyle advice
pelvic floor exercises
pads
surgery

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30
Q

Two causes of urge incontinence

A

neurological conditions- MS, dementia, PD
small capacity bladder
UTI

31
Q

Management of urge incontinence?

A

pelvic floor exercises
bladder retraining
anticholinergics
B3 agonist
Botox into bladder wall

32
Q

Two causes of overflow UI?

A

enlarged prostate
constipation
pelvic mass
neurological conditions

33
Q

List two components of an examination to assess urinary incontinence?

A

PR
Skin
Stand patient up/cough
Vaginal exam
Cognitive assessment
Check skin if concern for dementia/immobility

34
Q

Red flags for urinary incontinence?

A

pelvic pain
haematuria
back pain
loss of senstion/tone

35
Q

Investigations for urinary incontinence?

A

urine dip/culture
frequency volume diaries
post voidal bladder scan
blood tests- WCC/CRP, Hb- new anaemia, PSA- prostate

36
Q

List two hallmarks of diagnostic features of delerium

A
  1. Cognitive impairment
  2. Fluctuation in levels of consciousness/drowsy
  3. Inability to focus/inattentive
37
Q

List three causes of delerium

A

infection
drugs
constipation
pain
urinary retention
dehydration

38
Q

Does syncope increase mortality?

A

no

39
Q

List two characters of syncope

A

loss of postural tone
transient global cerebral hypoperfusion characterised by rapid onset, short duration and spontaneous recovery

40
Q

Name three causes of syncope

A

reflex- (trigger) vasovagal, carotid sinus, situational (cough, laugh)

Orthostatic hypotension= postural hypotension

Cardiac

41
Q

List two causes of postural hypotension/orthostatic hypotension

A

medications
hypovolaemia/dehydration
hypoadrenalism- short synacthen test
Primary autonomic dysfunction e.g. idiopathic parkinson’s disease
secondary autonomic dysfunction e.g. diabetes, lambert eaton syndrome, infections e.g. HIV

42
Q

Specific questions to ask about syncope in relation to orthostatic hypotension?

A

prodromal symptoms
diet/fluid intake
alcohol??
eyewitness account
recovery period
standing sitting
hot bath?
DRIVING

43
Q

Management of orthostatic hypotension?

A

identify triggers
improve hydration
medication review
24 hour BP monitor

44
Q

List three differentials for delerium

A

dementia
deaf/blind
depression
dysphasia
different language
alcohol- withdrawal

45
Q

List three differences between delirium and dementia

A

Onset- acute vs insidious
Course- fluctuating versus progessive
Conscious- clouded vs clear
Hallucinations vs absent
Delusions vs absent
Hyper/hypo activity vs normal

46
Q

List a screening test for delerium

A

4AT
CAM- confusion assessment method

47
Q

Difference between 4AT and AMT4?

A

AMT4- abbreviated mental test: age, DoB, place, year, indicates cognition while 4AT is delirium tool

48
Q

List two personal factors that increase risk of delirium

A

male
older age
dementia
depression
alcohol
sensory impairment

49
Q

List two environmental factors that precipitate delerium

A

severe medical illness
polypharmacy
surgery
dehydration
malnutrition
sleep deprivation

50
Q

List three complications of delerium

A

increases risk of future dementia
increased mortality
increased hospital stay
PTSD
pressure sores
falls
pneumonia
increased readmission rates

51
Q

What is the management of delirium?

A

target risk factors- dehydration, sensory loss, immobility, polypharmacy
TIME burdle
re-orientation
address pain
antipsychotics

52
Q

List three domains that dementia affects

A

memory
orientation
comprehension
learning capacity
calculation
language
judgement

53
Q

Three differentials for dementia?

A

delirium
depression
iatrogenic- anticholinergic medications
physical illness- anaemia, thyroid dysfunction

54
Q

List one cognitive test you would use to assess dementia?

A

MMSE
Montreal cognitive assessment MoCA
Addenbrookes cognitive exam

55
Q

List three components of dementia screening bloods?

A

FBC
U+E
LFT
CRP
Bone profile
Haematinics
TFT

56
Q

Discuss the pathophysiology of dementia

A

amyloid plaques and neurofibrillary tangles (tau hyperphosphorylation) causing atrophy

57
Q

Which regions of the brain are affected most in alzheimer’s disease

A

mediotemporal e.g. hippocampus

58
Q

List one genetic risk for dementia

A

presenellin 1 and 2
amyloid precursor protein APP

59
Q

In which type of dementia should you be cautious with antipsychotics?

A

lewy body dementia

60
Q

List two classes of drugs used in the treatment of dementia

A

acetylcholinesterase inhibitors e.g. rivastigmine
NMDA antagonist e.g. memantine

61
Q

Name one contraindication for acetylcholinesterase inhibitors?

A

bradycardia or 2nd degree heart block

62
Q

List two psychological treatments for dementia

A

cognitive stimulation therapy grou
memory management group
patient and carer education

63
Q

List two aspects of social treatment for dementia

A

power of attorney/guardianship
Home care, help with shopping etc
OT assessment (kitchen, baths)
Managing risk (smoke detectors, telecare, alarms, locked meds box)

64
Q

List four aspects of memory/dementia history you would take

A

daily tasks- cooking/dressing/cleaning
mobility
paying bills
Word finding
Mood/interests/attention
Using gadgets- tv remote, phone
falls
black outs
hallucinations
empathy?
taking medications?

65
Q

What is the difference between parkinson’s disease dementia and lewy body dementia?

A

If symptoms start >1 year after motor syx= PDD

If symptoms dementia start <1 year after or before motor symptoms= Lewy body dementia

66
Q

What are the key features of sporadic creutzfeldt jakob disease?

A

rapidly progressive dementia- memory, language, behaviour changes

Motor symptoms- ataxia, myoclonus, rigidity

Later stages- bed bound….

4 month prognosis from onset of symptoms!!

67
Q

List three ways in which distress can manifest in behaviour

A

physical aggression
verbal aggression
self harm
shouting
lack of self care
stripping
sleep problems
inappropriate sexual behaviors
spitting

68
Q

List two biological causes of physical aggression

A

alcohol withdrawal
Pain
Drug induced
Frontal lobe deficit

69
Q

List two psychological causes of aggression

A

frustration from being:
misunderstood
inability to communicate well
inability to understand

embarrassed during personal care

70
Q

List two social causes of aggression

A

does not like being touched
prevented from leaving building
not liking carer e.g. due to age, sex

71
Q

Two causes of excessive walking

A

distraction from pain
drug induced
boredom
sense of control
hungry

72
Q

Patient is sleepy and is picking at the air and at their clothes. What is this a classic sign of?

A

delirium!!

73
Q

Which anti psychotic can be used to calm/sedate distressed patient?

A

risperidone, in small doses

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