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COMP 2 > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

Abbreviated mental test score

A

Snapshot at that point in time

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2
Q

What is tested in AMT??

A 
Place 
Time
Year
Age
DOB
Immediate + short term memory
Dates of WWII
Monarch
Count  to 1
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3
Q

Folstein mini-mental test

A

30 questions.

snap shot

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4
Q

Clock drawing test

A

All on one side- neglect- lesion on the opposite side.

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5
Q

Anosognosia

A

Deny any problems with their clock

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6
Q

Interlocking pentagons

A

apraxia

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7
Q

ACER

A

Addenbrooks cognitive examination

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8
Q

MOCA

A

Montreaal cognitive assessment

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9
Q

BASDEC

A

Screen for depression (out of 21)

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10
Q

GDS

A

out of 15

Geriatric depression scale

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11
Q

Hamilton score

A

out of 30

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12
Q

Cornell score

A

Depression in dementia

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13
Q

Barthel Index Functional Scale

A

Stroke rehab

Out of 20 or 100

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14
Q

Berg Balance Score

A

PTs to assess stability

out of 56 (low is bad)

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15
Q

Dizziness affects

A

13-38% of the elderly.

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16
Q

Peripheral vestibular causes of dizziness

A

Vestibular end organs and nerves

Vertigo with a visual feeling of movement.

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17
Q

Peripheral vertigo

A

Tinnitus and ear pain

Feeling of a fullness in the ear.

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18
Q

Causes of middle ear sepsis

A

Otitis media

Cholesteatoma

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19
Q

Inner ear disease

A 
Menieres
Vestibular neuronitis
BPPV
Ramsey-Hunt
Drugs
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20
Q

Ramsey Hunt

A

Ramsay Hunt syndrome is typically associated with a red rash and blisters (inflamed vesicles or tiny water-filled sacks in the skin) in or around the ear and eardrum and sometimes on the roof of the mouth or tongue. HERPES

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21
Q

Vestibular neuronitis

A

Vestibular neuronitis is a paroxysmal attack of severe vertigo (dizziness) which is not accompanied by deafness or tinnitus (ringing in the ear). It affects young to middle-aged adults and often follows a nonspecific upper respiratory infection.

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22
Q

BPPV

A

A balance disorder that results in the sudden onset of dizziness, spinning, or vertigo when moving the head.

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23
Q

Menieres

A

Symptoms of Meniere’s disease often fluctuate and include ringing, ear fullness, hearing loss, and poor equilibrium.

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24
Q

Drugs that are ototoxic

A

Gentamycin

Furosemide

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25
Q

Central vertigo

A

Feelings of being pushed from the sides

Often precipitated by moving head.

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26
Q

Causes of central vertigo

A

Vertebrobasillar insufficiency
Cerebral infarct
Degenerative dieasess
Tumour

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27
Q

Majority of elderly vertigo?

A

Central

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28
Q

CVS dizziness what is it?

A

Impending faint
Decreased cerebral perfusion
0 usually when standing.

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29
Q

What causes CVS dizziness?

A

Orthostatic hypotension
Blood volume loss
Arrhythmias and vasovagal symptoms.

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30
Q

Drugs that cause vertigo

A 
Hypertensives
Anticonvulsants
Sedatives
Antibiotics
NSAIDS
Aspirin
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31
Q

Extreme drug for vertigo

A

Cinnarazine

Sedates vestibular system (only V.unwell acute vertigo).

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32
Q

Driving and syncope

A

Cannot drive for 1m

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33
Q

Definition of syncope

A

Transient LOC and spontaneous recovery

Decreased cerebral blood flow.

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34
Q

Left ventricular outflow tract obstructions

A

AS

Hypertrophic obstructive cardiomyopathy.

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35
Q

Cardiac conduction disorders causing syncope

A

VT
Complete heart block
Previous MI
Known LVF.

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36
Q

Pacemaker?

A

when pauses >2.7s

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37
Q

Sinus node arrhythmias (not usually life threatening)

A

Sinus arrest
Sinus bradycardia (with symptoms)
SVT

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38
Q

Ventricular arrhythmias and syncope

A

Broad complex tachycardia

VF

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39
Q

Vasovagal syncope

A

Vagal stimulation

XS heart rate slowing and vasodilatation

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40
Q

Who gets vasovagal?

A

Young- emotion and panic attacks

Old- dehydration, medication, baro-reflex malfunction

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41
Q

Tilt table

A

BP measured up to 70 degrees.
Nitroglycerin to exacerbate it.
Use after 2nd unexplained episode.

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42
Q

Carotid sinus syndrome

A

hypersensitivity of carotid sinus
Vasodilatation and bradycardia
Asystole of up to 3sec can happen.
Put deep pressure on sinus.

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43
Q

Postural hypotension

A

Doesn’t usually cause you to SYNCOPE
Associated with DM and Lewy Body
400-800ml of blood in abdomen and when we stand volume drop of up to 30%

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44
Q

Epilepsy in eldery

A

Less than 5% of new cases.

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45
Q

Plethysmograph

A

beat to beat monitorin

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46
Q

Treatment for VT

A

Drugs and implantable defib.

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47
Q

Dementia increases your falls risk by

A

200%

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48
Q

Get up and go test

A

Should be <20 secs (walk 3m each way)

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49
Q

Lying/standing BP

A

Lying for >5mins
Stand up and measure at 0, 1, 3 mins
>20mmHg drop with SYMPTOMS= diagnostic

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50
Q

Where can we refer people who have had falls??

A

PHYSIO!

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51
Q

Vit D

A

Important for balance.

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52
Q

DXA scan

A

T>-1 is normal.
T of -1 to -2.5= osteopaenia
T of >2.5= osteoporosis.

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53
Q

T score DXA scan

A

Compare to young age

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54
Q

Z score DXA scan

A

Compare to same age bone.

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55
Q

Fracture NOF treatment

A

Operate in 48h if possible.

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56
Q

Intracapsular fracture

A

Hemiarthroplasty- blood supply compromised.

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57
Q

Extracapsular fracture

A

Reduction and internal fixation DHS

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58
Q

Alendronate

A

Women over 75
Women 50-75 with T score <-2.5 and risk factors

(still need calcium and fit D.)

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59
Q

If unable to tolerate alendronate

A

Denosumab SC 6 monthly.

Zoledronic acid 1y infusion.

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60
Q

Imaging for NOF fracture

A

Plain Xray- MRI- CT

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61
Q

2nd line after bisphosphonates

A

SERMS
Strontium
(no longer really used- MI and blood clots).

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62
Q

If on steroids for more than 3 months

A

Give bone protection.

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63
Q

TACI

A
  1. Contralateral hemiparesis (w or w/o sensory deficit)
    2/3 body areas involved.
  2. Homonymous hemianopia
  3. Higher cortical dysfunction
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64
Q

PACI

A

Less intensive than a TACI.

  1. Isolated higher cortical dysfunction
  2. FOCAL motor/sensory loss
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65
Q

POCS

A

Brainstem ischaemia with CN involvement
SAME sided motor problems.
OPPOSITE side sensory problems.

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66
Q

LACS

A

Watershed zones

No visual signs, cortical defects or loss of consiousness.

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67
Q

Amaurosis fugax

A

transient occulsion of the retinal artery

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68
Q

Dragging leg in weeks preceeding to event

A

Tumour

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69
Q

Hypertension increases your risk of stroke by

A

4-6x

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70
Q

Biggest risk factor for stroke

A

HYPERTENSION

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71
Q

How many strokes have AF?

A

15%

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72
Q

CHADS2

A 
Congestive heart failure (1)
Hypertension (1)
Age >75 (1)
Diabetes (1)
Prior stroke/TIA (2)
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73
Q

Alternatives to warfarin

A

Dabigatran
Rivaroxaban
Apixaban

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74
Q

Avoid warfarin in:

A 
Recurrent falls
Alochol
Prior bleeding
Recent GI/cerebral bleed
Cognitive problems.
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75
Q

Target INR

A
  1. 5 for most

3. 5-4 for metal valve.

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76
Q

Most strokes are:

A

embolic

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77
Q

How many ischamic strokes will look normal initally on MRI?

A

30%

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78
Q

Where is a TACI?

A

Carotid or middle cerebral artery.

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79
Q

Where is a PACI?

A

Branch of middle cerebral

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80
Q

Where is a POCS?

A

Vertebrobasilar arteries

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81
Q

Cerebella ischaemia

A

same sided DANISH

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82
Q

Midbrain ischaemia

A

can have some ant + posterior circulation signs.

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83
Q

Antithrombotics for:

A

NIH of 8-15 in first 3 hours.
0.9mg/Kg of Alteplase
10% bolus in first 2 mins then rest over an hour.

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84
Q

Types of LACS

A

Pure motor
Pure sensory
Sensorimotor

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85
Q

Pure motor LACS where?

A

Internal capsule or pons

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86
Q

Pure sensory LACS where?

A

Thalamus

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87
Q

Sensorimotor LACS?

A

Thalamus or internal capsule

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88
Q

Best type of stroke for mortality?

A

LACI

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89
Q

Worst type of stroke for mortality?

A

TACI

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90
Q

How much does antithrombosis decrease mortality?

A

45%

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91
Q

ABCD2

A 
Age >60 (1)
BP (1)
Clinical: Unilateral weakness (2) Speech (1)
Duration: 10-60mins (1) >60mins (2)
Diabetes (1)
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92
Q

Stroke can cause what for the first time?

A

Hyperglycaemia

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93
Q

TEDS in stroke

A

no-no

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94
Q

anticoagulants after stroke

A

Postpone for 2 weeks.

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95
Q

Area around infarct

A

Penumbra

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96
Q

2nd prevention for stroke

A 
Clopidogren 75mg
Carotid endarterectomy
Warfarin
BP= Perindopril or Indapamide
Statins (chol>5.2)
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97
Q

Services for patients and carers with severe dysphasia

A

CONNECT

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98
Q

Dipyridamole

A

Anti-platelet

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99
Q

Assess swallowing

A

Video Fluoroscopy GOLD STANDARD
Fibreoptic, endoscopic examination of swallow (FEES)
Gag reflex- means NOTHING!
SALT review

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100
Q

Picks’ dementia

A 
Frontal dementia
Under 65s
Good orientation
Change in behaviour
Tau proteins
Speech (aphasia)
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101
Q

Down’s dementia

A

Its a thing

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102
Q

Reversible causes of dementia

A 
Hydrocephalus
Alcohol
Neurosyphillis
hypothyroidism
Vit B12 deficiency
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103
Q

Memory

A

Sensory
Primary- short term
Secondary- long term

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104
Q

Tests for dementia

A 
FBC
U&E
LFT
TFT
Plasma glucose
Vit B12
Serology for syphilils
CXR
Brain CT/MRI
LP
EEG
Autoimmune profile.
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105
Q

RF for Alzheimers

A 
Obese
Diabetic
Binge Drinkers
Low exercise
NOT ALUMINIUM
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106
Q

AD features on biopsy

A

Amyloid core in cortex and sub-cortex.
Depletion of ACh
Temporal lobe and hippocampus most affected.

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107
Q

Drugs for AD

A

AChEI:
Galantamine
Donepezil
Rivastigmine

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108
Q

Vascular dementia history

A

headaches and dizziness

UMN signs, primitive reflexes, pseudo-bulbar palsy

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109
Q

Treatment for vascular dementia

A

treat risk factors

low dose aspirin

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110
Q

Hachinski ischaemia score

A

Vascular dementia

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111
Q

Hydrocephalus triad

A

Gait disturbance
Urinary incontinence
Dementia

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112
Q

Where are lewy bodies?

A

Cerebral cortex.

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113
Q

Fearuers of LBD

A 
Fluctuating
Bradykinesia
Rigidity
Visual hallucinations
Postural hypotension.
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114
Q

Treatment LBD

A

Anti-parkinsonian drugs.

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115
Q

CAM

A

Confusion assessment measure

  1. Acute and fluctuating.
  2. Inattention
  3. Disorganised
  4. Altered level of consciousness.
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116
Q

CJD

A

Prion

Sporadic or from BSE (meat)

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117
Q

Wernickes

A

Delirium and opthalmoplegia

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118
Q

Korsakoff’s

A

Amnesia and confabulation

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119
Q

Treatment for wernickes/korsakoff

A

PABRINEX!

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120
Q

Features of delirium (science)

A

Cholinergic deficiency
domaine excess
Altered BBB
increase in cortisol

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121
Q

RF for delirium

A

Age over 65
Dementia
Hip fracutre
Severe illness

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122
Q

Causes of delirium

A 
Infection
Cardiac
Respiratory
Dehydration
Endocrine
Drugs
Withdrawal
Retention
Constipation
Neurological
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123
Q

Clinical features of delirium

A 
Acute
Fluctuating
Inattention
Altered consciousness
Disordered thinking
Altered sleep
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124
Q

If VERY delirious can consider:

A

Lorazepam 0.5mg PO or SC or IM

125
Q

Parkinsons triad

A

Bradykinesia
Tremor
Rigidity

126
Q

Clinical diagnosis of parkinson’s

A

Brain bank criteria

127
Q

Tremor in parkinsons

A

Pill rollin
4-6Hz (low
Asymmetrical
at rest

128
Q

Rigidity in parkinsons

A

Stiffness

Lead pipe or cogwheel (when you get the tremor on top)

129
Q

Bradykinesia in parkinsons

A 
Soft voice, hypomimia
Small writing
Stooped posture
Small step length
Decreased arm swing
Drooling
130
Q

Non motor features of parkinsons

A

Mental health- psychosis, depression, impulse control
Sleep disorders- vivid dreams and restless leg
Posture instability
ANS: bladder, erections, hypotension, constipation.

131
Q

What causes the PD tremor?

A

Excess ACh

132
Q

Progressive supranuclear palsy

A 
60 year olds.
Live for 5 years.
Dementia
abnormal eye movements
righting reflex
133
Q

Multi-system atrophy

A

50years old
Live for 5-8 years.
autonomic problems and pyramidal signs
Respiratory problems.

134
Q

Corticobasal degeneration

A

60 years old

rare

135
Q

Lewybody is a:

A

alpha synucleinopathy.
LBs in DA cells which then die.
PRE SYNAPTIC

136
Q

Lewybodies can also be found:

A

rest of brain
GI tract
heart
etc..

137
Q

Later on in PD:

A

serotonin and ACh pathways affected.

138
Q

Treatment for PD- gold standard:

A

L-dopa (with dopa-carboxylase)
Sinemet
Madopar

139
Q

Sinemet

A

Co-careldopa

140
Q

Madopar

A

Co-beneldopa

141
Q

COMT-i

A

Reduce breakdown of L-dopa

Entacapone

142
Q

Dopamine agonist

A

post-synaptic

Pramipexole

143
Q

MAOBi

A

Selegiline

Stopes breakdown of endogenous DA

144
Q

Anti-ACh

A

rarely used for tremor.

145
Q

Hypothermia definition

A

<35

146
Q

Mild hypothermia

A

32-35

147
Q

Moderate hypothermia

A

28-32

148
Q

Severe hypothermia

A

less than 28

149
Q

Hypothermia increases your risk of

A 
thrombosis
pneumonia
bronchitis
VF
pancreatitis
infection
150
Q

Body in hypothermia

A

decreased shivering
decreased BMR
Decreased perception of cold
decreased vasoconstriction

151
Q

Stages of response to hypothermia

A
  1. Peripheral vasoconstriction (increase HR and BP)
  2. decrease HR due to heartblock/VT/VF
  3. Cardiac arrest (decrease BP due to decrease CO)
152
Q

RF for hypothermia

A

Extremes of age:
Alcohol ingestion: vasodilation, impaired shivering and awareness, hypothalamic dysfunction
Sepsis
hypothyroidism, hypopituitarism, hypoadrenalism, diabetes, hypoglycemia
Head injury: central core temperature dysregulation
Drug ingestions (especially phenothiazines and barbiturates)

153
Q

GI side effects of hypothermia

A

Pancreatitis
Hepatic dysfunction
Decreased peristalsis

154
Q

Kidney side effects of hypothermia

A

decreased renal blood flow rate
decreased GFR
ATN

155
Q

Neuro side effects of hypothermia

A 
slurred speech
ataxia
tremor
rigidity
hyPO reflex
156
Q

Hormones in hypothermia

A

increase in cortisol

157
Q

metabolism in hypothermia

A

decreased BMR and oxygen consumption
increase glucose (insulin doesn’t work)
increased CK
Oedema

158
Q

Rewarming for >31deg

A

slow surface rewarming.
25 degree room, blankets+
+0.5deg an hour
measure BP, T, ECG every 30 mins

159
Q

Rapid surface rewarming

A

Hot bath (41-45deg) or hugger blanket.

160
Q

Risks with rapid surface rewarming

A

Vasodilatation
drop in BP
VT/VF

161
Q

warming someone under 28deg

A

Rapid core warming
Inhaled gas and IV fluids 42deg
Peritoneal lavage (38-48deg)

162
Q

CPR continues until patient is

A

30deg

163
Q

What happens to potassium on rewarming?

A

Falls

164
Q

Prevention of hypothermia in old/poor

A

Fuel grants
Essential household equipment
Cold weather payments

165
Q

Prevalence of pressure sores in over 70

A

50%

166
Q

RF for pressure sore

A 
Immobility
Incontinence
Decrease sensation
Hypotension
Oedema
Dehydration
Confusion
DM
Malnutrition
Anaemia
Low albumin
167
Q

Grades of pressure sores

A
  1. Erythema
  2. Erythema and blister/ulcer
  3. Ulcer to subcutanous
  4. Ulcer to deep fascia- destruction of muscle.
168
Q

Most common sites of pressure sores:

A

sacrum
Greater trochanter
(shoulders,occiput,heels)

169
Q

Score for sores

A

Waterlow

170
Q

Normal capillary pressure

A

12-32mmHg

171
Q

Topical enzymatic agents for sores

A

Streptokinase

172
Q

Gel to promote healine

A

Hydrocolloid

173
Q

Undernutrition definition

A

BMI <20

174
Q

MUST stands for

A

Malnutrition universal screening tool

175
Q

MUST

A

BMI 18.5-20 (1) 10%=2
Acute disease no food for 2 days (2)
Overall risk 0=low, 1=med, 3=high

176
Q

How to monitor undernutrirtion

A

Diary
Review monthly in care/community
weekly in hospital

177
Q

drugs that cause loss of appeitite

A 
Codeine
Tramadol
Morphine
Abx
Diuretics
SSRIs
178
Q

Drugs to improve appetite

A

Mirtazepine

179
Q

Prevalence of incontinence

A

50% in nursing home

15% in community

180
Q

Pudendal nerve

A

Somatic (not SNS or PSNS)
EXTERNAL SPHINCTER and pelvic floor
Contracts to hold urine in
activated during coughing and sneezing.

181
Q

PSNS for bladder

A

S2/3/4

Innervates detrusor to contract.

182
Q

SNS for bladder

A

INTERNAL sphincter
alpha adrenergic
lower thoracic and upper lumbar part of spinal cord.

183
Q

Drug causes of incontinence

A

Loop diuretics
Anti-cholinergics (impairs detrusor)
Sedatives
Narcotics (impairs detrusor)
alpha adrenergics- increase tone of internal sphin
anti-alpha adren- decrease tone of internal sphin

184
Q

beta adrenergic SNS

A

relaxes bladder.

185
Q

Overflow incontinence

A 
atonic bladder (DM, MS, Spinal injury)
dribbling
prostate, stricture, constipation
186
Q

Overactive bladder

A

commonest cause in elderly

Infection, tumour, stones, stroke, PD

187
Q

Stress incontinence

A

weak pelvic floor (most common cause in youngers
age
hormones
child birth

188
Q

Test for incontinence

A

Urodynamic tests

189
Q

Incontinence in PD

A

detrusor hyperactivity

URGE incontinence

190
Q

Normal capacity of bladder

A

300-600ml

191
Q

First urge to void

A

150-300ml

192
Q

Reversible causes of incontinence

A 
Delirium
Infection
Atrophic vaginitis
Drugs
Psychosocial
Endocrine
Restricted mobility
Stool
193
Q

Drugs for stress incontinence

A

Duloxetine

Oestrogen

194
Q

Faecal incontinence

A

Impaction
Behavioural problems
Damage during child birth
Malignancy

195
Q

Section 2 in a MDT

A

needs a social work assessment

196
Q

section 5 in MDT

A

medically stable and ready for discharge by awaiting social reason

197
Q

CM7

A

care plan that doctors and nurses fill in together highlighting needs and medical issues.

198
Q

Support for carers

A

crossroads

carersonline

199
Q

Carers allowance

A

£58

200
Q

Driving after unexplained syncope

A

6 month ban

201
Q

antalgic gait

A

limp

202
Q

gestinant gait

A

short- catching up with centre of gravity

Parkinson

203
Q

Drug absorption in eldery

A

unaltered

204
Q

Drug distribution

A

less muscle, more fat
less water
less albumin

205
Q

Drug metabolism

A

smaller liver + less blood to liver= decreased metabolism

less P450

206
Q

Drug elimination

A

lower GFR

207
Q

Prima facie

A

Wills

208
Q

Make decision when they no longer can

A

Lasting power of attorney
health or
property and finance

209
Q

Lay advocates

A

when no relatives or friends

210
Q

Advance directive- only health decisions

A

court of protection can overrule

211
Q

Human rights 2, 3, 5, 8,

A

2-life
3- no torture
5- liberty/security
8- private and family life.

212
Q

DNAR

A

valid for current admission only- within 72h of admission

213
Q

Glut

A

activates

214
Q

GABA

A

inhibits

215
Q

5HT

A

activates motor

inhibits sensory

216
Q

Rehab

A

Comprehensive geriatric assessment

217
Q

Discharge

A

Social services- plan package
Early discharge scheme- SS/OT/PT
Rapid response teams- medical review in community
Intermediate care: improve physical function in community.

218
Q

Dyspraxia

A

speech motor programming

219
Q

medicine reconciliation

A

talking between doctors and pharmacists

220
Q

what is important for position sense and control?

A

inner ear
brainstem
cerebellum
cortex

221
Q

What are the sensory receptors important for dizziness

A

vision
vestibular
peripheral
joint proprioceptors

222
Q

Increase sway with

A

increase age

223
Q

acute dizziness

A 
vestibular neuronitis
BPV
Menieres- but very rare and arguably not benign
acute MI
acute stroke
blood loss
224
Q

chronic dizziness affects

A

13-38% of the eldery

225
Q

Dizziness+tinnitus/hearingloss=

A

peripheral hearing loss

226
Q

Dizziness+double vision worse on reading

A

central- cranial nerve 9

227
Q

immediate recall looks at

A

concentration

228
Q

short term memory may need

A

prompts

229
Q

short term memory and problems in another domain may indicate

A

dementia

230
Q

Most common cause for an altered minimental

A

delirium

231
Q

PH9Q

A

depression used by GPs

232
Q

if significantly impaired what do you use to assess mental state

A

Cornell Score

observations

233
Q

carbocystein

A

mucolytic

234
Q

dizziness 6 hours after overdose of…

A

aspirin

235
Q

what position are you dizzy in with central neurological dizziness?

A

ALL

236
Q

Vertigo drugs that cause it:

A 
hypertensives
anticonvulsants
sedatives (benzos and antidepressants)
Antibiotics
NSAIDS
Aspirin
237
Q

Aspirin and dizziness

A

Tinnitus too!

238
Q

hall pike test

A

patients head turned 45deg to one side when sat upright then extended slightly whilst the patient lies supine so their head is over the side of cough.
positive if: vertigo or nystagmus occurs.

239
Q

Aortic Stenosis

A 
SECURES
Slow rising/small volume/syncope
Ejection click 
Carotid thrill
Upper right 
Ejection systolic
240
Q

Investigations for dizziness

A 
FBC (anaemic?)
U+Es (dehydrated?)
Glucose
TFT
24 ambulatory ECG
241
Q

ENT investigations for dizziness

A

audiology
MRI
caloric test
CT head only if experiencing central vertigo or has neuro signs.

242
Q

betahistine

A

tinnitus

243
Q

neuronitis

A

Nystagmus
Hearing loss
Pt tends to fall towards affected side
follows febrile illness.

244
Q

epley maneuver

A

BPPV
patient sits up straight and examiner rotates their head towards AFFECTED ear.
patient lies down rapidly with nexck extended over edge of bed.
examiner rotates patient’s head towards the other side.

245
Q

reasoning behind Epley

A

debris is removed from the semicircular canals

246
Q

most common structural cardiac problem in old age that is treatable and causes syncope

A

aortic stenosis

247
Q

aortic stenosis most often caused by

A

congenital bicuspid valves

248
Q

do an echo when: (syncope)

A

there is a murmur or abnormal ECG

249
Q

clues for life threatening cardiac syncope

A

previous MI
family history of sudden cardiac death
known left ventricular failure.

250
Q

if an arrythmia is suspected then you would do:

A

a 7 day R test or an implantable REVEAL depnding on symptom frequency

251
Q

tilt table

A

up till 70 deg

252
Q

do a tilt table when:

A

more than 1 unexplained syncope

single episode with injury.

253
Q

carotid sinus syndrome

A

asystoles of more than 3 seconds.
test at a special clinic by applying deep pressure to carotid sinus.
observe BP and ECG at the same time

254
Q

postural hypotension and fall

A

postural hypotension is a very uncommon cause for a fall

255
Q

othostatic intolerant

A

severe autonomic degenerative disease.

256
Q

people at risk of autonomic neuropathy

A

Diabetics

Lewy-Body disease

257
Q

epilepsy accounts for % of syncope

A

5%

258
Q

pacemaker in:

A

neurogenic syncope with asystolic resopnse and frequent symptoms

259
Q

VF

A

amiodarone

or implantable defibrilation

260
Q

fludrocortisone

A

postural hypotension

261
Q

midodrine

A

alpha agonist

262
Q

cannot drive for (syncope)

A

1 month

263
Q

number of >65s who fall in community in a year

A

1/3

264
Q

number of >75s who fall in community in a year

A

40%

265
Q

dementia increases your falls by

A

2x (200%)

266
Q

how many risk factors for falling?

A

> 400

267
Q

intrinsic risk factors

A

problem with the patient

268
Q

extrinsic factors

A

due to something other than the patient

269
Q

electrolyte causes of falling

A

low sodium
low potassium
high calcium

270
Q

drugs, dementia, depression

A

central processing of balance.

271
Q

fear of falling

A

well recognized
specific objective rating scales
Fall–>fear falling–>decrease acitivty–>decrease muscle–>unsteady–>fall repeat

272
Q

how many falls cause physical injury?

A

5-15%

273
Q

when to test PTH

A

raised calcium or

eGFR over 30

274
Q

falls clinics decrease falls by

A

30% a year

275
Q

otago programme

A

falls
personalised programme
5 home visits

276
Q

lifetime risk of fractured NOF

A

Men= 6%

Women=18%

277
Q

hip fractures and mortality

A

10% die in a month

30% in a year

278
Q

if there is any doubt about fracture NOF

A

xrays taken to consultant radiologist. MRI

279
Q

if a TIA lasts longer than an hour

A

usually an area of infarction that corresponds with the symptoms

280
Q

what type of occlusion might cause bilateral signs??

A

Basilar

281
Q

stroke is the … most common case of dearth in the UK

A

3rd

282
Q

after a stroke how many die in a year

A

1/3rd

283
Q

polycythemia a risk for

A

stroke

284
Q

homocysteinuria a risk for

A

stroke

285
Q

stroke NHS budget

A

2%

286
Q

15% of TIAs

A

get a stroke

287
Q

to reduce your risk of stroke by 46% you need a reduction of

A

7.5mmHg

288
Q

reducing just salt can reduce your BP by

A

3mmHg

289
Q

PEGS and stroke

A

can delay
NG feeding may cause a hyperglycaemia which is worse outcomes for stroke
PEG if need it for more than 2 weeks

290
Q

fever and strokes

A

makes it worse

291
Q

even if BP is normal

A

stroke people will be given anti-hypertensives

292
Q

main reasons for poor functional outcome are:

A

pneumonia
dehydration
malnutrition

293
Q

over 80s dementia prevalence

A

20%

294
Q

Causes of ‘reversible’ dementia

A 
normal pressure hydrocephalus
alcohol abuse
neurosyphillis
hypothyroidism
vit B12 deficiency
295
Q

encoding

A

short term memory to long term memory

296
Q

alzheimers disease chromosomes

A

1, 14, 21

apoE4 on 19

297
Q

low attenuation area

A

cerebral infarction

298
Q

Lewy body and falls

A

postural hypotension

299
Q

no phenothiazines for:

A

Lewy Body

300
Q

neuromalignant syndrome

A

phenothiazides in lewy body.

301
Q

4 risk factors for dilirium

A

Age >65
Cognitive impairment
Severe illness
fractured hip.

302
Q

4 phases of parkinsons

A

Diagnostic- may last some time
Mainetenance- good for years
Complex- progression and treatment
palliative- eventually IPD progresses to end of life care.

303
Q

decreased heat production

A 
hypothyroidism
hypopituitary
addisons
coma
malnutiriton
infection
304
Q

increased heat loss

A

extensive skin disease
loss of fat
pagets
alcohol

305
Q

WHO reccommend minimum indoor temp to be

A

18deg

306
Q

ischaemia likely to happen when normal cap pressure of …. exceeded

A

12-32mmHg

307
Q

turn patients how often (sores)

A

2 hourly.

308
Q

sore treatment

A

hydrocolloid gel.

COMP 2 (3 decks)

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