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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
List the presentations of pressure ulcer
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
List the common organisms implicated in pressure ulcer infection
Staphylococcus aureus Proteus mirabilis Pseudomonas aeruginosa Bacteroides
27
List the managements for pressure ulcers
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
List The National Pressure Ulcer Advisory Panel pressure injury staging
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
In what age does sarcopenia typically present
>65 years
30
Give definition for sarcopenia
Progressive and generalised skeletal muscle disorder that is associated with increased likelihood of adverse outcomes: * Falls * Fractures * Physical disability * Mortality
31
List the risk factors for sarcopenia
Advanced age Sedentary lifestyle Low / high BMI Low protein intake History of falls Smoking
32
List the causes for secondary sarcopenia
Electrolyte disturbances Hypogonadism Hyperparathyroidism Vitamin D deficiency Malnutrition Chronic diseases * COPD * Chronic heart failure * Renal impairment * Cancer
33
List the medications associated with muscle loss
Corticosteroids Gonadotropin-releasing hormone agonists Anti-testosterone agents Meglitinide (glinide) (antidiabetic medications).
34
Which type of muscle fibre is typically reduced in people with sarcopenia
Type II (fast-twitch)
35
List the presentations for sarcopenia
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
List the physical signs of sarcopenia
Excessive emaciation/adiposity Abnormal BMI Low hand grip strength Difficulty rising from a chair Slowness of movement (i.e. slow gait speed).
37
List the differential diagnosis for sarcopenia
Parkinson’s disease Amyotrophic lateral sclerosis Myopathy Cachexia Hyper/hypothyroidism
38
List the management options for sarcopenia
Protein intake Resistance exercise Aerobic exercise
39
List the items in SARC-F screening questionnaire
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
List the causes for faecal incontinence in adults
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
Define syncope
Sudden and transient loss of consciousness that is associated with a loss of postural tone, and resolves spontaneously and completely without intervention.
42
List the dysrhythmic causes of syncope
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
List the reflex mediated causes of syncope
Vasovagal syndrome Carotid sinus syndrome Situational syncope
44
List the dysautonomic causes of syncope
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
List the cardiac structural causes of syncope
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
List the drug causes of syncope
Alcohol Alpha-blockers eg. prazosin Diuretics, ACEi Clonidine, TCA Phenothiazines, antihistamines L-dopa, monoamine oxidase inhibitors
47
List the metabolic causes of syncope
Hypoglycaemia Hypoxia Hyperventilation with hypocapnia
48
What score is used to identify patients at risk of pressure sores
Waterlow score
49
What score is used to identify adults who are malnourished or at risk of malnutrition
The MUST score
50
What questionnaire is used to confirm frailty in an individual
PRISMA7
51
List the medications that could cause postural hypotension in the elderly
Nitrites Diuretics Anticholinergics Antidepressants ACEi beta-blockers L-dopa
52
What are the important additional blood tests which form part of the 'Confusion Screen'
TSH, B12, Folate & Glucose (macrocytic anaemias, B12/folate deficiency worsen confusion)
53

Medicine (9 decks)

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