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Phase 3a > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

What is the definition of frailty?

A

Increased vulnerability and decline (age related) in functional + psychological reserve

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2
Q

What are the geriatric giants?

A
  • Instability
  • Inanition (poor nutrition)
  • Immobility
  • Intellectual impairment
  • Iatrogenesis
  • Incontinence
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3
Q

What are the geriatric M’s?

A
  • Mind
  • Mobility
  • Multicomplexity
  • Medication
  • Matters Most (ICE)
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4
Q

Who is in the Geriatric MDT?

A

Medical - Drs, nurses, pharm, dietitian
Functional - OT, PT, SALT
Psych - Dr, Psychiatric nurse
Social - OT, social workers
Environmental - community nurse etc

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5
Q

What is the ACB?

A

Anticholinergic burden
Score >3 can increase risk of falls, confusion, and overall morbidity

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6
Q

What are some examples of ACB 3 medications?

A
  • paroxetine
  • amitriptyline
  • oxybutynin
  • clozapine
  • promethazine
  • quetiapine
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6
Q

What are the symptoms of acetylcholine syndrome?

A

PNS - can’t see, pee, spit, shit
CNS - agitation, decreased GCIS, ataxia

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7
Q

How do warfarin and NSAIDs interact?

A

Increased bleeding risk

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8
Q

How do warfarin and macrolide’s (erythromycin, clarithromycin) interact?

A

Increased bleeding risk

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9
Q

How do omeprazole and clopidogrel interact?

A

Omeprazole reduces the efficacy of clopidogrel?

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10
Q

How do SSRIs and NSAIDs interact?

A

Increased GI bleed risk - co prescribe a PPI

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11
Q

How do ACEi and spironolactone interact?

A

Increased AKI risk and hyperkalaemia

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12
Q

How do methotrexate and trimethoprim interact?

A

Can cause myelosuppression

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13
Q

How do statins and macrolides interact?

A

Causes myalgia

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14
Q

How do statins and grapefruit juice interact?

A

Causes myalgia

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15
Q

How do iron and tetracycline interact?

A

Iron decreases effects of tetracycline

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16
Q

What is pharmacokinetics?

A

The effect of the body acting on the drug

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17
Q

What is pharmacodynamics?

A

The effect of the drug on the body

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18
Q

Why was the MCA 2005 made?

A

To empower >16year olds to make decisions in any future scenario where they may lack capacity

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19
Q

What are the principles that you must adhere to with the MCA 2005?

A
  • Acting in the patients best interest
  • Assume capacity until otherwise proven
  • Don’t cause undue harm
  • Give all the info
  • Least restrictive option
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20
Q

What can an IMCA do for a patient?

A
  • Enquire about medications and advocate for the patients best interest
  • Cannot make decisions on the patients behalf
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21
Q

What is an IMCA (Independent mental capacity advocate)?

A

NHS appointed role for any patient who doesn’t have a lasting power of attorney

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22
Q

What is a LPA (Lasting Power of Attorney)?

A

Someone appointed by the patient to make decisions if lacking capacity

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23
Q

What are the two types of LPA?

A
  • Financial
  • Health
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24
Q

What is an advanced directive?

A

A written statement by someone >18 detailing treatment preferences should they lack capacity in the future

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25
Q

What is a CAD (Court appointed deputy)?

A

There’s no LPA and there’s a dispute over best interests - can apply to the court for temporary decision maker

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26
Q

What is DoLS (Deprivation of Liberty Safeguards)?

A

Patient is supervised 24/7 and they are unfree to leave for up to seven days (can last up to 12 months)

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27
Q

What are the principles of DoLS?

A
  • Must be in the best interest of the pt
  • Patient must identifiably pose a risk to themselves
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28
Q

What info is needed if a pt with capacity is wanting to self discharge?

A
  • Drug chart updated
  • Input from OT
  • Input from PT
  • GP follow-up must be put in place
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29
Q

What can and can’t be in and advanced directive?

A
  • Can’t demand treatment
  • Can’t refuse food/drink
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30
Q

What are the differences between delirium and dementia?

A
  • Delirium is transient whereas dementia is chronic and progressive
  • Delirium is acute
  • Delirium has fluctuations whereas dementia does not
  • Delirium’s pathology does not involve CNS whereas dementia’s does
  • Delirium is reversible whereas dementia is not
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31
Q

What is delirium?

A

Transient (<6m) acute symptoms in consciousness and cognition due to underlying pathology, it is reversible

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32
Q

What are the causes of delirium?

A

P - Pain
I - Infection (UTI/URTI)
N - Nutrition decreased
C - Constipation
H - Hydration reduced
M - Metabolic
E - Endocrine + electrolytic + environmental

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33
Q

What are the risks for delirium?

A
  • Increased age
  • PMH of delirium
  • Having dementia
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34
Q

What are the symptoms of delirium?

A
  • Clouded consciousness + cognition acutely
  • Fluctuations
  • Disturbed sleep-wake cycle
  • Disordered thinking
  • Complex visual hallucinations
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35
Q

What are the types of delirium?

A
  • Hyperactive
  • Hypoactive
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36
Q

What are the symptoms of hyperactive delirium?

A
  • Agitation
  • persecutory delusions
  • vivid hallucinations
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37
Q

What are the symptoms of hypoactive delirium?

A
  • Withdrawn
  • Reduced GCS
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38
Q

How is delirium diagnosed?

A
  • Confusion bloods - FBC, U+E, Ca++, B12/Folate, TSH, Glucose, ESR/CRP
  • Mid stream urine
  • ECG
  • Consider CXR, urine dip, CT head
  • Confirmed with SHORTCAM
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39
Q

How is delirium screened?

A

4AT test:
- Alertness
- Attention
- AMT4 - age, DOB, time, place

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40
Q

How is delirium treated conservatively?

A

Re-orient them:
- decrease noise
- same staff
- clocks on walls
- sleep-wake cycle
- family time

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41
Q

How do you treat delirium if the pt is agitated?

A
  • Verbally de-escalate
  • Haloperidol - for parkinson pts use diazepam
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42
Q

What is dementia?

A

A progressive decline in cognitive function in an alert pt for >6m with brain pathology, irreversible

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43
Q

What are the two types of demetia?

A
  • Cortical - Alzheimer’s, fronto-temporal, vascular, lewy-body
  • Subcortical - Parkinson’s, Huntington’s, alcohol, AIDS
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44
Q

What is Alzheimer’s?

A

A type of cortical dementia in which you get beta-amyloid plaques with widespread axonal damage and decreased acetylcholine

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45
Q

What are the risk factors for Alzheimer’s?

A
  • Genetic predisposition - Down’s, PSEN 1+2 genes, APP gene mutations
  • Family history
  • CVD
  • Alcohol
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46
Q

What are the symptoms of Alzheimer’s?

A

4A’s:
- Aphasia
- Agnosia - can’t recognise familiar objects
- Apraxia
- Amnesia
in Gradual decline

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47
Q

How common is ALzheimer’s?

A

Makes up 60% of all dementias

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48
Q

How common is vascular dementia?

A

makes up 20-30% of dementias

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49
Q

What are the risk factors for vascular dementia?

A
  • A result of a cardiovascular accident or repeated CVA causing cortical infarcts
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50
Q

What are the symptoms for vascular dementia?

A

4A’s:
- Aphasia
- Agnosia - can’t recognise familiar objects
- Apraxia
- Amnesia
STEPWISE DECLINE

51
Q

How common is lewy-body dementia?

A

5% of all dementias

52
Q

What is lewy-body dementia?

A

Deposits of ubiquitin and alpha-synuclein (lewy-bodies) in basal ganglia and cortex

53
Q

What are the risk factors for Lewy-body dementia?

A
  • Parkinson’s
  • Family history
  • Increased age
54
Q

What are the symptoms of Lewy-body dementia?

A
  • REM sleep disorder
  • Vivid visual hallucinations
  • Parkinsonism
  • Cognitive fluctuation
55
Q

Which is the most rapidly declining dementia?

A

Lewy-body

56
Q

How common is frontotemporal dementia?

A

5% of all dementias

57
Q

What is frontotemporal dementia?

A

Pick bodies (TAU + ubiquitin) in frontal/temporal lobes

58
Q

What are the risk factors for frontotemporal dementia?

A
  • Family history
  • Affects 50-60 year olds
  • TDP43
  • C9 of f72
  • MAPT
  • Associated with MND
59
Q

What are the symptoms of frontotemporal dementia?

A

Frontal - apathy, mood disorders, eating changes
Temporal - troubles with grammar

60
Q

How id dementia diagnosed?

A
  • Confusion bloods + syphilis and HIV
  • ADENBROOKE’s test <82/100 is abnormal, >88 is fine
  • MMSE >25/30 is fine
  • Imaging - CT, MRI head
61
Q

What is seen on an MRI head with Alzheimer’s?

A

Diffuse cortical atrophy, sulcal widening, ventriculomegaly

62
Q

What is seen on an MRI head with fronto-temporal dementia?

A

Deposits in the frontal and temporal lobes

63
Q

What is seen on an MRI head with vascular dementia?

A

> 1 white cortical infarct

64
Q

What is seen on an MRI head with Lewy Body dementia?

A

Cortical deposits/ basal ganglia deposits/ normal

65
Q

What can differentiate between frontotemporal and Alzheimer’s?

A

SPECT scan

66
Q

What scan can be used to diagnose Lewy body dementia or parkinsons?

A

Dat scan

67
Q

What MDT is used to treat dementia?

A
  • PT
  • OT
  • SALT
  • Neuro
  • GP
  • Social care
  • Family input
68
Q

What is the treatment for Alzheimer’s?

A

1st line - Acetylcholinesterase inhibitors - rivastigmine/ galantamine/ donepezil
2nd line - NDMA inhibitor - memantine

69
Q

What is the treatment for fronto-temporal dementia?

A

SSRIs, do not give acetylcholinesterase inhibitors

70
Q

How is vascular dementia treated?

A
  • Manage vascular risk factors
  • Statins and aspirin
71
Q

How is Lewy body dementia treated?

A

Consider Rivastigmine/ galantamine/ donepezil

72
Q

What are causes of falls in elderly patients?

A

M - MSK problems (fractures, osteoporosis)
I - Iatrogenic (high anticholinergic burden)
N - Neurological (TIA/stroke, seizures)
C - Cardiac (syncope, postural HTN)

73
Q

What do you want to assess in someone who has had a fall?

A

Circumstances of fall (before, during, after)

74
Q

What can be used to estimate frailty?

A

Rockwood Frailty score 0-9
1-4 mild 5-6 mod 7-9 severe frailty

75
Q

What can be used to score a patients baseline quality of life?

A

Barthel index /100 e.g.feeding, bathing, toileting, dressing
<90 mild <60 severe dependence <20 total dependence

76
Q

What can be used to calculate falls risk?

A

FRAT tool

77
Q

What diagnostic investigations would you do for a pt presenting with falls?

A
  • Bloods - FBC, U+Es, eGFR, CK, bone profile, B12 + folate, Vit d
  • Lying/standing BP
  • ECG
  • CXR, CT head
78
Q

What are the main complications of falls?

A
  • Subdural haemorrhage
  • Pneumothorax
  • Fractures
  • Rhabdomyolysis
79
Q

What is rhabdomyolysis?

A

Increased muscle breakdown after trauma

80
Q

What are the risk factors for rhabdomyolysis?

A
  • Long lie
  • anabolic steroids
  • hyperthermia
81
Q

What are the symptoms of rhabdomyolysis?

A

Coca Cola urine + muscle pain

82
Q

How is rhabdomyolysis diagnosed?

A
  • Increased CK in blood
  • Increased myoglobin
83
Q

How is rhabdomyolysis treated?

A

IV fluids and IV bicarb

84
Q

What is postural hypotension?

A

A drop systolicaly of >20mmHg or >10mmHg diastolicaly in BP afer standing from sitting which isn’t resolved in 3 mins

85
Q

What are the risk factors for postural hypotension?

A
  • Increased age
  • CVD
86
Q

What is the pathology of postural hypotension?

A

Impaired neuro-cardiac baroreceptor reflex causing blood to pool in the legs and decreased blood vessel plasticity, therefore reduced vasoaccomodation from blood vessels

87
Q

What are symptoms of postural hypotension?

A
  • Light-headedness + syncope after standing from sitting
  • Dizzy
  • Palpitations
88
Q

What are the causes of postural hypotension?

A

CV - HF, AF, MI
Neuro - Parkinson’s
Iatrogenic - BP meds (alpha and beta blockers)
Addison’s

89
Q

How is postural hypotension diagnosed?

A
  • lying/standing bp
  • ECG
  • rule out other causes - bloods
90
Q

How is postural hypotension treated?

A

Conservative - increased water, stand slow
Med (off license) - midodrine +fludrocortisone

91
Q

Where is the most common area to get a pressure sore?

A

Sacrum + bony prominences

92
Q

What are the risk factors for pressure sores?

A
  • Bed bound
  • Immobility
  • BMI
  • Diabetes
93
Q

Why do pressure sores happen?

A

Increased friction/pressure resulting in ischaemia and necrosis

94
Q

How is the severity of pressure sores scored?

A

Waterlow score:
1. non blanching erethymia
2. mucosal breach
3. full thickness skin involvement
4. bone/joint involvement

95
Q

How are pressure sores diagnosed?

A

Bloods and site swab to identify if any infective organisms

96
Q

How are pressure sores treated?

A

Prevent - reposition pt, barrier creams
Treatment:
grades 1+2 - pain ladder, consider IV fluclox
grades 3+4 - wound dressing + surgical debridement

97
Q

What is malnutrition?

A

Nutritional defect resulting in functional effects

98
Q

What are the causes of malnutrition?

A
  • Increasing age
  • EDs
  • Malabsorption (coeliac etc)
  • Poor diet
  • Dysphagia
  • Cancer
99
Q

How can you screen for screen for malnutrition?

A

MUST score - BMI + unintentional wt loss + last time ate properly
Score > 2 - dietitians input

100
Q

What are the symptoms of malnutrition?

A
  • Anaemia (fatigue, breathlessness)
  • Poor wound healing
  • Dehydration
  • Decreased libido
  • Constipation and decreased urination
101
Q

How would you diagnose malnutrition?

A
  • MUST score
  • Bloods - FBC, U+Es
  • lying/standing bp
  • ECG
102
Q

What is the treatment for malnutrition?

A

Conservative - increase cal intake, fortisips
Dietitian - assess swallowing, monitor electrolytes, advice on diet, advise feeding method

103
Q

What are the complications of malnutrition?

A
  • Osteoporosis
  • Falls + frailty
  • refeeding syndrome
  • CV - bradycardia, ECG signs, postural hypo
104
Q

What is osteoporosis?

A

T score of <2.5 on a dexa scan, presents with a decreased fragility fracture due to decreased bone mineral density

105
Q

What are the causes of osteoporosis?

A

S - steroids
H - hyperthyroidism
A - alcohol
T - thin
T - low testosterone
E - low oestrogen
R - renal/liver failure
E - rheumatoid arthritis
D - drugs (methotrexate, lithium, warfarin)

106
Q

What are the symptoms of osteoporosis?

A

Pathological fractures

107
Q

How is osteoporosis diagnosed?

A

Bloods - haem, U+E, bone profile, LFT
1. XR - fracture
2. DEXA scan

108
Q

What does a DEXA scan do?

A

Compares BMD to healthy 30 yr old of same sex

109
Q

What do different T scores mean (DEXA scan)?

A

0- -1 - normal
-1 - -2.5 - osteopenia
>-2.5 - osteoporotic

110
Q

How is osteoporosis treated conservatively?

A
  • Increase dietary intake (milk, dairy)
  • sunlight exposure
  • Ca++ supplement
111
Q

How is osteoporosis treated medically?

A
  1. Bisphosphonates - PO alendronate, IV zolendronate
  2. Denosumab
    Other - Raloxifene, HRT
112
Q

How would you advise a pt to take PO Alendronate?

A

Take on empty stomach, first thing in the morning, stay sat up 30 mins after

113
Q

What is urinary retetntion?

A

Acute (painful >600ml) or chronic (less painful, 1000-1500ml)

114
Q

What are causes of urinary retention?

A
  • BPH
  • Prostate Ca
  • Anticholinergics
  • Faecal impaction
115
Q

How can urinary retention be diagnosed?

A
  • PR exam
  • Urodynamic studies
116
Q

How is urinary retention treated?

A
  • Analgesia
  • Catheterisation
117
Q

What is the aim of palliative care?

A
  • Trying to maximise a patients quality of life
  • Encourage them to get their affairs in order
  • Maximise a patients spiritual state
  • Family time
118
Q

What is hypothermia?

A

Core body temp <35 degrees

119
Q

How is hypothermia diagnosed?

A
  • Temp
  • ECG - Osbourne J wave
120
Q

What are the symptoms of hypothermia?

A
  • Shivering
  • Autonomic symptoms - tachycardia, HTN
121
Q

How is hypothermia treated?

A

External rewarming

122
Q

What is hyperthermia?

A

Core body temp >40 degrees

123
Q

What are the symptoms of hyperthermia?

A
  • Confusion
  • Hot flushed skin
  • Hypotension
124
Q

How is hyperthermia diagnosed?

A
  • Temp
  • ECG
  • BP
125
Q

How is hyperthermia treated?

A
  • External cooling
  • IV fluid

Phase 3a (6 decks)

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