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year 3 > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

Define Acopia

A

Where patients are just admitted because they are struggling with ADLs

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2
Q

What is deconditioning

A
  1. After being bedbound for a few days people get confused, have a poor nutritional state and can’t walk

Incidence of falls is greater

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3
Q

What are the contents of the Comprehensive Geriatric Assessment

A
  1. Medical
  2. Functional
  3. Psychological
  4. Social and environmental
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4
Q

Name three professions involved in medical assessment

A

Doctor, nurse and pharmacists

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5
Q

Name three professions involved in Functional Assessment

A
  1. OT
  2. PT
  3. SaLT
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6
Q

Define rehabilitation

A
  1. Process of restoring patient to maximum function
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7
Q

Define abuse

A
  1. 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
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8
Q

Name three factors that can influence the frequency of falls

A
  1. INTRINSIC: Muscle strength and joint flexibility, CNS issues
  2. EXTRINSIC: Environmental supportive factors like railings and grip of floor
  3. Magnitude of stressor: How easy it is to fall
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9
Q

Factors that affect severity of the fall

A
  1. Multiple system impariemnts
  2. Osteoporosis
  3. secondary injruy (e.g. pressure sores, dehydration)
  4. Loss of confidence (psychological)
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10
Q

Risk factors for falls

A
  1. Polypharmacy
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11
Q

Tests in falls

A
  1. ECG
  2. FBC, B12, folate, U + E, calicum, phosphate and TFTs
  3. Vt D as it is common deficiency in older people
  4. Carotid sinus massage
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12
Q

Investigation for unexplained syncope, normal ECG and no sturtcural heart disease

A
  1. Head-up tilt table testing
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13
Q

How can we reduce fall frequency

A
  1. Drug reviews
  2. Treat orthostatic hypotension
  3. Strength and ablance training
  4. Walking aids
  5. Enviornmental assessment and modifictaion
  6. Visiual aids
  7. Reduce stressors
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14
Q

What drugs can cause falls

A
  1. Benzos
  2. Antidepressants
  3. Antipsychotics
  4. Diuretics
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15
Q

How do we prevent falls in th ehosiptal

A
  1. Good quality footwear and walking aids

2. Call bell close to hand

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16
Q

Define syncope

A
  1. Sudden transient loss of consciousness due to reduced cerebral perfusion
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17
Q

What causes syncope

A
  1. Hypotenison by upright posture,, eating, coughing and straining
  2. Vasovagal syncope
  3. Carotid sinus hypersensitivity syndrome
  4. Pump problem
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18
Q

What is vasovagal syncope

A
  1. Feeling of pale, clammy or light headed followed by nausea followed by loss of consciousness
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19
Q

Differential of syncope

A
  1. Epilepsy
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20
Q

Investigations of syncope

A
  1. Bloods for anaemia, spesis and MIs
  2. ECG
  3. tilt test
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21
Q

What causes balance disequilibrium

A
  1. Decreased visual acuity as we age
  2. Reduced hearing
  3. arthritis
  4. Sarcopenia due to inactivity
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22
Q

What are drop attacks

A
  1. Unexplained falls with no prodrome
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23
Q

What can cause drop attacks

A
  1. Cardiac arrest
  2. Carotid sinus Syndrome
  3. Orthostatic hypotension
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24
Q

How is orthostatic hypotension diagnosed

A
  1. A fall in BP of 20mmhG sytolic or 10mmhg diastolic.
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25
Q

Risk factors for orthostatic hypotension

A
  1. Drugs
  2. Chronic hypertension
  3. Spesis
  4. Adrenal insufficiency
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26
Q

How is orthostatic hypotension treated

A
  1. NaCl tablets or water

If these don’t work, Fludrocortisone

Compression stockings full length and head-tilt to bed

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27
Q

What is situational hypotensions

A
  1. Fall of 22mmHg 75 mins after meal (postprandial)
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28
Q

How is situational hypotenison treated

A
  1. Avoid alcohol and hypotensive drugs during meals

2. Lie down afte rmeal

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29
Q

What is Carotid sinus syndrome

A
  1. symptomatic bradycardia and/or hypotension due to a hypersensitive carotid baroreceptor reflex, resulting in syncope or near-syncope.
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30
Q

What triggers CSS

A
  1. Neck Turning
  2. Tight Collars
  3. Straining
  4. Prolongues standing
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31
Q

How is CSS diagnosed

A
  1. Systolic BP fall of 50mmHg after carotid sinus massage 5s
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32
Q

What is the referral criteria for falls

A
  1. Recurrent
  2. Loss of consciousness
  3. Injury
  4. Polypharmacy
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33
Q

Age-related changes that can cause incontinence

A
  1. Diminished bladder cpaacity
  2. Diminished bladder conrtactile function
  3. Atrophy and vagina and urethra

Also, FISTULAS, BPH, being bedbound and access to toilet

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34
Q

List two indications for catheterisations

A
  1. Urinary retentions symtpoms
  2. BOO
  3. Acute renal failure
  4. Sacral rpessure sores
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35
Q

When are catheterisations contraindicated

A
  1. Immbolity
  2. HF as furosemide
  3. Monitoring fluid balance
    4.
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36
Q

How often should cataheters be changed

A

Every 3 months

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37
Q

IF patient was to be on catheter more than a year what should be used instead

A

Supraubic

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38
Q

If you suspect the catheter is infected what shohuld you do

A
  1. Remove catheter and administer IM Gentamycin
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39
Q

What can cause faecal incontinence

A
  1. Disorders of anal sphincter and lower rectum
  2. contipation and diarrhoea
  3. Neurological issues
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40
Q

How to treat overflow incontinence

A
  1. Rehydration
  2. Phosphate enema od
  3. Complete colonic washout
  4. Laxatives
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41
Q

How should neurogenic incontinence be treated

A
  1. Loperamide and phosphate enema
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42
Q

Define stroke

A

Stroke is the sudden onset of a focal neurological deficit, lasting >24h or leading to death, caused by a vascular pathology.

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43
Q

What classifictaion is used to assess stroke

A
  1. Bamford Classification
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44
Q

Clinical Features of Total Anterior Circulation stroke

A
  1. Hemiparesis and hemisensory loss
  2. Homonymous Hemianopia
  3. Dysphagia, visuo-spatial and perceptual problems
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45
Q

Causes of a TACS

A
  1. Occlusion of internal carotid or MCA

2. EMboli

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46
Q

What causes a PACS

A
  1. Occlusion of Anterior cerebral or MCA
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47
Q

Features of a lacunar stroke

A
  1. Hemiparesis
  2. Ataxic Hemiparesis
  3. Hemisensory loss
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48
Q

Features of POCS

A
  1. Brainstem symptoms
Diplopia (CN3)
Vertigo (CN3)
Bilateral limb problems
Homonymous hemianopia 
cortical blindness
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49
Q

Causes of POCS

A
  1. Infarct in vertebral, basilar or PCA
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50
Q

Risk factors (fixed) for stroke

A
  1. Age, sex, wthnicity, FH, previous incident , vascular disease
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51
Q

Risk factors (modifiable)

A
  1. SMoking, alcohol, obesity, diet, oral contraceptive pill
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52
Q

What diseases can predispose someone to a stroke

A
  1. HTN
  2. AF
  3. Diabetes
  4. Hypercholesterolaemia
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53
Q

Name two assessments in strokes

A
  1. GCS

2. National Institute of Health Stroke Scale

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54
Q

Investigations for storkes

A
  1. Blood tests
  2. urinalysis
  3. ECG
  4. CXR
  5. CT brain
  6. Carotid doppler
  7. ECHO
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55
Q

Acute management of stroke

A
  1. Iv Alteplase but need CT head first
  2. 300 mg Aspirin ASAP if haemorrhagic is eliminated
  3. Oxygen supplementation
  4. Iv insulin if cglose is over 11mmol/L
    Treat seizures
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56
Q

What assessment is used by nutritionists when patient is high risk for swallowing difficulties

A
  1. SALT assessment

2. NGT

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57
Q

When should alteplase be used (time frame)

A

Within 4.5 hours of a stroke

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58
Q

When shoudl alteplase not be used

A
  1. Previous haemorrhage
  2. Seizure at onset
  3. Impaired coagulation
  4. Uncontrolled hypertension
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59
Q

How to protect patient from another stroke

A
  1. ANTIPLATELET THERAPY: 300mg for 2 weeks aspirin, followed by clopidogrel (75mg)
  2. Lower BP , CHolesterol, anticoag for AF (warfarin/DOAC)
  3. CAROTID ENDARTERECTOMY
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60
Q

Score system for TIA

A
  1. ABCD2
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61
Q

What is delirium

A
  1. Syndrome of disturbances of consciousness and cognition involving organic brain disorders
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62
Q
  1. Key features of delirium
A
  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)

  1. Disturbed sleep-wake cycle
  2. Emotional disturbance (fear, depressoin and anxiety)
  3. Delusions
    POOR INSIGHT
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63
Q

What can cause delirium

A
  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
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64
Q

What drugs can cause delirium

A
  1. Antipsychotics
  2. Antidepressants
  3. Opiates
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65
Q

Investigations for delirium

A
  1. CXR, blood tests, Blood culture, blood gases, drug levels
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66
Q

Non-drug managemnet of delirium

A
  1. Quiet environemny
  2. optimize visual and auditory acuity (spectacles and hearing aids
  3. Reassurance
  4. Epxlain who you are and what you wish to do
  5. Educate visitors
  6. Do not argue
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67
Q

When should drug interventions be done for delirium

A
  1. Signfiicant distress
  2. Safety of others an dtothemselves
  3. Ripping out iv lines, interrupting treatment
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68
Q

Drug treatment for deliirum

A
  1. SHORT ACTING BDZ (LORAZEPAM)

2. HALOPERIDOL or atypical (OLANZAPINE)

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69
Q

What causes pressure sores

A
  1. Skin necrosis due to ressure induced ischaemia
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70
Q

How are pressure sores graded

A
  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
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71
Q

How long doe sit take for pressure sores to develop

A

2 hours of ischaemia

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72
Q

Risk factors for pressure sores

A
  1. Age
  2. Immobility
  3. Neurological damage
  4. Sedatie drugs
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73
Q

Name a risk tool for pressure sores

A
  1. Waterlow scores
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74
Q

How are pressure sores managed

A
  1. Risk assessed 6 hrs into admission
  2. Pressure relieving
  3. Debridement
  4. Dressings
  5. Antibiotics
    Promote healthy helaing environment
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75
Q

Clinical features of Osteoporosis

A
  1. Acute painful fracture

2. Progressive kyphosis

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76
Q

Secondary causes of osteoporosis

A
  1. Steorids
  2. Phenytoin
  3. PPIs
  4. Heparin
  5. Ciclosporin

Hyperthyroidism, Hyperparathyroidism, kidney failure, smoking and alcohol

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77
Q

Primary prevention of osteoporosis

A
  1. Diet, excercise, stop smoking ,reduce alcohol

2. Prophylaxis with bisphosphonate

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78
Q

How is osteoporosis managed

A
  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
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79
Q

Surgery for osteoporosis

A
  1. VERTEBROPLASTY
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80
Q

Name three causes of malnutrition

A
  1. Decreased nutrient intake
  2. Increased nutrient requirement (sepsis/injury)
  3. Malabsroption
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81
Q

Consequences of malnutrition on the body

A
  1. Reduced immune system
  2. Muscle wasting
  3. Impaired wound healing
  4. Micronutrient deficiencies such as selicium
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82
Q

What assessment is used to recognise malnutrition

A

MUST

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83
Q

How is malnutrition treated

A
  1. Food
  2. Oral nutritional supplements
  3. Eneteral/parenteral
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84
Q

What is enteral nutrition

A

Direct feeding into the gut such as stomach, duodenum or jejunum
2 Preserves mucosa

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85
Q

Advantage of enteral nutrition

A

Inexpensive compared to parenteral

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86
Q

Disadvantages of enteral nutrition

A
  1. Tolerance (satiety, bowel size)
  2. Tube is uncomfortable
  3. Quality of life
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87
Q

Name two types of enteral methods

A
  1. NG

2. NJ

88
Q

Disadvantage of NG

A

Only used for 30 days or less

89
Q

How do we monitor NG tube

A
  1. Check pH aspirate to confirm position (<5.5)
90
Q

Diasvntage of Nj

A

Only used for less than 60

91
Q

Name tow ways we achieve long term enteral nutrition

A
  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
Q

What is parenteral nutrition

A
  1. Feeding when gut is inaccessible
93
Q

indications for parenteral nutrition

A
  1. Bowel obstruction
  2. GI Fistula
  3. prolongues bowel rest
94
Q

Disadvtange of parenteral

A
  1. Infection
  2. Costly
  3. Onvasive
95
Q

What is referring syndrome

A
  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
Q

How is referring syndrome managed

A

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
Q

What four things influence pharmacokinetics in older people

A
  1. Absorption
  2. Disrtibuton
  3. Metabolism
  4. Excretion
98
Q

How is propranolol conc affected in elderly

A

Hepatic first pass metabolism declines

99
Q

How is calcium carbonate absorption affected

A

Reduced as gastric pH increases from atrophy

100
Q

Why is salbutamol less effective

A

Calcification of blood vessels

101
Q

Why does digoxin conc increase

A

Renal excretion falls - can cause renal failure

102
Q

Clinical features of digoxin toxicity

A
  1. N and V, Abdo pain, yellow discolouration of vision, arrhythmia, hyperkalaemia
103
Q

Side-effects of oxybutynin

A
  1. Anti muscarinic: dry mouth, urinary retention and confusion

Ocybutinin is more potent elderly

104
Q

Effect of diazepam in elderly

A

Half life increase so causes side effects (drowsiness, confusion)

105
Q

Common adverse reactions in elderly

A
  1. Falls
  2. Confusion
  3. Bowel problems (diarrhoea and constipation)
106
Q

What medication is given to elderly people who are suffering from fractures

A

Give bisphosphonates (needed to build up bone) + low dose D3 + Calcium

107
Q

First-line Management of postural hypotension with no definitive cause

A

Only a 30 mmHg drop on lying and standing - so diagnosed postural hypotension but not underlying causes

Lifestyle Advice

108
Q

What defines postural hypotension

A

Reduction in 20mmHg systolic or 10mmHg diastolic within 3 minutes of standing

109
Q

When should BP be measured in lying and standing interventions

A

at 1 minute and then at 3 minutes

110
Q

What is the management steps in postural hypotension

A

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
Q

How does fludrocortisone function

A

Mineralocorticosteroids:

Acts like cortisol, increasing BP by increasing re-absorption of salt

112
Q

Two other indications for fludrocortisone

A

21-Hydroxylase deficiency (CAH)

Addison’s

113
Q

What drugs can cause falls

A 
Benzodiazepines
Z-drugs
Tricyclic antidepressants + Mirtazipine
Monoamine Oxidase Inhibitors
SNRIs
antipsychotics
Opioids
Anti-Epileptics
Antiparkinson drugs 
Alpha receptor blockers
GTN
ACEIs
114
Q

Name the main bisphosphonate used

A

Alendronate

115
Q

What is given to post-menopausal women at risk of Low BMD

A

Alendronate

116
Q

Why are bisphosphonates prescribed so easily (e.g., a woman falls with a fracture will get bisphosphanates even before her DEXA scan)

A

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
Q

What is a FRAX score

A

The probability of a fracture within the next ten year s

118
Q

How do we interpret a DEXA scan

A

A T-score less than -2.5 the standard deviation indicates osteoporosis

119
Q

What is osteopenia in a DEXA scan

A

-1 to -2.5

120
Q

WHat is a normal DEXA scan score

A

Anything greater than -1

121
Q

What is a Z score

A

A comparison of what a patients BMD is compared to the BMD of a male or female their weight

122
Q

What is the first line intervention for an elderly woman who has had a suspected fragility fracture

A

Bisphosphonates + Vit D and calcium supplements if you suspect a deficiency

123
Q

How do bisphosphonates work

A

They decrease osteo-clast mediated bone resorption

124
Q

What is a primary prevention of Osteoporosis

A

Vit D replacement to EVERYONE

+ Bisphosphonates

125
Q

Who should be assessed in a FRAx score

A

Women over 65
Men over 75
Younger patients on steroids or previous fractures

126
Q

What does a T score show

A

What their BMD is compared to a young adult population of the same gender

127
Q

What is the second line medictaion given for primary prevention of osteoporosis

A

Denosumab

128
Q

How does Denosumab work

A

A monoclonal antibody which inihbit receptors that mature osteoclasts

129
Q

Name other pharmacological treatments for OSteoporosis

A

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
Q

Side Effects of Bisphosphonates

A

AF
Osteonecrosis of the jaw
Atypical stress fracture

Oesophageal ulcers

131
Q

How should bisphosphonates be taken

A

Sit up for at least 30 minutes after the dose and drink a glass of water to stop oesophageal ulcers from forming

132
Q

What are the risk factors for osteoporosis

A

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
Q

What is the GOLD standard for confirming Osteoporosis

A

DEXA scan

X-Rays for any fractures

134
Q

How do loop diuretics function and when are they indicated

A

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
Q

Side Effect of Loop Diuretics

A

Hypokalaemia Metabolic Alkalosis

136
Q

How do thiazide diuretics work and when aret hey indicated

A

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
Q

What chronic condition can thiazide diuretic precipitate

A

GOUT

From chronic hyperuricaemia
and Hyperglycaemia

138
Q

What is the most common cause of hyponatraemia

A

Dehydration, from dementia - they forget to drink

139
Q

Cause of hypovolaemic hyponatraemia

A

Iv normal saline

140
Q

Causes of Euvolaemic hyponatraemia

A

SIADH

Hypothyroidism

141
Q

What causes hypervolaemic hyponatraemia

A

Fluid restriction

142
Q

What is the limit to the rate of hypertonic saline solution (3%) that can be given

A

12 mmol/L/day or lower - central pontine myelinolysis

143
Q

First Line investigation for hyponatraemia

A

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
Q

What is a side-effect seen in the elderly, caused by tramadol

A

SEIZURES - very common

145
Q

What drugs can reduce the seizure threshold

A 
Antipsychotics
Antibiotics: Penecillins, cephalosporins
SNRIs and Tricyclics
Tramadol 
Fentanyl 
Ketamine
Lidocaine
Lithium 
Antihistamines
146
Q

What should we look out for when prescribing first gen antihistamines in the elderly (chlorphenamine)

A

Can cause confusion and hallucinations

147
Q

What drugs can cause dlirium

A 
BDZs
Opitates
Antiparkinson Drugs
Tricyclics
Digoxin 
Beta BLockers
Steroids
Antihistamine (chlorphenamine)
148
Q

Side effect of digoxin

A

Can cause arrythmias

149
Q

What conditions can cause Charles Bonnet Syndrome

A

Age related macular degeneration
Glaucoma
Cataracts

150
Q

What is the first line investigation for acute confusion

A

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
Q

What is myelofibrosis

A

Marrow fibrosis -> pancytopenia

A common cause for anaemia in the elderly

152
Q

Clinica features of Myelofibrosis

A

Weight loss, fever and night sweats

Splenomegaly

Recurrent infections + easy bruising

Hepatosplenomegaly

Because of fibrosis, bone marrow may not be aspirated - dry tap

153
Q

How can we diagnose myelofibrosis

A

Blood film to see poikilocytes (tear shaped RBCs)

154
Q

Management of myelofibrosis

A

Stem cell transplantation

Thalidomide

155
Q

Most common cause of anaemia in the elderly

A

Iron deficiency

156
Q

How is gentamicin usually given

A

IV not oral, only given in hospitals

157
Q

What UTi medication commonly causes creatinine derangement

A

Trimethoprim - inhibits the excretion of creatinine into the urine

158
Q

Why should Nitrofurantoin be avoided in elderly patients

A

It’s not as effective as renal filtration of the drug is lowered in elderly populations, less likely to cure a UT I

159
Q

What opioid should be given to elderly patients and why

A

Oxycodone, because others are more likely to precipitate CKD

160
Q

What is Augmentin

A

Another term for co-amoxiclav

161
Q

WHat antibiotic is given for aspiration pneumonia

A

IV Cephalosporins and Metronidazole

Remember, oral first but only if they are not nil by mouth

162
Q

CXR findings in aspiration pneumonia

A

Consolidation in the right lung (as it’s wider and more vertical)

163
Q

Signs of staph. pneuomnia

A

Bilateral cavitating bronchopneumonia

164
Q

Characteristic of Klebsiella Pneumonia

A

Affects the upper lobes + red rusty sputum

More common in the elderly

165
Q

Signs of mycoplasma pneumoniae

A

Young, children

AIHA
Just flu like symptoms

166
Q

How do we interpret a CURB-65 score

A

0-1 = home treatment

1 = consider hospital treatment

3-5 = hospital admission + consider for ITU referral

167
Q

What should be done after placement and before each use of an NG tube

A

Confirm the position of the tube with an abdominal X-Ray before progressing (as if it’s misaligned = aspiration pneumonia)

168
Q

Management of urinary retention

A
  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
Q

What is DOLS

A

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
Q

Advanced care plan vs lasting power of attorny

A

Advanced care plan is usually done to refuse treatment vs seletcing an individual to make decisions for you

171
Q

What is the first line Opioid that is given to elderly people

A

Tramadol or Oxycodone

172
Q

What medicatio should not be used in conjunction to Sildenafil

A

Nitrates - as they also. cause vasodilation

173
Q

What is a grade I pressure ulcer

A

Non-blanchable erythema of intact skin + discolouration

174
Q

What is a Grade 2 pressure ulcer

A

Partial skin loss involving the epidermis or dermis or both

Ulcer is superficial (looks like an abrasion or blister)

175
Q

What is a grade 3 ulcer

A

Full thickness skin loss, with necrosis of subcutaneous tissue

176
Q

What is a grade 4 ulcer

A

Tissue necrosis or damage to muscle, bone or supporting structures

With or WITHOUt full thickness skin loss

177
Q

Why should antibiotics NOT be used in pressure ulcers

A

Only in signs of infection, usually pressure ulcers are non-infected so there’s no point

178
Q

What is the STOPP tool

A

Identifies medication risks (risk outweighs the benefits)

179
Q

What tool is used to assess Frailty, not a risk of fracture

A

PRISMA-7

180
Q

What is the START screening tool

A

AlertShows which medications should be used for conditions in patients ove r65

181
Q

What is the MELD model

A

Model for end-stage liver disease, stratifies severity of end stage liver disease when planning a transplant

182
Q

What is the PERC tool

A

Pulmonary Embolism Rule Out criteria

183
Q

First line management of overflow faecal incontinence

A
  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
Q

What three elements is the Z score based on

A

Age
Gender
Ethnicity

185
Q

Second line treatment for osteoporosis if alendronate is not tolerated

A

Switch to another bisphosphonate - risedronate

If GI problems persist, then bisphosphonates aren’t tolerated = Strontium Renelate, Raloxifene, Denosumab

186
Q

Lab Results for osteoporosis

A

ALL NORMAL

187
Q

In what conditions should bisphosphonates be given other than osteoporosis

A

Conditions or medications that can cause osteoporosis (e.g., prednisolone)

188
Q

If someone wants to stop their bisphosphonate use, what should be done

A

Repeat the DEXA and FRAX score and stop bisphosphonates if there is a low risk

Review in 2 years

189
Q

Indications for lifelong bisphosphonate use

A 
Age > 75
Glucorticoids therapy 
Previous hip/spine fracture
Further fractures during treatment
FRAX score
T
190
Q

How often should a FRAX score and DEXA scan be done in life long bisphosphonate treatments

A

Every 5 years

191
Q

What fracture is increased with use of bisphosphonates

A

Proximal femoral shaft fractures

192
Q

Why is Lorazepam not given in delirium

A

It increases the risk of falls in the elderly! And it exacerbates delirium

193
Q

What is Paget’s disease of the bone

A

Excessive osteoclastic resorption followed by increased osteoblast activity.

Common in older people

An isolated raised ALP

194
Q

Treatment of Paget’s disease of the bone

A

IV Bisphosphonates

195
Q

First line management of osteoarthritis

A

Paracetamol + NSAIDs

196
Q

When are bisphosphonates completely contraindicated

A

eGFR < 35 mL (so stage 3 CKD onwards)

Give denosumab etc instead.

Hypocalcaemia

197
Q

Describe the Mental Capacity Act

A
  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
Q

What is an independant mental capacity advocate

A

Represents a person who lacks capacity when it is proposed that the person receives serious medical treatment by the NHS or local authority

199
Q

What is the purpose of advance decisions

A

A list of SPECIFIC treatments you wish to refuse in the future

200
Q

Three elements of the deprivation of liberty safeguards

A
  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
Q

Where does DOLS take place

A

Hospital or care home

202
Q

What is advanced care planning

A

To make a person’s wishes on their management clear just in case they lose capacity in the future

203
Q

Three circumstances for a DNAR

A
  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
Q

When is an LPA contraindicated

A

Once the person has lost capacity or already been admitted into hospital

205
Q

Three issues of NSAIDs

A
  1. Fluid Retention
  2. Renal Toxicity
  3. Peptic Ulceration
206
Q

What tool is used to test for delirium

A

4AT test

207
Q

How can we increase orientation for delirium

A

Having clocks and calendars in the room

208
Q

If an ABCD2 score is >4 (high risk), what should be done

A

Aspirin 300mg daily

Referral to specialist within 24 hours of symptom onset

Secondary Prevention methods

208
Q

If an ABCD2 score is >4 (high risk), what should be done

A

Aspirin 300mg daily

Referral to specialist within 24 hours of symptom onset

Secondary Prevention methods

208
Q

If an ABCD2 score is >4 (high risk), what should be done

A

Aspirin 300mg daily

Referral to specialist within 24 hours of symptom onset

Secondary Prevention methods

208
Q

If an ABCD2 score is >4 (high risk), what should be done

A

Aspirin 300mg daily

Referral to specialist within 24 hours of symptom onset

Secondary Prevention methods

208
Q

If an ABCD2 score is >4 (high risk), what should be done

A

Aspirin 300mg daily

Referral to specialist within 24 hours of symptom onset

Secondary Prevention methods

208
Q

If an ABCD2 score is >4 (high risk), what should be done

A

Aspirin 300mg daily

Referral to specialist within 24 hours of symptom onset

Secondary Prevention methods

208
Q

If an ABCD2 score is >4 (high risk), what should be done

A

Aspirin 300mg daily

Referral to specialist within 24 hours of symptom onset

Secondary Prevention methods

209
Q

What should be done if an ABCD2 score <3

A

Referral to specialist within 1 week of symptom onset

year 3 (25 decks)

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