Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Anki 3a exports > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

What is benign paroxysmal positional vertigo?

A

Sudden episodic attacks of vertigo induced by changes in head position

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Describe the epidemiology of benign paroxysmal positional vertigo

A

Leading cause of vertigo
Increased incidence in the elderly
Increased risk in those with gallstones(calcium deposits)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe the aetiology of benign paroxysmal positional vertigo

A

Detachment of otoliths from the utricle of the inner ear
Detached particles migrate into semicircular canals where they stimulate hair cells and lead to vertigo symptoms
Acummulation of cholelithiasis in semi circular cells of inner earrr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Describe the presentation of patient with benign paroxysmal positional vertigo

A

Vertigo triggered by changes in head position (e.g. rolling in bed, looking up)
Recurrent episodes lasting aroung 30secs-1 minute
May be associated with nausea&vomiting
No auditory symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How is benign paroxysmal positional vertigo diagnosed?

A

Positive Dix-Hallpike maneouvre
Lie down with one ear pointed to ground-> check for nystagmus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Name some differentials for benign paroxysmal positional vertigo

A

Menieres disease
Vestibular neuritis
Labyrinthitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How is benign paroxysmal positional vertigo managed?

A

Epley maneuver-works in around 80%(aims to detach otoliths out of semicircular canal and back to utricle)
Usually resolves spontaneously after a few weeks/months
Can teach patients at home exercises: ‘vestibular rehab’: e.g Brandt-Daroff exercisesBetahistine not very useful

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe the prognosis for benign paroxysmal positional vertigo

A

1/2 will have recurrence of sx 3-5 years after diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What group of patients are more at risk of developing pressure ulcers?

A

Patients who are unable to move parts of their body due to illness, paralysis or advancing age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Where do pressure ulcers typicallly develop?

A

Over bony prminences like the sacrum or heel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Name some risk factors for developing pressure ulcers?

A

Malnourishment
Incontinence; urinary and faecal
Lack of mobility
Pain-; leads to decreased mobility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What scoring system is used to grade pressure ulcers?

A

Waterlow score

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How are pressure ulcers manageed?

A

Moist wound environemnt: hydrocolloid dressings and hydrogels(no soap)
Wound swabs not routinely done-> systemic abx use decided on clinical basis(surrounding cellulitis etc)
Consider referral to tissue viability nurses
Surgical debriedement for selected wounds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Whata re lower urinary tract sympotms?

A

Group of sx that occur as a result of abnormal storage, voiding or post micturition function of bladder, prostate or urethra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Describe the aetiology of LUTS

A

Neurological
Bladder
Prostate
Urethral
Other mass effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How can LUTS be classified?

A

Voiding
Storage
Post-micturition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Name somee voiding symptoms LUTS

A

Hesitancy
Straining
Terminal dribbling
Incomplete emptying
Weak/intermittent urinary stream

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Name some storage sx LUTS

A

Urgency
Frequency
Nocturia
Urinary incontinence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Name some post-micturition sx LUTS

A

Post-micturition dribbling
Sensation of incomplete emptying

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Name some differentials for LUTS

A

Bladder outlet obstruction
Overactive bladder syndrome
Urethral stricture
Prostatitis
Bladder cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What investigations might be done in a patient presenting with LUTS?

A

Urinalysis: exclude infection and check for haematuria
DRE: size and consistency of prostate
PSA test may be considered
Bladder diary
Urodynamic studies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How are LUTS managed?

A

Treat undelrying cause
Depends on type of LUTS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How aare voiding LUTS managed?

A

Conservatrive: pelvic floor/bladder trianing
BPH-5-alpha reductase inhibitor-finasteride
Alpha blocker if severe-doxazosin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How are voiding and storage LUTS managed?

A

Alpha blocker-doxazosin
Add anticholinergic-oxybutinin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How are overactive bladder symptoms managed?

A

Conservative: fluid management
Antimuscarininc if persistent-oxybutinin, tolteridone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How is nocturia managed?

A

Manage fluid intake at night
Furosemide 40mg in late afternoon
Desmopressin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the different types of urinary incontinence?

A

Stress; leaking small amounts when laughing/coughing
Urge/overactive; detrusor overactivity
Mixed: urge/stress
Overflow; bladder outlet obstruction
Functional

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What causes overflow incontinence

A

Bladder outlet obstruction(e.g. prostate enlargement)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Name some reversible causes of urinary incontinence

A

DIAPPERS
Delirium
Infection
Atrophic vaginitis/urethritis
Pharmaceutical(medications)
Psychiatric disorders
Endocrine disorders(diabetes)
Restricted mobility
Stool impaction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What investigations migh tbe done to look for causes of urinary incontinence?

A

Physical exam: organ prolapse and ability to contract pelvic floor muscles
Bladder diary: number and types of incontinenceUrinalysis: rule out infection
Cystometry: measures bladder pressure while voiding(not recommended where clear diagnosis)
Cystogram: Contrast in bladder and imaging(fistula)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is stress incontinence?

A

Leaking of urine when abdominal pressure is high; increases pressure on bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Name some risk factors for stress incontinence

A

Childbirth(especially vaginal); injury to pelvic floor muscles and connective tissue
Hysterectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Name some triggers for stress incontinence

A

Coughing
Laughing
Sneezing
Exercise
Anything that increases abdominal pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Describe the management of stress icontinence

A

Conservative: avoid fizzy, caffeinated drinks, pelvic floor exercises
Medical: Duloxetine
Surgical: GS: mid urethral slings(minimally invasive, done as outpatients)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Name some risk factors for urge incontinence

A

Recurrent UTI
High BMI
Increasing age
Smoking
Caffeine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Describe the management of urge incontinence

A

Conservative: Bladder training, avoid alcoholic/caffeinted/sugary drinks
Medical: anticholinergics: oxybutinin, tolterodine, fesoterodine
Surgical: bladder instillation, sacral neuromodulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Name a side effect of tolterodine

A

Increased risk of delirium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Name the causes of overflow incontinence

A

Underactivity of detrusor muscle(e.g from nerve damage) or if urinary outlet pressures are too high(constipation, prostatism)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What is functional incontinence?

A

Urge to pass urine but can’t access facilities so experience incontinence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Name some causes/risk factors for functional incontinence

A

Sedating meds
Alcohol
Dementias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is quamous cell carcinoma?

A

Locally invasive malignant tumour of epidermal keratinocytes
With invasion of basement membrane as it is a cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Name some risk factors for SCC

A

Excessive exposure to sunlight/UV light
Actinic keratosis and Bowen’s disease; predisposing lesions
Genetics: xeroderma pigmentosum Immunosuppresion
Smoking
Old age
Male

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

How might patients with SCC present?

A

Keratinised, scaly irregular nodules
Might be ulcerating or have everted edgesOften in sun exposed areas
Usually slow growing(months)
Pain, tenderness, bleeding
Complicaotins for local invasion-distant metastases is rare

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

How is SCC diagnosed?

A

Excision biopsy with 4mm margin
Might require 6mm margin if high risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Name some features of a possible SCC that make it more high risk

A

> 2cm diameter
Located on ear, lip, hands, feet or genitals
Elderly or immunosuppressed
Histology: poor differentiation, blood/nerve involvement, SC tissue invasion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

How is SCC treated?

A

Surgical excision
Radiotherapy may be needed
Lifestyle to prevent further lesions; sunscreen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What is the prognosis for SCC

A

5 year survival of 99% if detected early

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Name some poor prognostic factors for SCC

A

Poorly differentiated&>;2cm diameter&>4mm deep
Immunosuppression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

How can constipation be classified?

A

Primary: no organic cause: dysregulation of function of colon/anorectal muscles
Secondary: diet, medications, metabolic, endocrine, neuro, obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What criteria is used for classifying constipation?

A

Rome 6 criteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Describe the Rome 6 criteria for constipation

A

<3 bowel movements/week
Hard stool in >25% of movements
Tenesmus in >25% of movements
Increased straining in >25% of movements
Need for manual evacuation
Any or all of them can constitute a diagnosis of constipation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Name some risk factors for constipation

A

Increasing age
Inactivity
Low calorie diet
Low fibre diet
Certain medicationsFemale

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Name some possible causes of constipation

A

Inadequate fibre or fluid intake
Behavioural: inactivity of avoidance of defaecation
Electrolyte distrubances like hypercalcemia
Drugs: opiates, CCBs, antipsychotics
Neurological: spinal cord lesions, Parkinson’s, diabetic neuropathy
Endocrine-; hypothyroidism
Colon disease :strictures/cancer/obstruction
Anal disease- fissures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Name some red flag associated features of constipation

A

ALARMS
Anaemia
Lost weight
Anorexia
Recent onset
Melaena/bleeding
Swallowing difficulties

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What investigations might be done in a patient with constipation?

A

Constipation/diarrhoea+ weight loss+ >60yrs-> 2wwk wait urgent CT/US to rule out pancreatic cancer
Often no need for further ix
PR examStool sample: mcs, ova, cysts, parasites
FIT testing
Faecal calprotectin
Bloods: anaemia, hypercalcaemia, hypothyroidism
Barium enema if suspicion of impaction/rectal mass
Colonoscopy-> lower GI malgnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Describe the management of constipation

A

Conservative: dietary imrpovements and increase exercise
Laxatives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What are the different types of laxatives

A

Bulking agents
Stool softeners
Stimulants
Osmotic laxatives
Phosphate enemas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Give an example of a bulking agent

A

Ipsaghula husk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

How do bulking agents work?

A

Increase faecal bulk and peristalsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

When might bulking agents be contraindicated?

A

Dysphagia
GI obstruction
Faecal impaction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Name a side effect of bulking agents

A

Cramps

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Give an example of a stool softener

A

Docusate
Macrogol

63
Q

How do stool softeners work and when might they be used

A

Soften bowel movements
Good for fissures

64
Q

When are stool softeners contraindicated?

A

IBD
Ileus
Risk of inttestinal perforation

65
Q

Name some side effects of stool softeners

A

Flatulence
Nausea

66
Q

Give an example of a stimulant laxative

A

Senna
Biisacodyl

67
Q

How do stimulant laxatives work?

A

Increase intestinal motility

68
Q

When might stimulant laxatives be contraindicated?

A

Obstruction
Colitis

69
Q

Give a side effect of stimulatn laxatives

A

Cramps

70
Q

Give an example of on osmotic laxative

A

Lactulose
Movicol

71
Q

How do osmotic laxatives work?

A

Retain fluid in the bowel
Decrease NH3

72
Q

Give a side effect of osmotic laxatives

A

Electrolyte imbalances
Diarrhoea

73
Q

What must be done before a phosphate enema?

A

DRE first
Will cause rapid bowel evacuation

74
Q

Give some contraindications to a phosphate enema

A

Renal failure
Heart failure
Electrolyte abnormalities

75
Q

Give some side effects of a phosphate enema

A

Abdominal cramps
Dehydration

76
Q

Define malnutrition

A

BMI< 18.5 OR Unintentional weight loss >10% in the last 3-6 mths ORBMI <20 and unintentional weight loss >5% in the last 3-6 mths

77
Q

How is malnutrition diagnosed?

A

Malnutrition Universal Screen Tool (MUST)
Takes into account BMI, unplanned weight loss score and acute disease effect
Should be done on admission of if there is cause for concern
Categorises patients into low, medium and high risk

78
Q

How is malnutrition managed?

A

Dietician support if patient is high risk
‘Food-first’ approach with clear instructions(add full fat cream to potatoes etc)
Oral nutritional supplements between meals

79
Q

What is re-feeding syndrome?

A

Caused by reintroduction of glucose into the body after a period of malnutrition or fasting

80
Q

Describe the pathophysiology of re-feeding syndrome?

A

Reintroduction of glucose-> insulin secretion resumes-> shift in electrolytes

81
Q

How might patients with re-feeding syndrome present?

A

Low phosphate: weakness, resp failure, delirium, seizures
Low magnesium: muscle weakness, arrhythmias, NM excitability
Low potassium: weakness, paralysis, cardiac arrhythmias
High glucose: diabetes sx: increased thirst, urination, fatigue, blurred vision

82
Q

How is re-feeding syndrome managed?

A

Monitoring and correctin of electrolyte imbalances
Slow reintroduction of food and fluids to avoid sudden shiffts in electrolytes
Thiamine replacement for at risk patients to prevent Wernicke’s encephalopathy

83
Q

Name some risk ffactors for non-accidental injury

A

Caergive substance abuse
Caregiver mental health issues
Socioeconomic disadvantage

84
Q

How might elderly patients with non accidental injury ppresent-history?

A

Delayed presentation followwing injury
Inconsistencies in caregiver’s narratives
Unwitnessed injuries
Evidence of drug/alcohol use

85
Q

How might elderly patients with non accidental injury present-examination?

A

Injuries of varying ages
Subconjunctival/retinal haemorrhages
Bruises on arms, legs, or face consistent with grippping, burns, scalds

86
Q

Name some differentials for non accidental injury

A

Accidental injury
Bleeding disorders
Haematological malignancy

87
Q

What investigations might be done if non accidental injury is suspected?

A

Radiology: comprehensive skeletal survey(rib fractures, skull, finger, clavice etc)
Bloods: organic causes like clotting problems and blood cancers

88
Q

How should non accidentl injury be managed?

A

Report suspicions to informed senior or safeguarding lead
Measures: admit and ensure safety of anyone else in the home
Treat other injuries
Document everything
Contact social care liaison

89
Q

What is a DoLS?

A

Procedure used by law when necessary to deprive a patient or resident of their liberty as they lack capacity to consent to treatment/care to keep them safe from harm

90
Q

How must a DoLS be authorised by?

A

Supervisory authority(e.g. local authority)

91
Q

What conditions must be met to put a DoLS in place?

A

> 18yrs and mental disorder
In hospital or care home
Pt lacks capacity to decide for themselves about the proposed restrictions
Proposed restrictions in person’s best interest and would deprive person of their liberty
Not suitable for detention under the MHA

92
Q

What is Power of Attorney

A

Legal document that nominates another person to make decisions on their behalf related to financial/property or health/welfare

93
Q

What is an advanced decision?

A

Legally binding document to ensure an individual can refuse a specific treatment(s) they don’t want in the future

94
Q

What criteria must be met for an advanced decision to be put into place?

A

Valid(made when person had capacity)
Applicable(wording specific to medical decision)>18 yrs and fully informed when made
Not made under duress or influence of other people
Written down, signed and witnessed(if it concerns life saving treatment)

95
Q

What does an advanced decision cover?

A

Refusal of treatments including life sustaining treatments
Can’t refuse basic care, food/drink by mouth, measures designed purely for comfort(painkillers) or treatment of a mental health disorder if sectioned under the MHA
Can’t demand specific treatment/somethign illegal

96
Q

What is an advanced statement?

A

Statement of wishes and care preferences
Not legally binding by itself but legally must be taken into account when making a ‘best interests’ decision

97
Q

What creiteria must be met to make an advanced statement?

A

Can be made verbally but better written down for documentation
Copies can be given to anyone like GPs, carers, relatives

98
Q

What kind of things might be covered in n advanced statement?

A

Religious/personal views and how these relate to care
Food preferencesInfo about daily routine
People who you would like to be consulted when best interest decisions are being made on your behalf(not the same as creating a lasting power of attorney)

99
Q

What is osteoporosis?

A

Systemic skeletal disease characterised by decreased bone mass and altered micro-architecture of bone tissue resultin in increased bone fragility and fracture risk

100
Q

Describe the pathophysiology of osteoporosis

A

Primary: post menopausal(Type 1) and age related(type 2)-most common
Secondary: hyperthyroidism/hyperparathyroidism/alcohol abuse/immobilisation
Increased bone breakdown by osteoclasts and decreased bone formation by osteoblasts

101
Q

What genes are involved in osteoporosis?

A

Collagen
1A1Vitamin D receptor
Oestrogen receptor gene

102
Q

How does oestrogen deficiency result in osteoporosis?

A

Increases number of remodelling units
Premature arrest of osteoblastic synthetic activity and trabeculae perforation
Loss of resistance to fracture

103
Q

How do glucocorticoids cause osteoporosis?

A

Increase turnover rate initially(increased fracture risk in first 3 months)
Then decreased turnover rate with net loss due to decreased synthesis by osteoblasts
Usually when used minimum 10mg OD for >3 months

104
Q

How does ageing contribute to osteoporosis?

A

Increased turnover at the bone/vascular interface with cortical bone->weak structure for stresses in long bones/trabeculazation of cortical bone)

105
Q

Name some risk factors for osteoporosis

A

SHATTERED
Steroid use
Hyperthyroidism/hyperparathyroidism
alcohol and smoking
thin: BMI<22
testosterone deficiency(men with long term androgen deprivation therapy for prostate cancer)
early menopause-renal/liver failure erosive/inflammatory bone disease
diabetes
Also family history

106
Q

How do patients with osteoporosis present?

A

Pathological or fragility fractures(often from a fall at first
Most commonly vertebral compression fractures of appendicular fractures

107
Q

What are the most common frfactures for patients with osteoporosis?

A

Vertebral compression fractures
Appendicular fractures(proximal femur/distal radius)

108
Q

How do patients present with a vertebral fracture?

A

Sudden episode of acute back pain on rest/bending/liftingrestricted spinal felxion and intensified pain with prolonged standing
Dowager’s hump: thoracic kyphosis-. anterior thoracic spine
Paravertebral muscle spams and tenderness on deep palpation

109
Q

How do patient with appendicular fractures present?

A

NOF: hip pain, inability to weight bear, shortened and externally rotated leg
Colles: fall on outstrtched arm: wrist pain and decreased range of motion

110
Q

What is the gold standrad for diagnosing osteoporosis?

A

DEXA sacn(dual energy x-ray absorptiometry)
Can also use x-rays/MRI for suspected vertebral/other fractures

111
Q

How might you identify secondary causes of osteoporosis?

A

History and full exam
FBC, U&Es-Creatinine, calcium phosphate TFTsLFTs25OH vit D and 1-25 OH vit
Serum testosterone and prolactin
Lateral radiographs of thoracic and lumbar spine
Protein immunoelectrophoresis and urinary Bence Jones proteins

112
Q

Name some differentials for osteoporosis

A

Osteomalacia: similar but also generalised bone pain and myopathy
Paget’s: bone pain, joint pain, bone deformities, neuro complications
Malignancies: myeloma, lymphoma, metastatic/primary bone disease
Secondary causes: hyper(para)thyroidism, mastocytosis, Cushing’s, sickle cell

113
Q

For a patient with osteoporosis, what would their calcium, phosphate, ALP and PTH look like?

A

All normal

114
Q

For a patient with osteomalacia, what would their calcium, phosphate, ALP and PTH look like?

A

Low calcium
Low phosphate
High ALP
High pTH

115
Q

For a patient with Paget’s, what would their calcium, phosphate, ALP and PTH look like?

A

Normal calcium
Normal phosphate
High ALP
Normal PTH

116
Q

How should you interpret DEXA scan scoring?

A

T>;-1: normal
-1>T>;-2.5: osteopenia
T>-2.5: osteoporosis

117
Q

How is osteoporosis diagnosed?

A

DEXA scan and T score

118
Q

What scoring tool is used to determine the risk of fracture in a patient with osteoporosis?

A

FRAX score
Estimates 10 year probability of a major osteoporotic fracture

119
Q

What factors are used when calculating FRAX score?

A

Age: 40-90yrs
Gender
Previous fracture
Parental hip fracture
Smoking
Glucocorticoid use(>3 months at>5mg OD)
Rheumatoid arthritis
Secondary osteoporosis causes
Alcohol consumption
BMD

120
Q

How is FRAX score interpreted?

A

<10% :normal
10-20%: osteopenia
>20%: osteoporosis

121
Q

How is osteoporosis managed?

A

Lifestyle: decrease risk factors
Bisphosphonates
Denosumab

122
Q

What lifestyle modifications might be suggested in a patient with osteoporosis?

A

Decrease risk factors(smoking etc)
Increase calcium and vitamin D intake
Increase weight bearing and muscle strengthening exercises

123
Q

When might bisphosphonates be used as a treatment?

A

T score<-2.5 OR
-1–> -2.5 with a FRAX >20%

124
Q

How do bisphosphonates work?

A

Adhere to hydroxyapatite and inhibit oscteoclasts

125
Q

Give some examples of bisphosphonates and how they are used

A

Oral alendronate and risedronate(1 weekly doses)
Xoledronic acid(once a year infusion)

126
Q

How should bisphosphonates be taken?

A

On an empty stomach with water and remain upright for at least 30 minutes afterwards

127
Q

Name some side effects of bisphosphonates

A

Oesophagitis
Dyspepsia

128
Q

What is denosumab and when is it used?

A

Monoclonal antibody
Used for extensive osteoporosis

129
Q

How is denosumab administered?

A

SC injection every 6 months

130
Q

How does denosumab work?

A

Anti-resorptive agent that increases BMD and decreases fracture risk at spine

131
Q

Name some side efffects of denosumab

A

Limited mobilityIncreased fracture risk
Depression
Pain
Complications of medication

132
Q

What systems are required to function to have a normal gait?

A

Neurological: basal ganglia and cortical basal ganglia loop
MSK: appropriate tone and strength
Senses: sight, sound and sensation(including fine touch and proprioception)

133
Q

Name some risk factors for falls

A

biggest: previous falls
lower limb muscle weakness
Vision problems
balance/gait disturbances
polypharmacy
postural hypotension
psychoactive drugs
incontinence
>65 years
fear of falling
depression
cognitive impairment

134
Q

Name some drugs that can cause postural hypootension

A

Nitrates
Diuretics
Anticholinergics
Antidepressants
Beta blockers
Levodopa
ACE inhibitors

135
Q

Name some drugs that can cause falls through mechanisms other than postural hypotension

A

benzos
antipsychotics
opiates
anticonvulsants
codeine
digoxin
sedative agents

136
Q

What investigations might be done in patients who have had a fall?

A

Full hx, risk assessment and examination
Bedside: Obs, BP, glucose, urine dip, ECG
Bloods: FBC, U&Es, LFTs, bone profile
Imaging: x-rays of injured limbs, CT head, cardiac echo

137
Q

Describe the management of patients with falls

A

‘Turn 180 test’ or ‘Timed get up and go’ test
Consider MDT assessment
Treat underlying cause
Manage risk factors
Lifestyle/home changes

138
Q

When should an MDT assessment be considered in patients with falls?

A

> 65 yrs with>;2 falls in the last 12 months
Fall requiring medical treatment
Poor performance or failure to complete above tests

139
Q

What is delirium?

A

Acute and fluctuating disturbance in attention and cognition, often accompanied by a change in consciousness

140
Q

What are the 3 subtypes of delirium?

A

Hyperactive: increased psychomotor activity, restlessness, agitation and hallucinations
Hpoactive: lethargy, reduced responsiveness and withdrawal
Mixed: features of both hyper and hypo

141
Q

Descrieb the epidemiology of delirium

A

Common
Elderly
Incidence increases with age, severity of illness and pre-existing cognitive impairment

142
Q

Describe the aetiology of delirium

A

DELIRIUMS
Drugs and alcohol
Eyes, ears and emotional disturbances
Low output state(MI, ARDS, PE, CHF, COPD)
Infection
Retention(urine or stool)
Ictal
Under-hydration or under-nutrition
Metabolic(electrolyte imbalances, thyroid disorders, Wernicke’s
Subdural haematoma, sleep deprivation

143
Q

Name some drugs that can cause delirium?

A

Anti-cholinergics
Opiates
Anti-convulsants
Recreational

144
Q

Name some symptoms of delirium

A

Disorientation
Hallucinations
Inattention
Memory problems
Change in mood or personality
Sundowning-> worse agitation/confusion in late afternoon/evening
Disturbed sleep
Hypoactive can be easily missed

145
Q

Give some differential diagnoses for delirium

A

Dementia
Psychosis
Depression
Stroke

146
Q

How is delirium diagnosed/assessed?

A

4AT and CAM: tools
Bedside: bladder scan, review meds, ECG, urine MCS
Bloods: FBC, U&E,LFTs, TFTs, blood cultures
Imaging: CXR, US, neuroimaging if suspected cause

147
Q

Describe the management of delirium

A

Treat underlying cause
Good lighting, regular sleep-wake cycle, regular orientation and reassurance, glassess and hearing aids if needed
If severely agitated: haloperidol/lorazepam, olanzapine as last resort due to side effects
Don’t give haloperidol for Parkionsonism(blocks dopamine receptors)

148
Q

Name some factors favouring delirium over dementia

A

Acute onset
Impairment of consciousness
Fluctuation of symptoms(worse at night, periods of normality)
Abnormal perception(hallucinations, illusions)
Agitation, fear
Delusions

149
Q

Name some risk factors for delirium

A

Age>65 yrs
Background of dementia
Significant injury(hip fracture)
Frailty or multimorbidity
Polypharmacy

150
Q

Describe the features of a Grade 1 pressure ulcer

A

non-blanchable erythema of intact skin. Discolourationof skin, warmth, oedema or hardness used as indicators

151
Q

Describe the features of a Grade 2 pressure ulcer

A

Partial thickness skin loss involving epidermis/dermis or both.
Ulcer is superficial and present clinically as an abrasion/blister

152
Q

Describe the features of a Grade 3 pressure ulcer

A

Full thickness skin loss involving damage to or necrosis of SC tissue that may extend down to but not through underlying fascia

153
Q

Describe the features of a Grade 3 pressure ulcer

A

Extensive destruction, tissue necrosis ordamage to muscle, bone or supporting structures with/wihtout full thickness skin loss

154
Q
A

Anki 3a exports (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions