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Phase 3a Medicine🩺 > Geriatrics👵🏻 > Flashcards

Geriatrics👵🏻 Flashcards

1
Q

What is frailty?

A

State of increased vulnerability resulting from ageing associated decline in reserve and function across multiple physiologic systems such as the ability to cope with everyday or acute stress is compromised.

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2
Q

What can cause delirium?

A

Drugs and alcohol
Eyes, ears and emotion
Low output state
Infection
Retention (of urine or stool)
Ictal
Under hydration/Nutrition
Metabolic

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3
Q

What drug should you avoid in Parkinson’s patients?

A

Haloperidol

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4
Q

What drugs can cause postural hypotension?

A

Nitrates, diuretics, anticholinergic medications, antidepressants (SSRIs), Beta-blockers, L-Dopa, ACE-i

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5
Q

What is the definition of dementia?

A

Dementia is a progressive global decline in cognitive function

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6
Q

What genes are associated with Alzheimers disease?

A

Most common genetic mutation is APOE4.
An early onset autosomal dominant disease is associated with PSEN-1 and PSEN-2.

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7
Q

What drugs are used in Alzheimers disease?

A

Anticholinesterase drugs such as Donepezil and galantamine
NMDA receptor antagonists such as memantine

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8
Q

What is the pathology of osteoporosis?

A

It is due to an imbalance of osteoclast vs osteoblast activity. It is an oestrogen-sensitive process which is why post menopausal women are at greatest risk/ `

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8
Q

What is the medical management of osteoporosis?

A

Bisphosphonates such as Alendronic acid. These work by decreased the rate of absorption by osteoclasts.
Denosumab is a monoclonal antibody which binds to RANKL a signaller released by osteoblasts ad taken up by osteoclasts. By binding to it osteoclast activity is reduced.

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9
Q

What score can be used to screen people at risk of developing pressure ulcers?

A

Waterlow Score- It includes a number of factors including BMI, nutritional status, skin type, mobility and continence

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10
Q

What investigations can you do for pressure ulcers?

A

CRP, ESR, WCC, swabs, X-Ray for any bony involvement

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11
Q

What is refeeding syndrome?

A

Metabolic disturbances as a result of reinstitution of nutrition to patients who are starved/severely malnourished

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12
Q

What are the biochemical features of refeeding syndrome?

A

Hypophosphatemia
Hypokalemia
Thiamine deficiency
Abnormal glucose metabolism

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13
Q

What are the complications of refeeding syndrome?

A

Cardiac arrhythmias, coma, convulsions or cardiac failure

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14
Q

What test can you do to assess mental state in confusion?

A

MMSE

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15
Q

Give risk factors for pressure ulcers.

A

Age, Immobility, malnutrition, dehydration, sensory impairment, obesity, urinary/feacal incontinence, reduced tissue perfusion

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16
Q

List differentiating features of a parkinsonian tremor?

A

Slow (pill-rolling)
Worse at rest
Asymmetrical
Reduced on distraction and reduced on movement

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17
Q

How does MAO-B inhibitors work?

A

Inhibits dopamine breakdown

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18
Q

How do COMT inhibitors work?

A

Inhibits dopamine breakdown, adjunct to Levodopa.

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19
Q

What are some causes of hyponatraemia?

A
  • Dilutional effect: Heart failure, hypoproteinaemia, SIADH, hypervolaemia/fluid excess, NSAIDs (promote water retention), oliguric renal failure (dilution)
  • Sodium loss: Addison’s disease (aldosterone insufficiency), diarrhoea & vomiting, osmotic diuresis (e.g. Diabetes mellitus, diuretic excess), severe burns, diuretic stage of acute renal failure.
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20
Q

What are the symptoms of hypocalcaemia?

A

Paraesthesia (usually fingers, toes and around mouth).
Tetany.
Carpopedal spasm (wrist flexion and fingers drawn together).
Muscle cramps
Seizures.
Prolonged QT
Laryngospasm; bronchospasm

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21
Q

What are the clinical features of refeeding syndrome?

A

CVS: arrhythmia, HT, CHF
GI: abdo pain, constipation, vomiting, anorexia
MUSC: weakness, myalgias, rhabdomyolysis, osteomalacia
RESP: SOB, ventilator dependence, respiratory muscle weakness
NEURO: weakness, paraesthesia, ataxia
METABOLIC: infections, thrombocytopaenia, haemolysis, anaemia
OTHER: ATN, Wernicke’s encephalopathy, liver failure

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22
Q

What are the clinical features of refeeding syndrome?

A

CVS: arrhythmia, HT, CHF
GI: abdo pain, constipation, vomiting, anorexia
MUSC: weakness, myalgias, rhabdomyolysis, osteomalacia
RESP: SOB, ventilator dependence, respiratory muscle weakness
NEURO: weakness, paraesthesia, ataxia
METABOLIC: infections, thrombocytopaenia, haemolysis, anaemia
OTHER: ATN, Wernicke’s encephalopathy, liver failure

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23
Q

How do you assess capacity?

A

Assessment of capacity:
Understand the information relevant to the decision
Retain the information
Weigh up the information
Communicate the decision

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24
Q

What are the principles of the Mental Capacity Act?

A
  1. Assume capacity – person assumed to have capacity until proven otherwise
  2. Maximise decision-making capacity – all practical support to help a person make a decision should be given
  3. Freedom to make seemingly unwise decisions – an apparently unwise decision in itself does not prove incapacity
  4. Best interests – all decisions taken on behalf of the person must be in their best interests
  5. Least restrictive option – when making a decision on another person’s behalf, the alternative that achieves the necessary goal and interferes the least with the person’s rights and freedom of action must be chosen.
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25
Q

What is a DoLs?

A

“DoL occurs when a person does not consent to care or treatment, for example, a person with dementia who is not free to leave a care home and lacks capacity to consent to this”

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26
Q

What is an LPA?

A

“A document which a person can nominate someone else to make certain decision on their behalf (for example on finances, health and personal welfare) when they are unable to do so themselves”.
To be valid, it needs to be registered with the Office of the Public Guardian

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27
Q

What are some risk factors for osteoporosis?

A

Smoking
Early menopause
Steroid use
Underweight
Inactivity
Alcohol
ALL ELDERLY PEOPLE

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28
Q

What tool is used to assess nutritional status?

A

Malnutrition universal screening tool (MUST screening tool)

29
Q

What medications increase risk of falls in elderly people?

A

-Beznodiazepines - sedative so impair coordination
-Diuretics
-Anti-hypertensives – ACEi, CCB, Beta blockers
-Antidepressants
-Antipsychotics
-Polypharmacy

30
Q

Name 3 complications of L-dopa therapy?

A

-Development of choreiform movements (L-dopa induced dyskinesia)
-Become tolerant to the medication – even if the -dose is increased the effect will become less
-Confusion
-Hallucinations
-Postural hypotension on starting treatment

31
Q

Name 4 different types of dementia and their key features?

A

Alzheimer’s – Agnosia, Apraxia, Amnesia, Aphasia

Vascular dementia – stepwise progression of symptoms following ischaemic brain injury

Lewy body dementia – sleep behaviour disorder, falls, impaired consciousness, visual hallucinations, Parkinsonism

Frontotemporal dementia– memory fairly preserved, extreme personality changes and disinhibition

32
Q

List blood tests you would do to exclude treatable causes of dementia?

A

-Vitamin B12, thiamine and folate levels
-Thyroid function
-Full blood count looking for anaemia
-Syphilis serology (neurosyphillis)
-Liver function tests (hepatic encephalopathy, alcoholism)

33
Q

What are the 2 subtypes of delirium?

A

Hyperactive - agitated, inappropriate behaviour, hallucinations

Hypoactive - lethargy, reduced concentration

34
Q

What are the components of the FRAX scoring system?

A

Parent hip fracture
Height and weight (BMI)
Smoking
Alcohol >3 units a day
Steroids
Previous hip fracture
Femoral neck bone mineral density
Female gender
Age
RA
Secondary osteoporosis

35
Q

How is malnutrition diagnosed?

A
  • BMI <18.5kg/m2
  • Unintentional weight loss >10% in the last 3-6months
  • BMI <20kg/m2 plus unintentional weight loss >5% within the last 3-6 months
36
Q

What is the definition of postural hypotension?

A

A drop of >20/10 mmHg within 3 minutes of standing
Occurs in 30% of patients over 70

37
Q

How is postural hypotension investigated?

A
  • Lying and standing blood pressure
  • Investigate for medical causes - medication review, blood tests
38
Q

What is included in a confusion screen?

A

Bloods (FBC, CRP, U&E, LFT, Co
Chest X-Ray
Urinalysis for a urinary tract infection

39
Q

What is hyperactive delirium?

A

The person may have increased sensitivity to their immediate surroundings with agitation, restlessness, sleep disturbance, and hypervigilance. Restlessness and wandering are common.

40
Q

What is hypoactive delirium?

A

(more common) — the person may be lethargic, have reduced mobility and movement, lack interest in daily activities, have a reduced appetite, and become quiet and withdrawn.

41
Q

What is chronic pain?

A

Pain that persists despite adequate time for healing
Pain for >12 weeks

42
Q

What are yellow flags in chronic pain?

A

They are features that associated with poor outcome in chronic pain

43
Q

What is the definition of dementia?

A

Progressive global decline in cognitive function, without the impairment of consciousness

44
Q

What are some risk factors for Alzheimer’s disease?

A

Cholesterol, atherosclerosis and inflammation are thought to be implicated.
Family history
Hypothyroidism
Depression,
Hx of head injury
HIV
Parkinson’s disease

45
Q

How does memantine work?

A

an inhibitor of glutamate NMDA receptors. It binds selectively, depending on the voltage, and thus prevents excitotoxicity, without altering glutamates role in normal memory and learning.

46
Q

What is the cut off for drug treatment in dementia?

A

MMSE >12

47
Q

What are the management options for faecal incontinence?

A

Perianal exercises may be used in sphincter weakness.
Surgical anal sphincter repair.
Steroids or GTN gel – In the presence of anorectal pathology.
Bowel training can be used to develop predictable pattern.
Diarrhoea and constipation should be managed

48
Q

What are risk factors for urinary incontinence?

A
  • Multiparity
  • Hysterectomy
  • Obesity
  • Bowel dysfunction
  • Menopause
  • Dietary factors (caffeine, alcohol)
  • Drugs (TCA’s, diuretics)
49
Q

How is osteoporosis confirmed?

A

Low bone density on densiometry (T score <-2.5) OR
A fragility fracture – a low impact fracture from standing height that would otherwise not be expected to cause a fracture – e.g. hip fracture, or spine fracture

50
Q

What is the main risk factor to consider with bisphosphonates?

A

risk of osteonecrosis of the jaw

51
Q

What are the clinical features of Paget’s disease of the bone?

A

It is a chronic progressive disease.
Often asymptomatic, and is only discovered incidentally with a raised ALP in the blood or discovered incidentally on X-Ray
If you have symptoms (in 15-40% of cases) Bone pain is the most common symptom.
You can get deafness if the skull is affected the vestibulocochlear nerve can be compressed

52
Q

What is the treatment for Paget’s disease of the bone?

A

Bisphosphonates

53
Q

What is the medical management of orthostatic hypertension?

A
  • Fludrocortisone (retains the fluid). Monitor weight and beware if CCF or low albumin : Oedema worsens
  • Sympathomimetics e.g. midodrine or ephedrine. Can give pyridostigmine if detrusor under-activity too.
54
Q

Where are the common sites for osteoporosis related fractures?

A

Thoracic vertebrae
Lumbar vertebrae
Proximal femur
Distal radius

55
Q

What is the Garden classification and what is it used for?

A

Used in Hip fractures and classifies fractures according to the degree of displacement as seen on an AP radiograph.

56
Q

What is the Pauwels classification?

A

Classifies hip fractures according to the angle of the fracture line from horizontal

57
Q

What are the typical clinical findings of a neck of femur fracture?

A
  • Affected leg is shortened, externally rotated and abducted
  • Palpation of the hip produces pain
  • The patient is unable to perform a straight leg raise
  • Pain on gentle internal and external rotation of the affected leg
  • Soft tissue symptoms: Bruising and swelling in and around the hip areas
58
Q

What is the surgical management for an intracapsular fracture?

A

In younger or physiologically fit patients, the femoral head should be rescued ( cannulated screws or a dynamic hip screw can be inserted )
In older patients a total or hemi hip arthroplasty is recommended

59
Q

What is the surgical treatment for extracapsular fractures?

A

Internal fixation is favourable with DHS or trochanteric femoral intramedullary nailing.

60
Q

What are some important complications of a neck of femur fracture

A
  • Avascular necrosis of the femoral head
  • Non- Union
  • Prosthesis problems
61
Q

What does a DaTScan look at?

A

Looks for areas of decreased dopamine uptake. It can be used to help distinguish between essential tremor and parkinsons disease. It is also used in the diagnosis of Lewy Body dementia

62
Q

What is the Fried Criteria?

A

Five criteria for frailty, the sum of this score classifies people into not frail (0), pre frail (1-2) and frail (3-5)
- Weight loss
- Exhaustion
- Low physical activity
- Slowness (slow walking speed)
- Weakness: specifically grip strength

63
Q

What is the first-line drug treatment used in the early stages of Parkinson’s?

A

Co-carledopa/co-beneldopa

This is L-dopa combined with a dopa-decarboxylase inhibitor

64
Q

When is apomorphine used?

A

Non-selective dopamine agonist
Given in rescue pen form, helpful for end of dose deterioration

65
Q

Give an example of an osmotic laxative and how it works?

A

Lactulose
Draws water from the rest of the body to soften stools
Takes 2-3 days to work

66
Q

Give an example of a bulk forming laxative and how it works?

A

Fybogel
Increased bulk of stools which increases bowel stimulation
Takes 2-3 days to work

67
Q

Give an example of a stimulant laxative and how it works?

A

Senna
Stimulates the muscular layer of the intestines
Takes 6-12 hours to work

68
Q

Give an example of a stool softener?

A

Docusate

69
Q

What is the best practice tariff in geriatric fractures?

A
  • Promotes surgery within 36 hours
  • Prompt orthogeriatric assessment within 72 hours
  • Pre-operative cognitive testing
  • Delirium assessment post-operatively
  • Fracture prevention assessment
  • Nutritional assessments

Phase 3a Medicine🩺 (12 decks)

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