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Year 3 Medicine > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

What is a Comprehensive Geriatric Assessment?

A

Multidimensional diagnostic process to determine medial, psychological and functional capabilities of a frail older person to come up with an integrated plan.

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2
Q

What is Polypharmacy?

A

When 6 or more drugs are prescribed at a time

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3
Q

What is ‘Section 2’ when discharge planning?

A

A referral made to social services to assess for funding (for care home), direct payments or package of care

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4
Q

What is ‘Section 5’ when discharge planning?

A

A referral made to social services by nursing staff when a patient is medically fit for discharge

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5
Q

What is Frailty?

A

Health state where multiple body systems gradually lose their inbuilt reserves and the patient becomes more at risk of adverse outcomes

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6
Q

Give 5 causes of Syncopal Falls

A

Vasovagal
Situational
Postural Hypotension
Autonomic Failure
Carotid Sinus Hypersensitivity

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7
Q

Give 3 causes of Non Syncopal falls

A

Poor Vision
Muscle Weakness
Labrynthitis

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8
Q

Give 3 types of drugs that contribute to Osteoporosis

A

Steroids
Tamoxifen
Anti-Epileptics

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9
Q

Define Delirium

A

Acute confusional state with sudden onset and fluctuating course, developing over 1-2 days

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10
Q

What does the mnemonic THINK DELIRIUM stand for?

A

Trauma, Hypoxia, Increasing age, NOF fracture, smoKer
Drugs, Environment, Lack of sleep, Imbalanced electrolytes, Retention, Infection, Uncontrolled pain, Medical conditions (dementia)

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11
Q

Delirium can be either hyperactive or hypoactive, give 3 common features of both

A

Memory impairment/disordered thinking
Sleep wake cycle reversal
Tactile/visual hallucinations

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12
Q

What is SQiD?

A

Single question indicating delirium
Is this patient more confused than before?

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13
Q

Give 5 ways to manage Delirium

A

Reorientate the patient
Encourage friends/family visitation
Encourage physical activity
Sleep hygiene
Remove catheters/cannulas

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14
Q

What is the link between dementia and delirium?

A

Delirium increases your chances of developing Dementia, but Dementia is a risk factor for Delirium

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15
Q

Define Dementia

A

Neurodegenerative syndrome with progressive decline in various cognitive functions with clear consciousness

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16
Q

Give 3 cognitive impairments of Dementia

A

Memory impairment
Reduced orientation
Reduced learning capacity

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17
Q

What are the three non cognitive presentations of Dementia? Give examples

A

Behavioural (Aggression, Agitation)
Psychotic (Delusions)
Sleep (Insominia)

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18
Q

Give 2 microscopic and 2 macroscopic features of Alzheimers

A

Macro - Cortical atrophy, Sulcal widening
Micro - Senile plaques (aggregated AB protein from amyloid breakdown), Hyperphosphorylated Tau Proteins

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19
Q

Give 2 features of Vascular Dementia

A

Stepwise presentation
Focal neurological symptoms

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20
Q

Describe the difference in pathophysiology between DLB and Parkinsons

A

Aggregations of Lewy Bodies (a- syn nuclein proteins) are widespread across the brain (whereas in Parkinsons they are localised to Substantia Nigra)

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21
Q

Give 3 features of DLB

A

Fluctuating cognition and alertness
Visual hallucinations
Spontaneous features of Parkinsons

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22
Q

What is neuroleptic malignant syndrome?

A

Drop in dopamine when you start anti-psychotics
FEVER (Fever, Encephalopathy, Vital sign instability, Elevated enzymes, Rigidity)

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23
Q

What is Frontotemporal Dementia?

A

Atrophy of the frontal and temporal lobes
Symptoms are lobe dependent

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24
Q

Describe the pathophysiology of AIDs Dementia

A

HIV infested macrophages enter CNS and damage neurones
Insiduous onset and rapid progression

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25
Q

What are 2 pharmacological managements of Dementia?

A

Donepazil - AChEsterase inhibitor
Memantine - NMDA Antagonist (blocks glutamate)

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26
Q

What is functional incontinence?

A

The patient is unable to reach the toilet in time due to cognitive/physical problems

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27
Q

Give a conservative, pharmacological and surgical management of stress incontinence

A

C - Lose weight
P - Duloxetine (increases sphincter contraction)
S - Urethral bulking

28
Q

Give a conservative, pharmacological and surgical management of urge incontinence

A

C - Absorbent pad/Sheath catheter
P - Mirabegron (B3 Agonists)
S - Ileocystoplasty

29
Q

Give 3 causes of faecal incontinence

A

Faecal impaction
Sphincter Dysfunction (haemorrhoids, tears from vaginal delivery)
Impaired Sensation

30
Q

Give 2 complications of Faecal Incontinence

A

Urinary Retention
Stercoral Perforation

31
Q

What is the ‘Break and Accelerate’ method

A

Constipate then evacuate, i.e give small intermittent doses of Loperamide

32
Q

Define TIA

A

Focal neurological deficits (with no tissue damage on imaging) due to blockage of blood supply to part of brain

33
Q

What is Amaurosis Fugax?

A

Central retinal artery occlusion/reduced perfusion of optic nerve causing unilateral or bilateral vision loss (like a curtain descending down)

34
Q

Give 4 causes of TIA

A

Atherothromboembolism from Carotids
Cardioembolism
Hyperviscocity
Vasculitis

35
Q

What is ABCD2?

A

Risk assessment of patient having a stroke after having a TIA
Age, Blood pressure, Clinical features, Duration of symptoms, Diabetes
Greater than or equal to four indicates high risk

36
Q

What are the pharmacological management options of TIA?

A

Control CVS risk factors
Initial 300mg Aspirin for 2/52 before switching to Clopidogrel 75mg

37
Q

What is a potential surgical management of TIA?

A

Carotid Endarterectomy

38
Q

Define Stroke

A

Sudden onset of focal neurological deficit due to infarction/haemorrhage (used to be lasting more than 24hrs - now where there is tissue damage on CT/MRI)

39
Q

Describe the features of the Bramford Classification: TACS

A

Unilateral weakness and sensory deficit
Homonymous Hemianopia
Higher cerebral dysfunction

40
Q

Describe the features of the Bramford Classification: PACS

A

Two of the TACS criteria

41
Q

Describe the features of the Bramford Classification: POCS

A

Cranial nerve palsy AND contralateral motor/sensory deficit
Conjugate eye movement disorder
Cerebellar dysfunction
Macular Sparing Homonymous Hemianopia

42
Q

Describe the features of the Bramford Classification: LAC

A

Pure sensory, Pure motor or Sensorimotor

43
Q

Give two PRIMARY causes of a haemorrhagic stroke

A

Hypertension
Amyloid Angiopathy

44
Q

Give two SECONDARY causes of a haemorrhagic stroke

A

Trauma
Anticoagulants

45
Q

What is Thrombolysis and when would you carry it out?

A

Clot dissolution with Alteplase
If the onset was less than 4.5hrs ago (best results within 90 minutes)

46
Q

Apart from Thrombolysis what other medical management would you give someone for an Ischaemic Stroke?

A

300mg Aspirin OD for 2/52

47
Q

What is Malignant MCA Syndrome

A

Cerebral Oedema surrounding an infarct in MCA
Treated with decompressive hemicraniotomy

48
Q

There are two scores used to discuss anticoagulation suitability. Describe the components of CHADS-VASc

A

CHF, Hypertension, Age>75 (2), Diabetes Mellitus, Stroke (2), Vascular disease, Aged 65-74, Sex (F)
A score >2 requires anticoag

49
Q

There are two scores used to discuss anticoagulation suitability. Describe the components of ORBIT

A

Low Haemoglobin (2)
Age>74
Bleeding history (2)
Renal impairment
Treatment with antiplatelets

50
Q

Give four arguments against the use of Enteral Feeding

A

Still an aspiration risk
Decreased enjoyment of food
Costly
May never be able to return to normal feeding again

51
Q

What is Palliative Care?

A

Switching to a more holistic approach when a cure is no longer viable.
Different to EOL care

52
Q

Give 4 examples of medications used in Palliative Care and what they are used for

A

Morphine Subcut - Pain relief
Levomepromazine - N&V
Midazolam - Agitation
Glycoporonium - Respiratory Secretions

53
Q

What are the features of confirming a death certificate?

A

Pupils fixed and dilated
No response to pain
No breath/heart sounds after one minute of auscultation
Completed by a doctor who has cared for the patient in the last 2 weeks

54
Q

What are the components of a death certificate?

A

1a - Cause of death
1b - Condition leading to cause of death
1c - Additional condition leading to 1b
2 - Any contributing factors/conditions

55
Q

Define Capacity (in terms of the mental capacity act 2007)

A

Able to understand, retain, weigh up the pros and cons and come to a decision

56
Q

What are J waves?

A

Positive deflection occuring between QRS complex and ST segment
Normally due to Hypothermia

57
Q

What is the prodromal phase of Shingles?

A

Pain in the distribution
May have fever etc

58
Q

What are the complications of shingles

A

Post Herpetic Neuralgia
Herpes Zoster Opthalmicus
Ramsey Hunt

59
Q

What is Post Herpetic Neuralgia

A

Most common complication

Pain in region

Usually resolves within six months

60
Q

Describe the Shingles rash

A

Initial erythematous macular rash
Develops into vesicular rash
Does not cross midline

61
Q

How would you treat shingles

A

analgesia
antivirals (reduces post-herpetic neuralgia)

62
Q

Discuss the infectivity of Shingles

A

Avoid pregnant and immunocompromised
Not infective after day 5-7 (when lesions have crusted over)
Covering rash reduces infectivity

63
Q

Name four factors included within the Waterlow score

A

Mobility
Continence
Skin Type
BMI

64
Q

Highlight the four grades of pressure ulcer

A

I - Non blanching erythema
II - Superficial erosion (eg blisters)
III - Deep erosion (down to submucosa)
IV - Erosion of bone/muscle

65
Q

How would you manage a pressure ulcer

A

Hydrogel/Hydrocolloid dressing (treated best in moist environment)
Nutrition
Tissue Viability Nurse

Year 3 Medicine (10 decks)

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