geriatrics Flashcards
what is a TEP form
treatment escalation plan
a way of your doctor recording your individual treatment plan, focusing on which treatments may or may not be most helpful for you. A variety of treatments can be considered, such as antibiotics, artificial feeding or ventilation of your lungs.
TTO
o Take Out (TTO) or To Take Home (TTH) -discharge
what is DOLS
The Deprivation of Liberty Safeguards (DoLS) is the procedure prescribed in law when it is necessary to deprive of their liberty a resident or patient who lacks capacity to consent to their care and treatment in order to keep them safe from harm.
what is a package of care
NHS continuing healthcare is a package of care you may be entitled to receive if you have a serious disability or illness. It covers the full cost of your care (in your own home or a care home), including: healthcare. personal care, such as help getting washed and dressed. care home fees, including accommodation costs
in geriatrics what should you do on exmaiantion
invlves bladder
check for urinary retention
other effect of morphine
Morphine and related opioids reduce respiratory drive by shifting the ventilation–arterial carbon dioxide partial pressure (Paco2) response curve down and to the right. Therefore, patients who retain carbon dioxide are most sensitive to the respiratory depressant actions of opioids.
what is a spinal catheter used for
The catheter allows access to the epidural space to inject medication such as local anesthetics and/or narcotics for relief of pain
q waves are a sing of what
previous pathological infarct - anterior territory
someone having seizure what dose of lorazepam
4mg - 2mg per min
1st line for orthostatic hypotension
fludrocortiosne - increased blood volume and therfore blood pressure
side also works on alpha receptors
what drugs cause confusion
oxybutynin - anticholinergic medication
lorazepam also causes confusion
COPD vs asthma
what dose of prednisilone
COPD pred 30mg , asthma 40-50mg visual chage 60mg
rate limiting calcium channel blockers examples
diltiazem or verapamil
decrease contractility and heart rate
non-dihydropyridines also block calcium going into the conducting cells in the heart, which has the effect of slowing down the heart rate.
dihydropyridine calcium-channel blocker - non rate such as
amlodopine, nifedipine used for blood pressure
if CT and potentially got intracrnaila bleed cuasing the haemorrhage on CT what else can you do
CT angio
what is insulinoma
nsulinomas are tumors in your pancreas. They make extra insulin, more than your body can use. Insulinomas can cause hypoglycemia, or low blood sugar. Low blood sugar can cause confusion, sweating, weakness, and a rapid heartbeat. If your blood sugar gets too low, you can pass out and even go into a coma.
A fasting test helps doctors diagnose insulinomas. You stay in hospital and have regular blood tests to check your blood sugar levels. The fasting test usually takes 72 hours (3 days).
how many weeks on abx if have osteomyelitis
6w
gold standard test for osteomyelitis
MRI
3 way cather how much fluid do you need
15-30ml to dilate balloon
irrgation of clots
URT - darker and more clots, lower urianry tract - less red
MND you get clonus and both UMN and LMN lesions and clonus
when can you not use daltaparin/enoxaparin
CKD
budenoside decreases what
decrease protein in the urine in patients with primary immunoglobulin A nephropathy
fornier gangrene and necoris of scotum associated in
diabetics and homeless - need surgical debridement - testicles survive as differnt blood supply
what is a TWOC
A trial without catheter is when a catheter which has been inserted via the urethra (water pipe) is removed from the bladder for a trial period to determine whether you are able to pass urine spontaneously.
what is a periprostethesis
Periprosthetic fractures (PF) are considered fractures associated with an orthopedic implant, whether a replacement or internal fixation device.
fracture where already mended
haemotinics - what antibody assays
folate
B12
ferritin
intrinsic factor
IMCA
independent mental capacity act - hospital advocat - dosent really work in emergencies
what do you igve for extrapyramdial side effects associated with typical antipsychotics
procylizine hydrochloride as well as anticholinergics
can you operate on aspriin
yes
when do you give lactulose
decompensated alcoholic liver disease
what drug do you use for a femoral nerve block
levoburpracaine
rf for osteoporosis
obese
anoxeria when young as a kid like 17 growing ages
reduced mobility
malabsoprtion of ca and vi d
cealiac disease
crohns
long term steriods
familial links
falls
height
smokign and drinking
rheumatoid
bed bound condtions
se of aledronate
osteonecorsis of jaw
atrypical stress fractures - slows down bone turnover
dont use in egfr below 35
bulbar palsy
Bulbar palsy is a set of conditions that can occur due to damage to the lower cranial nerves. Clinical features of bulbar palsy range from difficulty swallowing and a lack of a gag reflex to inability to articulate words and excessive drooling. Bulbar palsy is most commonly caused by a brainstem stroke or tumor
another name for fragmin
dalteparin
what is an EMG
Electromyography (EMG) is a diagnostic procedure to assess the health of muscles and the nerve cells that control them (motor neurons).
what causes more orthostatic hypotension bisoprolol or atenolol
atenolol
NOF bundle
laxative
PPI - gastric stais and upper gi bleed
dalteparin 28day
painkilers PRN
oxycodone
anti sickness
naloxone
what is gastric stasis
Gastroparesis, or gastric stasis, is a disorder of delayed gastric emptying in the absence of mechanical obstruction. It is manifest clinically through a set of largely non-specific symptoms such as early satiety, bloating, nausea, anorexia, vomiting, abdominal pain, and weight loss.
donezipil is what kind of drug
Donepezil is an acetylcholinesterase inhibitor and therefore has cholinergic effects.
cholinergic effects include
The effects of activating cholinergic receptors include muscle contraction, heart rate deceleration, constriction of the iris (miosis) and of the lens, mucus secretion and broncho-constriction
stimulants such as cocaine and mehtylphenidate dialte eyes whereas relaxants such as cannabis constrict eyes
what must you do before arranging a DOLS
Correct. DoLS is a procedure in law used where it is necessary to deprive a patient of their liberty as they lack capacity to consent to treatment or care to keep them safe from harm. Therefore, assessing her capacity is the most important step before issuing a DoLS.
normal MSE talking about dementia could be what
pseudodementia more like depression
drug induced vs true parkinsonian tremor
A true Parkinson’s tremor is typically unilateral or asymmetrical. In comparison, drug-induced Parkinsonism is more likely to present with a symmetrical tremor and bilateral.
features of delirium
According to the CAM diagnostic criteria, features of delirium include: 1) acute onset with fluctuating course, 2) inattention, 3) disorganised thinking, 4) altered level of consciousness. Level of consciousness would be expected to be normal in dementia.
cx of delirium
D - Drugs and Alcohol (Anti-cholinergics, opiates, anti-convulsants, recreational)
E - Eyes, ears and emotional
L - Low Output state (MI, ARDS, PE, CHF, COPD)
I - Infection
R - Retention (of urine or stool)
I - Ictal
U - Under-hydration/Under-nutrition
M - Metabolic (Electrolyte imbalance, thyroid, wernickes
(S) - Subdural, Sleep deprivation
glutamate receptor antagonist used in moderate
Memantine
se of L=dopa
Hypotension
Restlessness
Gastrointestinal upset
In rare cases, dopamine excess can result in psychiatric reactions including acute psychosis.
subdural occur in
older patients hisotry of fall and on blood thinner
what is an advanced statement
An advance statement is a record of someone’s preferences and values regarding future care if they were to become unwell and unable to make or communicate decisions about their care. An advance statement can be made verbally. For example, a patient could explain their wishes and preferences to a friend or family member at a time when they have full mental capacity. However, patients should be advised to make a permanent record of this.
pallaitive care patient needs pain relief but got egf below 30 what do you give
oxycodone
who can overrride an advanced decision
A lasting power of attorney (LPA) may be able to override an advance decision
are DOLS part of the mental capacity act
yes 2005
benserazide
Benserazide is a decarboxylase inhibitor which prevents the peripheral breakdown of levodopa. This means that levodopa is decarboxylated into dopamine in the brain, enabling the full therapeutic dose to take effect.
quick delirum score
Correct. The 4AT is a tool to quickly assess whether a patient has delirium or not. A score of 4 and above is suggestive of possible delirum +/- cognitive impairment.
4 componetns of capacity
The four components of capacity are to be able (1) to understand, (2) to retain, (3) to be able to weigh up and (4) to be able to communicate a decision
fluctuating confusion and coscioness in elederly post fall
subdural heamorrhage
phsophate enema works how
Phosphate enemas are irritant and encourage the bowels to contract and expel the contents of the rectum. Whilst they can be very effective at treating constipation, in general, oral methods to treat constipation should be trialled before rectal methods.
how does glycerin seposiotry work
Phosphate enemas are irritant and encourage the bowels to contract and expel the contents of the rectum. Whilst they can be very effective at treating constipation, in general, oral methods to treat constipation should be trialled before rectal methods.
somotic laxatives like macrogol soften stool
An 85-year-old man is admitted to hospital with a urinary tract infection and delirium. He has no background of cognitive impairment but currently does not have capacity to make decisions about his treatment. He is becoming increasingly agitated, and often wanders around the ward trying to leave. The patient constantly asks staff if he can go home. What is the most appropriate action?
apply for DOLS
loop diuretics cause orthostatic hypotenion
yes
mechanism of action of midodrine
Midodrine is an alpha-1-adrenergic receptor agonist. Activation of alpha-1-adrenergic receptors leads to an increase in vascular tone and an increase in blood pressure.
of dementia that usually presents with worsening short term memory and confusion.
alzeihermers
paradoxical diarrhoea
overflow diarrhoea
preservation of memory and visuospatial skills.
frontomporal dementia
sx pseudodementia
Short duration of dementia
Equal effect on long and short term memory
Amnesia concerning specific events (often events are emotionally charged)
Often patient will very detailed complaint about memory disturbance
Patient may highlight failures in answers to questions relating to memory
Loss of social skills early in the illness
Patient will often answer “don’t know” to questions, as opposed to guessing close answers
Patient may make little effort in performing tasks
history of depression
how do you knwo the differnce between parkinosns and lewy body dementia
If features of Parkinsonism precede dementia by more than one year, this is suggestive of Parkinson’s disease with dementia rather than Lewy body dementia.
differnce between advanced statements and decsions
Incorrect. This would be an example of an advanced decision, not advanced statement. Advanced decisions focus upon the refusal of treatments which are life sustaining, including aspects such as giving CPR in a situation of cardiac arrest.
Correct. An Advance Statement also known as a “Statement of Wishes and Care Preferences,” allows an individual to make general statements about their wishes, beliefs, feelings and values and how these influence their preferences for their future care and treatment. This includes expressing wishes regarding food preferences, spiritual/religious beliefs, where they would want to be treated and who they would like to have with them during their final days.
when to refer for bowel cancer
Correct. According to NICE guidance, new onset constipation, especially in patients over 50 years of age, or accompanying symptoms such as anaemia, abdominal pain, weight loss, or overt or occult blood in the stool should provoke urgent investigation because of the risk of malignancy or other serious bowel disorder.
is capacity assumed
yes
lasting power of attorney can make decisions
There are 2 types of LPA: for health and welfare, and for property and financial affairs. An LPA who has attorney for health and welfare can make medical decisions on behalf of a patient who lacks capacity.
APOE gene
linked with alzeiherms
An 69 year old man has presented to the GP as he has been having visual hallucinations over the last few months. He reports seeing animals in his flat but has no pets. He has a history of severe glaucoma and wears glasses for hypermetropia in both eyes. He is aware that his hallucinations are not real and has never experienced this prior to six months ago. He has no other past medical or psychiatric history of note.
Which clinical disorder is this man most likely experiencing?
Charles Bonnet Syndrome (CBS)
Correct. This patient is experiencing new visual hallucinations on a background of vision loss, particularly peripheral (suggested by glaucoma). These symptoms, combined with the insight of the hallucinations not being real and the absence of psychiatric disorders, suggests that CBS is the most likely diagnosis. In CBS, it is thought that damage to the visual system causes these hallucinations. It is not a psychiatric disorder.
delirium equals DOLS - mentla health condition then means detain
hypodense means
less dense
