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Phase 3a > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

Which type of stroke is more common?

A

Ischaemic

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2
Q

What are the risk factors for strokes?

A

Same as CVD
- Age
- Male
- HTN/hyperlipidaemia
- Diabetes
- Smoking
- Previous TIA
- Heart disease/AF
- COC (ischaemic)

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3
Q

What are the clinical features of a stroke?

A
  • Sudden limb/facial weakness
  • Dysphasia
  • Visual/sensory loss
  • N+V
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4
Q

What are the investigations for haemorrhagic strokes?

A
  • FIRST LINE = CT
  • Diffusion-weighted MRI
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5
Q

What is the management for haemorrhagic strokes?

A

Acute:
- Neurosurgery - evacuate blood
- IV mannitol for high ICP
- Stop anticoagulants

Secondary:
- Anticoagulant
- BP aim of 140/90
- External ventricular drain (if hydrocephalus)
- Rehabilitation (SALT/PT/OT)

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6
Q

What type of infarcts occur in ischaemic strokes?

A

Cerebral:
- More common
- Occlusion of large blood vessel to cerebrum (e.g. internal carotid artery/middle cerebral artery)

Lacunar:
- Infarcts of smaller blood vessels
- Affected smaller areas e.g. internal capsule/basal ganglia/thalamus/pons
- Produce more specific symptoms

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7
Q

What are the investigations for ischaemic strokes?

A
  • FIRST LINE = Bloods and CT (to rule out haemorrhagic)
  • Diffusion-weighted MRI
  • Carotid USS
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8
Q

What is the Bamford classification?

A

Categorises ischaemic strokes based on initial presenting features
- Total anterior circulation stroke
- Partial anterior circulation stroke
- Lacunar syndrome
- Posterior circulation syndrome
- Lateral medullary syndrome (Wallenberg’s syndrome)
- Weber’s syndrome
- Basilar artery

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9
Q

What is the Bamford classification criteria for total anterior circulation stroke?

A

ALL THREE:
- Unilateral weakness (and/or sensory deficit of face/arm/leg)
- Homonymous hemianopia
- Higher cerebral dysfunction (e.g. dysphasia/visuospatial disorder)

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10
Q

What is the Bamford classification criteria for partial anterior circulation stroke?

A

TWO:
- Unilateral weakness (and/or sensory deficit of face/arm/leg)
- Homonymous hemianopia
- Higher cerebral dysfunction (e.g. dysphasia/visuospatial disorder)

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11
Q

What is the Bamford classification criteria for lacunar syndrome?

A

ONE OF:
- Pure sensory stroke
- Pure motor stroke
- Sensorimotor stroke
- Ataxic hemiparesis

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12
Q

What is the Bamford classification criteria for posterior circulation syndrome?

A

ONE OF:
- CN palsy and a contralateral motor/sensory deficit
- Bilateral motor/sensory deficit
- Conjugate eye movement disorder (e.g. gaze palsy)
- Cerebral dysfunction (e.g. ataxia/nystagmus/vertigo)
- Isolated homonymous hemianopia/cortical blindness

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13
Q

What is the Bamford classification criteria for lateral medullary syndrome?

A
  • Ipsilateral ataxia/nystagmus/dysphagia/facial numbness/CN palsy e.g. Horner’s syndrome
  • Contralateral limb sensory loss
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14
Q

What is the Bamford classification criteria for Weber’s syndrome?

A
  • Ipsilateral CN III palsy
  • Contralateral weakness
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15
Q

What is the Bamford classification criteria for a basilar artery stroke?

A

‘Locked in’ syndrome

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16
Q

What is the management for ischaemic strokes?

A

Acute:
- Exclude haemorrhagic stroke (CT)
- Oral/rectal aspirin 300mg
- Thrombolysis = IV alteplase (within 4.5 hours of sx onset)
- Mechanical thrombectomy (within 6 hours)

  • Aspirin 300mg daily for 2 weeks then clopidogrel
  • Warfarin/apixaban
  • Rehabilitation (SALT/OT/PT)
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17
Q

What is Wallenberg syndrome/lateral medullary syndrome?

A

Stroke due to blockage of posterior inferior cerebellar artery
- Causes ischaemia in lateral part of medulla oblongata in brainstem
- Involvement of lateral spinothalamic tract
- Ipsilateral facial pain and loss of temperature sensation
- Contralateral limb/torso pain and loss of temperature sensation
- Ataxia
- Nystagmus

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18
Q

What is lateral pontine syndrome?

A

Stroke due to blockage of anterior inferior cerebellar artery
- Artery supplies the pons
- Similar presentation to lateral medullary syndrome
- Ipsilateral facial paralysis
- Ipsilateral deafness

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19
Q

What are the clinical features of a stroke affecting the anterior cerebral artery?

A
  • Contralateral hemiparesis and sensory deficits
  • Lower extremities worse affected
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20
Q

What are the clinical features of a stroke affecting the middle cerebral artery?

A
  • Contralateral hemiparesis
  • Upper extremities worse affected
  • Contralateral homonymous hemianopia
  • Aphasia
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21
Q

What are the clinical features of a stroke affecting the posterior cerebral artery?

A
  • Contralateral homonymous hemianopia with macular sparing
  • Visual agnosia
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22
Q

What are the clinical features of a stroke affecting the retinal/ophthalmic artery?

A

Amaurosis fugax

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23
Q

What are the clinical features of a stroke affecting the basilar artery?

A

Locked-in syndrome

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24
Q

Describe lacunar strokes

A
  • Strong association with HTN
  • Common sites = basal ganglia/thalamus/internal capsule
  • Isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia
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25
Q

What are causes of transient ischaemic attacks?

A
  • Thromboemboli
  • Hypoviscosity
  • Hypoperfusion
  • Vasculitis
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26
Q

What is a crescendo TIA?

A
  • 2 or more TIAs in 1 week
  • High risk factor for stroke
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27
Q

What are the clinical features of a transient ischaemic attack?

A
  • Last <24 hours without infarction (typically resolve within 10 minutes)
  • Sudden facial/limb weakness
  • Dysphasia
  • Sensory/visual loss
  • N+V
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28
Q

What are the investigations for transient ischaemic attacks?

A
  • Blood glucose (hypoglycaemia can cause focal neurological symptoms)
  • CT
  • Diffusion-weighted MRI
  • Carotid doppler
  • ACBD2 risk score (age/BP/clinical features/duration/diabetes)
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29
Q

What is the management for transient ischaemic attacks?

A
  • Aspirin (acute)
  • Clopidogrel and atorvastatin (long term prophylaxis)
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30
Q

What are the most common types of dementia?

A
  1. Alzheimer’s
  2. Vascular
  3. Dementia with Lewy-body
  4. Frontotemporal dementia (a.k.a Pick’s disease)
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31
Q

Describe the pathophysiology of Alzheimer’s

A
  • Mostly affects temporal lobes
  • Senile plaques (deposits of beta-amyloid outside of neurons)
  • Neurofibrillary tangles (aggregation of hyperphosphorylated tau proteins inside neurons which cause necrosis of neural tissue)
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32
Q

What are key clinical features of Alzheimer’s?

A
  • Early impairment of memory
  • Short-term memory loss/difficultly learning new information
  • 4 A’s = amnesia, aphasia, agnosia, apraxia
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33
Q

What are investigations for Alzheimer’s?

A
  • Cognitive assessment
  • Memory assessment
  • Bloods (TFTs/B12)
  • CSF Tau studies
  • CT/MRI
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34
Q

What is a common cognitive assessment?

A

AMT (abbreviated mental test):
1. Age
2. Time
3. Current year
4. Home address
5. Jobs of people asking questions (e.g. nurses/doctors)
6. DOB
7. Year WW1 started
8. Current monarch
9. Count backwards from 20
10. Repeat word mentioned earlier

<8 suggests cognitive impairment

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35
Q

What medications can be used for patients with dementia?

A

Mostly for Alzheimer’s:
- Acetylcholinesterase inhibitors e.g. donepezil, rivastigmine, galantamine
- N-methyl-D-aspartic acid receptor antagonists (NMDA) e.g. memantine (for memory loss)
- Antipsychotics

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36
Q

What is the difference between dementia and delirium?

A

Dementia = slowly progressive changes with limited fluctuation. Attention is usually intact and very early memories may be preserved

Delirium = acute, transient and usually reversible changes. Often an associated acute illness

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37
Q

What are the most common causes of delirium?

A

PINCH ME:
- Pain
- Infection
- Nutrition
- Constipation
- Hydration
- Medication/metabolic
- Environment

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38
Q

What are the clinical features of delirium?

A
  • Acute onset
  • Fluctuating symptoms
  • Disturbance in awareness and attention
  • Disturbance in cognition
  • Evidence of an organic cause
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39
Q

What are clinical features of hypoactive delirium?

A
  • Lethargy
  • Apathy
  • Excessive sleeping
  • Inattention
  • Withdrawn
  • Motor retardation
  • Drowsy
  • Unrousable
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40
Q

What are clinical features of hyperactive delirium?

A
  • Agitation
  • Aggression
  • Restlessness
  • Rapidly distracted
  • Wandering
  • Delusions
  • Hallucinations
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41
Q

What are the investigations for delirium?

A
  • Bloods (FBC/U&Es/TFTs/LFTs/B12 and folate/coagulation and INR/calcium/glucose/blood cultures)
  • Urine dipstick
  • MRI/CT
  • CXR
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42
Q

What criteria is used for delirium?

A

DSM-5 criteria:
- Disturbance in awareness
- Acute onset
- Disturbance in cognition
- Not better explained by a pre-existing established or evolving neurocognitive disorder
- Absence of severely reduced GCS
- Evidence of organic cause

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43
Q

What is the management for delirium?

A
  • Determine/treat underlying cause
  • Rapid tranquilisation (benzodiazepines e.g. lorazepam/antipsychotics e.g. haloperidol, olanzapine)
  • De-escalation methods (maintain adequate distance/move to safe, low-stimulant environment/use non-threatening verbal and non-verbal techniques/involve relatives or people close to patient)
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44
Q

Describe the pathophysiology of vascular dementia

A
  • Subcortical VD (disease affected small vessels of brain)
  • Stroke-related VD (following large cortical stroke)
  • Single/multi-infarct VD (following single/multiple small strokes)
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45
Q

Describe the pathophysiology of Lewy-Body dementia

A
  • If dementia symptoms 12 months before motor symptoms
  • Histopathological findings of intracytoplasmic inclusions (Lewy bodies) that contain alpha-synuclein
  • Lewy bodies lead to reduced levels of acetylcholine and dopamine in the brain
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46
Q

Describe the pathophysiology of frontotemporal dementia

A
  • Tissue deposition of aggregated proteins (phosphorylated tau or transactive response DNA-binding protein 43)
  • Atrophy around frontal/temporal lobes
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47
Q

What are general clinical features of dementia?

A
  • Slow onset sx
  • Lack of insight
  • Cognitive impairment
  • Behavioural and psychological sx
  • Decreased ability to carry out ADLs
48
Q

What are key clinical features of vascular dementia?

A
  • Stepwise decline in function
  • Gait/attention/personality changes
  • Focal neurological symptoms e.g. aphasia/weakness
49
Q

What are key clinical features of Lewy-Body dementia?

A
  • Fluctuating cognitive impairment
  • Parkinsonism sx (tremor/rigidity/bradykinesia/postural instability)
  • Falls/syncope/hallucinations
  • Sleep disturbances/restlessness at night
50
Q

What are key clinical features of frontotemporal dementia?

A
  • Personality changes and behavioural disturbances (disinhibition)
  • Memory and perception relatively preserved
  • Stereotypical, repetitive, compulsive behaviour/emotional blunting/abnormal eating/language problems
51
Q

What is sundowning?

A

Increase in certain symptoms (e.g. distress/agitation/hallucinations/delusions) in dementia patients that often occur in the late afternoon/evening

52
Q

What are investigations for dementia?

A
  • Exclude alternative diagnoses
  • Cognitive assessments
  • Bloods
  • ECG
  • Virology
  • Syphilis testing
  • CXR
  • CT/MRI head
53
Q

What are some differential diagnoses for dementia?

A
  • Depression
  • Drugs with anticholinergic effects
  • Delirium
54
Q

What is the management for dementia?

A
  • Assess capacity
  • Inform DVLA
  • Cognitive stimulation therapy
  • Cognitive rehabilitation
  • Reminiscence work
  • Admiral nurses
  • Reduce risk factors (e.g. for VD) - stop smoking/exercise/statins/etc.
  • Medications
55
Q

What are risk factors for Parkinson’s?

A
  • Age
  • Male
  • Pesticide exposure
56
Q

Describe the pathophysiology of Parkinson’s

A
  • Basal ganglia responsible for coordinating habitual movements
  • Substantia nigra = part of basal ganglia that produce dopamine (needed for functioning of basal ganglia)
  • Parkinson’s = gradual fall in production of dopamine
57
Q

What are the clinical features of Parkinson’s?

A
  • Unilateral symptoms (bilateral suggests drug-induced)
  • Resting ‘pill rolling’ tremor better on voluntary movement
  • Cogwheel rigidity
  • Bradykinesia (shuffling gait/small handwriting/hypomimia)
58
Q

What investigation can differentiate Parkinson’s Disease and benign essential tremor?

A

DAT scan:
- Normal in tremor

59
Q

What is the management for Parkinson’s?

A
  • FIRST LINE = Levodopa + peripheral decarboxylase inhibitors (Carbidopa/benserazide)
  • Catechol-o-methyltransferase (COMT) inhibitors e.g. entacapone
  • Dopamine agonists e.g. bromocriptine/cabergoline/pergolide
  • Monoamine oxidase-B inhibitors e.g. selegiline/rasagiline
60
Q

What are the side effects of excess dopamine?

A
  • Dyskinesias (dystonia/chorea/athetosis)
  • Treat with amantadine (glutamate antagonist)
61
Q

What is benign paroxysmal positional vertigo and what are some causes?

A

Sudden onset of dizziness and vertigo triggered by changes in head position
- Caused by displacement of otoconia due to infection/trauma/ageing

62
Q

Describe the pathophysiology of benign paroxysmal positional vertigo

A
  • Crystals of calcium carbonate (otoconia) become displaced in semi-circular canals (most often posterior)
  • Crystals disrupt normal flow of endolymph through canals
  • Head movements creates the flow of endolymph in the canals, triggering vertigo
63
Q

What are the clinical features of benign paroxysmal positional vertigo?

A
  • Triggered by head movements e.g. turning over in bed
  • Vertigo
  • Sx settle after around 20-60 seconds
  • Asx between attacks
  • NO hearing loss/tinnitus
64
Q

What is the investigation for benign paroxysmal positional vertigo

A

Dix-Hallpike manoeuvre:
- Sit patient upright with head turned 45 degrees to one side
- Support patient’s head to stay in 45 degree position whilst lowering patient backwards until head is hanging off end of bed, extended 20-30 degrees
- Hold patient’s head still
- Watch eyes
- Positive = rotational nystagmus and symptoms of vertigo

65
Q

What is the management for benign paroxysmal positional vertigo

A
  • Epley manoeuvre
  • Daroff exercises
66
Q

What are causes of falls in the elderly?

A

I HATE FALLING:
- Inflammation
- Hypotension
- Arrhythmia
- Tremor
- Equilibrium (balance issues - drug induced/other)
- Foot pain
- Auditory/visual impairment
- Leg length discrepancy
- Lack of conditioning
- Illness
- Nutrition poor
- Gait problems

67
Q

What are the investigations for falls in the elderly?

A
  • Bloods
  • CT
  • ECG
  • Medication review
  • PRISMA-7 (frailty assessment questionnaire)
68
Q

What medications can increase the likelihood of falls in the elderly?

A
  • Beta blockers (bradycardia)
  • Diabetic medications (hypoglycaemia)
  • Antihypertensives (hypotension)
  • Benzodiazepines (sedation)
  • Abx (intercurrent infection)
69
Q

What is the management for falls?

A
  • Stop medications that can cause falls
  • Footwear/walking aid
  • Fludrocortisone (if postural hypotension)
  • PT/OT/ACP/care home
70
Q

What is the PRISMA-7 questionnaire?

A

Frailty assessment questionnaire:
- >85 years
- Male
- Any health problems that require you to limit activities
- Need someone to help you on a regular basis
- Any health problems that require you to stay at home
- Can you count on someone close to you to help
- Do you regularly use a stick/walker/wheelchair

71
Q

How else can frailty be assessed?

A

Rockwood clinical frailty scale:
- 1 = very fit
- 2 = well
- 3 = managing well
- 4 = vulnerable
- 5 = mildly frail
- 6 = moderately frail
- 7 = severely frail
- 8 = very severely frail
- 9 = terminally ill

72
Q

What are risk factors for osteoporosis?

A
  • Older age
  • Female
  • Low mobility/activity
  • Low BMI (<19)
  • Low calcium/vitamin D intake
  • Alcohol/smoking
  • Personal/family history of fractures
  • Chronic diseases e.g. RA/CKD/hyperthyroidism
  • Long term corticosteroids
  • Certain medications e.g. SSRIs/PPIs/anti-epileptics/anti-oestrogens
73
Q

What are the investigations for osteoporosis?

A
  • DEXA (dual energy x-ray absorptiometry) scan = T-score and Z-score of femoral neck
  • Qfracture tool/FRAX = 10 year risk of major osteoporotic fracture and hip fracture
74
Q

Describe the results of a T-score

A

Number of standard deviations away from average healthy young adult
- Normal = >-1
- Osteopenia = -1 to -2.5
- Osteoporosis = <-2.5

75
Q

What is the management for osteoporosis?

A
  • Calcichew + bisphosphonates (e.g. alendronate/risedronate/zoledronic acid)
  • HRT
  • Denosumab
  • Raloxifene
  • Strontium ranelate
  • Ranelate
76
Q

How should bisphosphonates be taken?

A

Taken on an empty stomach with a full glass of water and afterwards, patient should sit upright for 30 minutes before moving or eating to reduce risk of reflux and oesophageal erosions

77
Q

What are side effects of bisphosphonates?

A
  • Reflux and oesophageal erosions
  • Atypical fractures
  • Osteonecrosis of jaw
  • Osteonecrosis of external auditory canal
78
Q

What are side effects of raloxifene?

A
  • Stimulates oestrogen receptors in bone but not in uterus or breast
  • Increases risk of VTE
79
Q

What are side effects of strontium ranelate?

A

Increases risk of VTE and MI

80
Q

What are causes of constipation?

A
  • Dietary (inadequate fluid/fibre)
  • Behavioural (inactivity/avoidance)
  • Electrolyte disturbance (hypercalcaemia)
  • Drugs (opiates/CCBs/antipsychotics)
  • Neurological disorders (spinal cord lesions/Parkinson’s/diabetic neuropathy)
  • Endocrine disorders (hypothyroidism)
  • Colon disease (stricture/malignancy)
  • Anal disease (fissue/proctitis)
81
Q

What criteria is used for constipation?

A

ROME IV criteria:
- Infrequent bowel motions (<3 per week)
- Hard stool in >25% of BMs
- Tenesmus in >25% of BMs
- Excessive straining in >25% of BMs
- A need for digital evacuation of BMs

82
Q

What are clinical features of constipation?

A
  • Difficulty passing BMs
  • Abdominal distension
  • Abdominal mass
  • Rectal bleeding
  • Anal fissures
  • Haemorrhoids
  • Presence of hard stool/impaction on DRE
83
Q

What are the investigations for constipation?

A
  • Bristol stool chart
  • Bloods
  • Abdominal x-ray
  • Barium enema
  • Colonoscopy
84
Q

What is the management for constipation?

A
  • Bulk laxatives e.g. ispaghula husk/methylcellulose
  • Stool softeners e.g. docusate sodium
  • Osmotic laxatives e.g. lactulose/macrogol
  • Stimulant laxatives e.g. senna/bisacodyl
85
Q

What are the main types of urinary incontinence?

A
  • Urge = overactivity of detrusor muscle
  • Stress = weakness of pelvic floor/sphincter muscles
  • Overflow = chronic urinary retention due to outflow obstruction
86
Q

What are age-related causes of urinary incontinence?

A
  • Reduced total bladder capacity
  • Reduced bladder contractile function
  • Reduced ability to postpone voiding
  • Atrophy of vagina/urethra
  • Loss of pelvic floor/urethral sphincter musculature
  • Hypertrophy of prostate
  • Comorbidity (reduced mobility/medication/constipation/impaired cognition)
87
Q

What are the investigations for urinary incontinence?

A
  • Bladder diary
  • Vaginal/rectal/neuro examination
  • Urinalysis/MSU
88
Q

What is the management for urge incontinence?

A
  • Bladder retraining
  • Anticholinergic medication e.g. oxybutynin/tolterodine/solifenacin
  • Mirabegron
  • Botox in bladder wall
89
Q

What is the management for stress incontinence?

A
  • Avoid caffeine/diuretics
  • Avoid excessive/restricted fluid intake
  • Weight loss
  • Pelvic floor exercises
  • Sling procedure
  • Duloxetine
  • Finasteride/tamsulosin (if BPH)
90
Q

What are the main causes of malnutrition?

A
  • Decreased nutrient intake (starvation)
  • Increased nutrient requirements (sepsis/injury)
  • Inability to utilise ingested nutrients (malabsorption)
91
Q

What are the clinical features of malnutrition?

A
  • Low skeletal muscle mass
  • Depleted subcutaneous fat stores
  • High susceptibility/long duration of infections
  • Slow/poor wound healing
  • Altered vital signs (bradycardia/hypotension/hypothermia)
92
Q

What is the investigation for malnutrition?

A

MUST score
- BMI (>20/18.5-20/<20 = 0/1/2)
- Unplanned weight loss in past 3-6 months (<5%/5-10%/>10% = 0/1/2)
- Acute disease with no nutritional intake for >5 days (2)
- = low/medium/high risk (0/1/2+)

93
Q

What is the management for malnutrition?

A
  • Treat cause
  • Dietician
  • Oral nutrition
  • Gastrostomy (PEG/RIG) or jejunostomy
  • Parenteral nutrition
94
Q

What are the MUST guidelines for malnutrition?

A
  • Low risk = routine clinical care, repeat screening weekly/monthly/annually
  • Medium risk = document dietary intake for 3 days; if adequate repeat screening; if not, set goals, improve/increase nutritional intake, monitor/review care plan
  • High risk = refer to dietician/nutritional support team, set goals, improve/increase nutritional intake, monitor/review care plan
95
Q

What is a complication of treating malnutrition?

A

Refeeding syndrome - metabolic disturbances as a result of reintroduction of nutrition to patients who are already starved/severely malnourished

96
Q

What are the clinical features of refeeding syndrome?

A
  • Hypophosphatemia
  • Hypokalaemia
  • Thiamine deficiency
  • Abnormal glucose metabolism
97
Q

What is the management for refeeding syndrome?

A
  • Monitor blood biochemistry
  • Commence refeeding with guidelines
  • Recognise electrolytes (phosphate/K+/Mg)
  • Monitor glucose/Na levels
  • Supportive care
98
Q

What are the complications of refeeding syndrome?

A
  • Arrhythmias
  • Coma
  • Convulsions
  • Cardiac failure
99
Q

What components are required for someone to be deemed to have capacity?

A
  • Understand information
  • Retain information
  • Weigh up information
  • Communicate decision
100
Q

What are some legal actions that are more relevant to geriatrics?

A
  • Deprivation of liberty safeguards (DoLS)
  • Lasting power of attorney
  • Independent mental capacity advocate
  • Mental capacity act
  • Advanced directives
101
Q

What is required to make a advanced directive legally binding?

A
  • Patient is an adult
  • Was competent and fully informed when making the decision
  • Decision is clearly applicable to current circumstances
  • There is no reason to believe that they have since changed their mind
102
Q

What are the most common causes of adverse drug reaction related admissions?

A
  • NSAIDs
  • Diuretics
  • Warfarin
  • ACEIs/AIIRAs
  • Antidepressants
  • Beta blockers
  • Opiates
  • Digoxin
  • Prednisolone
  • Clopidogrel
103
Q

What tools are used in polypharmacy?

A
  • START tool = Screening Tool to Alert to Right Treatment
  • STOPP tool = Screening Tool of Older People’s Prescriptions
104
Q

What is an example of the STOPP tool?

A

Medications such as TCAs (amitriptyline) should be stopped in patients with dementia due to risk of worsening cognitive impairment

105
Q

What are the main risk factors for pressure sores?

A
  • Malnourishment
  • Incontinence
  • Lack of mobility
  • Pain
106
Q

Describe the pathophysiology of pressure sores

A
  • Prolonged pressure on particular area causes skin breakdown
  • Due to combination of reduced blood supply and localised ischaemia, reduced lymph drainage and a deformation of the tissue under pressure
107
Q

What are the clinical features of pressure sores?

A
  • Discoloured non-blanching patches of skin
  • Patch of skin that feels warm/spongy/hard
  • Pain/itchiness in affected area
  • Blister/open wound
  • Exposed layers of skin/muscle/bone
108
Q

What are the investigations for pressure sores?

A
  • Waterlow score = assess risk

Classification:
- 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 subcutaneous tissue
- Grade 4 = extensive loss, destruction/necrosis of muscle, bone or support structures

109
Q

What is the management for pressure sores?

A
  • Moist wound environment = hydrocolloid dressings and hydrogels
  • Surgical debridement
  • Abx (only if signs of infection)
110
Q

What are preventative measures for pressure sores?

A
  • Barrier creams
  • Pressure redistribution
  • Repositioning
  • Regular skin assessment
111
Q

How is lying/standing BP measured?

A
  • BP after 5 mins of lying down
  • BP after 1 min of standing
  • BP after 3 mins of standing
112
Q

What is the criteria for a diagnosis of orthostatic/postural hypotension?

A
  • Systolic drops >20mmHg
  • Systolic drop to below 90mmHg
  • Diastolic drop >10mmHg + symptoms
113
Q

What is the management for orthostatic/postural hypotension?

A
  • Compression stockings
  • Fludrocortisone
114
Q

What is compartment syndrome and what are the main causes?

A

Post fracture - raised pressure within close anatomical space which compromises tissue perfusion and leads to necrosis

  • Supracondylar fractures
  • Tibial shaft injuries
115
Q

What are the clinical features of compartment syndrome?

A
  • Pain (especially on movement)
  • Paraesthesia
  • Pallor
  • Pulses may be weak
  • Paralysis of muscle group may occur
116
Q

What is the investigation and management for compartment syndrome?

A
  • Intracompartmental manometry (>40+mmHg)
  • Fasciotomy

Phase 3a (21 decks)

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