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Z IPE > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

Neural causes of syncope

A

• Neural causes:
○ Vasovagal (most common):
§ Severe pain, fear, blood phobia
§ Orthostatic stress eg prolonged standing or in hot places
○ Situational eg micturition, Cough, sneeze
Carotid sinus hypersensitivity - while shaving, tight collar

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2
Q

Postural hypotension causes of syncope

A

Postural hypotension:
○ Autonomic failure - postprandial, medication, MSA, parkinsons, diabetic neuropathy
Hypovolemia - haemorrhage, addisons, dehydration

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3
Q

Cardiac arrhythmia causes of syncope

A

○ Long QT
○ Drug induced arrhythmia
AV conduction disease

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4
Q

Structural cardiopulmonary causes of syncope

A

○ Aortic stenosis
○ ACS
○ Pericardial tamponade
HOCM

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5
Q

Hx of syncope

A 
• Was LOC complete?
	• How long LOC? How quickly did it come on?
		○ Vasovagal is brief complete LOC not lasting more than 20 secs
	• Warning sx?
	• Recovery spontaneous and total?
		○ Postictal sx - seizure
	• Situational trigger?
	• Change In meds?
FHx of sudden death? - HOCM
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6
Q

Ix of syncope

A 
Ix:
	• LS BP
	• Cardiac exam
	• ECG
	• FBC - anaemia
Fasting BM - hypoglycaemia
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7
Q

Syncope differentials

A 
Syncope differentials:
	• Epilepsy
	• Narcolepsy
	• Dizziness without LOC
	• TIA/Stroke
Hypoglycaemia
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8
Q

Rules on driving for seizures

A

Seizures:
• 1st seizure - No driving for 6 mths
• Multiple seizures:
Seizure free for 12 months - may qualify for license

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9
Q

Rules on driving for syncope

A

Syncope:
• Simple faint - no restriction
• Single episode, explained & treated - 4 wks off
• Single episode, unexplained - 6 mths off
2+ eps - 12 mths off

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10
Q

Stroke driving rules

A

• 1 mth off driving may not need to inform DVLA if no residual neurological deficit
Multiple TIAs over short period of time - 3 mths off + inform DVLA

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11
Q

Tremor differentials and classification

A

Classifying tremors:
• Rest - PD (pill rolling, bradykinesia)
• Intention - Cerebellar disease
• Tremor on movement - Essential tremor, thyrotoxicosis, anxiety, drugs (beta agonists)

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12
Q

inheritance of essential tremor, S&S, tx

A

Benign auto dom condition which affects both upper limbs

S&S:
• Postural tremor worse if arms outstretched
• Improved by alcohol and rest

Tx:
• Propanolol

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13
Q

guillan barre S&S and causes

A 
S&S:
	• Ascending weakness
	• Parasthesia
	• Hyporeflexia
	• Severe cases lead to muscle weakness and resp failure
Caused by:
	• Often triggered by infection Campylobacter jejuni
	• Lymphomas esp hodgkins
	• Pregnancy
	• Surgery
	• Drugs
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14
Q

Explain ROSIER tool

A

ROSIER tool to assess stroke likelihood:
• New onset asymmetrical facial weakness, limb weakness, speech disturbance, or visual field defect - 1 point each
• LOC or seizure = -1 point
• Stroke likely if >0 points

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15
Q

Tx of stroke

A 
Acute Tx:
	• ABCDE
	• High flow o2
	• Optimise BM
	• Ischemic stroke:
		○ IV alteplase if within 4.5 hrs of symptoms
		○ 300mg Aspirin
	• Hemorrhagic stroke:
		○ Neurosurgery referral
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16
Q

S&S of intracranial abscess

A 
S&S:
	• Fever
	• Headache
	• GCS lowered
	• Focal deficits
	• Generalised tonic clonic seizures
	• Meningism
	• Infants - Bulging fontanelles
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17
Q

ix and tx of intracranial abscess

A 
Ix:
	• FBC
	• Blood cultures
	• LP - rules out meningitis. Only if no signs of raised ICP
	• CT head
	• Abscess aspiration for culture

Tx:
• Drain and culture
• Sepsis 6
• IV dexamethasone if cerebral oedema suspected
• Surgery - surgical excision of abscess

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18
Q

S&S of NPH

A

Wet, wobbly, and whacky:

• Urinary incontinence, gait ataxia, dementia

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19
Q

Ix and tx of NPH

A

Ix:
• Imaging reveals hydrocephalus with enlarged 4th ventricle

Tx:
• Ventriculoperitoneal shunting

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20
Q

Patho and S&S of degenerative cervical myelopathy

A

Spinal stenosis at the cervical level

S&S:
	• Pain in limbs and neck
	• Loss of motor function
	• Loss of sensory function - numbness
	• Loss of autonomic function - continence, impotence
21
Q

Ix and tx of degen cerv myelopathy

A

Ix:
• MRI cervical spine

Tx:
• Surgical Decompression

22
Q

S&S of parkinsons

A 
S&S:
	• Classic triad:
		○ Bradykinesia - short shuffling steps (MUST HAVE)
		○ Tremor - pill rolling typical
		○ Rigidity - lead pipe rigidity
	• Mask like facies
	• Drooling of saliva
	• Depression

Sx worse on one side than other usually

23
Q

Tx of parkinsons

A

Tx:
• Delay tx until onset of disabling sx and then introduce dopamine receptor agonist (DRA)
• DRA:
○ Bromocriptine
○ ADR - day time somnolence, impulse control disorders
• Levodopa:
○ Reduced effectiveness over time usually 2 yrs
○ ADR - dyskinesia, dry mouth, anorexia, postural hypotension

24
Q

Patho of huntingtons

A

Patho:
• Auto dom
• Huntingtin protein accumulates in brain and causes damage

25
Q

S&S and ix of huntingtons

A 
S&S:
	• Involuntary movements
	• Argumentative behaviour
	• Depression
	• Chorea - quick, "dancing" movements of hand and face
	• Rigidity
	• Dystonia
	• Dementia
	• Weight loss

Ix:
• FHx
• DNA analysis
• CT head

26
Q

Tx of huntingtons

A

Tx:
• Antidepressants
• Tranqs to control chorea

27
Q

S&S of multi systems atrophy

A

S&S:
• Parkinsonism
• Postural hypotension
• Ataxic gait - uncoordinated movements, drunk like

28
Q

S&S of myasthenia gravis. when is it a crisis

A 
S&S:
	• Weakness and fatiguability
	• Ptosis
	• Diplopia
	• Dysphagia
	• Dysarthria
	• Myasthenic crisis - Resp function affected
29
Q

Ix and tx of MG

A

Ix:
• Ach receptor antibodies
• Tensilon test - anticholinesterase test
• CXR - look at thymus (thymus abnormal in majority)

Tx:
	• Anticholinesterases eg pyridostigmine
	• Surgery - thymectomy
	• Immunosuppressants - steroids, DMARDs
	• Myasthenic crisis - IV immunoglobulins, plasmapheresis
30
Q

Patho of syringomyelia and S&S

A

Patho:
• Development of cysts in spinal cord that compress

S&S:
	• Asymmetrical initially
	• Wasting and weakness of arms
	• Spinothalamic sensory loss - pain and temp
	• Loss of reflexes
31
Q

Causes of sensory neuropathy

A 
Sensory neuropathy causes:
	• Diabetes
	• Alcohol
	• RA
	• Drugs
	• Malignancy
	• B12 deficiency
32
Q

Causes of motor neuropathy

A 
Motor Neuropathy causes:
	• Guillan Barre
Motor neurone disease
	• Charcot-marie-tooth disease
	• Lead toxicity
33
Q

Ix of peripheral neuropathies

A 
Ix:
	• Urine dipstick
	• BM
	• FBC
	• B12 levels
	• History of alcohol
34
Q

Diseases of motor neurone disease

A

Diseases:
• Amyotrophic lateral sclerosis
• Progressive muscular atrophy
• Bulbar palsy

35
Q

S&S of MND

A 
S&S:
	• Fasciculations
	• Absence of sensory signs/symptoms
	• Mix of lower motor neurone and upper motor neurone signs - eg absent reflexes in upper limb and exaggerated reflexes in lower limb
	• Wasting of small hand muscles
36
Q

Causes of 4th nerve palsy and S&S

A

Cause:
• Head trauma
• CV risk factors

S&S:
• Eye is elevated
• Unable to look down and in or read

37
Q

Causes of 6th nerve palsy and S&S

A

Cause:
• CV risk factors
• Raised ICP
• Vasculitis

S&S:
• Eye unable to abduct beyond the midline

38
Q

Causes of 3rd nerve palsy and S&S

A

Causes:
• DM
• Vasculitis
• Posterior communicating artery aneurysm

S&S:
• Eye down and out
• Ptosis
• Pupil dilated

39
Q

Causes of Horners and S&S

A 
S&S:
	• Miosis (constricted pupil)
	• Ptosis
	• Anhidrosis (loss of sweating over half of face)
	• Apparent enopthalmos

Causes:
• Pancoast tumour
• Iatrogenic - thyroidectomy
• MS

40
Q

Bells palsy patho, epi

A

Epidemiology:
• 20-40 years peak incidence
• Pregnant women more common

Acute, unilateral, idiopathic facial nerve palsy

41
Q

S&S of bells palsy and tx

A

S&S:
• Lower motor neuron facial nerve palsy - FOREHEAD AFFECTED:
○ In upper motor neuron lesion, upper face is spared
• Post auricular pain
• Altered taste
• Dry eyes

Tx:
• Prednisolone
• Artificial tears

42
Q

S&S of trigeminal neuralgia and tx

A

S&S:
• Severe unilateral pain - sudden, shock like
• Triggered by touch to face or using face

Tx:
• Carbamazepine
• Referral to neurology if no response

43
Q

S&S of alzheimers, lewy body, frontotemporal dementia, vascular dementia, and normal pressure hydrocephalus and pseudodementia

A

Alzheimers - 50% of cases:
• Presentation:
○ Gradual with progressive cognitive decline
○ Diagnosis supported via radiology

Vascular Dementia - 25% of cases:
• Presentation:
○ CVA evidence
○ Deterioration in cognitive function

Frontotemporal Dementia - 7% of cases:
• Presentation:
○ Decline in social and personal conduct - personality change and disinhibition
○ Emotional blunting
○ Echolalia, mutism
○ Lack of insight but sparing other cognitive functions

Lewy Body Dementia - 15% of cases:
• Presentation:
○ Day to day fluctuations in cognitive performance
○ Visual hallucinations
○ Parkinsonism
○ Extreme sensitivity to anti-psychotics

Normal Pressure hydrocephalus:
• Triad of symptoms - urinary incontinence, gait ataxia, dementia. whacky, wobbly, wet

Pseudodementia:
Reversible and due to depression - SSRIs

44
Q

Steps for nutrition if malnourished

A

Steps for nutrition:

1. Oral nutrition
2. Enriched oral nutrition - high calorie foods eg butter
3. Oral nutritional supplements - fortisip
4. Alternative routes of feeding
45
Q

Alternative routes of feeding for malnourished. when to use each.

A 
Alternative routes of feeding:
	• NG tube:
		○ <14 days
	• Gastrotomy:
		○ Tube feeds directly into stomach via abdo surface
		○ LT feeding
46
Q

How can you monitor someones nutrition?

A

Monitoring nutrition:
• Weight changes
• Fluid balance
• Nutrient intake - prescribed vs delivered

47
Q

Mechanism of refeeding syndrome

A

Mechanism:

1. In the catabolic state, body turns to fat and protein metabolism which depletes phosphate
2. When body reintroduced to carbs, insulin rises which increases cellular phosphate demand.
3. Mg, sodium, potassium, and thiamine also required for cellular pumps
4. Leads to hypophosphatemia, hypomagnesemia, hypokalaemia
48
Q

Pts at risk of refeeding syndrome

A

At risk pts:
• Very little food intake >5days, especially if already undernourished
• Undernourished - BMI <20, unintentional weight loss >5% within last 3-6 mths
CANCER

49
Q

Tx of refeeding syndrome

A 
Tx:
	• Before and during first 10 days of feeding:
		○ Oral thiamine
		○ Vitamin B complex
		○ Multivitamin and mineral supplement
	• Monitor biochemistry - K, P, Mg

Z IPE (15 decks)

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