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Medical Finals 2020 > Geriatrics > Flashcards

Geriatrics Flashcards

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USMLE® Step 1 flashcards
1
Q

What is delirium?

A

A confused state with reduced attention, altered behaviour and cognition with fluctuating consciousness.

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2
Q

Do you give antibiotics in pressure ulcer treatment?

A

Not unless there is sign of infection

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3
Q

What is the preferred dressing for a pressure ulcer?

A

Hydrocolloid and hydrogels - help facilitate a moist wound environment to encourage healing

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4
Q

Which antipsychotic should no be given in Parkinson’s Disease?

A

Haloperidol

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5
Q

Define ‘frailty’

A

A ‘clinically recognisable state of increased vulnerability resulting from aging-associated decline in reserve and function across multiple physiological systems’.

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6
Q

Who is involved in a Comprehensive Geriatric Assessment?

A

Medical Assessment: Doctor, nurse, pharmacist, dietitian, SaLT
Functional Assessment: OT, PT, SaLT
Physiological Assessment: Doctor, nurse, OT, psychologist
Social and Environmental Assessment: OT, social worker

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7
Q

What are some common causes of falls in the elderly?

A

Drugs
Age-related changes
Medical - vertigo, arrythmias, stroke, MI, postural hypotension
Environmental

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8
Q

Give 5 causes of immobility in the elderly.

A 
Pain
Joint stiffness - arthritis, gout, osteoporosis
Weakness - neurological
Visual impairment
Frequent falls
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9
Q

What is polypharmacy?

A

Polypharmacy is when a patient is currently prescribed over 4 medications concurrently.

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10
Q

What are the risks of polypharmacy?

A

Increased side effects
Increased falls risk
Drug interaction
Decreased compliance

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11
Q

What antibiotic covers gram negatives?

A

Gentamycin

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12
Q

What antibiotic is best suited for anaerobes?

A

Metronidazole

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13
Q

What antibiotics are contraindicated in pregnancy?

A

Trimethoprim - 1st trimester

Nitrofurantoin - 3rd trimester

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14
Q

Give the class and names of drugs that can be used in Alzheimer’s Disease?

A

Memantine, Rivastigmine, Donepezil (AChE inhibitor)

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15
Q

Give 5 investigations you would do in an old lady with new onset confusion.

A

FBC, U&E, LFT, MSU, CXR, ECG, TFT, B12/Folate, Ca2+ ESR/CRP

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16
Q

How can nurses help reduce the risk of delirium?

A

Clocks in room
Avoid unnecessary procedures
Keep patient in same room - avoid transfers

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17
Q

What tests could you do to assess someone’s mental state?

A

AMT

MMSE

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18
Q

Give 3 risk factors for pressure ulcers excluding age.

A

Immobility, fall, malnutrition, dehydration, sensory impairment, obesity, urinary/foecal incontinence, related tissue perfusion

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19
Q

How can you prevent pressure ulcers (3 things)?

A

Repositioning, improved mobility, pressure redistribution mattresses, barrier creams

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20
Q

Hip fracture was result of reduced bone density. Name 2 treatments that will improve bone health.

A

Allendronic Acid, vitamin D and calcium supplements

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21
Q

List 6 causes of delirium.

A

Infection, metabolic (hypo, renal failure, liver failure, electrolyte imbalance), drugs (benzos, opiates, alcohol), hypoxia, MI, intercranial lesion, nutritional deficiency (B12, folate)

22
Q

List 4 blood tests you would do to exclude treatable causes of dementia.

A

Syphilis serology. B12/Folate. Calcium. TFT. LFT (alcoholism, hepatic encephalopathy)

23
Q

What is Donepezil and what types of dementia can it be used to treat?

A

It is an acetylcholinesterase, used to treat Alzheimer’s

24
Q

What are the four key clinical signs of delirium?

A

Acute behavioural change, altered levels of consciousness, altered social behaviour, falling and loss of appetite

25
Q

Give 3 reversible causes for confusion and how do you rule these out?

A

CT head - SDH normal pressure hydrocephalus, tumour

26
Q

What do you see on MRI of someone with Alzheimers?

On biopsy?

A

Atrophy in areas of hippocampus, temporal neocortex, subcortical nuclei, amygdala, amyloid plaques

Beta-amyloid and neurofibrillary tangles

27
Q

What do you see on MRI of someone with Lewy-Body Dementia? What do you see on biopsy?

A

Lewy bodies in brainstem and neocortex

Lewy Bodies, eosinophilic intracytoplasmic neuronal inclusions, Ubiquitin and A-synuclein, Neuronal loss

28
Q

Give 7 causes of acute delirium?

A

Infection (UTI), SDH, Alcohol, Opiates, Benzodiazepines, Hypoglycaemia, Brain Tumours

29
Q

What are risk factors for delirium?

A

Drugs, change in environment, recent surgery, frailty, infection, dehydration, constipation, diabetes,

30
Q

What are differentials for dementia?

A

Brain tumours, delirium, metabolic, endocrine (hyperthyroidism), syphilis infection, alcohol, NPH, depression

31
Q

What are memory blood tests?

A

TFT, LFT, FBC, CRP/ESR, Ca, Glucose, U&E, B12/Folate, Lipids, Cholesterol

32
Q

What scores can be used for dementia?

A

Addenbrookes, GPCOG, MOCA, MMSE, AMT, 6CIT

33
Q

List 4 causes of hyponatraemia.

A

Fluid excess (heart failure, SIAHD, NSAIDs promote water retention. Sodium loss (Addison’s disease/aldosterone insufficiency, diarrhoea, vomiting, osmotic diuresis, diabetes, severe burns, diuretic stage of acute renal failure)

34
Q

Name 4 symptoms of hypocalcaemia and another 4 for hypercalcaemia.

A

Low Ca: paraesthesia, tetany, muscle cramps, seizures, prolonged QT. High Ca: bones, stones, moans, groans. Bone pain, fractures, renal stones, drowsiness, renal impairment, nauea, weight loss, HTN, shortened QT

35
Q

How do bisphosphonates work?

A

Bisphosphonates are analogues of pyrophosphate, a molecule which decreases demineralisation in bone. They inhibit osteoclasts by reducing recruitment and promoting apoptosis.

36
Q

List 3 adverse effects of bisphosphonates

A

GORD, osteonecrosis of the jaw, increased risk of atypical stress fracture of the proximal femoral shaft

37
Q

What increases your risk of osteoporosis?

A

Menopause, steroid use, rheumatoid arthritis, smoking, alcohol, underweight, obesity, inactivity, age

38
Q

What is refeeding syndrome and what are the electrolyte deficiencies? What are refeeding bloods?

A

Low phosphate, potassium, thiamine, abnormal glucose, metabolic disturbance as result of reintroduction of nutrition, monitor biochemical markers; u&E, LFT, Mg, Glucose, Phosphate

39
Q

What are risk factors for pressure ulcers? How can these be avoided?

A

Incontinence, Skin frailty, immobility, malnutrition, dehydration, obesity

40
Q

Define an ulcer?

A

A break or tear of the skin that fails to heal. A pressure ulcer is caused by pressure or sheer force over bony prominence.

41
Q

Name 3 risk factors for a pressure ulcer?

A 
Immobility
Incontinence
Poor nutrition
Smoking
Dehydration
42
Q

What score is used to assess the risk of developing a pressure ulcer?

A

Waterlow Score

43
Q

Name 3 ways of preventing a pressure ulcer?

A 
Encourage mobility
Barrier creams
Regular skin assessment
Repositioning
Pressure mattress
44
Q

Name 5 risk factors for recurrent falls?

A 
Arrythmias/Cardiac insufficiency
Medications – Beta blockers
Environmental hazards
Poor vision
Weakness – post stroke
45
Q

Name 5 causes of collapse?

A 
Neuro, CVS, drugs, other
Hypoglycaemia
Opiate overdose
Atrial fibrillation
Dementia
Heart Block
Bradycardia
46
Q

Define syncope?

A

A feeling of lightheadedness that results in a fall and transient loss of consciousness. It has a fast onset, short duration spontaneous recovery.

47
Q

What T-score is considered osteoporosis?

A

< -2.5

48
Q

Name 3 supportive methods of management of delirium?

A 
Put the patient in a quiet, side room.
Rehydration
Remove IV lines
Adequate lighting
Clocks and calendars
Try to avoid IM haloperidol or benzos
49
Q

Name 5 causes of delirium.

A 
Environmental
Infection
Dehydration
Constipation
Medication – opiates
Electrolyte abnormalities
50
Q

Name 5 investigations which are part of the Delirium screen?

A 
FBC – look for raised WCC
ESR/CRP – inflammatory markers
U&amp;E – electrolytes
TFTs
LFTs – liver failure of alcohol abuse
CXR – infection
Urine dipstick/MSU
51
Q

Define delirium and name the 2 types.

A

Delirium is a state of acute confusion, transient, fluctuating consciousness. It can be hyper or hypo active.
Hyperactive – agitation, inappropriate behaviour, hallucinations
Hypoactive – lethargy, reduced consciousness

Medical Finals 2020 (25 decks)

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