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Finals > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

What are the symptoms of hyperactive delirium?

A

Confusion/disorientated, motor agitation, restlessness, aggression, hallucinations

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2
Q

What are the symptoms of hypoactive delirium?

A

Confusion/disorientated, motor retardation, apathy, slowing of speech, appear sedated, hallucinations

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3
Q

What are the common causes of delirium?

A

Pain, infection, nutrition, constipation, hydration, medication, environment (PINCH ME)

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4
Q

What are the risk factors for developing delirium?

A

Old age, dementia, sensory impairment, change of environment, sleep deprivation

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5
Q

How can you diagnose delirium?

A

Collateral history, MMSE

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6
Q

How can you differentiate delirium from dementia?

A

Delirium has sudden onset and fluctuates over days to weeks, variation in consciousness, impaired attention, psychomotor changes

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7
Q

What is involved in a delirium screen?

A

FBC, U+E, LFTs, TFTs, B12, folate, calcium, magnesium, syphilis serology, urine dipstick/MC+S, CXR

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8
Q

How do you treat agitation caused by delirium?

A

Haloperidol 0.5mg PO or IM= 1st line
Lorazepam = 2nd line

But try modifying the environment and reassurance/escalating techniques first

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9
Q

What are the risk factors for developing Alzheimer’s?

A

Early onset = autosomal dominant disease, Down’s syndrome

General = insulin resistance, high cholesterol, family history, hypothyroid, depression, HIV, Parkinson’s

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10
Q

What is the pathophysiology of Alzheimer’s?

A

General atrophy of brain tissue with frontal and temporal lobes being most affected (temporal will show first signs)

Amyloid plaques and Tau protein deposition in cortex

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11
Q

What are the features of vascular dementia?

A

Occurs in patients that have had strokes/hypertension/heavy smokers etc. due to multiple small infarcts in brain

Stepwise progression where there is period of stability followed by acute decline

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12
Q

What are the features of Lewy body dementia?

A

Vivid visual hallucinations, Parkinsonism (cognitive decline will precede this), sleep disorders, fluctuating cognition

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13
Q

What are the features of Fronto-temporal dementia?

A

Often family history
More common in people under 65
Changes in personality and behavior

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14
Q

What medications can be used in Alzheimer’s?

A

Donepezil (1st line if mild-to-moderate)
Memantine (1st line if moderate to severe)

Only initiate drug therapy in those with MMSE >12 as otherwise side effects will likely outweigh benefits

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15
Q

How is vascular dementia treated?

A

Reduce vascular risk factors - aspirin/warfarin, BP control

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16
Q

How is Lewy body dementia managed?

A

1st line = donepezil, rivastigmine

17
Q

What medications can increase risk of falls?

A

Laxatives - urgency to go to toilet
Pain killers - can cause confusion
Diuretics/antihypertensives- drop in BP and postural hypotension
Benzodiazepines - cause sedation

18
Q

What are some common causes of falls?

A

Postural hypotension, infection, cognitive impairment, hypoglycaemia, peripheral neuropathy, anaemia, dehydration, electrolyte abnormalities, chronic alcohol use, hearing/visual issues, environmental hazards, polypharmacy

19
Q

What is the definition of postural hypotension?

A

Systolic drop >20mmHg when going from sitting to standing

Measure BP at 1 min and 3 min after standing

20
Q

What medications can cause postural hypotension?

A

Nitrates, diuretics, anticholinergic, antidepressants, beta blockers, l-dopa, ACE inhibitors

21
Q

What is the definition of a fragility fracture?

A

Fractures that result from mechanical forces that would not ordinarily result in fractures i.e. standing height or less

22
Q

What are the risk factors for fragility fractures?

A

Increasing age, female, low body mass, steroid therapy, Cushing’s syndrome, excessive alcohol intake, falls

23
Q

What is the definition of frailty?

A

A distinct health state characterised by a reduction in physiological reserve resulting in adverse outcomes following minor stressor events such as fall or infection

24
Q

How can you manage frailty?

A

Regular review of medications, assess physical and mental health needs, address any risk factors for falls, create personalised care plan, support them to eat well

25
Q

What are risk factors for incontinence in the elderly?

A

Dementia, UTIs, prostate issues, Parkinson’s, stool impaction

26
Q

How can you manage urinary incontinence in the elderly?

A

Avoid caffeine, keep pathways clear and clutter free, regular bathroom breaks, bladder retraining, pads

27
Q

What scoring system is used to identify patients at risk of developing pressure ulcers?

A

Waterlow score

28
Q

What is the management of pressure ulcers?

A

Wound dressing, appropriate analgesia, nutritional assessment, pressure relieving support e.g. mattress

Only give antibiotics if there is signs of infection

29
Q

When withdrawing treatment can you withdraw basic care needs such as food and drink?

A

No this must always be offered even if patient refuses

Can only withdraw advanced care needs like antibiotics

30
Q

What is a lasting power of attorney?

A

Needs to be put in place when the patient has capacity

1 person for health and welfare and 1 person for financial - they are able to make decisions for you if you lack capacity

31
Q

What is a court appointed deputy?

A

When patient has already lost capacity you can apply to court to act as someone’s deputy and make decisions on their behalf

32
Q

What is an independent mental capacity advocate?

A

Person lacks capacity at the time the decision needs to be made and nobody else is willing to represent them

33
Q

What is a deprivation of liberty safeguards?

A

Only applies to people who live in care homes or in hospital - the patient is unable to leave the place where they are cared for

34
Q

How do you assess capacity?

A

Need to assess, retain, weigh up and communicate their decision

35
Q

How can you differentiate depression and dementia?

A

Factors that suggest depression over dementia:

Short history/rapid onset
Weight loss, sleep disturbance
Patient worried about poor memory
Reluctant to do MMSE/tests
Global memory loss as opposed to short term memory loss

Finals (21 decks)

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