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Belle: Phase 3a > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

Irreversible causes of dementia

A

Neuro: AD, LBD, FTD
Infection: HIV, syphilis
Toxins: alcohol, BZD
Vascular: VD, CVD
Trauma: head trauma

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2
Q

Reversible causes of dementia

A

Neuro: hydrocephalus, tumours, SDH
Vitamin: B12, folic, thiamine deficiencies
Endocrine: Cushing’s, hypothyroidism

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3
Q

Dementia investigations

A

Adenbrook’s Ix
GPCOG
6 item CIT

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4
Q

Alzheimer’s pathology (2)

A

Beta amyloid plaques
Neurofibrillary tangles

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5
Q

Alzheimer’s risk factors (4)

A

Down’s
Amyloid precursor protein gene mutation
Age
1st degree relative

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6
Q

Clinical picture Alzheimer’s

A

Short term memory loss (progressive and persistent)
Global cognitive impairment
Irritable, mood swings, apathy

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7
Q

Alzheimer’s Ix

A

CT
MMSE

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8
Q

2 pharmacological treatments for AD

A

ACh-esterase inhibitor
NMDA receptor antagonist

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9
Q

Lewy body dementia pathology

A

Cerebral atrophy + Lewy bodies = alpha synuclein +ve cytoplasmic inclusions in neurones

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10
Q

Risk factors Lewy body dementia (4)

A

> 60 y/o
Male
FHx
Parkinson’s/LBD

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11
Q

Clinical picture Lewy body dementia

A

EPSE
Visual hallucinations
Falls
REM sleep disturbance
Fluctuates but overall worse with time

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12
Q

Lewy body dementia Ix

A

SPECT - shows reduced metabolism and reduced occipital perfusion

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13
Q

Lewy body dementia Tx

A

Levodopa
DA agonists

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14
Q

Frontotemporal dementia causes

A

Alcohol
Trauma
Genetics

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15
Q

Frontotemporal pathology

A

FT atrophy
Pick bodies (tau proteins)
Pick’s disease

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16
Q

Frontotemporal clinical picture

A

<65 year old onset
Impulsive
Irritable
Crying
Overweight (pick’s increases appetite)
Akinesia
Hallucinations
Parkinsonism later

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17
Q

Frontotemporal treatment

A

SSRI for depression
Olanzapine for agitation/hallucinations

NB: drugs used for AD make FTD Sx worse

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18
Q

Vascular dementia risk factors

A

HTN
DM
Age
Hyperlipidaemia

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19
Q

Vascular dementia clinical picture

A

Sudden onset, stepwise deterioration, motor disorders, behavioural changes, cognitive impairment

20
Q

Vascular dementia Ix

A

MMSE, carotid USS, CT/MRI head

21
Q

Vascular dementia treatments

A

Treat RFs
Antiplatelets
Aspirin (secondary prevention)
Cholinesterase inhibitors if AD comorbidity

22
Q

Delirium causes
(HE IS NOT MAAD)

A

Hypoxia - resp failure, MI, PE
Endocrine - Cushing’s, thyroid, glucose
Infection - pneumonia, UTI
Stroke - ^ICP, head trauma
Nutrition - thiamine/B12 deficiency
Others - pain, lack of sleep
Theatre - anaesthetics
Metabolic - electrolytes
Abdominal - urine retention
Alcohol - intox + withdrawal
Drugs - BZD, opioids

23
Q

Clinical picture delirium

A

Disordered thinking
Fear
Euphoria
Language impairment
Inattention
Delusions

24
Q

Delirium Ix

A

Brief MSE
Confusion assessment method (CAM)
ABC
GCS
Vitals
Bloods
Urinalysis
Blood culture
CXR
ABG
CT head
EEG if epileptic

25
Q

Delirium Rx

A

Underlying cause
Calm environment
IM haloperidol (Larazopam if PD)

26
Q

4 differences between delirium and dementia

A

Onset: delirium is abrupt/dementia is insidious
Duration: delirium days to weeks/dementia permanent
Speech: delirium incoherent/dementia word-finding difficulty
Thought: delirium disorganised/dementia impoverished

27
Q

Investigations after a fall

A

Bloods (FBC, UE, LFT, TFT, vitamins)
If head injury: CT head
ECG
PRISMA-7 to assess frailty

28
Q

Postural hypotension medication

A

Fludrocortisone

29
Q

Causes of falling in elderly
(I HATE FALLING)

A

Inflammation (joints)
Hypotension
Arrhythmia
Tremor
Equilibrium (balance issues, drug induced or other causes)
Foot pain
Auditory/visual impairment
Leg length discrepancy
Lack of conditioning
Illness
Nutrition
Gait problems

30
Q

osteoporosis risk factors

A
31
Q

Ix osteoporosis

A

FRAX: risk of fracture in 10 years (for females >65, males >75)

DEXA scan (done at the hip)

T-SCORE: BMD of healthy young person
Z-SCORE: corrected to patient age

32
Q

T score indications

A

>

  • 1 = normal
  • 1 to - 2.5 = osteopenia
    < - 2.5 = osteoporosis
    < - 2.5 + fracture = severe osteoporosis
33
Q

1st line management osteoporosis

A

Calcichew + bisphosphonates

34
Q

Ischaemic stroke treatment <4.5 hours after onset

A

Thrombolysis w/ alteplase

35
Q

Ischaemic stroke treatment >4.5 - 6 hours after onset

A

Thrombectomy (stent/aspirate) if proximal LV occlusion

If thrombectomy is contraindicated give aspirin

Endarterectomy for carotid stenosis

36
Q

Secondary prevention of ischaemic stroke

A

Clopidogrel, atorvastatin, treat modifiable RFs

37
Q

Causes of urinary incontinence

A

Overactive bladder
Dementia
Stress incontinence
BPH
Hypotonic bladder
Nocturia

38
Q

management for different causes of urinary incontinence (6)

A

Overactive bladder: antimuscarinics + bladder retraining
Dementia: regular toileting
Stress incontinence: pelvic floor exercise
BPH: antiandrogens, surgery
Hypotonic bladder: intermittent catheter
Nocturia: desmopressin (not for >65 due to hyponatraemia), drainage sheath

39
Q

Faecal incontinence

A
40
Q

Parkinson’s disease clinical picture

A

Resting tremor
Bradykinesia
Shuffling gait
Flexor rigidity resisting passive extension

Anosmia
REM sleep disturbance

41
Q

PD management

A

Levodopa + COMTi (Sx relief)
DA agonists
MAO-Bi
PT, OT, SALT, deep brain stimulation, Co morbid tx

42
Q

Huntingtons disease inheritance

A

Autosomal dominant

43
Q

Huntington’s onset

A

30 to 50 yrs

Anticipation (each generation has more CAG repeats = earlier onset)

44
Q

Huntington’s genetic mutation

A

Trinucleotide CAG repeat HTT gene chromosome 4

45
Q

Huntington’s pathology

A

Degeneration of cholinergic + GABAergic neurones

46
Q

Huntington’s signs and symptoms

A
47
Q

Huntington’s pharm treatment

A

Olanzapine for psych Sx
SSRI for depression
Diazepam
Tetrabenazine (DA-depleting agent)

Belle: Phase 3a (7 decks)

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