geriatrics Flashcards

Question

common presentation stroke

Answer 1

Unilateral weakness – often in arms and face, Slurred speech (dysarthria), Dysphasia (unable to understand words or communicate what they mean), MCA stroke – leg sparing

Answer 2

CT: Hyperdense MCA, Loss of grey white matter differentiation and sulcal effacement (squishing) – cortical infarction, Hypodense basal ganglia (deep vessel infarct)

Answer 3

Aspirin – 300mg for 2 weeks, Potential for thrombolysis – alteplase, cut off time 4.5h, Control BP

Answer 4

Control bleeding & Control blood pressure

Answer 5

Sx for less than 24h (usually less than 60 mins),

Answer 6

Smoking cessation, Control hypertension – medications and diet (reduce salt intake), Control hypercholesterolaemia (diet and medications) , Control diabetes (diet and medications) , Encourage active lifestyle and weightloss, Reduce alcohol intake

Answer 7

Investigations – 72 hour ECG to look for paroxysmal AF, carotid doppler to look for carotid stenosis, BP, echo (to look for patent foramen ovale or endocarditis – can throw clots), if neck pain – investigate for dissectino with CTA/MRA Drugs – aspirin, clopi, antihypertensives, statins, dietary controla nd diabetes management

Answer 8

CHADSVASC: Congestive heart failure – 1, Hypertension – 1, Age > 75 – 2, Previous stroke/TIA/VTE – 2 , Vascular disease – 1, Age > 65, Sex category female – 1

Answer 9

On anticoagulants (can if on warfarin and below 1.7) Haemorrhagic stroke > 6 hours after onset of symptoms Recent surgery or GI bleed If active cancer Hypertension – cut off 185/110

Answer 10

Raised ICP – cerebral oedema, haemorrhage (signs = hypertension, new neurological signs, reduced GCS) Aspiration (if the stroke affects their swallowing Pneumonia VTE due to immobility Pressure sores Depression Cognitive impairment Long-term disability

Answer 11

Involves middle and anterior cerebral arteries All 3 of: unilateral hemiparesis and/or hemisensory loss of the face, arm & leg homonymous hemianopia higher cognitive dysfunction

Answer 12

Involves smaller arteries of anterior circulation e.g. upper or lower division of middle cerebral artery 2 of: unilateral hemiparesis and/or hemisensory loss of the face, arm & leg homonymous hemianopia higher cognitive dysfunction

Answer 13

involves perforating arteries around the internal capsule, thalamus and basal ganglia presents with 1 of the following: unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three. pure sensory stroke. ataxic hemiparesis

Answer 14

involves vertebrobasilar arteries presents with 1 of the following: cerebellar or brainstem syndromes loss of consciousness isolated homonymous hemianopia

Answer 15

posterior inferior cerebellar artery) aka Wallenberg's syndrome ipsilateral: ataxia, nystagmus, dysphagia, facial numbness, cranial nerve palsy e.g. Horner's contralateral: limb sensory loss

Answer 16

ipsilateral III palsy contralateral weakness

Answer 17

locked in” syndrome

Answer 18

is one of the most common causes of vertigo encountered. It is characterised by the sudden onset of dizziness and vertigo triggered by changes in head position. The average age of onset is 55 years and it is less common in younger patients

Answer 19

vertigo triggered by change in head position (e.g. rolling over in bed or gazing upwards) may be associated with nausea each episode typically lasts 10-20 seconds positive Dix-Hallpike manoeuvre, indicated by: patient experiences vertigo, rotatory nystagmus

Answer 20

Epley manoeuvre (successful in around 80% of cases) teaching the patient exercises they can do themselves at home, termed vestibular rehabilitation, for example Brandt-Daroff exercises Medication is often prescribed (e.g. Betahistine) but it tends to be of limited value.

Answer 21

Previous fall, Lower limb muscle weakness, Vision problems, Balance/gait disturbances (DM, RA, PD etc), Polypharmacy (4+ medications), Incontinence, >65, Have a fear of falling, Depression, Postural hypotension, Arthritis in lower limbs, Psychoactive drugs, Cognitive impairment

Answer 22

Identify those at risk and why 'Turn 180° test' or the 'Timed up and Go test’ MDT assessment in falls clinic

Answer 23

Nitrates, Diuretics, Anticholinergic medications, Antidepressants, Beta-blockers, L-Dopa, Angiotensin-converting enzyme inhibitors - (ACE) inhibitors

Answer 24

Benzodiazepines, Antipsychotics, Opiates, Anticonvulsants, Codeine, Digoxin, Other sedative agents

Answer 25

blurry/yellow vision

Answer 26

A drop in systolic BP of 20mmHg or more (with or without symptoms) A drop to below 90mmHg on standing even if the drop is less than 20mmHg (with or without symptoms) A drop in diastolic BP of 10mmHg with symptoms (although clinically much less significant than a drop in systolic BP).

Answer 27

Pressure ulcers, Dehydration, Rhabdomyolysis , Hypothermia

Answer 28

State of increased vulnerability resulting from ageing-associated decline in functional reserve, Across multiple physiological systems, Resulting in compromised ability to cope with everyday or acute stressors

Answer 29

gait speed, self-reported health status, or the PRISMA-7 questionnaire

Answer 30

Decreased bone mineral density due to imbalance between remodelling and resorption

Answer 31

Smoking, Early menopause, Steroid use, Underweight, Inactivity, Alcohol, ALL ELDERLY PEOPLE

Answer 32

FRAXX: 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

Answer 33

DEXA scan Serum biochemistry – calcium, phosphate, alkaline phosphatase (normal)

Answer 34

DEXA scan: -1 to +1 = healthy , - 1 to -2.5 = osteopenia, ≤ -2.5 = osteoporosis, ≤ 2.5 and a current fragility fracture = severe osteoporosis

Answer 35

Bisphosphonates (zoledronate, alendronate)

Answer 36

Thoracic vertebrae – fractures here may lead to kyphosis and loss of height, Lumbar vertebrae , Proximal femur, Distal radius (Colles’ fracture)

Answer 37

Age-related changed: reduced total bladder capacity, reduced bladder contractile function, reduced ability to postpone voiding, atrophy of vagina and urethra, loss of pelvic floor and urethral sphincter musculature, hypertrophy of prostate Comorbidity: reduced mobility, medication, constipation, impaired cognition Reversible: UTI, delirium, drugs, constipation, polyuria, urethral irritability, prolapse, bladder stones and tumours Environmental: bed bound, toilet too far/hard to access

Answer 38

Symptoms (stress, urgency, obstructive), bladder diary Examination: vaginal, rectal, neuro Urinalysis and midstream urine

Answer 39

Depends on cause Bladder retraining, regular toileting, pelvic floor exercises. Overactive bladder->oxybutynin, BPH->finasteride/tamsulosin

Answer 40

Sx urinary retention, obstructed outflow and deteriorating renal function, acute renal failure, intensive care

Answer 41

Blockage, bypassing, infection

Answer 42

sigmo-rectal sphincter, ano-rectal angle, anal sphincters, ano-rectal sensation

Answer 43

most commonly faecal impaction or neurogenic. Others include haemorrhoids, rectal prolapse, tumours, IBD, drugs

Answer 44

Treat constipation Neurological: toilet at appropriate time, planned evacuation (loperamide) Overflow incontinence: rehydrate, enema (phosphate agent), complete colonic washout, manual evacuation, laxatives Prevention: once or twice weekly enema

Answer 45

State in which a deficiency of energy, protein, and/or other nutrients causes measurable adverse effects on the body’s form, composition, function and clinical outcome.

Answer 46

Decreased nutrient intake (starvation), Increased nutrient requirements (sepsis or injury), Inability to utilise ingested nutrients (malabsorption)

Answer 47

BMI <18.5kg/m2, Unintentional weight loss >10% last 3-6mths , BMI <20kg/m2 AND unintentional weight loss >5% within last 3-6mths

Answer 48

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

Answer 49

Hypophosphataemia, Hypokalaemia, Thiamine deficiency, Abnormal glucose metabolism

Answer 50

Cardiac arrhythmias, Coma, Convulsions, Cardiac failure

Answer 51

Monitor blood biochemistry, Commence re-feeding with guidelines , Recognise electrolytes (phophate, K+, Mg), Monitor glucose and Na levels, Supportive care, Refer to nutritional support team/dietician

Answer 52

Malnourishment, Incontinence, Lack of mobility, Pain (leads to a reduction in mobility)

Answer 53

The Waterlow score: includes a number of factors including body mass index, nutritional status, skin type, mobility and continence

Answer 54

Barrier creams , Pressure redistribution , Repositioning , Regular skin assessment

Answer 55

Moist wound environment encourages ulcer healing: Hydrocolloid dressings and hydrogels Surgical debridement antibiotics only if there are signs of infection

Answer 56

Grade 1 – non-blanching erythema with intact skin Grade 2 – partial thickness skin loss involving epidermis, dermis or both (abrasion/blister) Grade 3 – full-thickness skin loss involving damage/necrosis of sub-cut tissue Grade 4 – extensive loss, destruction/necrosis of muscle, bone or support structures Unstageable – depth unknown, base of ulcer covered by debris

Answer 57

4+ medications

Answer 58

START tool: Suggests medications that may provide additional benefits i.e., proton pump inhibitors for gastroprotection in patients on medications increasing bleeding risk STOPP tool: Used to assess which drugs can be potentially discontinued in elderly patients undergoing polypharmacy

Answer 59

Understand the information relevant to the decision, Retain the information , Weigh up the information, Communicate the decision

Answer 60

Assume capacity – person assumed to have capacity until proven otherwise Maximise decision-making capacity – all practical support to help a person make a decision should be given Freedom to make seemingly unwise decisions Best interests – all decisions taken on behalf of the person must be in their best interests 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

Answer 61

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

Answer 62

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

Answer 63

support and represent people who lack capacity and they do not have anyone else to represent them in decisions about changes in long-term accommodation or serious medical treatment. They can also be present for decisions regarding care reviews or adult protection.

Answer 64

Whether the person is likely to regain capacity and can the decision wait How to encourage and optimise the participation of the person in the decision The past and present wishes, feelings, beliefs, values of the person and any other relevant factors Views of other relevant people

Answer 65

Used to authorise or request specific procedures and refuse treatment in a predefined future situation (advance directive) Advance refusals of treatment are legally binding if: The person is an adult, Was competent and fully informed when making the decision, The decision is clearly applicable to current circumstances, and There is no reason to believe that they have since changed their mind

Answer 66

Fluctuating cognitive impairment. Classically, there are visual hallucinations, gait and sleep disturbances. Patients may be restless at night.