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Phase 3A > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

What is delirium?

A

An acute fluctuating syndrome of encephalopathy causing disturbed consciousness, attention, cognition and perception.

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2
Q

What are the 3 subtypes of delirium and how are they defined?

A

Hypoactive - reduced motor activity, lethargy, withdrawal, drowsiness and staring into space (most common in the elderly)
Hyperactive - increased agitation, delusions and disorientation
Mixed - switching back and forth between hypo and hyperactive states

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3
Q

What are the major risk factors for delirium? (x6)

A
  • age 65+
  • male
  • pre-existing cognitive deficit e.g. dementia, stroke
  • multiple comorbidities
  • previous episodes of delirium
  • recent surgery
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4
Q

What are some potential causes of delirium? (x5)

A
  • acute infections (e.g. UTI, pneumonia, sepsis)
  • prescribed drugs (e.g. benzodiazepines, analgesics, anti-parkinsons meds)
  • toxic substances (e.g. alcohol, CO, substance misuse/withdrawal)
  • metabolic causes (e.g. hypoxia, electrolyte imbalance, hypoglycaemia)
  • surgery - due to problems with cranial bv’s, reduced bp during/after surgery, stress, increased inflammation in body/brain
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5
Q

What are the 8 signs of delirium?

A

Disordered thinking
Euphoric, fearful or angry
Language impairment
Illusions/delusions/hallucinations
Reversed sleep/wake cycle
Inattention
Unaware/disorientated
Memory impairment

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6
Q

What are the common differentials for delirium diagnosis? (x5)

A
  • dementia
  • depression
  • bipolar disorder
  • functional psychoses e.g. schizophrenia
  • thyroid disease
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7
Q

What are the 4 categories of management which must be considered when treating delirium?

A
  • supportive management
  • environmemntal measures
  • medical management
  • management post-discharge
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8
Q

What are some supportive management measures for delirium? (x3)

A
  • clear communication
  • reminders of the day, time, location and identification of people
  • readily visible clocks and calendars
  • familiar objects in surroundings
  • staff consistency
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9
Q

What are some environmental measures taken in delirium management? x4

A
  • avoid sensory extremes
  • encouragement of normal sleep/wake cycle
  • control and maintenance of environment e.g. noise, lighting, temperature
  • adequate nutrition
  • maintain competence (e.g. walking in ambulant patients)
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10
Q

What are the aims in medical management of delirium? x3

A
  • optimised treatment of comorbidities
  • correct underlying precipitants (e.g. treat UTI, constipation etc.)
  • only use pharmacological management in select patients who will benefit (e.g. antipsychotics)
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11
Q

What are the diagnostic tools used in assessing patients for delirium?

A
  • CAM (confused assessment method)
  • 4AT (4 A’s test = alertness, AMT4, attention, acute change or fluctuating course)
  • DSM-5 (diagnostic and statistical manual of mental disorders)
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12
Q

What are the 6 main precipitants of delirium?

A

Pain
Infection
Nutrition
Co-morbidities
Hydration
Medication
Environment
+ bladder

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13
Q

What is dementia?

A

not a specific disease but a syndrome defined by memory impairment, some aspects of cognitive decline and difficulties with activities of daily living - it is caused by a number of brain disorders.

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14
Q

What are the 3 groups of symptoms seen in dementia patients?

A
  • cognitive impairment (difficulties with memory, language, attention, orientation etc.)
  • psychiatric or behavioural disturbances (changes in personality, emotional control, social behaviour)
  • difficulties with ADLs (e.g. driving, shopping, eating, dressing)
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15
Q

What are the 4 main causes of dementia?

A
  • Alzheimer’s disease (≈50%)
  • Vascular dementia (≈25%)
  • Lewy body dementia (≈15%)
  • Fronto-temporal dementia (<5%)
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16
Q

What are some of the causes of potentially treatable dementias? (x5+)

A
  • substance misuse
  • hypothyroidism
  • space-occupying intracranial lesions
  • normal pressure hydrocephalus
  • syphilis
  • vit B12 deficiency
  • folate deficiency
  • pellagra (vit B3 deficiency)
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17
Q

What are the diagnostic criteria for all types of dementia?

A

There are cognitive or behavioural symptoms which:

  • affect ability to function in normal activities
  • represent a decline from a previous level of function
  • cannot be explained by delirium or other major psychiatric disorder
  • have been established by history-taking from patient and informant, and formal cognitive assessment
  • involve impairment of at least two of the following domains:
  • ability to acquire and remember new information
  • judgement, ability to reason or handle complex tasks
  • visuospatial ability
  • language functions
  • personality and behaviour
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18
Q

What are some examples of non-pharmacological treatments for dementia? x5

A
  • cognitive stimulation programmes
  • music/art/dance therapy
  • aromatherapy
  • structured exercise programmes
  • multisensory stimulation
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19
Q

What are the 2 main groups of medications used in dementia treatment?

A
  • ACE inhibitors e.g. donepezil, galantamine (most used in AD)
  • N-methyl-D-aspartate (NMDA) antagonists e.g. ketamine, memantine, dextromethorphan
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20
Q

What are the questions in the 6 CIT test for dementia?

A

What year is it?
What month is it?
Give an address with 5 parts (John, Smith, 42, High, St, Bedford)
Count 20-1
Say months of year in reverse
Repeat address

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21
Q

What is depression?

A

the presence of depressed mood or diminished interest in activities occurring most of the day, nearly every day, for at least 2 weeks accompanied by additional characteristic symptoms

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22
Q

What are the characteristic symptoms seen in patients with depression? x8

A
  • reduced ability to concentrate and sustain attention, or marked indecisiveness
  • beliefs of low self-worth or excessive and inappropriate guilt
  • hopelessness about the future
  • recurrent thoughts of death or suicidal ideation
  • significantly disrupted sleep or excessive sleep
  • significant changes in appetite or weight
  • psychomotor agitation or retardation
  • reduced energy or fatigue
23
Q

What are the 4 categories of depression severity?

A
  • subthreshold symptoms - <5 symptoms
  • mild depression - few symptoms in excess of the 5 required for diagnosis, symptoms resulting in minor functional impairment
  • moderate depression - symptoms or functional impairment between mild and severe
  • severe depression - most symptoms present + symptoms which interfere significantly with normal function
24
Q

What is the definition of chronic depressive symptoms ?

A

people with chronic depressive symptoms include those who
1. continually meet the criteria for the diagnosis of a major depressive episode for at least 2 yrs
2. have persistent subthreshold symptoms for at least 2 yrs
3. have persistent low mood with or without concurrent episodes of major depression for at least 2 yrs

25
Q

What are some of the major risk factors for depression? 5+

A
  • chronic co-morbidities
  • other mental health problems
  • female
  • older age
  • recent childbirth
  • psychosocial issues
  • family or personal history of depression
  • adverse childhood experiences
  • personality factors
  • past head injury
26
Q

What are some of the non-pharmacological treatments for depression? x5

A
  • CBT and or group behavioural activities
  • interpersonal psychotherapy (IPT)
  • counselling
  • short-term psychodynamic psychotherapy (STPP)
  • electroconvulsive therapy (ECT)
27
Q

What are three classes of medications commonly used in depression treatment?

A
  • selective serotonin reuptake inhibitors (SSRIs) e.g. citalopram, escitalopram, fluoxetine, sertraline
  • serotonin and norepinephrine reuptake inhibitors (SNRIs) e.g. duloxetine, desvenlafaxine, levomilnacipram
  • tricyclic antidepressants (TCAs) e.g. amitryptyline, clomipramine, dosulepin
28
Q

What are the major risk factors for falls in the elderly? 5+

A
  • age 80+
  • female
  • low weight
  • previous fall
  • polypharmacy/medications (commonly benzodiazepines, antidepressents, bp-lowering drugs, anticonvulsants)
  • cognitive impairment
  • orthostatic hypotension
  • vision problems
  • chronic health conditions affecting mobility
29
Q

What is frailty?

A

a clinical state of increased vulnerability and reduced ability to cope with everyday/acute stressors resulting from aging-associated decline in reserve and function across multiple physiological systems

30
Q

What are the acute presentations of frailty? (also known as frailty syndromes)

A
  • falls
  • sudden reduced mobility
  • new or accelerated state of confusion (delirium)
  • acute change in continence
  • sensitivity to a new medication
31
Q

What are the most common comorbidities contributing to frailty? 5+

A
  • stroke
  • CHD
  • Diabetes Mellitus
  • Alzheimer’s Disease
  • urinary problems
  • depression
  • visual loss
  • hearing and visual impairment
  • falls
32
Q

What are the key focuses of frailty management? x5

A
  • treatment of unstable medical conditions and any treatable problems
  • reviewing drug treatment (including polypharmacy)
  • early mobilisation
  • nutrional support
  • comprehensive rehabilitation
33
Q

What are the 6 types of incontinence?

A
  • stress incontinence (weakness of urinary outlet)
  • urge incontinence (failure of bladder storage due to high pressure)
  • mixed incontinence (combination of stress and urge incontinence)
  • overflow incontinence (bladder outlet obstruction)
  • abnormal communications of the urinary tract (i.e. fistulae)
  • functional incontinence (due to more general impairment e.g. cognitive)
34
Q

What are the storage symptoms of incontinence? x 5

A
  • frequency
  • urgency
  • stress incontinence
  • urge incontinence
  • nocturia
35
Q

What are the voiding symptoms of incontinence? x 5

A
  • post-micturition dribble
  • hesitancy
  • terminal dribbling
  • incomplete emptying
  • intermittent stream
36
Q

What are the main risk factors for incontinence? x7

A
  • female
  • increased age
  • post-menopausal state
  • increased BMI
  • previous pregnancies + vaginal deliveries
  • neurological conditions
  • cognitive impairment and dementia
37
Q

What are the 4 main management strategies for incontinence?

A
  • lifestyle changes (avoid caffeine, diuretics and overfilling of bladder, weight loss)
  • pelvic floor exercises
  • anticholinergic drugs (oxybutinin, tolterodine, solifenacin)
  • surgery (tension-free vaginal tape, autologous sling procedure)
38
Q

How do pressure ulcers form?

A

They occur when skin and underlying tissues are placed under pressure that impairs blood supply leading to tissue damage. They can be caused by pressure, shear, friction or a combination.

39
Q

What is the most important risk factor for pressure ulcers?

A

immobility

40
Q

What are some other risk factors for pressure ulcers?

A

malnourishment
incontinence (urinary and faecal)
pain –> mobility reduction
alzheimer’s

41
Q

What assessment scales are used for pressure ulcers?

A

The Norton, Braden and Waterlow scales

42
Q

What are the factors considered in pressure ulcer assessment? x11

A
  • cause of ulcer
  • site/location
  • dimensions of ulcer
  • stage or grade
  • exudate amount and type
  • signs of infection
  • pain
  • wound appearance
  • surrounding skin
  • undermining/tracking (sinus/fistula)
  • odour
43
Q

What are the 5 grades of pressure ulcers?

A

1: non-blanchable erythema of intact skin
2: partial-thickness skin loss involving epidermis and/or dermis - superficial ulcer which presents as an abrasion or blister
3: full-thickness skin loss involving damage/necrosis of subcut tissue
4: extensive destruction, tissue necrosis, or damage to muscle/bone/supporting structures without or without full thickness skin loss
Unstageable: full-thickness tissue loss in which the base of the ulcer is covered by slough and or eschar in the wound bed so it is unstageable

44
Q

What are the key focuses of pressure ulcer treatment? x6

A
  • respositioning of the patient
  • treatment of concurrent conditions which may delay healing
  • pressure-relieving support surfaces
  • local wound management
  • pain relief
  • infection control
45
Q

What is polypharmacy?

A

the prescribing or taking of too many medicines

46
Q

What are some of the risks associated with polypharmacy?

A
  • adverse drug events
  • hospital admissions
  • increased health care costs
  • non-adherence
47
Q

What are the 4 geriatric giants?

A
  • Instability
  • Immobility
  • Incontinence
  • Intellectual impairment
48
Q

What is benign paroxysmal positional vertigo?

A

an inner ear problem which causes short periods of vertigo when the head is moved in certain positions

49
Q

What are the causes of BPPV?

A

mostly idiopathic but can be caused by:
- head injury
- spontaneous degeneration of the labyrinth
- post-viral illness
- complication of stapes surgery
- chronic middle ear disease

50
Q

What are the risk factors for BPPV?

A

older age
female
meniere’s disease
anxiety disorders
migraine

51
Q

What is the management for BPPV?

A

symptoms are usually self-limiting over a few weeks
limit symptoms by getting out of bed slowly and reducing head movements
Epley’s manoeuvre

52
Q

What is Epley’s manoeuvre?

A

used to reposition otoliths back into the utricles from the posterior semicircular canals

53
Q
A

Phase 3A (8 decks)

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