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Phase 3A Flashcards > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

what proportion of geriatric patients with depression have comorbid alcohol abuse?

A

1/3

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2
Q

what are some more common symptoms in geriatric depression?

A
  1. lethargy
  2. anxiety
  3. physical/ somatic symptoms
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3
Q

which anti-depressant drug is good for patients who have previously had a heart attack?

A

sertraline

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4
Q

what are 4 drugs commonly prescribed in the elderly that can cause depression?

A
  1. centrally acting antihypertensives
  2. lipid soluble beta blockers
  3. benzodiazepines
  4. progesterone contraceptives
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5
Q

what are 3 risk factors for relapse of depression?

A
  1. more than 3 episodes of major depression
  2. episode in the last 12 months
  3. relapse after drug discontinuation
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6
Q

what are 7 risk factors for dementia?

A
  1. increased age
  2. female
  3. lower education
  4. african-american men
  5. genetics
  6. head injury
  7. mild cognitive impairment
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7
Q

how is mild cognitive impairment defined?

A

cognitive deficits greater than expected for a persons age

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8
Q

what are 4 protective factors for dementia?

A
  1. coffee
  2. fish
  3. decreased dietary fat
  4. increased physical activity
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9
Q

what score ranges must people score on MMSE for mild dementia?

A

20-24 / 30

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10
Q

what score ranges must people score on MMSE for moderate dementia?

A

13-20 / 30

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11
Q

what score ranges must people score on MMSE for severe dementia?

A

<12 / 30

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12
Q

what is delirium?

A

acute disturbance of consciousness, change in cognition and reduced ability to focus, sustain and shift attention

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13
Q

is delirium fluctuating or constant?

A

fluctuating

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14
Q

what are 4 factors that make delirium more likely?

A
  1. sensory impairment
  2. severe illness
  3. cognitive impairment
  4. high urea/ creatinine ratio (kidneys not working well)
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15
Q

what medications make delirium more likely?

A
  1. sedatives (EG diazepam)
  2. narcotics (EG codeine)
  3. anticholinergics (EG atropine)
  4. psychotropics (EG antidepressants)
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16
Q

what does the PINCH ME mnemonic for delirium stand for?

A 
P- pain
I- infection
N- nutrition
C- constipation
H- hydration
M- medication
E- environment
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17
Q

how do you measure delirium on the bedside?

A

confusion assessment method

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18
Q

what are the 5 criteria in the confusion assessment for delirium?

A
  1. acute onset
  2. fluctuating course
  3. inattention
  4. disorganised thinking
  5. altered consciousness
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19
Q

how do you manage delirium?

A

pharmacological management is poorly supported. approach patient calmly, reassure, consider unmet needs and treat causes, optimise vision and hearing, and optimise sleep

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20
Q

what is the clinical presentation of hypoactive delirium?

A
  1. apathy

2. quiet confusion

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21
Q

what is the clinical presentation of hyperactive delirium?

A
  1. agitation
  2. delusions
  3. disorientation
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22
Q

what should be included in the assessment of delirium?

A
  1. ABC
  2. GCS
  3. vital signs
  4. blood glucose
  5. cardio/ resp/ gi/ neuro exams
  6. confusion assessment method
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23
Q

what are 4 differentials for delirium?

A
  1. dementia
  2. depression
  3. bipolar
  4. schizophrenia
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24
Q

what should be included in the investigations for the assessment of delirium?

A
  1. bloods
  2. urine dipstick
  3. blood cultures
  4. ECG
  5. CXR
  6. head CT
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25
Q

what medication can be used on patients with delirium who are aggressive?

A

haloperidol/ olanzapine

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26
Q

what is delirium tremens?

A

delirium caused by the rapid withdrawal from alcohol

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27
Q

how do you treat delirium tremens medically?

A

diazepam or chlordiazepoxide

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28
Q

what are 4 complications of drug induced delirium?

A
  1. pressure sores
  2. hospital acquired infections
  3. fractures
  4. progress to stupor/ coma/ death
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29
Q

what is functional incontinence?

A

inability to reach the toilet on time due to immobility or unfamiliar surroundings

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30
Q

what is stress incontinence?

A

leakage of urine on sneezing, coughing or general exertion

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31
Q

what is urge incontinence?

A

leakage of urine preceded by urge of micturition

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32
Q

what is overactive bladder syndrome and what causes it?

A

urge without urge incontinence, and is caused by detrusor overactivity

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33
Q

what is overflow incontinence and what causes it?

A

incontinence due to chronic bladder outflow obstruction and is due to prostatic disease

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34
Q

what condition can overflow incontinence lead to?

A

obstructive nephropathy

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35
Q

what is true incontinence?

A

continuous leakage of urine

36
Q

what are 4 risk factors in women for incontinence?

A
  1. pregnancy (vaginal birth)
  2. diabetes mellitus
  3. oral oestrogen therapy
  4. high BMI
37
Q

what are 4 risk factors in men for incontinence?

A
  1. lower urinary tract symptoms
  2. functional/ cognitive impairment
  3. neurological disorders
  4. prostatectomy
38
Q

what should the assessment for incontinence in women include?

A
  1. digital pelvic floor examination
  2. vaginal exam
  3. abdo/ pelvic/ neuro exam
39
Q

what should the assessment for incontinence in men include?

A
  1. digital rectal exam

2. abdo/ pelvic/ neuro exam

40
Q

what investigations should be included in assessing incontinence?

A
  1. urine dipstick
  2. renal function test
  3. post void residual volume
  4. urinary flow rates
  5. ultrasound of kidneys
41
Q

what are red flag symptoms for incontinence?

A
  1. visible haematuria
  2. microscopic haematuria >50y/o
  3. persistent UTI >40y/o
  4. palpable bladder after voiding
  5. LUTS
  6. renal impairment
42
Q

how do you generally treat incontinence?

A
  1. temporary containment products such as pads until specific plan
  2. 1st line is pelvic floor exercises and bladder training
  3. 2nd line oxybutynin (antimuscarinic)
  4. solifenacin if not tolerated
43
Q

how do you specifically treat overflow incontinence?

A
  1. treating obstruction

2. intermittent self-catheterisation

44
Q

how do you specifically treat incontinence caused by neurological disease?

A
  1. 1st line artificial sphincter
  2. antimuscarinic (also in overactive bladder disease)
  3. botox injection is sometimes used
45
Q

what are 4 situations where an indwelling catheter is recommended?

A
  1. chronic urinary retention
  2. patient cannot self catheterise
  3. skin wounds are present that could be contaminated by urine
  4. there is distress caused to the patient by changing clothes
46
Q

what are 9 risk factors for falls?

A
  1. age over 80
  2. female
  3. low weight
  4. history of falls
  5. dependency
  6. orthostatic hypertension
  7. polypharmacy
  8. vision impairment
  9. balance issues
47
Q

what are four risk factors for proximal femur fractures?

A
  1. osteoporosis
  2. osteomalacia
  3. paget’s disease
  4. bone mets
48
Q

what should the examination of a patient who has sustained a fall include?

A
  1. mental state
  2. visual impairment
  3. cardio/ neuro exam
  4. timed up and go test
49
Q

how can you prevent falls?

A
  1. mobility equipment
  2. occupational therapy
  3. active lifestyle and exercise
50
Q

what are 4 neurological causes of falls?

A
  1. myopathy
  2. parkinson’s disease
  3. dementia
  4. neuropathy
51
Q

what blood results would you look for in a patient you suspect has sustained a fall due to alcohol abuse?

A
  1. abnormal LFT’s

2. macrocytosis

52
Q

what is a drop attack

A

a fall where the cause is unknown

53
Q

what are 4 common causes of drop attacks after investigation?

A
  1. cerebrovascular disease
  2. carotid sinus hypersensitivity
  3. transient ischaemic attack
  4. orthostatic hypotension
54
Q

what are 4 primary techniques to prevent falls?

A
  1. increasing exercise
  2. reviewing medications
  3. changing environmental factors
  4. improved management of medical conditions
55
Q

what factors should multifactorial assessment of falls include?

A
  1. cognitive impairment
  2. continence problems
  3. history of falls
  4. unsuitable footwear
  5. other health conditions
  6. medication
  7. postural instability
  8. syncope syndrome
  9. visual impairment
56
Q

what is the clinical presentation of a pressure ulcer and where do they usually occur?

A
  1. usually occurs as persistently red, blistered, broken or necrotic skin
  2. usually occur over bony prominence
  3. may extend to muscle and bone
57
Q

what are 5 risk factors for pressure ulcers?

A
  1. cardiovascular disease
  2. continence
  3. diabetes mellitus
  4. hip fracture
  5. limb paralysis
58
Q

what risk assessment scales are used for pressure ulcers?

A
  1. norton
  2. braden
  3. waterlow
59
Q

what is the braden risk assessment for pressure ulcers made up of?

A
  1. sensory perception
  2. moisture
  3. activity
  4. mobility
  5. nutrition
  6. friction

graded 1-4 and lower score is higher risk

60
Q

what 10 things should an ulcer assessment include?

A
  1. cause
  2. site
  3. dimensions
  4. grade
  5. exudate amount and type
  6. infection
  7. pain
  8. appearance
  9. surrounding skin
  10. odour
61
Q

what is a grade 1 ulcer?

A

discolouration of the skin with oedema

62
Q

what is a grade 2 ulcer?

A

partial thickness skin loss, superficial presentation as a blister

63
Q

what is a grade 3 ulcer?

A

full thickness skin loss with subcutaneous necrosis

64
Q

what is a grade 4 ulcer?

A

extensive destruction, tissue necrosis and damage to underlying structures

65
Q

what grades of ulcer should be referred to specialist services?

A

grade 3 and 4 ulcers that are deteriorating

66
Q

how do you treat ulcers?

A
  1. pressure management
  2. nutrition
  3. wound management
  4. treating conditions that delay healing
  5. infection control
  6. pain management
67
Q

what are 4 common sites for pressure ulcers?

A
  1. sacrum
  2. heels
  3. back of head
  4. shoulder
68
Q

which areas are at the most risk of forming pressure ulcers in someone with spinal injury?

A

sacral and ischial areas

69
Q

what is an advanced directive?

A

a persons wishes about their future medical or social care

70
Q

what is a lasting power of attorney?

A

a persons nomination of another person to make health and social care related decisions after they lose capacity to do so

71
Q

what court makes decisions and appoints deputies to act on behalf of people without capacity?

A

the court of protection

72
Q

if someone did not appoint a LPA and has nobody willing to represent them, who represents them?

A

an independent mental capacity advocate

73
Q

what is enteral feeding?

A

feeding that is delivered by a tube via the gastrointestinal tract

74
Q

what are 4 methods of enteral feeding?

A
  1. gastrostomy
  2. nasogastric tube
  3. jejunostomy
  4. oesophagostomy
75
Q

what is parenteral feeding?

A

intravenous feeding

76
Q

what are 5 conditions where a person would require parenteral feeding?

A
  1. inadequate absorption
  2. GI fistula
  3. bowel obstruction
  4. prolonged bowel rest
  5. severe malnutrition
77
Q

what are 4 risks of parenteral feeding?

A
  1. infection
  2. venous thrombus
  3. hypoglycaemia
  4. hyperglycaemia
78
Q

who should be the main point of contact for end of life care of a patient?

A

a key worker

79
Q

if there is a problem out of hours with end of life care who should be contacted?

A

local provider of unscheduled care

80
Q

what are 10 common end of life symptoms?

A
  1. anorexia
  2. insomnia
  3. constipation
  4. sweating
  5. nausea
  6. dyspnoea
  7. dysphagia
  8. neuropsychiatric symptoms
  9. vomiting
  10. dyspepsia
81
Q

what method of taking medications should ideally be kept to in end of life care?

A

medications taken by mouth

82
Q

how many medications is described as polypharmacy?

A

> 5 medications

83
Q

what are 3 interventions in patients with polypharmacy to prevent inappropriate prescribing?

A
  1. MDT case conferences
  2. computerised support systems
  3. pharmacists
84
Q

what 2 things related to geriatrics should trigger a medication review for a patient?

A
  1. functional decline

2. development of geriatric symptoms

85
Q

what conditions should be screened for if non-adherence is suspected?

A
  1. dementia

2. depression

86
Q

what are 4 risks of prescribing in older adults?

A
  1. frailty
  2. lack of communication
  3. polypharmacy
  4. changes in pharmacokinetics and pharmacodynamics
87
Q

what are 4 criteria for a drug that is inappropriately prescribed?

A
  1. contraindicated drugs
  2. inappropriate dose or duration
  3. adversely affects prognosis
  4. makes no difference to patient outcome

Phase 3A Flashcards (6 decks)

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