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Phase 3a🩺 > Geriatrics👴🏽 > Flashcards

Geriatrics👴🏽 Flashcards

1
Q

What is dementia?

A

Dementia is a condition that causes progressive and irreversible impairment in memory, cognition, personality and communication

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2
Q

What is the most common type of dementia?

A

Alzheimer’s

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3
Q

What type of dementia is associated with halluciations?

A

Lewy body dementia

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4
Q

What kind of decline does vascular dementia show?

A

Stepwise decline

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5
Q

What is the pathophysiology of lewy body dementia?

A

Lewy bodies build up in the substantia nigra, paralimbic and neocortical areas

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6
Q

What are lewy bodies?

A

Alpha-synuclein cytoplasmic inclusions

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7
Q

How does lewy body dementia differ from Parkinson’s?

A

Dementia usually occurs before any parkinsonism (both within a year)

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8
Q

What are the features of lewy body dementia? (3)

A

Parkinsonism Visual hallucinations Progressive cognitive impairmentREM sleep behavioural disturbance

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9
Q

How does cognition change day to day in lewy body dementia?

A

Cognition is fluctuating

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10
Q

What investigation can be carried out to help diagnose lewy body dementia?

A

DaTscan

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11
Q

Why may a DaTscan be performed in someone with suspected lewy body?

A

To differentiate from Alzheimer’s

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12
Q

What is the first line medical management of lewy body dementia?

A

AcetylCholinesterase inhibitor eg donepezil

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13
Q

What is the first line management of lewy body dementia?

A

Supportive treatment

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14
Q

What kind of medications should be avoided in patients with lewy body dementia?

A

Antipsychotic medications

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15
Q

Trisomy 21 leads to an increased risk of which type of dementia?

A

Alzheimer’s

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16
Q

What are the risk factors of developing Alzheimer’s? (3)

A

Increasing age
Family history
Genetics
Down’s syndrome
Caucasian ethnicity

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17
Q

What are the histopathological changes seen in Alzheimer’s disease? (3)

A

Neurofibrillary triangles Beta amyloid plaques Cortical atrophy

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18
Q

What is a potentially reversible cause of dementia?

A

Normal pressure hydrocephalus

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19
Q

What is the first line medical management of Alzheimer’s?

A

Acetylcholinesterase (AChE) inhibitors

Donepezil, galantamine and rivastigmine

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20
Q

What is the second line medical management of Alzheimer’s?

A

Memantine (for mild to severe disease)

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21
Q

What drug class is memantine?

A

NMDA receptor antagonist

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22
Q

What other management options should be offered to people with Alzheimer’s?

A

Group therapies - cognitive stimulation therapy Activities to promote wellbeing

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23
Q

What is vascular dementia caused by?

A

Vascular dementia is secondary to cerebrovascular disease

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24
Q

What are the risk factors for vascular dementia? (5)

A

Hypertension AF Diabetes History of stroke History of TIA Smoking ObesityFamily history of stroke or TIA

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25
Q

What are the symptoms of vascular dementia? (3)

A

Focal neurological deficits Memory disturbance Speech disturbance Gait disturbance Difficulty with attention and concentration

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26
Q

What criteria is used for the diagnosis of vascular dementia?

A

NINDS-AIREN criteria

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27
Q

What is the NINDS-AIREN criteria? (3)

A

A relationship between cognitive decline and cerebrovascular disease:- Onset of cognitive decline within 3 months of a cerebrovascular event- An abrupt decline in cognitive function - Fluctuating, stepwise deterioration of cognitive function

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28
Q

What is the mainstay of treatment for patients with vascular dementia?

A

Prevention of another cerebrovascular event Symptomatic treatment

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29
Q

What secondary prevention medication should vascular dementia patients be on?

A

Antiplatelet therapy - aspirin or clopidogrel

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30
Q

What other medication can be used in patients with Lewy body dementia?

A

Levodopa

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31
Q

What investigations can be used to diagnose Alzheimer’s?

A

CT head Mini mental state exam

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32
Q

What cognitive assessments can be used to assess cognition? (3)

A

AMT - abbreviated mental test
Addenbrooke’s cognitive examination (ACE-III)
MoCA test
General Practitioner assessment of cognition (GPCOG)

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33
Q

Give 3 risk factors for lewy body dementia

A

> 60 years, Male, Family history of Parkinson’s or lewy body dementia

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34
Q

What investigations can be carried out in the diagnosis of vascular dementia? (3)

A

MMSE Carotid USS CT head MRI head

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35
Q

What is the preferred investigation for diagnosing vascular dementia?

A

MRI head

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36
Q

What is pseudo-dementia?

A

A decline in cognitive function that can be seen in older adults with depression

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37
Q

How does pseudodementia present?

A

Patients will often answer ‘don’t know’Short duration of dementia Equal effect on long term and short term memory Amnesia concerning specific events

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38
Q

Give an example of an acetlycholinesterase inhibitor.

A

Donepezil

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39
Q

On what side does ischaemia to the cerebellum cause symptoms?

A

Ipsilateral side

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40
Q

Where does the PICA supply?

A

Inferior cerebellum

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41
Q

What is the gold standard investigation for stroke?

A

Diffusion weighted MRI

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42
Q

What features are caused by an anterior inferior cerebellar artery infarct? (3)

A

Ipsilateral deafness and facial paralysis Sudden onset of vertigo and vomiting

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43
Q

What features are caused by a posterior inferior cerebellar artery infarct? (4) What is it also known as?

A

Ipsilateral: dysphagia, Facial numbness, CN palsy e.g. Horner’s

Contralateral: limb sensory loss (pain and temp)

Ataxia
Nystagmus

Lateral medullary syndrome/Wallenberg’s syndrome

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44
Q

What are the risk factors for haemorrhagic stroke? (3)

A

Anticoagulation therapy Age Hypertension Arteriovenous malformation

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45
Q

What are the risk factors for ischaemic stroke? (5)

A

AgeHypertension Smoking Hyperlipidaemia DiabetesAtrial fibrillationHRTOral contraceptive

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46
Q

What symptoms are seen in a total anterior circulation infarct?

A

Unilateral hemiparesis, or unilateral hemisensory loss of upper or lower limb Homonymous hemianopia Higher cognitive dysfunction e.g dyphasia

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47
Q

Which limbs are more typically affected in anterior circulation infarcts?

A

Lower limbs

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48
Q

Which limbs are more typically affected in middle cerebral artery infarcts?

A

Upper limbs

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49
Q

What kind of symptoms would be seen with an ophthalmic artery stroke?

A

Amaurosis fugax

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50
Q

What is the first line investigation for a suspected stroke?

A

Non-contrast CT head

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51
Q

What is the difference between stroke and Bell’s palsy?

A

Strokes are forehead sparing (UMN LESION), whereas Bell’s palsy involves the forehead (LMN LESION)

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52
Q

What is the Bamford classification?

A

A system of classifying and diagnosing ischaemic stroke

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53
Q

What is the Bamford classification of a total anterior circulation infarct?

A

All three symptoms: - Homonymous hemianopia- Unilateral weakness or sensory deficit of the face, arm and leg- Higher cerebral dysfunction

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54
Q

What is the Bamford classification of a partial anterior circulation infarct?

A

Two out of three symptoms: - Homonymous hemianopia- Unilateral weakness or sensory deficit of the face, arm and leg- Higher cerebral dysfunction

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55
Q

What is the Bamford classification of a posterior circulation stroke?

A

One of the following symptoms?- Cranial nerve palsy and contralateral motor/sensory deficit- Cerebellar dysfunction - Bilateral sensory or motor deficit- Conjugate eye movement disorder- Isolated homonymous hemianopia

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56
Q

What is the Bamford classification of a lacunar stroke?

A

One of the following symptoms:- Pure sensory stroke - Pure motor stroke - Sensori-motor stroke- Ataxic hemiparesis

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57
Q

What is the initial management of an ischaemic stroke?

A

300mg aspirin Thrombolysis if presented within 4.5 hours Thrombectomy if between 4.5-6 hours

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58
Q

What drug is used in thrombolysis?

A

Alteplase

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59
Q

What secondary prevention will be given after an ischaemic stroke? (4)

A

Clopidogrel 75mg daily Statin Anti hypertensives Carotid endarterectomy

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60
Q

What is the initial management of a haemorrhagic stroke? (4)

A

Aim for BP 140/90
Stop anticoagulants and antithrombotics
Reverse any anticoagulation
Refer to neurosurgery

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61
Q

What tools can be used to assess stroke?

A

FASTROSIERABCD2

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62
Q

What is a TIA?

A

A sudden onset of a focal neurological deficit (of vascular origin) that resolves in 24 hours

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63
Q

What are crescendo TIAs?

A

More than 1 TIA in 7 daysTIAs that are increasing in frequency and severity

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64
Q

What is the definition of a stroke?

A

Sudden onset of a focal neurological deficit of vascular cause, with symptoms lasting more than 24 hours.

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65
Q

What drugs are likely to cause osteoporosis?

A

Corticosteroids

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66
Q

What risk score can be used to calculate risk of a fracture?

A

FRAX

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67
Q

What are the risk factors for osteoporosis? (5)

A

SHATTERED FAMILY Steroid useHyperthroidism, hyperparathyroidismAlcohol and smoking Thin Testosterone deficiency Early menopause Renal or liver failureErosive or inflammatory bone diseaseDiabetesFamily history

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68
Q

What investigations can be used to diagnose osteoporosis? (3)

A

DEXA scan LFTs TFTs CRP Serum calcium Bone profile

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69
Q

What will ALP, PTH, calcium and phosphate levels be in a patient with osteoporosis?

A

All normal

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70
Q

What is the first line pharmacological therapy for osteoporosis?

A

Bisphosphonates

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71
Q

What types of drugs can increase the risk of osteoporosis?

A

Corticosteroids heparin

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72
Q

What factors is a Z score adjusted for?

A

Age, sex, ethnicity

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73
Q

What is a FRAX score?

A

The 10 year risk of a fracture in an adult aged 40-90

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74
Q

What is a T score?

A

Bone mineral density, compared to the average healthy young adult

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75
Q

What T score is diagnostic of osteoporosis?

A

<-2.5

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76
Q

What is a normal T score?

A

> -1

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77
Q

What T score is diagnostic of osteopenia?

A

Between -1 and -2.5

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78
Q

What is the gold standard investigation for osteoporosis?

A

DEXA scan

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79
Q

What other investigations are carried out in someone with suspected osteoporosis? (3)

A

Bone profile
Vitamin D level
TFTs
Urinary free cortisol
Testosterone
Bence jones protein

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80
Q

How should bisphosphonates be taken?

A

Patients should sit up for 30 minutes after taking, and should take with a large glass of water

81
Q

What are the second line medications for patients with osteoporosis?

A

Denosumab HRT Raloxetine - used in post menopausal women

82
Q

When are bisphosphonates contraindicated? (3)

A

Reduced GFR Hypocalcaemia Oesophageal abnormalities Pregnancy/breastfeeding

83
Q

What is the classic triad of Parkinson’s?

A

BradykinesiaResting tremorRigidity

84
Q

What is the pathophysiology of Parkinson’s?

A

A reduction in the amount of dopaminergic neurons in the substantia nigra

85
Q

What are some other common symptoms of Parkinson’s? (4)

A

Stooped posture
Facial masking
Reduced arm swing
Shuffling gait
Small handwriting
Difficulty initiating movement

86
Q

What kind of tremor can be seen in Parkinson’s?

A

Pill rolling tremor

87
Q

What is the difference between Parkinson’s and benign essential tremor?

A

Parkinson’s- Worsens with rest- Asymmetrical- Improves with intentional movement - No change with alcohol Benign essential tremor - Improves with rest- Symmetrical - Worsens with intentional movement - Improves with alcohol

88
Q

What are the differential diagnoses of Parkinson’s? (3)

A

Lewy body dementia Benign essential tremor Drug-induced Parkinsonism Progressive supranuclear palsyMultiple system atrophy corticobasal degeneration

89
Q

What is the first line treatment of Parkinson’s?

A

Levodopa/carbidopa

90
Q

What is levodopa?

A

L-dopa is a precursor to dopamine

91
Q

What is carbidopa?

A

A decarboxylase inhibitor that prevents levodopa from being broken down before reaching the brain - leads to a lower dose of levodopa needed, and fewer side effects

92
Q

What is the second line treatment of Parkinson’s?

A

Dopamine agonists, COMT inhibitors, MAO-B inhibitors

93
Q

When might a dopamine agonist be considered for initial therapy?

A

To delay starting levodopa, as levodopa’s effectiveness reduces overtime

94
Q

What are the signs of multiple system atrophy?

A

Parkinsonism Autonomic dysfunction Cerebellar signs

95
Q

What is multiple system atrophy?

A

A rare neurodegenerative disorder that causes gradual damage to neurons

96
Q

What are the common side effects of levodopa? (3)

A

Dry mouth
Palpitations
Psychosis
Anorexia
Postural hypotension

97
Q

Give an example of a dopamine receptor agonist.

A

Cabergoline

98
Q

What medication is contraindicated in Parkinson’s?

A

Haloperidol - it promotes dopamine blockade

99
Q

What medication can be used to sedate Parkinson’s patients?

A

Lorazepam

100
Q

What is the most important side effect of dopamine agonists?

A

Impulsivity

101
Q

What is delirium?

A

Delirium is an acute confusional state, characterised by a disturbed consciousness and reduced cognitive function.

102
Q

What are the four features of delirium?

A

A change in cognition A disturbance in attention Disturbance develops over a short period of timeEvidence of coinciding physiological changes

103
Q

What are the three types of delirium?

A

Hyperactive delirium Hypoactive delirium Mixed delirium

104
Q

What are the signs of hyperactive delirium? (4)

A

RestlessnessAgitation Inappropriate behaviour Hallucinations

105
Q

What are the signs of hypoactive delirium? (3)

A

Lack of interest Lethargy Reduced motor activityIncoherent speech

106
Q

What are the signs of mixed delirium?

A

A mix of hyperactive and hypoactive signs

107
Q

What are the differentials of delirium? (3)

A

Dementia Pain Stroke Head traumaPsychosis Depression

108
Q

What are the risk factors for delirium? (3)

A

Older ageDementia or cognitive impairment Decreased oral intake Visual or hearing impairment History of deliriumPolypharmacy Physical frailty

109
Q

What are some common causes of delirium? (5)

A
110
Q

What must be considered for a diagnosis of delirium?

A

Baseline cognitive and functional status to differentiate from dementia

111
Q

What investigations can be carried out to find a cause of delirium? (5)

A

FBC - rule out anaemia or infection U&EsUrinalysisCXRDrug levels in patients on certain drugs ECG ABGBlood cultureMMSEConfusion assessment method - screening/diagnostic tool for delirium

112
Q

What drugs can cause delirium? (3)

A

Benzodiazepines Analgesics e.g opioids Anti-cholinergics

113
Q

What is the primary treatment of delirium?

A

Treat the underlying cause

114
Q

What drugs can be given to manage the delirium itself?

A

IM haloperidol (lorazepam in PD and lewy body dementia patients)

115
Q

What assessment tool can be used to diagnose delirium?

A

Short-CAM (confusion assessment method)

116
Q

What is the ICD-10 criteria for delirium? (5)

A

Impairment of consciousness and attention Global disturbance in cognition Psychomotor disturbance Disturbance of sleep wake cycle Emotional disturbances

117
Q

What are the types of urinary incontinence?

A

Stress incontinence Urge incontinence Overflow incontinence Functional incontinence Mixed incontinence

118
Q

What is stress incontinence?

A

Incontinence when intra-abdominal pressure is raised

119
Q

What is urgency incontinence?

A

The sudden and involuntary loss of urine associated with the urge to urinate

120
Q

What is overflow incontinence?

A

The leakage of small amounts of urine without warning

121
Q

Why does overflow incontinence occur?

A

When the pressure of the bladder overcomes the pressure of the outlet structures - usually due to underactivity of the detrusor muscle, or extra pressure on the urinary outlet structures

122
Q

What can put extra pressure on the urinary outlet structures?

A

BPH Constipation

123
Q

What is functional incontinence?

A

The patient has the urge to pass urine, but is unable to access the necessary facilities

124
Q

What are the causes of functional incontinence? (3)

A

Sedating medications Alcohol Dementia

125
Q

What are the risk factors for stress incontinence?

A

Childbirth Hysterectomy

126
Q

What can trigger stress incontinence? (3)

A

Laughing Coughing Physical activitySneezing

127
Q

What are the risk factors for urge incontinence? (3)

A

Recent or recurrent UTI High BMI SmokingCaffeine

128
Q

What investigations are helpful in diagnosing urinary incontinence? (4)

A

Questionnaires Bladder diary Cystometry - measures bladder pressure whilst voiding Cystogram - radiological image with contrastUrine dip MSU

129
Q

What lifestyle advice can improve stress incontinence?

A

Pelvic floor exercises Avoiding alcohol and caffeineAvoiding excessive fluid intake

130
Q

What is the surgical management of stress incontinence? (Gold standard)

A

Incontinence pessaries - supports the base of the bladderUrethral bulking agents - injections into the area around the urethra to improve the sphincter’s ability to closeMid urethral sling procedure (gold standard)

131
Q

What is the medical management of urge incontinence/ overactive bladder?

A

Anticholinergic medications - Oxybutynin - Tolterodine - Festerodine

Side effects of anticholinergics (blurred vision, Urinary retention, dry mouth, constipation) … can’t see, can’t pee, can’t spit, can’t shit

132
Q

What is the surgical management of urge incontinence?

A

Botox injections (to paralyse the detrusor)Sacral neuromodulation

133
Q

Give 4 reversible causes of urinary incontinence.

A

UTI Type 2 diabetesDiuretics Delirium

134
Q

What are the risk factors for constipation? (5)

A

Increasing age Inactivity Low fibre diet Medications Low calorie intake Surgical procedures Female

135
Q

What are the symptoms of constipation? (5)

A

Passing stools < 3 times per weekDifficulty passing stools Sensation of incomplete evacuation - tenesmusAbdominal distension Abdominal mass in left or right lower quadrantsHaemorrhoids

136
Q

What are the red flag features of constipation? (4)

A

Weight lossDark stools Abdominal massLoss of appetite

137
Q

What investigations would you perform for a constipated patient? (5)

A

DRE FBC U&E TFTs Abdominal XR Colonoscopy Barium enema

138
Q

What are the causes of constipation? (5)

A

Dietary - low calorie, low fibreBehavioural - avoidance of defecation Electrolyte disturbanceDrugs - opiates, calcium channel blockers, antipsychoticsNeurological disordersEndocrine disordersColon disease - cancer, strictureAnal disease - fissure

139
Q

What is the initial management of constipation?

A

Lifestyle advice
- Increase fibre
- - Increase calorie intake
- - Increase fluid intake
- - Regular exercise

140
Q

What is the initial pharmacological management of constipation?

A

Bulk laxative - ispaghula husk - Methylcellulose

141
Q

What other medications can be used to manage constipation?

A

Stool softeners - docusate sodiumOsmotic laxatives - lactulose, macrogolStimulant laxatives - senna

142
Q

What other management options are there for constipation when medical managements are not effective?

A

Enema if stool is impacted Suppositories

143
Q

What type of stools does constipation usually present with?

A

Type 1 or 2Can be type 7 if there is overflow diarrhoea

144
Q

What is a deprivation of liberty?

A

Article 5 states that everyone has the right liberty - no person should be deprived of that liberty unless in accordance with the law- Under a Deprivation of Liberty safeguard it is necessary and legal to deprive a person of their liberty

145
Q

What are the key principles of the mental capacity act?

A

Capacity is assumed and needs to be proven otherwise
Enables people to make their own decisions
Unwise decisions don’t mean the patient lacks capacity
Acts in the best interests of the patient
The least restrictive management option should always be chosen

146
Q

What is Charles Bonnet syndrome?

A

Patients with visual loss will have hallucinations as the brain tries to fill in the missing picture. The patient is aware that the hallucinations aren’t real

147
Q

What is BPPV?

A

Benign paroxysmal positional vertigo - sudden onset of vertigo following head movements

148
Q

How does BPPV present?

A

Sudden onset vertigo (feeling everything around you is spinning) after head movements Vertigo lasts 20-60 seconds Patients are asymptomatic between attacks

149
Q

How is BPPV differentiated from labyrnithitis?

A

BPPV does not cause hearing loss

150
Q

What is the cause of BPPV?

A

Calcium carbonate crystals called octonia become lodged in the semi circular canals. The normal flow of endolymph through the canals is distrupted.

151
Q

What causes the crystals to become displaced in BPPV? (3)

A

Viral infection
Head trauma
Aging
Idiopathic

152
Q

Where are the crystals most commonly displaced in BPPV?

A

Posterior semicircular canal

153
Q

How is BPPV diagnosed?

A

Dix-hallpike manoeuvre

154
Q

How is the dix-hallpike manoeuvre performed?

A

Start with the patient sitting upright on a couch Turn the patient’s head to 45 degreesQuickly lower the patient backwards, with their head hanging off the back of the bedLook for nystagmusRepeat on the other side

155
Q

What is the first line management of BPPV?

A

Epley manoeuvre

156
Q

What else can be done to improve BPPV?

A

Brandt-Daroff exercises

157
Q

What is involved in Brandt-Daroff exercises?

A

Involves sitting on the edge of a bed and lying sideways, from one side to the other

158
Q

What is Meniere’s disease?

A

Recurrent episodes of vertigo, nausea, hearing loss, tinnitus and aural fullness

159
Q

How does Meniere’s disease differ from acute labyrinthitis?

A

Symptoms are similar, but Meniere’s disease is recurrent whereas acute labyrinthitis occurs as one episode

160
Q

What medication can be used for prophylaxis of menieres disease?

A

Betahistine

161
Q

What medication can be used to treat acute attacks of menieres’s disease?

A

Prochlorperazine Antihistamines

162
Q

What is the progression of hearing loss in meniere’s disease?

A

Fluctuated at first, with hearing loss associated with attacks of vertigo - Then becomes a more progressive and permenant sensorineural hearing loss

163
Q

What is the pathophysiology of Meniere’s disease?

A

It is associated with excessive build up of endolymph in the labyrinth of the inner ear, which increases pressure in the inner ear and disrupts signalling

164
Q

What systems are involved in normal gait?

A

Neurological system - basal ganglia Musculoskeletal system Fine touch and proprioception

165
Q

What are the risk factors for falls? (5)

A

Lower limb muscle weaknessVision problems Balance problems Polypharmacy Incontinence >65 years old Fear of falling Depression Postural hypotension Psychoactive drugs Previous falls Cognitive impairment

166
Q

What medications can cause postural hypotension? (5)

A

Tamsulosin Beta-blockers Nitrates Diuretics Anticholinergic medications L-Dopa ACE inhibitors

167
Q

What other medications are associated with falls? (3)

A

Benzodiazepines Antipsychotics OpiatesAnticonvulsants Codeine Digoxin

168
Q

What investigations are recommended in someone who has fallen? (5)

A

Blood pressure Blood glucose Urine dip FBC U&ELFTs Bone profile X-ray of chestX-ray of affected limbs CT head Echocardiogram

169
Q

Which fall patients should be referred for a multidisciplinary assessment? (3)

A

> 2 falls in a year A fall that requires medical treatment Failure to complete Turn 180 or Timed up and go test

170
Q

What is the length of a normal timed up and go test?

A

10 seconds or less

171
Q

What is the turn 180 test?

A

Patient should be able to get up from a chair, walk 10 feet, turn around and walk back within 20 seconds

172
Q

What tests are used to assess the risk of falls?

A

Turn 180 test Timed up and go test

173
Q

What management options can help prevent future falls? (3)

A

Strength and balance training Home hazard assessment Medication review Vision assessment

174
Q

What is mild hypothermia?

A

32-35 degrees body temperature

175
Q

What is moderate or severe hypothermia?

A

<32 degrees body temperature

176
Q

What are the causes of hypotheramia in the elderly? (3)

A

Exposure to cold in the environment Inadequate insulation in the operating theatreCardiopulmonary bypass

177
Q

What are the risk factors for hypothermia? (3)

A

General anaesthesia Substance abuse Hypothyroidism Impaired mental status HomelessnessExtremes of age

178
Q

What are the signs of hypothermia? (3)

A

Shivering Cold and pale skin Slurred speech Tachypnoea Respiratory depression Bradycardia Confusion

179
Q

What are the investigations for hypothermia? (3)

A

12 lead ECG Temperature FBC Blood glucose ABG Coagulation factors CXR

180
Q

What would be seen on an ECG in hypothermia?

A

Acute ST elevation J wave

181
Q

What might be seen on bloods in someone with hypothermia?

A

Elevated haemoglobin and haematocrit Hypokalaemia

182
Q

What is the initial management of hypothermia? (3)

A

Remove patient from environment Remove wet blankets or clothing Warm the body with blankets Secure the airway and monitor breathing Warm IV fluids or passing warm air over the patient

183
Q

What is the definition of hyperthermia?

A

Body temperature of more than 40 degrees

184
Q

What features of the elderly make them more susceptible to hyperthermia?

A

Reduced cardiac output
Chronic volume depletion
Normal deficiencies in heat shock protein

185
Q

What are the features of hyperthermia? (5)

A

Agitation
Lethargy
Seizures
Hot dry skin
Elevated core body temperature
Intense thirst
Weakness
Syncope
Headache
Tachypnoea
Tachycardia

186
Q

What are the risk factors for hyperthermia? (4)

A

Age > 65 Pre-existing dehydration Obesity Environmental factorsDiabetesCardiovascular diseaseCongenital disordersDrug and alcohol misuseMedications - Diuretics - Beta blockers - Anticholinergics - Antidepressants - Antihistamines

187
Q

What investigations should be performed in someone with hyperthermia? (5)

A

FBC
LFTs
Renal function
Rectal temperature
Glucose
U&E
ABG
Creatine Kinase
Urinalysis
ECG

188
Q

What electrolyte abnormalities might be seen in hyperthermia?

A

Hypokalaemia Hyponatraemia

189
Q

What other blood tests results might be seen in hyperthermia?

A

Elevated CK
Elevated urea
Elevated ALT and AST

190
Q

What is the management of hyperthermia? (3)

A

Remove excess clothingRapid active cooling:- Wetting and fanning the skin - Wetted ice packs Oxygen IV fluids Small dose benodiazepines

191
Q

What temperature should patients with hyperthermia be cooled to?

A

No less than 39 degrees

192
Q

Why are IV benzodiazepines sometimes given in hyperthermia?

A

IV benzos increase shivering, which causes heat gain and makes cooling less effective - this ensures that patients are not cooled too much or too quickly

193
Q

Why do pressure ulcers occur?

A

They develop in patients who are unable to move due to illness, paralsis or advancing age

194
Q

What are the risk factors for pressure ulcers? (3) what score is used to assess this risk of developing pressure ulcers?

A

Malnutrition Incontinence Lack of mobility Pain

Waterlow score

195
Q

What is a grade 1 pressure ulcer?

A

The skin is intact with non-blanchable erythema

196
Q

What is a grade 2 pressure ulcer?

A

Partial thickness skin loss involving the epidermis, dermis, or both

197
Q

What is a grade 3 pressure ulcer?

A

Full thickness skin loss involving damage to or necrosis of subcutaneous tissue that may extend down to, but not through, the fascia

198
Q

What is a grade 4 pressure ulcer?

A

Full-thickness skin loss that extends through the fascia with considerable tissue loss. There may be muscle, bone, tendon or joint involvement.

199
Q

What is the management of pressure ulcers? (3)

A

A moist wound environment - hydrocolloid dressings and hydrogels Referral to tissue viability nurse Surgical debridement Systemic antibiotics

Phase 3a🩺 (12 decks)

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