Geriatrics Flashcards
1
Q
Define Acopia
A
Where patients are just admitted because they are struggling with ADLs
2
Q
What is deconditioning
A
- After being bedbound for a few days people get confused, have a poor nutritional state and can’t walk
Incidence of falls is greater
3
Q
What are the contents of the Comprehensive Geriatric Assessment
A
- Medical
- Functional
- Psychological
- Social and environmental
4
Q
Name three professions involved in medical assessment
A
Doctor, nurse and pharmacists
5
Q
Name three professions involved in Functional Assessment
A
- OT
- PT
- SaLT
6
Q
Define rehabilitation
A
- Process of restoring patient to maximum function
7
Q
Define abuse
A
- A single or repeated act, or lack of appropriate action, that occurs in a relationship where there is an expectation of trust, causing harm or distress
8
Q
Name three factors that can influence the frequency of falls
A
- INTRINSIC: Muscle strength and joint flexibility, CNS issues
- EXTRINSIC: Environmental supportive factors like railings and grip of floor
- Magnitude of stressor: How easy it is to fall
9
Q
Factors that affect severity of the fall
A
- Multiple system impariemnts
- Osteoporosis
- secondary injruy (e.g. pressure sores, dehydration)
- Loss of confidence (psychological)
10
Q
Risk factors for falls
A
- Polypharmacy
11
Q
Tests in falls
A
- ECG
- FBC, B12, folate, U + E, calicum, phosphate and TFTs
- Vt D as it is common deficiency in older people
- Carotid sinus massage
12
Q
Investigation for unexplained syncope, normal ECG and no sturtcural heart disease
A
- Head-up tilt table testing
13
Q
How can we reduce fall frequency
A
- Drug reviews
- Treat orthostatic hypotension
- Strength and ablance training
- Walking aids
- Enviornmental assessment and modifictaion
- Visiual aids
- Reduce stressors
14
Q
What drugs can cause falls
A
- Benzos
- Antidepressants
- Antipsychotics
- Diuretics
15
Q
How do we prevent falls in th ehosiptal
A
- Good quality footwear and walking aids
2. Call bell close to hand
16
Q
Define syncope
A
- Sudden transient loss of consciousness due to reduced cerebral perfusion
17
Q
What causes syncope
A
- Hypotenison by upright posture,, eating, coughing and straining
- Vasovagal syncope
- Carotid sinus hypersensitivity syndrome
- Pump problem
18
Q
What is vasovagal syncope
A
- Feeling of pale, clammy or light headed followed by nausea followed by loss of consciousness
19
Q
Differential of syncope
A
- Epilepsy
20
Q
Investigations of syncope
A
- Bloods for anaemia, spesis and MIs
- ECG
- tilt test
21
Q
What causes balance disequilibrium
A
- Decreased visual acuity as we age
- Reduced hearing
- arthritis
- Sarcopenia due to inactivity
22
Q
What are drop attacks
A
- Unexplained falls with no prodrome
23
Q
What can cause drop attacks
A
- Cardiac arrest
- Carotid sinus Syndrome
- Orthostatic hypotension
24
Q
How is orthostatic hypotension diagnosed
A
- A fall in BP of 20mmhG sytolic or 10mmhg diastolic.
25
Risk factors for orthostatic hypotension
1. Drugs
2. Chronic hypertension
3. Spesis
4. Adrenal insufficiency
26
How is orthostatic hypotension treated
1. NaCl tablets or water
If these don't work, Fludrocortisone
Compression stockings full length and head-tilt to bed
27
What is situational hypotensions
1. Fall of 22mmHg 75 mins after meal (postprandial)
28
How is situational hypotenison treated
1. Avoid alcohol and hypotensive drugs during meals
| 2. Lie down afte rmeal
29
What is Carotid sinus syndrome
1. symptomatic bradycardia and/or hypotension due to a hypersensitive carotid baroreceptor reflex, resulting in syncope or near-syncope.
30
What triggers CSS
1. Neck Turning
2. Tight Collars
3. Straining
4. Prolongues standing
31
How is CSS diagnosed
1. Systolic BP fall of 50mmHg after carotid sinus massage 5s
32
What is the referral criteria for falls
1. Recurrent
2. Loss of consciousness
3. Injury
4. Polypharmacy
33
Age-related changes that can cause incontinence
1. Diminished bladder cpaacity
2. Diminished bladder conrtactile function
3. Atrophy and vagina and urethra
Also, FISTULAS, BPH, being bedbound and access to toilet
34
List two indications for catheterisations
1. Urinary retentions symtpoms
2. BOO
3. Acute renal failure
4. Sacral rpessure sores
35
When are catheterisations contraindicated
1. Immbolity
2. HF as furosemide
3. Monitoring fluid balance
4.
36
How often should cataheters be changed
Every 3 months
37
IF patient was to be on catheter more than a year what should be used instead
Supraubic
38
If you suspect the catheter is infected what shohuld you do
1. Remove catheter and administer IM Gentamycin
39
What can cause faecal incontinence
1. Disorders of anal sphincter and lower rectum
2. contipation and diarrhoea
3. Neurological issues
40
How to treat overflow incontinence
1. Rehydration
2. Phosphate enema od
3. Complete colonic washout
4. Laxatives
41
How should neurogenic incontinence be treated
1. Loperamide and phosphate enema
42
Define stroke
Stroke is the sudden onset of a focal neurological deficit, lasting >24h or leading to death, caused by a vascular pathology.
43
What classifictaion is used to assess stroke
1. Bamford Classification
44
Clinical Features of Total Anterior Circulation stroke
1. Hemiparesis and hemisensory loss
2. Homonymous Hemianopia
3. Dysphagia, visuo-spatial and perceptual problems
45
Causes of a TACS
1. Occlusion of internal carotid or MCA
| 2. EMboli
46
What causes a PACS
1. Occlusion of Anterior cerebral or MCA
47
Features of a lacunar stroke
1. Hemiparesis
2. Ataxic Hemiparesis
3. Hemisensory loss
48
Features of POCS
1. Brainstem symptoms
```
Diplopia (CN3)
Vertigo (CN3)
Bilateral limb problems
Homonymous hemianopia
cortical blindness
```
49
Causes of POCS
1. Infarct in vertebral, basilar or PCA
50
Risk factors (fixed) for stroke
1. Age, sex, wthnicity, FH, previous incident , vascular disease
51
Risk factors (modifiable)
1. SMoking, alcohol, obesity, diet, oral contraceptive pill
52
What diseases can predispose someone to a stroke
1. HTN
2. AF
3. Diabetes
4. Hypercholesterolaemia
53
Name two assessments in strokes
1. GCS
| 2. National Institute of Health Stroke Scale
54
Investigations for storkes
1. Blood tests
2. urinalysis
3. ECG
4. CXR
5. CT brain
6. Carotid doppler
7. ECHO
55
Acute management of stroke
1. Iv Alteplase but need CT head first
2. 300 mg Aspirin ASAP if haemorrhagic is eliminated
4. Oxygen supplementation
5. Iv insulin if cglose is over 11mmol/L
Treat seizures
56
What assessment is used by nutritionists when patient is high risk for swallowing difficulties
1. SALT assessment
| 2. NGT
57
When should alteplase be used (time frame)
Within 4.5 hours of a stroke
58
When shoudl alteplase not be used
1. Previous haemorrhage
2. Seizure at onset
3. Impaired coagulation
4. Uncontrolled hypertension
59
How to protect patient from another stroke
1. ANTIPLATELET THERAPY: 300mg for 2 weeks aspirin, followed by clopidogrel (75mg)
2. Lower BP , CHolesterol, anticoag for AF (warfarin/DOAC)
3. CAROTID ENDARTERECTOMY
60
Score system for TIA
1. ABCD2
61
What is delirium
1. Syndrome of disturbances of consciousness and cognition involving organic brain disorders
62
1. Key features of delirium
1. Disturbance of consciousness
2. Change in cognition (memory, speach etc)
3. Acute onset and fluctuates
You are iether HYPERACTIVE (aggressive, niosy and psychotic) or HYPOACTIVE (lethargy, quiet)
4. Disturbed sleep-wake cycle
5. Emotional disturbance (fear, depressoin and anxiety)
6. Delusions
POOR INSIGHT
63
What can cause delirium
1. Infection
2. Drug intoxication
3. Disorders of electrolyte and fluid balance
4. Organ fialure
5. Endocrine
6. Epileptic post-ictal state
7. Pain
8. Constipation
9. Surgery
64
What drugs can cause delirium
1. Antipsychotics
2. Antidepressants
3. Opiates
65
Investigations for delirium
1. CXR, blood tests, Blood culture, blood gases, drug levels
66
Non-drug managemnet of delirium
1. Quiet environemny
2. optimize visual and auditory acuity (spectacles and hearing aids
2. Reassurance
3. Epxlain who you are and what you wish to do
4. Educate visitors
5. Do not argue
67
When should drug interventions be done for delirium
1. Signfiicant distress
2. Safety of others an dtothemselves
3. Ripping out iv lines, interrupting treatment
68
Drug treatment for deliirum
1. SHORT ACTING BDZ (LORAZEPAM)
| 2. HALOPERIDOL or atypical (OLANZAPINE)
69
What causes pressure sores
1. Skin necrosis due to ressure induced ischaemia
70
How are pressure sores graded
1. Non-blanching
2. Broken skin or blistering
3. Full-thickness skin loss, subcut fat or sloughing seen
4. Ulcer down to bone, joint or tendon
71
How long doe sit take for pressure sores to develop
2 hours of ischaemia
72
Risk factors for pressure sores
1. Age
2. Immobility
3. Neurological damage
4. Sedatie drugs
73
Name a risk tool for pressure sores
1. Waterlow scores
74
How are pressure sores managed
1. Risk assessed 6 hrs into admission
2. Pressure relieving
3. Debridement
4. Dressings
5. Antibiotics
Promote healthy helaing environment
75
Clinical features of Osteoporosis
1. Acute painful fracture
| 2. Progressive kyphosis
76
Secondary causes of osteoporosis
1. Steorids
2. Phenytoin
3. PPIs
4. Heparin
5. Ciclosporin
Hyperthyroidism, Hyperparathyroidism, kidney failure, smoking and alcohol
77
Primary prevention of osteoporosis
1. Diet, excercise, stop smoking ,reduce alcohol
| 2. Prophylaxis with bisphosphonate
78
How is osteoporosis managed
1. Oral calcium and Vt D
2. Bisphosphonates (any over 75s need it) - risedronate
3. IV ZOLENDRONIC ACID if oral not tolerated
DENOSUMAB
STRONTIUM RENELATE
79
Surgery for osteoporosis
1. VERTEBROPLASTY
80
Name three causes of malnutrition
1. Decreased nutrient intake
2. Increased nutrient requirement (sepsis/injury)
3. Malabsroption
81
Consequences of malnutrition on the body
1. Reduced immune system
2. Muscle wasting
3. Impaired wound healing
4. Micronutrient deficiencies such as selicium
82
What assessment is used to recognise malnutrition
MUST
83
How is malnutrition treated
1. Food
2. Oral nutritional supplements
3. Eneteral/parenteral
84
What is enteral nutrition
Direct feeding into the gut such as stomach, duodenum or jejunum
2 Preserves mucosa
85
Advantage of enteral nutrition
Inexpensive compared to parenteral
86
Disadvantages of enteral nutrition
1. Tolerance (satiety, bowel size)
2. Tube is uncomfortable
3. Quality of life
87
Name two types of enteral methods
1. NG
| 2. NJ
88
Disadvantage of NG
Only used for 30 days or less
89
How do we monitor NG tube
1. Check pH aspirate to confirm position (<5.5)
90
Diasvntage of Nj
Only used for less than 60
91
Name tow ways we achieve long term enteral nutrition
1. Percutaneous endoscopic gastrostomy (dysphagia, CF, oral nutrition is inadequate)
2. Post pyloric surgical JEJ (delayed gastric emptying, upper GI, high risk of aspiration, severe acute pancreatitis)
92
What is parenteral nutrition
1. Feeding when gut is inaccessible
93
indications for parenteral nutrition
1. Bowel obstruction
2. GI Fistula
3. prolongues bowel rest
94
Disadvtange of parenteral
1. Infection
2. Costly
3. Onvasive
95
What is referring syndrome
1. Feeding initiates increase in insulin and uptake of cellular potassium, phosphate and mg
shifts fluids and electrolytes causing fluid retention/arrythmias/respiratory insufficiency and death
96
How is referring syndrome managed
IV Pabrinex/thiamine, Vit B BEFORE FEEDING and first 10 days
1. Slow introduction of nutrition
Monitor blood levels (u and E, phosphate/mg)
97
What four things influence pharmacokinetics in older people
1. Absorption
2. Disrtibuton
3. Metabolism
4. Excretion
98
How is propranolol conc affected in elderly
Hepatic first pass metabolism declines
99
How is calcium carbonate absorption affected
Reduced as gastric pH increases from atrophy
100
Why is salbutamol less effective
Calcification of blood vessels
101
Why does digoxin conc increase
Renal excretion falls - can cause renal failure
102
Clinical features of digoxin toxicity
1. N and V, Abdo pain, yellow discolouration of vision, arrhythmia, hyperkalaemia
103
Side-effects of oxybutynin
1. Anti muscarinic: dry mouth, urinary retention and confusion
Ocybutinin is more potent elderly
104
Effect of diazepam in elderly
Half life increase so causes side effects (drowsiness, confusion)
105
Common adverse reactions in elderly
1. Falls
2. Confusion
3. Bowel problems (diarrhoea and constipation)
106
What medication is given to elderly people who are suffering from fractures
Give bisphosphonates (needed to build up bone) + low dose D3 + Calcium
107
First-line Management of postural hypotension with no definitive cause
Only a 30 mmHg drop on lying and standing - so diagnosed postural hypotension but not underlying causes
Lifestyle Advice
108
What defines postural hypotension
Reduction in 20mmHg systolic or 10mmHg diastolic within 3 minutes of standing
109
When should BP be measured in lying and standing interventions
at 1 minute and then at 3 minutes
110
What is the management steps in postural hypotension
Lifestyle Advice -> Medication Review (remove any that can precipitate this) -> Non-pharmacological measures (Fluids, salts, stockings, abdominal binders and excercise) -> Pharmacological measures (*Fludrocortisone*, Midodrine, droxidopa, pyridostigmine) -> combined pharmacological approach
111
How does fludrocortisone function
Mineralocorticosteroids:
Acts like cortisol, increasing BP by increasing re-absorption of salt
112
Two other indications for fludrocortisone
21-Hydroxylase deficiency (CAH)
Addison's
113
What drugs can cause falls
```
Benzodiazepines
Z-drugs
Tricyclic antidepressants + Mirtazipine
Monoamine Oxidase Inhibitors
SNRIs
antipsychotics
Opioids
Anti-Epileptics
Antiparkinson drugs
Alpha receptor blockers
GTN
ACEIs
```
114
Name the main bisphosphonate used
Alendronate
115
What is given to post-menopausal women at risk of Low BMD
Alendronate
116
Why are bisphosphonates prescribed so easily (e.g., a woman falls with a fracture will get bisphosphanates even before her DEXA scan)
It is a first-line intervention for SECONDARY prevention of falls - can be given without the need for any DEXA scan or FRAX score
117
What is a FRAX score
The probability of a fracture within the next ten year s
118
How do we interpret a DEXA scan
A T-score less than -2.5 the standard deviation indicates osteoporosis
119
What is osteopenia in a DEXA scan
-1 to -2.5
120
WHat is a normal DEXA scan score
Anything greater than -1
121
What is a Z score
A comparison of what a patients BMD is compared to the BMD of a male or female their weight
122
What is the first line intervention for an elderly woman who has had a suspected fragility fracture
Bisphosphonates + Vit D and calcium supplements if you suspect a deficiency
123
How do bisphosphonates work
They decrease osteo-clast mediated bone resorption
124
What is a primary prevention of Osteoporosis
Vit D replacement to EVERYONE
+ Bisphosphonates
125
Who should be assessed in a FRAx score
Women over 65
Men over 75
Younger patients on steroids or previous fractures
126
What does a T score show
What their BMD is compared to a young adult population of the same gender
127
What is the second line medictaion given for primary prevention of osteoporosis
Denosumab
128
How does Denosumab work
A monoclonal antibody which inihbit receptors that mature osteoclasts
129
Name other pharmacological treatments for OSteoporosis
Raloxifene: Binds to oestrogen receptors, inhibiting osteoclastic action (similar effect to oestrogen)
Teriparatide (PTH hormone) - stimulates bone growth
Strontium Renelate - reduces bone turnover and stimulates growth
130
Side Effects of Bisphosphonates
AF
Osteonecrosis of the jaw
Atypical stress fracture
Oesophageal ulcers
131
How should bisphosphonates be taken
Sit up for at least 30 minutes after the dose and drink a glass of water to stop oesophageal ulcers from forming
132
What are the risk factors for osteoporosis
SHATTERED FAMILY
```
S- Steroids
H - Hyperthyroidism, Hyperparathyroidism
A - Alcohol and Smoking
T - Thin (BMI <22)
T - Testosterone deficiency
E - Early menopause
R - Renal/Liver Failure
E - Erosive/ Inflammatory Bone Disease
D - Diabetes
```
FAMILY HISTORY
133
What is the GOLD standard for confirming Osteoporosis
DEXA scan
X-Rays for any fractures
134
How do loop diuretics function and when are they indicated
Bind to Na+/Cl- co transporters (the chloride part)
Stops reabsorption and causes more water to be dispelled in the urine
Hypertension and oedematous states
135
Side Effect of Loop Diuretics
Hypokalaemia Metabolic Alkalosis
136
How do thiazide diuretics work and when aret hey indicated
Act on the PCT and block the Na+/Cl- co transporter.
However, competes for uric acid in PCT, causing raised uric acid in the blood
Calciuria,
Nephrogenic DI
Oedamatous states
Hypertension
137
What chronic condition can thiazide diuretic precipitate
GOUT
From chronic hyperuricaemia
and Hyperglycaemia
138
What is the most common cause of hyponatraemia
Dehydration, from dementia - they forget to drink
139
Cause of hypovolaemic hyponatraemia
Iv normal saline
140
Causes of Euvolaemic hyponatraemia
SIADH
| Hypothyroidism
141
What causes hypervolaemic hyponatraemia
Fluid restriction
142
What is the limit to the rate of hypertonic saline solution (3%) that can be given
12 mmol/L/day or lower - central pontine myelinolysis
143
First Line investigation for hyponatraemia
U and E to confirm hyponatraemia
If that's confirmed, first thing we need to do is exclude SIADH;
Urine and plasma osmolalities
Urine Sodium
Urine dip
TSH and cortisol to exclude hypothyroidism and Addison's
144
What is a side-effect seen in the elderly, caused by tramadol
SEIZURES - very common
145
What drugs can reduce the seizure threshold
```
Antipsychotics
Antibiotics: Penecillins, cephalosporins
SNRIs and Tricyclics
Tramadol
Fentanyl
Ketamine
Lidocaine
Lithium
Antihistamines
```
146
What should we look out for when prescribing first gen antihistamines in the elderly (chlorphenamine)
Can cause confusion and hallucinations
147
What drugs can cause dlirium
```
BDZs
Opitates
Antiparkinson Drugs
Tricyclics
Digoxin
Beta BLockers
Steroids
Antihistamine (chlorphenamine)
```
148
Side effect of digoxin
Can cause arrythmias
149
What conditions can cause Charles Bonnet Syndrome
Age related macular degeneration
Glaucoma
Cataracts
150
What is the first line investigation for acute confusion
Mid stream Urine Test
FBC, ESR, CRP for anaemia
TFTs, Ca2+ ion tests
AKIs
B12 and folate
LFTs
To cross out any preventable causes for delirium
151
What is myelofibrosis
Marrow fibrosis -> pancytopenia
A common cause for anaemia in the elderly
152
Clinica features of Myelofibrosis
Weight loss, fever and night sweats
Splenomegaly
Recurrent infections + easy bruising
Hepatosplenomegaly
Because of fibrosis, bone marrow may not be aspirated - dry tap
153
How can we diagnose myelofibrosis
Blood film to see poikilocytes (tear shaped RBCs)
154
Management of myelofibrosis
Stem cell transplantation
Thalidomide
155
Most common cause of anaemia in the elderly
Iron deficiency
156
How is gentamicin usually given
IV not oral, only given in hospitals
157
What UTi medication commonly causes creatinine derangement
Trimethoprim - inhibits the excretion of creatinine into the urine
158
Why should Nitrofurantoin be avoided in elderly patients
It's not as effective as renal filtration of the drug is lowered in elderly populations, less likely to cure a UT I
159
What opioid should be given to elderly patients and why
Oxycodone, because others are more likely to precipitate CKD
160
What is Augmentin
Another term for co-amoxiclav
161
WHat antibiotic is given for aspiration pneumonia
IV Cephalosporins and Metronidazole
Remember, oral first but only if they are not nil by mouth
162
CXR findings in aspiration pneumonia
Consolidation in the right lung (as it's wider and more vertical)
163
Signs of staph. pneuomnia
Bilateral cavitating bronchopneumonia
164
Characteristic of Klebsiella Pneumonia
Affects the upper lobes + red rusty sputum
More common in the elderly
165
Signs of mycoplasma pneumoniae
Young, children
AIHA
Just flu like symptoms
166
How do we interpret a CURB-65 score
0-1 = home treatment
1 = consider hospital treatment
3-5 = hospital admission + consider for ITU referral
167
What should be done after placement and before each use of an NG tube
Confirm the position of the tube with an abdominal X-Ray before progressing (as if it's misaligned = aspiration pneumonia)
168
Management of urinary retention
1. Check catheter
2. Check fluid output after catheter and replace
3. Consider TWOC (trial without catheter) -> IP/OP
4. COnsider Tamsulosin
5. Urology review
169
What is DOLS
It is the process to deprive a patient of their liberty as they lack capacity to consent to treatment or care to keep themselves from harm.
It protects the rights of the patient, encompassing having to prove they are lacking capacity
170
Advanced care plan vs lasting power of attorny
Advanced care plan is usually done to refuse treatment vs seletcing an individual to make decisions for you
171
What is the first line Opioid that is given to elderly people
Tramadol or Oxycodone
172
What medicatio should not be used in conjunction to Sildenafil
Nitrates - as they also. cause vasodilation
173
What is a grade I pressure ulcer
Non-blanchable erythema of intact skin + discolouration
174
What is a Grade 2 pressure ulcer
Partial skin loss involving the epidermis or dermis or both
Ulcer is superficial (looks like an abrasion or blister)
175
What is a grade 3 ulcer
Full thickness skin loss, with necrosis of subcutaneous tissue
176
What is a grade 4 ulcer
Tissue necrosis or damage to muscle, bone or supporting structures
With or WITHOUt full thickness skin loss
177
Why should antibiotics NOT be used in pressure ulcers
Only in signs of infection, usually pressure ulcers are non-infected so there's no point
178
What is the STOPP tool
Identifies medication risks (risk outweighs the benefits)
179
What tool is used to assess Frailty, not a risk of fracture
PRISMA-7
180
What is the START screening tool
AlertShows which medications should be used for conditions in patients ove r65
181
What is the MELD model
Model for end-stage liver disease, stratifies severity of end stage liver disease when planning a transplant
182
What is the PERC tool
Pulmonary Embolism Rule Out criteria
183
First line management of overflow faecal incontinence
1. Increase movicol dose
2. Then add a stimulant laxative (Senna)
3. Give glycerol to help soften stools if laxative effect is taking a while
4. Then final line is a sodium phosphate or archaise oil enema
184
What three elements is the Z score based on
Age
Gender
Ethnicity
185
Second line treatment for osteoporosis if alendronate is not tolerated
Switch to another bisphosphonate - risedronate
If GI problems persist, then bisphosphonates aren’t tolerated = Strontium Renelate, Raloxifene, Denosumab
186
Lab Results for osteoporosis
ALL NORMAL
187
In what conditions should bisphosphonates be given other than osteoporosis
Conditions or medications that can cause osteoporosis (e.g., prednisolone)
188
If someone wants to stop their bisphosphonate use, what should be done
Repeat the DEXA and FRAX score and stop bisphosphonates if there is a low risk
Review in 2 years
189
Indications for lifelong bisphosphonate use
```
Age > 75
Glucorticoids therapy
Previous hip/spine fracture
Further fractures during treatment
FRAX score
T
```
190
How often should a FRAX score and DEXA scan be done in life long bisphosphonate treatments
Every 5 years
191
What fracture is increased with use of bisphosphonates
Proximal femoral shaft fractures
192
Why is Lorazepam not given in delirium
It increases the risk of falls in the elderly! And it exacerbates delirium
193
What is Paget's disease of the bone
Excessive osteoclastic resorption followed by increased osteoblast activity.
Common in older people
An isolated raised ALP
194
Treatment of Paget's disease of the bone
IV Bisphosphonates
195
First line management of osteoarthritis
Paracetamol + NSAIDs
196
When are bisphosphonates completely contraindicated
eGFR < 35 mL (so stage 3 CKD onwards)
Give denosumab etc instead.
Hypocalcaemia
197
Describe the Mental Capacity Act
1. Every adult must be assumed to be able to make their own decisions
2. All help and support must be provided to help a person make their own decision
3. Every adult can make a decision, even if it feels unwise or strange to others
4. If a person lacks capacity, decisions must be in their best interests
5. If a person lacks capacity, decisions must be the least restrictive to their rights and freedom
198
What is an independant mental capacity advocate
Represents a person who lacks capacity when it is proposed that the person receives serious medical treatment by the NHS or local authority
199
What is the purpose of advance decisions
A list of SPECIFIC treatments you wish to refuse in the future
200
Three elements of the deprivation of liberty safeguards
1. Apointing a representative
2. Give person to challenge deprivation through courts
3. Provide mechanism for such processes to be reviewed and monitored regularly
201
Where does DOLS take place
Hospital or care home
202
What is advanced care planning
To make a person's wishes on their management clear just in case they lose capacity in the future
203
Three circumstances for a DNAR
1. Patient asks to not be resuscitated
2. Doctor reckons DNACPR would be futile
3. Where a doctor considers that CPR may worsen quality of life
204
When is an LPA contraindicated
Once the person has lost capacity or already been admitted into hospital
205
Three issues of NSAIDs
1. Fluid Retention
2. Renal Toxicity
3. Peptic Ulceration
206
What tool is used to test for delirium
4AT test
207
How can we increase orientation for delirium
Having clocks and calendars in the room
208
If an ABCD2 score is >4 (high risk), what should be done
Aspirin 300mg daily
Referral to specialist within 24 hours of symptom onset
Secondary Prevention methods
208
If an ABCD2 score is >4 (high risk), what should be done
Aspirin 300mg daily
Referral to specialist within 24 hours of symptom onset
Secondary Prevention methods
208
If an ABCD2 score is >4 (high risk), what should be done
Aspirin 300mg daily
Referral to specialist within 24 hours of symptom onset
Secondary Prevention methods
208
If an ABCD2 score is >4 (high risk), what should be done
Aspirin 300mg daily
Referral to specialist within 24 hours of symptom onset
Secondary Prevention methods
208
If an ABCD2 score is >4 (high risk), what should be done
Aspirin 300mg daily
Referral to specialist within 24 hours of symptom onset
Secondary Prevention methods
208
If an ABCD2 score is >4 (high risk), what should be done
Aspirin 300mg daily
Referral to specialist within 24 hours of symptom onset
Secondary Prevention methods
208
If an ABCD2 score is >4 (high risk), what should be done
Aspirin 300mg daily
Referral to specialist within 24 hours of symptom onset
Secondary Prevention methods
209
What should be done if an ABCD2 score <3
Referral to specialist within 1 week of symptom onset
