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Phase 3a conditions list flashcards > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

What is frailty?

A

Decline in functional/ physiological reserve –> reduced ability to recover

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2
Q

What are the members of an elderly care MDT (10)?

A
  • Geriatrician
  • Nurse
  • Pharmacist
  • Dietician
  • OT
  • Physio
  • SALT
  • Psychiatrist
  • Social workers
  • Community nurse
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3
Q

What is polypharmacy?

A

5 or more drugs prescribed

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4
Q

What is appropriate polypharmacy?

A

Medications that are needed
e.g. for MI prevention

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5
Q

What are 2 common causes of inappropriate polypharmacy?

A
  • Sequential prescribing/ prescribing cascades
  • Pain management
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6
Q

What are some consequences of having multiple anticholinergic drugs (2)?

A
  • High falls risk
  • Altered mental state
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7
Q

What are some side effects of anticholingerics (8)?

A

Anticholinergic syndrome:
* Can’t see
* Can’t pee
* Can’t spit
* Can’t shit
* Flushing
* Agitation
* Reduced GCS
* AMS

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8
Q

What are some examples of anticholinergics (5)?

A
  • TCAs
  • Antihistamines
  • Antipsychotics
  • Paroxetine (most of all SSRIs)
  • Oxybutynin (for bladder control)
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9
Q

What drugs does warfarin commonly interact with to increase bleeding risk/ INR (2)?

A
  • NSAIDs
  • Macrolides (clarythromycin/ erythromycin)
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10
Q

What does clopidogrel interact with to reduce the efficacy of clopidogrel?

A

Omeprazole - increased clothing risk
other PPIs don’t cause interactions

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11
Q

What risk is associated with NSAID and SSRI co-prescription?

A

Higher risk of GI bleed - prescribe a PPI

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12
Q

What is ACE-i and spironolactone co-prescription associated with (2)?

A
  • High AKI risk
  • Hyperkalaemia
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13
Q

What can methotrexate and trimethoprim co-prescription cause?

A

Severe bone marrow suppression (myelosuppression)

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14
Q

What can statins interact with to increase their levels (2)?

A
  • Macrolide
  • Grapefruit juice
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15
Q

How can iron interact with tetracycline?

A

Reduces levels of tetracyclines

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16
Q

What is pharmacokinetics vs dynamics?

A
  • Kinetics = body on drug
  • Dynamics = drug on body
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17
Q

What are the principles of mental capacity act (2005) (5)?

A
  • Best interest of patient
  • Assume capacity until proved otherwise
  • An unwise decision should be accepted (if they have capacity)
  • Least restrictive option
  • Support to make own decision (give all info)
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18
Q

What is an independant mental capacity advocate?

A

Appointed advocate to represent the patient and what is best for them, however cannot make decisions on patients behalf

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19
Q

What is a lasting power of attorney?

A

Person appointed by patient to make decisions for them if they were to lack capacity

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20
Q

What are the two types of LPA?

A
  • Financial
  • Medical
    or both
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21
Q

What is an advanced directive?

A

Written statement by patient detailing what treatment they would/ wouldn’t want to receive, should they lack capacity. This is situation dependant and they cannot demand treatment (only refuse)

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22
Q

What is a court appointed deputy (CAD)?

A

Person appointed by a court who CAN make decisions for patient
usually used when depute over patient best interest

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23
Q

What is DOLs?

A

Deprivation of liberties - patient lacks capacity so is unfree to leave hospital/ care home if they posy risk to themselves or others

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24
Q

What is delirium (acute confusional state)?

A

Acute change in conciseness/ cognition due to underlying pathology

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25
Q

What are the causes of delirium (7)?

A
  • Pain
  • Infection
  • Nutrition
  • Constipation
  • Hydration
  • Medication
  • Environment + electrolytes
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26
Q

What increases the risk of developing delirium (3)?

A
  • Older age
  • History of delirium
  • Dementia
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27
Q

What are the signs/ symptoms of delirium (7)?

A
  • Memory disturbances (short worse than long)
  • Agitated
  • Disorientated
  • Mood changes
  • VISUAL hallucinations
  • Disturbed sleep cycle
  • Poor attention
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28
Q

How long should symptoms of delirium have gone on for?

A

Less than 6 months
after this point alternative diagnoses become more likely

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29
Q

What is a key feature of delirium?

A

Fluctuations in severity of Sx

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30
Q

What medications can trigger/ exacerbate delirium (4)?

A
  • TCAs
  • Opiates
  • Parkinsons meds
  • Benzos
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31
Q

What are the two types of delirium?

A
  • Hyperactive - agitation, delusions/ hallucinations
  • Hypoactive - reduced GCS
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32
Q

How is delirium investigated?

A
  • Confusion bloods
  • Investigate source of infection (CXR, CT head, urine dip)
  • Screening test
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33
Q

What confusion bloods should be done on those with delirium (7)?

A
  • FBC
  • U&E
  • Calcium
  • B12/folate
  • TSH
  • Glucose
  • ESR/CRP
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34
Q

What screening tests can be used for delirium (2)?

A
  • 4As = alertness, AMT4 (age, DOB, name, place), attention (months backward), acute course
  • Short CAM (confusion assessment method)
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35
Q

How is delirium treated?

A
  • Orientate = decrease noise, clocks on wall, same staff, family
  • 1st = haloperidol (for severe agitation)
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36
Q

What is important to note in treatment of agitation in those with parkinsons?

A

Usual first line treatment with haloperidol can worsen Sx of parkinsons
* 1st = atypical antipsychotics e.g. clozapine
* 2nd = benzos

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37
Q

What is dementia?

A

Progressive decline in cognitive function

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38
Q

What are the important features of patients with dementia to differentiate it from delirium (3)?

A
  • Patient is alert
  • Cognitive decline over more than 6 months
  • Irreversible
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39
Q

What are the 4 common causes of cortical dementia?

A
  • Alzheimers = MC (60%)
  • Vascular
  • Frontotemporal
  • Lewy body
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40
Q

What is the pathophysiology of Alzheimers?

A

Beta amyloid plaques and tau neurofibrillary tangles accumulation in cortex causes axon damage and reduced Ach

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41
Q

What are some risk factors for Alzheimers (5)?

A
  • Family history/ genetics
  • Older age
  • Caucasian
  • Female
  • Downs (inevitable)
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42
Q

What genes are associated with Alzheimers (3)?

A
  • APO-E4
  • PSEN 1+2
  • APP gene (autosomal dominant inheritance)
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43
Q

What are the signs/ symptoms of Alzheimers (4)?

A
  • Aphasia
  • Agnosia
  • Aphagia
  • Amnesia
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44
Q

What is the pathophysiology of vascular dementia?

A

Recurrent ischemic events in the brain damage it –> Sx of dementia

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45
Q

What are some risk factors for vascular dementia (8)?

A
  • History of stroke/ TIA
  • AF
  • Hypertension
  • Hyperlipidaemia
  • DM
  • Smoking
  • Obesity
  • CHD
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46
Q

What is the typical presentation of vascular dementia?

A

Stepwise or sudden deterioration of cognitive function

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47
Q

What are some signs/ symptoms of vascular dementia (5)?

A
  • Poor memory
  • Speech disturbance
  • Difficulty concentrating
  • Focal neurological abnormalities
  • Emotional disturbance
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48
Q

What is the pathophysiology of Lewy body dementia?

A

Ubiquitin + alpha synuclein (Lewy bodies) build up in the basal ganglia and cortex

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49
Q

What is the difference between levy body dementia and parkinsons dementia?

A
  • Lewy body = dementia first then Parkinsonism
  • Parkinsons = Parkinsonism then dementia
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50
Q

What are some risk factors for levy body dementia (3)?

A
  • Parkinsons
  • fHx
  • Older
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51
Q

What are some signs/ symptoms of lewy body dementia (3)?

A
  • VISUAL hallucinations
  • REM sleep disorder
  • Fluctuating levels of consciousness
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52
Q

What is the pathophysiology of frontotemporal dementia?

A

Pick bodies (tau-neurofibrillary tangles + ubiquitin) in frontal/ temporal lobes

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53
Q

What genes are associated with frontotemporal dementia (3)?

A
  • TDP-43
  • C9ORF72
  • MAPT gene
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54
Q

When does frontotemporal dementia usually present?

A

Younger age groups <65

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55
Q

What are the signs/ symptoms of frontotemporal dementia (5)?

A
  • Personality change
  • Disinhibition
  • Relatively preserved memory
  • Insidious onset
  • Hyperphagia
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56
Q

What symptom might indicate involvement of temporal lobe in FTD?

A

Trouble with grammar/ speech

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57
Q

How is dementia investigated (3)?

A
  • Confusion bloods (+ syphilis/ HIV)
  • Addenbrookes cognitive examination/ MMSE
  • MRI
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58
Q

What MMSE score is suggestive of cognitive impairment?

A

<25

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59
Q

What are the signs of Alzheimers on MRI (3)?

A
  • Cortical atrophy
  • Enlarged ventricles
  • Sulcal widening
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60
Q

What are the signs of FTD on MRI?

A

Frontotemproal deposits

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61
Q

What features are suggestive of vascular dementia on MRI?

A

White cortical deposits

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62
Q

What feature is suggestive of Lewy body on MRI?

A

Cortical/ BG deposits

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63
Q

What is a SPECT scan (single positron emission CT) good at differentiating (2)?

A
  • FTD
  • Altzheimers
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64
Q

What is a DaT (dopamine transporter) scan good at diagnosing?

A

Lewy body dementia

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65
Q

How is Alzheimers managed (2)?

A
  1. Ach-ase inhibitors (donepezil, galantamine, rivastigmine)
  2. Memantine (NMDA antagonist)
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66
Q

What medication should NOT be given to those with Alzheimers?

A

Antipsychotics

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67
Q

What is a contraindication for donepezil?

A

Bradycardia

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68
Q

What is a side effect of donepezil?

69
Q

How is FTD treated?

A

No approved treatments
SSRIs, antipsychotics can be given, Ach-ase inhibitors NOT given

70
Q

How is vascular dementia treated?

A

No approved treatments

71
Q

How is lewy body dementia treated?

A

Same as Alzheimers - Ach-ase inhibitors, memantine, NO antipsychotics

72
Q

What are some other causes of dementia (8)?

A
  • CJD - rapid dementia within 1 year
  • HIV associated neurological disorder
  • Normal pressure hydrocephalus (wet, wacky, wobbly)
  • Alcohol (Korsakoff)
  • Wilsons (auto recessive, high copper, keiser fleisher rings)
  • Neurosyphilis
  • Parkinsons
  • Huntingtons
73
Q

What is pseudodementia?

A

Dementia caused by depression (global memory loss, MMSE often normal)

74
Q

What would be suggestive of delirium rather than dementia (5)?

A
  • Shorter onset
  • Impaired consciousness
  • Fluctuating Sx
  • Visual hallucinations
  • Agitation
75
Q

What are some risk factors for falls (7)?

A
  • Weakness
  • Vision problems
  • Balance/ gait disturbance (e.g. parkinsons, RA)
  • Polypharmacy
  • Incontinence
  • Postural hypotension
  • Cognitive impairment
76
Q

How should a patient who has fallen be assessed (4)?

A
  • Circumstances before, during and after fall
  • Barthel index (assess ADLs)
  • Rockwood clinical frailty score
  • Fall risk - FRAT score
77
Q

How should a fall be investigated (4)?

A
  • Bloods
  • L/S BP
  • ECG
  • CXR + CT head
78
Q

What bloods are important in those who have fallen (7)?

A
  • FBC
  • U&E
  • eGFR
  • CK
  • Bone profile
  • B12/folate
  • Vitamin D
79
Q

How is a fall treated (4)?

A
  • Medication review
  • Physio + OT
  • Home assessment
  • Eye check
80
Q

What are some complications of a fall (4)?

A
  • Fracture (esp HIP)
  • Subdural haematoma
  • Rhabdomyolysis
  • Pneumothorax
81
Q

What is rhabdomyolysis?

A

Muscle breakdown and release of contents into bloodstream

82
Q

What is rhabdomyolysis common after a fall?

83
Q

What are some risk factors for rhabdomyolysis (2)?

A
  • Steroid use
  • Hyperthermia
84
Q

What are the signs/ symptoms fo rhabdomyolysis (2)?

A
  • Muscle pain
  • Coca-cola urine
85
Q

What blood results would be suggestive of rhabdomyolysis (3)?

A
  • Raised creatinine kinase
  • Raised myoglobin
  • Hyperkalaemia
86
Q

How is rhabdomyolysis treated (2)?

A
  • IV fluids
  • IV sodium bicarbonate
    to prevent AKI
87
Q

What medications commonly cause falls in elderly (6)?

A
  • BP meds
  • Nitrates
  • Anticholinergics
  • Antidepressants
  • Benzos
  • Opiates
88
Q

What are the criteria for a diagnosis of postural hypotension (3)?

A
  • Drop in 20mmHg or more union standing - systolic BP
    or
  • Drop in 10mmHg or more upon standing - diastolic BP
    within 3 minutes of standing
89
Q

What is the pathophysiology of postural hypotension?

A

Impaired neuro-cardiac baroreceptor reflex + decreased BV plasticity –> blood pools in legs + low BP

90
Q

What are some causes of postural hypotension (5)?

A
  • Heart failure/ AF
  • Autonomic dysfunction e.g. diabetes, parkinsons
  • Medications (esp. BP meds)
  • Alcohol
  • Addisons
91
Q

What are the signs/ symptoms of postural hypotension (5)?

A
  • Lightheadedness
  • Syncope
  • Dizzy
  • Palpitations
  • Visual changes
92
Q

How should postural hypotension be investigated (3)?

A
  • L/S BP
  • ECG
  • Bloods
93
Q

How should postural hypotension be managed (3)?

A
  • Conservative = stand slowly, increased water intake
  • Midrodine (alpha 1 agonist)
  • Fludrocortisone (aldosterone)
94
Q

What is the pathophysiology of a pressure sore?

A

Pressure –> reduced blood flow + friction –> erosion of tissues

95
Q

What are the most common sites of pressure sores (2)?

A

Bony prominences (e.g.):
* Sacrum
* Heel

96
Q

What are some risk factors for pressure sores (4)?

A
  • Immobility
  • Malnourishment + dehydration
  • Incontinence
  • Pain (causes lack of mobility)
97
Q

What scoring system is used to classify the risk of developing pressure sores?

A

Waterlow score

98
Q

What are the criteria for grading the different severities of pressure sores (4)?

A
  1. Non blanching erythema + intact skin
  2. Mucosal breach (only affecting epidermis/ dermis)
  3. Full thickness skin involvement (can affect SC tissue)
  4. Bone/ muscle/ joint involvement (through fascia)
99
Q

How are pressure sores investigated (2)?

A
  • Bloods
  • Sore swab (MC&S)
100
Q

How are pressure sores prevented (2)?

A
  • Repositioning
  • Barrier cream
101
Q

How are pressure sores managed (4)?

A
  • Pain ladder
  • IV fluclox (if cellulitis suspected)
  • Wound dressing
  • Surgical debridement (grade 3/4)
102
Q

What is malnutrition?

A

Nutritional defect with functional/ biological effects

103
Q

What are some risk factors/ causes for malnutrition (6)?

A
  • Older age
  • Eating disorders
  • Malabsorption (e.g. IBD, crohns)
  • Poor diet
  • Dysphagia (e.g. stroke)
  • Cancer
104
Q

How can the risk of malnutrition be screened for?

A

MUST (malnutrition universal screening tool)

105
Q

What are the 3 criteria in the MUST tool?

A
  • BMI
  • Unintended weight loss
  • Likely to not be able to eat properly for 5+ days
106
Q

What do the different scores in the MUST tool mean?

A
  • 0 = nothing
  • 1 = observe
  • 2+ = dietician review
107
Q

What are the signs/ symptoms of malnutrition (5)?

A
  • Anaemia (fatigue…)
  • Poor wound healing
  • Dehydration
  • Constipation
  • Reduced urine output
108
Q

How is malnutrition investigated (3)?

A
  • Bloods
  • L/S BP
  • ECG
109
Q

How is malnutrition managed (4)?

A
  • Fortispis + increase dietary intake
  • Dietician review
  • Enteral feeding methods
  • Parenteral feeding
110
Q

What would a dietician assess in a review (4)?

A
  • Swallow
  • Monitor electrolytes (reseeding syndrome)
  • Advise diet
  • Advise feeding method
111
Q

What are the types of enteral feeding (3)?

A
  • Nasogastric/ nasojejunal feeding
  • Percutaneous endoscopic gastrostomy
  • Percutaneous endoscopic jejunostomy
112
Q

How long can a NG tube stay in for?

A

30-60 days

113
Q

What is an paraenteral feeding method?

A

PICC feeding

114
Q

What are some complications of malnutrition (5)?

A
  • Osteoporosis
  • Falls
  • Refeeding syndrome
  • CV (bradycardia, arrhythmias)
  • Poor immunity
115
Q

What is osteoporosis?

A

Reduced bone mineral density

116
Q

What is the diagnostic criteria for osteoporosis?

A

Femoral head BMD < -2.5 on DEXA scan

117
Q

What causes osteoporosis (9)?

A
  • Steroids
  • Hyperthyroid/ parathyroid
  • Alcohol + smoking
  • Thin
  • Testosterone (low)
  • Early menopause
  • Renal/ liver failure
  • Erosive bone disease (e.g. RA)
  • Drugs
118
Q

What drugs commonly cause osteoporosis (other than steroids) (3)?

A
  • AEDs (e.g. phenytoin)
  • PPIs
  • SSRIs
    + steroids obviously
119
Q

How is osteoporosis investigated (2)?

A
  • Bloods
  • DEXA scan
    X-ray to look for fractures
120
Q

What does the T-score compare the BMD to?

A

Healthy 30 year old

121
Q

What is the Z score?

A

BMD compared to average for same demographic

122
Q

What are the different T-scores suggestive of? (3)

A
  • > -1 = normal
  • -2.5 –> -1 = osteopenia
  • < -2.5 = osteoporosis
123
Q

What score assess the risk of people with osteoporosis?

A

FRAX score

124
Q

What specific risk does the FRAX score assess?

A

Risk of major osteoporotic fracture in next 10 years (in 40-90 year old)

125
Q

What are the different risk categories according to FRAX score (3)?

A
  • < 10% = low risk –> follow up
  • 10-20% = medium risk –> DEXA scan
  • > 20% = high risk –> treat + DEXA
126
Q

How is osteoporosis managed (5)?

A
  • ADCAL D3
  • Bisphosphinates = 1st line
  • Denosumab
  • Raloxifene
  • HRT
127
Q

When should a patient be immediately started on osteoporosis meds without the need for a DEXA scan?

A

Fragility fracture in patients over 75

128
Q

What are two options for bisphosphinates?

A
  • PO alendronate
  • IV zoledronate (yearly)
129
Q

How should oral alendronate be taken?

A
  • Empty stomach (30 min before or 2 hour after food)
  • Stay sat for 30 minutes
  • Take with a glass of water
130
Q

What are two side effects of alendronate (2)?

A
  • Gord
  • Osteonecrosis of the jaw
131
Q

How does Denosumab work?

A

Inhibits RANK-L
RANK-L increases osteoclasts activity and decreases osteoblast activity

132
Q

How does raloxifene work?

A

Oestrogen agonist at bone (inhibitor at endometrium)

133
Q

What is incontinence?

A

Involuntary enuresis

134
Q

What are the types of incontinence (5)?

A
  • Urge/ overactive bladder
  • Stress
  • Mixed
  • Overflow
  • Functional
135
Q

What are the features of urge incontinence (2)?

A
  • Key in door syndrome
  • Nocturnal Sx
136
Q

What triggers stress incontinence?

A

Valsalva manoeuvres

137
Q

What is overflow incontinence?

A

Lower urinary tract obstruction e.g. BPH –> post void retention –> unexpected leaks

138
Q

What are some risk factors for incontinence (9)?

A
  • Female
  • Multiparity
  • Older age
  • Abdo surgery
  • BPH
  • Spinal trauma (neurogenic bladder)
  • Constipation
  • Medications (e.g. diuretics)
  • Ketamin use
139
Q

How is incontinence investigated (5)?

A
  • Bladder diary
  • Vaginal exam
  • Urine dip
  • Urodynamics
  • Imaging?
140
Q

How is urge incontinence treated (3)?

A
  • Bladder retraining (6 weeks)
  • Oxybutynin (antimuscarinics)
  • Mirabegron (for older people - not anticholinergic)
141
Q

How is stress incontinence treated (3)?

A
  • Pelvic floor exercises (for 3 months)
  • Surgery
  • Duloxetine
142
Q

What are the two types of urine retention?

A
  • Acute
  • Chronic
143
Q

What is acute vs chronic urine retention in terms of volume?

A
  • Acute > 600ml
  • Chronic 1000-1500ml
144
Q

What are some causes of urinary retention (3)?

A
  • BPH/ prostate cancer
  • Anticholinergics, TCAs, opioids
  • Faecal impaction
145
Q

How is urinary retention investigated (4)?

A
  • Urinalysis
  • PR exam (for faecal impaction/ enlarged prostate)
  • Bloods
  • USS bladder
146
Q

How is urinary retention treated (2)?

A
  • Catheterise
  • Analgesia
147
Q

What are 3 complications of urinary retention?

A
  • Hydronephrosis
  • Pyelonephritis
  • AKI
148
Q

What time period does palliative care usually refer to?

A

Less than 3 months left to live

149
Q

What are the principles of palliative care (4)?

A
  • Maximise QOL
  • Set affaris in order (e.g. will)
  • Address spiritual needs
  • Look after family
150
Q

What is often first line for pain in palliative care?

A

Morphine/ other opioids

151
Q

What are some examples of opioids other than morphine (4)?

A
  • Codeine (50% oral bioavailability)
  • Tramadol
  • Oxycodone
  • Diamorphine
152
Q

What is first line for agitation in palliative care?

A

Haloperidol
when terminal = midazolam

153
Q

How are secretions treated in palliative care (2)?

A
  • Hyoscine
  • Glycopyrronium
154
Q

What is first line for N+V in palliative care?

A

Metoclopramide

155
Q

How is dyspnoea treated in palliative care (3)?

A
  • Opioids
  • Midazolam
  • O2
156
Q

How can medications be delivered in palliative care if patient is unable to take them orally?

A

Syringe diver

157
Q

What is hypothermia?

A

Core temperature < 35

158
Q

What are the signs/ symptoms of hypothermia (5)?

A
  • Shivering
  • Cold + pale skin
  • Slurred speech
  • Tachypnoea + tachycardia
  • Confusion
159
Q

How should hypothermia be investigated?

A
  • Take temperature
  • ECG
160
Q

What might an ECG show for those with hypothermia?

A

Osborn-J waves
small humps at end of QRS

161
Q

How is hypothermia treated (3)?

A
  • ABCDE
  • External reheating
  • Warm IV fluids
162
Q

What is considered hyperthermia?

A

Core body temperature > 40

163
Q

Who is typically affected by hyperthermia (2)?

A
  • Young patient due to exertion
  • Older patient due to temperature
164
Q

What are the signs/ symptoms of hyperthermia (6)?

A
  • Tachycardia
  • Hot flushed skin
  • AMS + confusion
  • Muscle cramps
  • Seizures
  • Hypotension
165
Q

How should hyperthermia be investigated (3)?

A
  • Take temperature
  • ECG
  • BP
166
Q

How is hyperthermia managed (3)?

A
  • ABCDE
  • IV fluids
  • COOLING
167
Q

What muscles are commonly affected by nocturnal cramps (2)?

A
  • Claf
  • Feet muscles
168
Q

How can nocturnal cramps be treated?

A

Quinine
SE = ECG changes, hypotension, metabolic acidosis

169
Q

What care packages can the NHS provide (4)?

A
  • Home apparatus (e.g. handrails, ramps)
  • Allowances (e.g. PIP, attendance allowance)
  • Carers up to 4 times per day
  • Continued NHS healthcare (e.g. palliative care)

Phase 3a conditions list flashcards (31 decks)

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