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Geriatrics > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

What is delirium?

A

an acute and fluctuating state of confusion, usually precipitated by illness, injury or drug toxicity or withdrawal

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2
Q

Types of delirium?

A

Hyperactive
Hypoactive
Mixed

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3
Q

4 Key Characteristics of delirium?

A

Fluctuating Pattern
Inattention
Acute change in cognition
Temporary in relation to illness

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4
Q

Causes of Delirium?

A

Pain
Infection
Constipation/Urinary Retention
Hydration/Nutrition
Medications
Electrolyte Disturbances/Environment

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5
Q

What medications can trigger delirium?

A

tricyclic antidepressants
anticholinergics
benzodiazepines
tramadol
anti-histamines

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6
Q

Screening test for delirium?

A

4-AT Test

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7
Q

Components of 4-AT Test

A

Alertness (4)
AMT-4 (age, DOB, place, yr) (2)
Attention (2)
Acute change/fluctuating (4)

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8
Q

Delirium vs Dementia?

A

acute onset
altered consciousness/drowsiness
inattention
disorganised thinking

can have both -> not mutually exclusive

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9
Q

Treatment for delirium?

A

primarily non-pharmacological
treat any underlying cause

person -> minimise sensory deprivation, sleep deprivation, hydration, nutrition, elimination, engage family

environment -> keep constant, clocks right, calendars right, room with windows, items from home, limit restraints, discontinues unnecessary lines

occupation -> re-establish pre-existing routines, sleep hygiene, stimulate an appropriate amount

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10
Q

Pharmacological Treatment of Delirium?

A

anti-psychotics (haloperidol, risperidone, quetiapine, olanzapine)

start low, go slow

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11
Q

When is pharmacological treatment of delirium necessary?

A

if the patient is posing a risk to themselves or to other patients

last resort as does not treat the delirium and may in fact lengthen it

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12
Q

When are benzos used in delirium?

A

Alcohol/Benzo withdrawal
Patients with Parkinson’s or Lewy Body Dementia

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13
Q

Subtypes of dementia?

A

Alzheimer’s Disease
Vascular Dementia
Frontotemporal Dementia
Dementia with Lewy Bodys
Parkinson’s Dementia
Progressive Supranuclear Palsy
Corticobasal Degeneration

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14
Q

Pathology of Alzheimer’s Disease?

A

build-up of beta amyloid plaques and Tau protein neurofibrillary tangles

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15
Q

Presentation of Alzheimer’s?

A

gradually progressive decline in cognitive function
short-term memory affected first
neuropsychiatric symptoms common

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16
Q

Features of Vascular Dementia?

A

‘step-wise’ deterioration
associated with CVS risk factors and stroke
more acute than AD

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17
Q

Lewy Body Dementia vs Parkinson’s Disease Dementia?

A

dementia symptoms within 1 year of PD onset -> Lewy Body Dementia
dementia symptoms after more than 1yr with PD -> Parkinson’s Disease Dementia

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18
Q

Features of Lewy Body Dementia?

A

motor features of PD
cognitive impairment
visual hallucinations v common

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19
Q

Features of PD Dementia?

A

v similar to Lewy Body
early impairment in executive function

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20
Q

Features of Frontotemporal Dementia?

A

early decline in social interpersonal contact
emotional blunting
overlap with MND and PD

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21
Q

Evaluating Suspected Dementia Patient?

A

detailed Hx -> collateral is key
medication review (STOPSTART)
full exam
cognitive screening (MoCA, MMSE)
Bloods (Ca, U&Es, TFTs, B12 and folate, HIV/Syphillis)
ECG
neuroimaging
LP

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22
Q

Pharmacological Tx of Alzheimer’s Disease?

A

1st line -> cholinesterase inhibitors (donepezil, galantamine, rivastigmine)
More severe -> memantine (NMDA receptor antagonist)

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23
Q

Non-pharmacological Tx for AD?

A

cognitive stimulation exercises
exercise
diet
early management of CVS RFs
support groups
art and music therapy
support for family and carers

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24
Q

Treatment of BPSD?

A

patient-centred psychosocial interventions
memantine
antipsychotics if risk to selves or others -> quetiapine

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25
Q

Members of MDT?

A

doctors
nurses
GP
OT
physio
SALT
Dieticians
Discharge Coordinator
Social Work

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26
Q

Osteoporosis Definition?

A

T-Score on DEXA <-2.5
or
prev. frailty fracture

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27
Q

What is a frailty fracture?

A

fracture from a fall from standing or sitting down
common sites include hip, wrist (FOOSH), pubic ramus

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28
Q

Blood results in osteoporosis?

A

Ca normal, phosphate normal, alk phos normal, PTH normal

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29
Q

Risk Factors for osteoporosis?

A

Incr. age
Female
post-menopause
FHx
red. mobility
long-term corticosteroid use
PPI use
low BMI
low Ca or Vit D intake
alcohol and smoking
prev fractures
CKD, hyperthyroidism, RA

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30
Q

Who should be screened for osteoporosis?

A

anyone on long-term corticosteroids
anyone with prev frailty fracture
anyone > 50 with RFs
women > 65
men > 70

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31
Q

How to screen for osteoporosis?

A

QFracture Tool
FRAX tool

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32
Q

How to diagnose osteoporosis?

A

DEXA scan gold standard but not always necessary

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33
Q

Management for Osteoporosis?

A

address modifiable RFs
supplement with Vit D and Ca
bisphosphonates first-line
denosumab
teripartide

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34
Q

Examples of bisphosphonates?

A

alendronate weekly oral
risedronate weekly oral
zoledronic acid yearly IV

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35
Q

How to take oral bisphosphonates?

A

first thing in morning
empty stomach
take and stay upright for 30 minutes to minimise GI SEs

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36
Q

Side Effects of bisphosphonates?

A

oesophagitis and oesophageal erosions
atypical femoral fractures
osteonecrosis of jaw
osteonecrosis of external auditory canal
hypocalcaemia

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37
Q

What is Denosumab?

A

monoclonal antibody that targets osteoclasts

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38
Q

How is Denosumab taken and for how long?

A

S/C injection every 6 months
initially cont. for 10 yrs but risk of rebound osteoporosis on stopping Tx

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39
Q

What is Teripartide?

A

PTH
anabolic function
daily injection

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40
Q

Parkinson’s Disease Symptoms?

A

Tremor
Rigidity
Akinesia/Bradykinesia
Postural instability
Postural hypotension
Sleep Disorders
Psychosis (visual hallucinations)
Depression/Dementia

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41
Q

Parkinson’s Pathology?

A

neurodegenerative disease caused by loss of dopaminergic neurons in the substantia nigra in the basal ganglia

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42
Q

Differentials for Tremor?

A

Parkinson’s Disease
Benign Essential Tremor
Cerebellar (intention) Tremor
Postural Tremor (lithium, inhalers, anxiety, hyperthyroidism)

43
Q

PD Medications?

A

Dopamine Agonists (ropinirole, pramipexole)
MAOb inhibitors (selegeline, rasagiline)
Levodopa + prevent breakdown

44
Q

SEs of dopamine agonists?

A

impulsive behaviour
nausea, constipation
nightmares
hallucinations
sleep attacks (NB for driving)
hypotension

45
Q

Issues with medications for PD?

A

slow in the mornings waiting for effect to kick in
‘wearing off’ phenomenon

46
Q

Parkinson’s + Conditions?

A

Multiple Systems Atrophy
Progressive Supranuclear Palsy
Corticobasilar Degeneration

47
Q

Differentiating Multiple Systems Atrophy?

A

Parkinsonism +
autonomic dysregulation
orthostatic hypotension
urinary incontinence/retention
anhidrosis

48
Q

Differentiating Progressive Supranuclear Palsy?

A

Parkinsonism +
vertical gaze palsy
axial rigidity with head tilted backwards

49
Q

Differentiating Corticobasilar Degeneration?

A

speech problems
astereognosis
alien limb phenomenon

50
Q

Key Features Suggestive of Stroke?

A

abrupt onset
focal neurological signs and symptoms
maximal deficit occurring within seconds
negative symptoms

51
Q

What investigations if suspected stroke?

A

CT brain non-contrast (rule out haemorrhage, check for ischaemia)
CT angiogram (check for LVO)
CT perfusion (see infarcted areas and penumbra)

52
Q

Acute Interventions for Stroke?

A

Thrombolysis and Thrombectomy

53
Q

Time-set for thrombolysis?

A

Within 4.5hrs of onset of symptoms

54
Q

Time-set for thrombectomy?

A

Within 24hrs of onset of symptoms

55
Q

Assessing for cause of stroke?

A

Atherosclerosis of Large Vessels
Small Vessels arteriosclerosis
Cardio-embolic events
Others

56
Q

What is the one thing that improves outcome in 100% of stroke patients?

A

Early admission to an acute stroke unit

57
Q

Prevention of further strokes?

A

dual antiplatelet therapy for 3 wks (aspirin 300mg and clopidogrel 75mg)
monotherapy clopidogrel 75mg
statin therapy
BP <130/80
If AFib -> anticoagulate

58
Q

Risk Factors for Stroke?

A

Age
A Fib
Prev. stroke or TIA
carotid artery disease
CVD
HTN
diabetes
smoking
vasculitis
thrombophilia
COCP

59
Q

Initial management of suspected stroke?

A

exclude hypoglycaemia
CT brain non-contrast to rule out haemorrhagic stroke
aspirin 300mg
thrombolysis
thrombectomy if appropriate
don’t treat HTN (risk of hypoperfusion)

60
Q

Management of TIA?

A

urgent referral to stroke specialist (24hrs)
aspirin 300mg daily
secondary prevention measures for CVD

61
Q

Rehab for stroke?

A

MDT!!!!!!!!
doctors, nurses, OTs, physio, SALTs, dieticians, psychology, social work, discharge coordinators, family

62
Q

What is syncope?

A

transient LOC and postural tone with spontaneous recovery

63
Q

Discriminating syncope from other pathology?

A

Sudden Cardiac Death -> recovery in syncope
TIA -> no LOC in TIA
Seizure -> discriminating features include lateral tongue bite, faecal incontinence and recovery time

64
Q

Causes of syncope?

A

Neurally-mediated
Cardiogenic

65
Q

Neurally-mediated types of syncope?

A

vasovagal
situational
orthostatic hypotension
postprandial hypotension
carotid sinus syndrome

66
Q

Cardiogenic types of syncope?

A

structural (aortic stenosis, HOCM, myxoma, dissection, PE)
arrhythmias (SVT, brady/tachyarrhythmias, Brugada Syndrome)

67
Q

Diagnosing neurally-mediated syncope?

A

tilt-table test
orthostatic hypotension (>20mmHg systolic, >10mmHg diastolic)
carotid sinus massage

68
Q

Diagnosing cardiogenic syncope?

A

CVS Exam (murmurs, HR)
ECG
CXR
Echo

69
Q

Treatment for syncope?

A

explain and reassure
avoid precipitating factors
medication review (antihypertensives, anticholinergics, antidepressants)

70
Q

Consequences of Urinary Incontinence?

A

psychosocial (embarrassment, depression, isolation, dec. self-esteem, institutionalisation)
medical (pressure ulcers, rashes, UTI, falls, fractures, red. mobility, red. ADLs)

71
Q

Types of Urinary Incontinence?

A

Mixed
Functional
Urge/OAB
Overflow
Stress

72
Q

Reversible causes of urinary incontinence?

A

Delirium
Infection
Atrophic vaginitis
Pharmaceuticals
Psychological
Excessive urine output
Restricted mobility
Stool impaction

73
Q

What medications can cause urinary incontinence?

A

anti-cholinergics
diuretics

74
Q

Treatment for urinary incontinence?

A

maximise independence (mobility, prompted voiding, avoid catheter)
minimise precipitants (caffeine, alcohol, weight loss)
muscle exercises (bladder retraining, pelvic floor exercises)

75
Q

Medications for urinary incontinence?

A

try to avoid
inc. risk of falls, incontinence and retention, cognitive impairment
tamsulosin (alpha blocker)
finasteride (5 alpha reductase inhibitor)
oxybutynin (anti-cholinergic)
mirabegron (beta 3-adrenoceptor agonist -> best in elderly frail patients)

76
Q

Confusion Screen Bloods?

A

FBC
U&Es
LFTs
coagulation screen
TFTs
Calcium
B12/Folate/Haematinics
Glucose
Blood cultures

77
Q

Scale for assessing ADLs?

A

Barthel Index

78
Q

Scales for assessing cognitive impairment?

A

AMTS (/10)
MoCA (/30)
MMSE (/30)

79
Q

Scales for assessing degree of disability after a stroke?

A

Modified Rankin Scale (0-6)

80
Q

Scale for quantifying stroke severity?

A

NIHSS (/42 -> thrombolysis advised if >4)

81
Q

Scale for assessing frailty?

A

Clinical Frailty Scale (1-9)

82
Q

Medications which increase risk of falls?

A

Antipsychotics
Benzos
Antidepressants
Antihypertensives
Diuretics
Anticholinergics

83
Q

Medications which increase risk of orthostatic hypotension?

A

beta blockers
alpha blockers
diuretics
calcium channel blockers

84
Q

DDx for Stroke?

A

Sepsis
Space-occupying lesion
Sugars -> hypoglycaemia
Seziures -> post-ictal weakness
Syncope
Sore -> migraine
Silly -> delirium
Stroke functional -> functional disorder

85
Q

When is warfarin used over DOACs?

A

mechanical heart valve
antiphospholipid syndrome
eGFR < 15ml/min

86
Q

Scale for assessing risk of pressure ulcers developing?

A

Waterlow Score

87
Q

What is the MMSE test used for?

A

To assess cognitive function

88
Q

What is the MoCA test used for?

A

To assess cognitive function

89
Q

What is the AMTS used for?

A

To assess cognitive function (abbreviated)

90
Q

What is the 4AT test used for?

A

To assess for delirium

91
Q

What is the Barthel Index used for?

A

To assess a person’s independence in completing their ADLs

92
Q

What is the Waterlow Score used for?

A

To assess for the risk of a person developing pressure ulcers

93
Q

What is the Clinical Frailty Score used for?

A

To assess how frail a person is

94
Q

What is the Modified Rankin Score used for?

A

To assess a person’s level of disability after a stroke

95
Q

What is the NIHSS used for?

A

To assess the severity of a stroke and thus if the person will benefit from thrombolysis

96
Q

What are senile purpura?

A

common benign condition characterised by the formation of ecchymosis on the extensor surfaces of the arm

97
Q

What are pressure ulcers?

A

localised injury to tissue (usually over a bony prominence) as a result of pressure

98
Q

Risk Factors for pressure ulcers?

A

exposure to sustained pressure and shear
immobility
increased age
incontinence
malnutrition

99
Q

What is a stage 1 pressure ulcer?

A

non-blanching erythema of intact skin, usually over a bony prominence (sacrum)

100
Q

What is a stage 2 pressure ulcer?

A

partial thickness skin loss or blistering
***reportable to HIQA

101
Q

What is a stage 3 pressure ulcer?

A

full thickness skin loss with visible S/C fat

102
Q

What is a stage 4 pressure ulcer?

A

full thickness tissue loss with exposed bone, muscle and tendon
***if exposed bone -> assume osteomyelitis

103
Q

Management of pressure ulcers?

A

prevent further injury -> prevent pressure, friction, shearing
identify RFs and reduce if possible
promote new tissue growth
manage exudate
protect surrounding skin
remove devitalised tissue
promotion of granulation from base of wound

104
Q

Prevention of pressure ulcer formation?

A

Skin Assessment (head to toe, focus on bony prominences)
Surface (special mattresses)
Keep moving
Incontinence
Nutrition (MUST score)

Geriatrics (1 decks)

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