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Medicine > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

Define frailty

A

Decline in functional state across multiple physiological systems, meaning more vulnerability to stressor events.

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2
Q

List the risk factors for frailty

A

Age
Cognitive impairment
Depression
Diabetes
Physical inactivity
High cardiovascular disease risk score
High inflammatory-related disease count

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3
Q

Define the phenotype model of frailty

A

Unintentional weight loss
Self-reported exhaustion
Low energy expenditure
Slow gait
Weak grip

Presence of:
3/5 = ‘frail’
1~2/5 = ‘pre-frail’
0/5 = ‘robust’

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4
Q

What are people with frailty at significant risk of

A

Deconditioning
Delirium
Malnutrition

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5
Q

List the consequences of malnutrition in old people

A

Loss of muscle
Higher rates of infection
Impaired wound healing
Longer hospital stay

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6
Q

List the medications potentially inappropriate for use in people with frailty and why

A

Loop diuretics eg. furosemide
Calcium channel blockers
* Inappropriate in postural hypotension - increases syncope and falls
TCAs
* Accelerate cognitive decline in dementia
* Exacerbate glaucoma
* Increase risks of arrhythmia
* Cause constipation and urinary retention
SSRIs
* Contraindicated in hyponatraemia within the previous two months
Benzodiazepines
* Increase risks of falls and confusion
Bladder antimuscarinic drugs
* Cause confusion in dementia
* Exacerbate glaucoma and constipation
* Cause urinary retention in prostatism
NSAIDs
* Risks of deterioration of renal function
* Should not be prescribed to patients with heart failure

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7
Q

List the medications that increase the risks of falls

A

Benzodiazepines, antidepressants, anxiolytics
Orthostatic hypotension:
* alpha/beta-blockers
* anti-hypertensives, diuretics
* bromocriptine, levodopa
NSAIDs, marijuana, opioids, sedatives, hypnotics, sildenafil, TCA
Hypoglycemia: diabetes medications (insulin, thiazolidinediones)
Highly anticholinergic medications eg. first-generation antihistamines (diphenhydramine), muscle relaxants, vasodilators
Cholecalciferol

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8
Q

Give the DSM-5-TR criteria for delirium

A

Evident disturbance in attention
* Reduced clarity of awareness of the environment
* Reduced ability to focus, sustain, shift attention
Change in cognition
* Memory deficit
* Disorientation
* Language disturbance
The disturbance develops over a short period of time
* Acute change from baseline
* Tends to fluctuate during the course of the day
Evident physiological disturbance

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9
Q

List three clinical subtypes of delirium

A

Hyperactive
Hypoactive
Mixed

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10
Q

List the precipitating factors for delirium

A

PINCH ME
P - pain
I - infection
N - nutrition
C - constipation
H - dehydration
M - medication
E - environment

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11
Q

List the acute, life threatening causes of delirium

A

Hypoxia
Hypoglycemia
Hypotension
Drug intoxication/withdrawal

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12
Q

List the interventions to preventing delirium

A

Addressing cognitive impairment
Ensuring hydration
Managing constipation
Monitoring oxygen and addressing any hypoxia
Monitoring for infection
Avoiding unnecessary catheterisation
Encouraging mobilisation
Addressing pain
Reviewing medication
Addressing nutrition
Addressing any sensory problems
Encouraging good sleep hygiene

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13
Q

List the management for delirium

A

Initial:
* Reduce disorientation: well-lit room, clock, calendar
* Encourage family, friends, carers visit
* Verbal/non-verbal de-escalation
Pharmacological - short-term (1~2 day) antipsychotic/sedative
* Haloperidol (CI: Parkinson’s disease/Lewy body dementia)

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14
Q

Define osteoporosis

A

T-score < -2.5

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15
Q

Define fragility fracture

A

Fracture following a fall from standing height or less

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16
Q

List the risk factors for osteoporotic fractures

A

(Risk factors that reduce BMD):
Endocrine disease
* Diabetes mellitus
* Hyperthyroidism
* Hyperparathyroidism
GI conditions (malabsorption)
* Inflammatory bowel disease
* Coeliac disease
* Chronic pancreatitis
Chronic kidney disease
Chronic liver disease
COPD
Menopause
Immobility
BMI < 18.5 kg/m²

(Risk factors that do not reduce BMD):
Age
Oral corticosteroids
Smoking
Alcohol (>3)
Previous fragility fracture
Rheumatoid arthritis/other inflammatory arthropathies.
Parental history of hip fracture.

(Drugs)
Selective serotonin reuptake inhibitors.
Proton pump inhibitors.
Anticonvulsant drugs eg. carbamazepine

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17
Q

List the non-osteoporotic causes for fragility fractures

A

Metastatic bone disease
Multiple myeloma
Osteomalacia
Paget’s disease

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18
Q

List the management options for osteoporosis

A

Bone-sparing treatment
* alendronate 10 mg once daily or 70 mg once weekly
* risedronate 5 mg once daily or 35 mg once weekly
Calcium intake (700 mg/day)
Vitamin D
Hormone replacement therapy for younger postmenopausal women

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19
Q

List the contraindications for oral bisphosphonates

A

Hypocalcaemia, parathyroid dysfunction, hypovitaminosis D
Severe CKD
Unable to stand/sit upright for >30 minutes
Abnormalities of the oesophagus/delayed emptying of the oesophagus
* Oesophagus strictures
* Achalasia
Pregnant/breastfeeding women

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20
Q

List the adverse effects of oral bisphosphonates

A

Gastrointestinal (most common)
* Nausea
* Dyspepsia
* Mild gastritis
* Abdominal pain
Bone, joint, muscle pain (common).
Oesophageal reactions (uncommon)
* Oesophagitis
* Oesophageal ulcers
* Strictures
* Erosions
Osteonecrosis of the jaw/external auditory canal (rare)
Atypical stress fractures

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21
Q

List the drug interactions that may reduce absorption of bisphosphonates

A

Calcium supplements and antacids
Coffee and orange juice

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22
Q

How should oral bisphosphonate be taken

A

On empty stomach
* Risedronate: before breakfast, between meals, in the evening at the same time each day.
* Alendronate: >30 minutes before the first food.
The tablet
* swallowed whole + taken with a glass of water.
* not be sucked/chewed (oropharyngeal ulceration).
Taken while in an upright position.
Not lie down for >30 minutes after taking the medication.

23
Q

List the four main factors in forming pressure ulcers

A

Pressure
Shear
Friction
Moisture

24
Q

List the key risk factors for pressure ulcers

A

Immobility
Age >70 years
Recent surgery / intensive care stay
Malnutrition
Loss of sensation
Paralysis

25
Q

List the presentations of pressure ulcer

A

An area of non-blanchable erythema
Marked localised skin changes
A wound of varying severity on an anatomical site that is exposed to significant unrelieved pressure.

26
Q

List the common organisms implicated in pressure ulcer infection

A

Staphylococcus aureus
Proteus mirabilis
Pseudomonas aeruginosa
Bacteroides

27
Q

List the managements for pressure ulcers

A

Pressure relief
* Repositioning
* Support surface - mattresses, cushions
Dietary optimisation: +ve nitrogen balance (1.2~1.5g protein/kg/day, 30~35 kcal/kg/day)
Pain management
* Mild: paracetamol / NSAIDs
* Moderate to severe: codeine / oxycodone
Hygiene, cleansing, dressing

28
Q

List The National Pressure Ulcer Advisory Panel pressure injury staging

A

Category/grade/stage 1 - intact skin with a localised area of non-blanchable erythema, which may appear differently in darkly pigmented skin.
Category/grade/stage 2 - partial-thickness skin loss with exposed dermis.
Category/grade/stage 3 - full-thickness skin loss, in which adipose is visible in the ulcer and granulation tissue and epibole (rolled wound edges), is often present.
Category/grade/stage 4 - full-thickness skin and tissue loss with exposed or directly palpable fascia, muscle, tendon, ligament, cartilage, or bone in the ulcer.
Unstageable full-thickness pressure injury - full-thickness skin and tissue loss in which the extent of tissue damage within the ulcer cannot be confirmed because it is obscured by slough or eschar.
Deep tissue pressure injury - intact or non-intact skin with localised area of persistent non-blanchable deep red, maroon, purple discolouration, or epidermal separation revealing a dark wound bed or blood-filled blister.

29
Q

In what age does sarcopenia typically present

A

> 65 years

30
Q

Give definition for sarcopenia

A

Progressive and generalised skeletal muscle disorder that is associated with increased likelihood of adverse outcomes:
* Falls
* Fractures
* Physical disability
* Mortality

31
Q

List the risk factors for sarcopenia

A

Advanced age
Sedentary lifestyle
Low / high BMI
Low protein intake
History of falls
Smoking

32
Q

List the causes for secondary sarcopenia

A

Electrolyte disturbances
Hypogonadism
Hyperparathyroidism
Vitamin D deficiency
Malnutrition
Chronic diseases
* COPD
* Chronic heart failure
* Renal impairment
* Cancer

33
Q

List the medications associated with muscle loss

A

Corticosteroids
Gonadotropin-releasing hormone agonists
Anti-testosterone agents
Meglitinide (glinide) (antidiabetic medications).

34
Q

Which type of muscle fibre is typically reduced in people with sarcopenia

A

Type II (fast-twitch)

35
Q

List the presentations for sarcopenia

A

Low muscle strength
History of weight loss
Slow usual gait speed
Difficulty in performing activities of daily living (cleaning, shopping for groceries)
Difficulty with activities related to mobility (walking, climbing stairs, taking public transport)
Falls / Fear of falling
Reduction in outdoor activities or being housebound

36
Q

List the physical signs of sarcopenia

A

Excessive emaciation/adiposity
Abnormal BMI
Low hand grip strength
Difficulty rising from a chair
Slowness of movement (i.e. slow gait speed).

37
Q

List the differential diagnosis for sarcopenia

A

Parkinson’s disease
Amyotrophic lateral sclerosis
Myopathy
Cachexia
Hyper/hypothyroidism

38
Q

List the management options for sarcopenia

A

Protein intake
Resistance exercise
Aerobic exercise

39
Q

List the items in SARC-F screening questionnaire

A

Strength
Ambulation (walking)
Rising from a chair
Climbing stairs
Falls

Each item has a minimum of 0 and a maximum of 2 points.
Maximum score 10.
A total score ≥4 indicates risk of sarcopenia.

40
Q

List the causes for faecal incontinence in adults

A

Structural anorectal abnormalities
* 3/4th degree obstetric injury
* Rectal prolapse
Neurological conditions
* Multiple sclerosis
* Stroke
* Pudendal neuropathy
Alterations in stool consistency
* Infectious diarrhoea
* Inflammatory bowel disease
Overflow
* Impaction
* Reduced reservoir function due to bowel surgery
Cognitive/behavioural dysfunction
* Dementia
* Learning difficulties
General disability
* Ageing
* Acute illness
Idiopathic

41
Q

Define syncope

A

Sudden and transient loss of consciousness that is associated with a loss of postural tone, and resolves spontaneously and completely without intervention.

42
Q

List the dysrhythmic causes of syncope

A

Ventricular arrhythmias
Sinus node dysfunction - bradycardia/tachycardia syndrome
Atrioventricular conduction blocks
Paroxysmal supraventricular tachycardia
Inherited syndromes
* Long QT syndromes
* Brugada syndrome
Implanted device malfunction
Drug-induced pro-arrhythmias - sotalol, flecainide, quinidine, procainamide, disopyramide

43
Q

List the reflex mediated causes of syncope

A

Vasovagal syndrome
Carotid sinus syndrome
Situational syncope

44
Q

List the dysautonomic causes of syncope

A

Catecholamine disorders
* Baroreflex failure
* Dopamine-beta-hydroxylase deficiency
* Pheochromocytoma
* Neuroblastoma
* Familial paraganglioma syndrome
* Tetrahydrobiopterin deficiency
Central autonomic disorders
* Multiple system atrophy
* Parkinson’s disease with autonomic failure
Peripheral autonomic disorders
* Acute idiopathic polyneuropathy (Guillain-Barre syndrome)
* Chagas’ disease
* Diabetic autonomic failure
* Familial dysautonomia
* Pure autonomic failure (Bradbury-Eggleston syndrome)
Orthostatic intolerance syndrome
* Postural tachycardia syndrome
* Mitral valve prolapse
* Idiopathic hypovolemia
Paroxysmal autonomic syncopes: neurocardiogenic syncope

45
Q

List the cardiac structural causes of syncope

A

Cardiac valvular diseases
* Mitral stenosis - most commonly associated with syncope during periods of atrial fibrillation
* Aortic stenosis - exertional syncope
* Acute aortic, mitral, or tricuspid insufficiency
* Prosthetic valve dysfunction
Hypertrophic cardiomyopathy - exertional syncope
Acute myocardial ischaemia/infarction
Atrial myxoma
Acute aortic dissection
Pulmonary embolism and pulmonary hypertension (decreased LV preload)
* In chronic pulmonary hypertension, activities that acutely raise intrathoracic pressure, such as coughing or Valsalva during defecation, can produce syncope
Cardiac tamponade

46
Q

List the drug causes of syncope

A

Alcohol
Alpha-blockers eg. prazosin
Diuretics, ACEi
Clonidine, TCA
Phenothiazines, antihistamines
L-dopa, monoamine oxidase inhibitors

47
Q

List the metabolic causes of syncope

A

Hypoglycaemia
Hypoxia
Hyperventilation with hypocapnia

48
Q

What score is used to identify patients at risk of pressure sores

A

Waterlow score

49
Q

What score is used to identify adults who are malnourished or at risk of malnutrition

A

The MUST score

50
Q

What questionnaire is used to confirm frailty in an individual

A

PRISMA7

51
Q

List the medications that could cause postural hypotension in the elderly

A

Nitrites
Diuretics
Anticholinergics
Antidepressants
ACEi
beta-blockers
L-dopa

52
Q

What are the important additional blood tests which form part of the ‘Confusion Screen’

A

TSH, B12, Folate & Glucose
(macrocytic anaemias, B12/folate deficiency worsen confusion)

53
Q
A

Medicine (8 decks)

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