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PHASE 3A > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

What is the criteria for diagnosing postural hypotension?

A

A systolic drop of >20mmHg or diastolic drop >10 mmHg within 3 minutes of standing from a sitting position

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2
Q

What are the results on imaging of vascular dementia?

A

MRI- infarcts and white matter hyperintensities

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3
Q

What is the characteristics of Alzheimer’s Disease histologically?

A

Characterised by beta amyloid depositions and neurofibrillary tangles composed of TAU proteins

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4
Q

What class of medications is contraindicated when prescribing sildenafil for erectile dysfunction?

A

Nitrates

Can cause severe hypotension

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5
Q

What medication can be prescribed in postural hypotension although not regularly done?

A

Fludrocortisone or Midodrine (alpha 1 agonist)

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6
Q

List the 4 cardinal Sx of Parkinson’s disease?

A

Lead pipe rigidity
Bradykinesia
Pill rolling tremor (resting)
Postural instability

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7
Q

What factors should be assessed in frailty and what questionnaire can be utilised to help make a diagnosis?

A

Gait speed
self reported health
PRISMA-7 Questionnaire

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8
Q

What are the side effects of L dopa?

A

Postural hypotension
Nausea and vomiting

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9
Q

Side effect of MAO-B inhibitors?

A

Serotonin syndrome

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10
Q

What medications are used in the treatment of Parkinson’s disease?

A

L-dopa
Dopamine agonists (ropinorole, bromocriptine)
MAO-B inhibitors (seligline)
COMT inhibitors (talcapone)

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11
Q

What clinical score can be used to determine severity of frailty?

A

Rockwood

  • Level of independence
  • Physical activity
  • Cognitive status
  • Functional status

1–3: Not frail (fit, well, or managing well)
4: Vulnerable (pre-frail)
5–9: Various degrees of frailty, with 9 indicating terminal illness.

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12
Q

List the different types of laxative giving an example for each?

A

Stimulant - senna, basocodyl
Bulk forming - isphagula husk
Osmotic - macrogrol, lactulose
Stool softener - docusate sodium

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13
Q

List 4 causes of postural hypotension

A

Medications
Dehydration - hypovolemia
Autonomic dysfunction
Adrenal insufficiency
Sepsis
Alcohol

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14
Q

What is osteoporosis

A

A systemic skeletal disease characterised by low bone mass and microarchitectural deterioration therefore increase in bone fragility and susceptibility to fractures

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15
Q

List three endocrine disease that contribute to osteoporosis

A

Cushings
Hyperthyroidism
Hyperparathyroidism
Male hypogonadism

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16
Q

Rf for osteoporosis

A

‘SHATTERED FAMILY’
Steroid use
Hyperthyroidism/Hyperparathyroidism
Alcohol and smoking
Thin (BMI <22)
Testosterone deficiency
Early menopause
Renal/liver failure
Erosive/inflammatory bone disease
Diabetes
Family Hx

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17
Q

What abnormal finding can be found in cross section of bone in osteoporosis

A

Fewer trabecular in spongy bone
Thinning of cortical bone
Widening Haversian canals

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18
Q

Gs Ix for osteoporosis and results

A

Dexa scan- t score of -2.5 or less

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19
Q

What 2 areas are commonly affected in osteoporosis that the dexa scan focuses on

A

Lumbar spine
hip

Hip

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20
Q

What is a t score

A

Standard deviation that is compared to gender matched young adult mean

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21
Q

What criteria are listed in the FRAX assessment tool

A 
Sex 
Weight 
Height 
Previous fracture
Corticosteroid use 
Current smoking 
Parent fractured hip 
Alcohol
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22
Q

Other than dexa scan what other Ix can be done in osteoporosis

A 
X-ray of wrist, spine, hip- of fracture suspected 
MRI spine 
Bone profile- calcium, phosphate, alp 
Vit d levels 
TFTs
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23
Q

Tx for osteoporosis

A

Rx- lifestyle advise (stop smoking, diet, regular exercise)
1st line Rx- bisphosphoneates + vit d and calcium
2nd line- Desonumab, HRT, Teriparatide

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24
Q

What advice should be given for bisphosphonates

A

Take whole (swallow) with plenty water while standing or sitting on empty stomach at least 30 minutes beofre breakfast and stay upright after taking ~30 mins

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25
Q

What are the adverse effects of bisphosphonates?

A

oesophagitis
oesophageal ulcers
osteonecrosis of the jaw

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26
Q

What t score is indicative of osteopaenia

A

t score of -1 to -2.5

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27
Q

What t score is indicative of osteoporosis

A

t score of less than -2.5

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28
Q

What factors is the Z score adjusted for?

A

Gender, ethnicity and age

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29
Q

What is OA

A

Is a non inflammatory degenerative joint pain characterised by the deterioration of articulate cartilage and new bone formation

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30
Q

List 5 symptoms of OA

A

Joint stiffness
Joint pain - associated w/ activity
Bone enlargements
Crepitus
Restricted range of motion

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31
Q

What joints are affected in OA

A

PIP
DIP
Carpometacarpal joint

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32
Q

What signs of OA

A

Heberdens nodes- DIP
Bouchard nodes- Pip
squaring of carpometacarpal Joint

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33
Q

Signs on X-ray in OA

A

Loss of joint space
Osteophytes
Subarticular sclerosis
Subchondral cysts

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34
Q

Tx for OA

A

Cx- lose weight, exercise, braces, physio/occupational therapy

Rx- oral paracetamol/topical NSAIDs, NSAIDS

Sx- osteotomy, arthroplasty, arthroscopy, fusion of joints

35
Q

Rf for OA

A

Female
Increasing age
Trauma bone
Early menopause
FHx
Obesity

36
Q

What sign is seen in patients with NOF?

A

Shortening and external rotion of the affected hip

37
Q

List 3 rf for falls

A

Postural hypotension
Polypharmacy
Vsion problems
>65
Balance/gait problems

38
Q

What physical tests may you perform in a person presenting with falls?

A

Turn 180 test or
timed up and go test

39
Q

List 5 medications that can cause postural hypotension?

A

Nitrates
Diuretics
Anticholinergic medications
Antidepressants
Beta Blockers
L-Dopa
ACEI

40
Q

List 3 drugs that could be associated with falls?

A

Benzodiazepines
Antipsychotics
Opiates
Codeine
Digoxin

41
Q

What other condition is polymyalgia rheumatica associated with?

A

GCA

42
Q

List 5 features of polymyalgia rheumatica?

A

Shoulder/hip girdle stiffness (usaully in morning)
Reduced appetite
WL
Malaise
Low grade fever

43
Q

What is BPPV?

A

characterised by sudden episodic attacks of vertigo by changes in head position

44
Q

What is the cause of BPPV?

A

Detachement of otholiths from the utricle in the inner ear

45
Q

What is the diagnostic test for BPPV?

A

Dip-Hllpike manoeuvre

46
Q

What is the mx of BPPV?

A

Epley Manouevre

47
Q

What would be the murmur associated with AS

A

Ejection Systolic

48
Q

What would be the murmur associated with AR

A

Early diastolic murmur

49
Q

What would be the murmur associated with MS

A

Rumbling mid diastolic

50
Q

What would be the murmur associated with MR

A

Pansystolic

51
Q

What non-pharmacological stratergies should be trialled in managing a patient with delerium?

A

Provide a quiet environement with good lighting
Maintaing a regular sleep-wake cycle
Regular orientation and reassurance
Ensuring patient glasses and hearing aids are used if needed

52
Q

List 3 RF for pressure sores?

A

Immobility
Sensory impairment
Malnourishment
Older age
Surgery-
Incontinence

53
Q

What clinical score is used to screen patinets who at risk of developing pressure sores?

A

Waterlow score

54
Q

How can pressure sores be avoided?

A

Barrier creams
Pressure redistribution
Repositioning
Regular skin assessment

55
Q

What is the management of pressure sores?

A

Moinst wound environement- Hydrocoloid dresssings
Surgical debridement
Antibiotics if signs of infection

56
Q

WHat is the START tool

A

Suggests medications that may provide additional benefits

57
Q

WHat is the STOPP tool

A

Used to assess which drugs can be potentially discontinued in elderly patients undergoing polypharmacy

58
Q

WHat metabolic disturbances can be seen in refeeding syndrome?

A

Hypophosphataemia
Hypokalaemia
Hypomagnesia
Thiamine deficiency
Abnormal glucose metabolism

59
Q

WHta are the potential complications of refeeding syndrome?

A

Cardiac arrythmias
Coma
Convulsions
Cardiac Failure

60
Q

List primary prevention for strokeS?

A

Smoking cessation
COntrol HTN
Control Hypercholestraemia
Control diabetes
Encourage actuve lifestyle

61
Q

List secondary prevention for strokes?

A

72 Hour ECG to look for paroxsyml AF
CAROTID DOPPLER
bp
eCHO

62
Q

List the initial mx of ischaemic stroke>

A

Aspirin 300mg
Thrombolysis w/ alteplase if less than 4.5 hours
Control BP

63
Q

List 3 RF for ischaemic stroke

A

Hypertension
Hypercholestraemia
Diabetes
Smoking
AFIB
Carotid stenosis

64
Q

List 3 RF for haemorrhagic strokes?

A

AVM
Aneursyms
Anticoagulants

65
Q

Which abx should be avoided in old patients w/ epilepsy as it could lower seizure threshold?

A

Ciprofloxacin

66
Q

list a short term and long term se of levodopa?

A

short- abnormal dreams
long- on and off states

67
Q

List 2 sx of pseudodemnetia?

A

repsonds to answers with ‘i dont know’
symtopms of depression

68
Q

MOA of bisphosphonates?

A

Inhibit osteoclastic bone resorption

69
Q

What are the common sites for pathological fractures in OP?

A

distal radius
proximal humerus
proximal femur (NOF fracture)
Pelvis
Vertebrae

70
Q

What is the tool used to screen patients for malnutrition?

A

The Malnutrition Universal Screening Tool (MUST)

71
Q

What is hyperthermia?

A

Defined as a core temperature over 40 degrees with CNS dysfunction

72
Q

Name some risk factors for hyperthermia.

A

Older age, impaired cognition, pre-existing dehydration, obesity

73
Q

What is hypothermia defined as?

A

Core body temperature <35 degrees Celsius

Mild hypothermia: 32-35°C
Moderate or severe hypothermia: < 32°C

74
Q

What can rapid re-warming on an individual in hypothermia cause>

A

Distributive shock and Peripheral Vasodilation

75
Q

What blood results are most consistent with Osteoporosis?

A

Normal calcium
Normal phosphate
Normal alkaline phosphatase
Normal PTH

76
Q

What laxative is generally given first line?

A

Bulk forming laxative - ispaghula

77
Q

What laxative is generally given second line?

A

Osmotic laxative such as macrogol

78
Q

What to do if a patient with Osteoporosis taking Alendronate has significant upper GI side effects?

A

Switch to Risedronate or Etidronate

79
Q

What is malignant hyperthermia?

A

Inherited autosomal dominant condition seen after administration of anaesthetic agents characterised by hyperpyrexia and muscle rigidity

Excess calcium ion release from skeletal muscle

80
Q

What is Benign Paroxysmal Positional Vertigo (BPPV)?

A

A medical condition characterized by sudden, episodic attacks of vertigo induced by changes in head position.

81
Q

What is the gold standard investigation for BPPV?

A

Dix-Hallpike Manoeuvre, where the patient is rapidly lowered to the supine position with an extended neck. A positive test recreates the symptoms of BPPV.

82
Q

What is the first-line management for BPPV?

A

Epley manoeuvre, successful in around 80% of cases. It aims to move the detached otoliths out of the semi-circular canal and back to the utricle. Patients are also taught exercises to do at home, such as Brandt-Daroff exercises.

83
Q

What is Mx for a post-menopausal woman who has an osteoporotic fracture?

A

Bisphosphonates

Dont wait for DEXA

PHASE 3A (11 decks)

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