Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NP- Phase 3a Medicine > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

what is delirium?

A

an acute state of fluctuating disturbance in attention, cognition and consciousness level, which can be precipitated by infection, drugs, dehydration or hypoxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are the subtypes of delirium?

A
  • Hyperactive- patients will be agitated, disoriented, delusional and may experience hallucinations
  • Hypoactive- patients will appear subdued, confused, disoriented and apathetic
  • Mixed- fluctuating between the hyperactive and hypoactive states of delirium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

causes of delirium

A
  • Drug initiation- benzodiazepines, analgesic and anticholinergic medications are those associated most with delirium
  • Withdrawal
  • Vascular- stroke/ MI
  • Hypoxia- respiratory/ cardiac failure
  • Systemic infection- pneumonia, UTI, malaria, wounds, IV-line infection
  • Metabolic derangement- hypo/hypernatremia, hypoglycaemia, uraemia
  • Surgery
  • Pain
  • Stroke/ seizures
  • Systemic organ failure
  • Intracranial infection/ head injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are 3 differentials of delirium?

A

dementia, anxiety, epilepsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

investigations in delirium

A
  • Identify cause- do FBC, U&E, LFT, blood glucose, ABG, septic screen (urine dipstick, CXR, blood cultures), ECG, EEG, CT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

how would you manage a patient with delirium?

A
  • Identify cause
  • Reorientate patient- clocks, calendars etc
  • Visits from friends and family
  • Manage fluid balance
  • Mobilize the patient
  • Remove anything invasive- catheters, IV;s etc
  • Review medications- discontinue any unnecessary agents
  • haloperiodol to regucy agitation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

how can you differentiate delirium from dementia?

A

Delirium- acute onset

Delirium- inattention, distractibility and disorganised thinking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what are the 4 subtypes of dementia?

A

Alzheimers
vascular
fronto-temporal
lewy body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is Alzheimers dementia?

A

progressive, global cognitive impairment- affects visuo-spatial skill, memory, verbal abilities and executive function (planning)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are some causes and risk factors of Alzheimers dementia?

A

Causes- environmental, genetic, accumulation of B-amyloid.

Risk factors- 1st degree FH, downs syndrome, depression, smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is vascular dementia?

A

cumulative effect of multiple small strokes, focal neurological signs, usually sudden onset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is dementia?

A

neurodegenerative syndrome with a progressive decline in several cognitive domains

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are the key features of fronto-temporal dementia?

A

personality change! Plus socially inappropriate actions, disinhibition, poor judgement, decreased motivation. Memory is preserved until later stages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is Picks disease?

A

type of fronto-temporal dementia in which Pick inclusion bodies can be found on histology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are the features of Lewy body dementia?

A

fluctuating cognitive impairment, detailed visual hallucinations, develops into Parkinsonism. Lew bodies (eosinophilic intracytoplasmic inclusion bodies) found in brainstem and neocortex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

how is Alzheimers diagnosed?

A

CT/ MRI- beta amyloid plaques, neurofibrillary tangles, atrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

how is frontotemporal dementia diagnosed?

A

CT-MRI- frontotemporal atrophy, Pick cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

how is vascular dementia diagnosed?

A

imaging will show vascular infarcts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

how is Lewy body dementia diagnosed?

A

imaging- lewy bodies in cortex of midbrain, generalised atrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

how is Alzheimers dementia managed?

A

donepezil (acetylcholinesterase inhibitors), memantine, treat depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

how is lewy body dementia managed?

A

acetylcholinesterase inhibitors, memantine, levodopa, physiotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what medications must be avoided when treating dementia?

A

neuroleptics, sedatives, tricyclic antidepressants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what are some examples of acetylcholinesterase inhibitors (AChE)?

A

donepazil
rivastigmine
galantamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

give an example of an antiglutamatergic treatment of dementia

A

Memantine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what is the triad seen in Parkinsons?

A

extrapyramidal triad of:
- pill rolling tremor
hypertonia- cogwheel rigidity
- bradykinesia- slow to initiate movements

26
Q

what are causes of Parkinsons disease?

A

loss of dopaminergic neurons in the substantia nigra- associated with lewy bodies

27
Q

what are some non-motor symptoms of parkinsons?

A
  • autonomic dysfunction- postural hypotension, constipation, urinary frequency/urgency, dribbling
  • sleep disturbance
    reduced sense of smell
28
Q

what are some neurophyschiatric symptoms of parkinsons?

A

depression
dementia
psychcosis

29
Q

what is the risk with beginning levodopa treatment in parkinsons?

A

efficacy reduces over time- so stronger doses needed (resulting in worse side effects and reduced response)- so usually start late

30
Q

what are pharmacological treatment options for parkinsons?

A
  • levodopa
  • dopamine agonists- ropinirole
  • apomorphine
  • anticholinergics (orphenadrine)
  • MAO-B inhibitors (rasagilline, selegiline)
  • COMT inhibitors (entacapone, tolcapone)
31
Q

what is the difference between 1st and 2nd degree osteoporosis?

A

1st- age related

2nd- related to another condition. medication

32
Q

risk factors of osteoporosis

A
  • female
  • over 50
  • white/asian
  • post-menopausal
  • FH
  • alcoholism
  • RA
  • Steroid use (long-term prednisolone)
  • thin
33
Q

how is osteoporosis investigated?

A

DEXA scan

bloods- normal calcium, phosphate and ALP- rules out other metabolic bone diseases

34
Q

what are the T score ranges from a DEXA scan

A

0 to -1= BMD is in the top 84%, no evience of osteoporosis

-1 to -2.5= osteopenia- risk of later osteoporotic fracture

worse than -2.5= osteoporosis

35
Q

pharmacological management of osteoporosis

A
  • bisphosphonates- alendronic acid (1st line)
  • calcium and vitamin D
  • HRT
36
Q

causes of urinary incontinence in men

A

prostate enlargement

urinary retention

37
Q

causes of urinary incontinence in womenn

A

functional incontinence- immobility (unable to reach toilet etc)

stress incontinence- coughing and laughing result in an increased intra-abdominal pressure, resulting in the loss of small, but frequent, amounts of urine

urge incontinence- sudden urge to go to the toilet- caused by detrusor overactivity

38
Q

oxford bamford classification- total anterior circulation stroke (large ACA/MCA stroke)

A

all 3 of:

  • unilateral weakness (and/or sensory deficit) of face, arm and leg
  • homonymous hemianopia
  • higher cerebral dysfunction (dysphasia, visuospatial disorder)
39
Q

oxford Bamford classification- - partial anterior circulation stroke

A

2 of:

  • unilateral weakness (and/or sensory deficit) of face, arm and leg
  • homonymous hemianopia
  • higher cerebral dysfunction (dysphasia, visuospatial disorder)
40
Q

Oxford bamford classification- posterior circulation stroke

A

one of:

  • cerebellar or brainstem syndromes
  • loss of consciousness
  • isolated homonymous hemianopia
41
Q

Oxford bamford classification- lacunar syndrome (LACS) (subcortical- midbrain and internal capsule)

A

one of:
- unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all 3

  • pure sensory loss
  • ataxic hemiparesis (cerebellar and motor symptoms)
42
Q

management of a stroke

A
  • ABCDE
  • o2 sats greater than 95%
  • nill by mouth (risk of aspiration pneumonia)
  • thrombolysis- e.g. altepase within 4.5 hours
  • antiplatelet therapy- clopidogrel
43
Q

what medications are associated with falls?

A
  • benzodiazepines
  • antidepressants- SSRI’s and tricyclics
  • antipsychotics
  • diuretics
  • ACE inhibitors
  • beta blockers
44
Q

what is vasovagal syncope?

A

‘simple faint’ vagal stimulation (fright, pain, emotion) leads to hypotension and syncope

45
Q

causes of postural hypotension

A
  • drugs- vasodilators, diuretics
  • chronic hypertension
  • volume depletion (dehydration, haemorrhage)
  • sepsis- vasodilation
46
Q

clinical features of cardiac syncope

A
  • ecg abnormalities
  • chest pain
  • arrythmias
  • palpitations
  • hypotension
  • loss of conciousness
47
Q

what is the sepsis 6?

A

3 in, 3 out:

  • IV fluids, IV antibiotics, 02 sats 94%
  • lactate, blood cultures, U&E’s
48
Q

what are the geriatric giants?

A
  • immobility
  • instability
  • intellectual impairment
  • incontinence
  • iatrogenesis
  • inanition
49
Q

clinical features of delirium

A
  • marked memory deficit
  • acute
  • disordered and disorientated thinking
  • worsened concentration, slow responses
  • reduced mobility/ movement
50
Q

what medications are associated with causing delirium

A
  • opiates
  • benzodiazepines
  • zopiclone
  • anticholinergics
  • Dopimanergic meds
51
Q

management of alcoholism

A

chlordiazepoxide

52
Q

what is Korsakoff syndrome?

A
  • hypothalamic damage and cerebral atrophy due to B1 deficiency
  • decreased ability to acquire new memories, confabulations, lack of insight and empathy
53
Q

what triad is seen in Wernicke’s encephalopathy?

A
  • confusion
  • ataxia
  • opthalmoplegia
54
Q

what is the sepsis 6?

A
  • oxygen (target >94%)
  • blood cultures
  • IV Abx
  • fluid resus
  • serum lactate and Hb
  • catheterise
55
Q

causes of faecal incontinence

A
  • sphincter dysfunction- due to vaginal delivery, surgical trauma
  • impaired sensation- due to diabetes, MS, dementia, spinal cord problems
  • idiopathic
56
Q

treatment and management of faecal incontinence

A
  • treat cause
  • ensure toilet is easy to get to
  • pelvic floor rehab
  • loperamide
  • skin care
  • enemas
57
Q

causes of urinary incontinence in men

A

prostate enlargement

58
Q

causes of urinary incontinence in women

A
  • functional incontinence
  • stress- incompetent sphincter (incontinence occurs with rise in intra abdominal pressure- coughing)
  • urge incontinence (precipitated by arriving home, cold, water running, caffeine- all due to detrusor overactivity)
59
Q

management of stress incontinence

A

pelvic floor exercises

  • intravaginal electrical stimulation
  • duloxetine
60
Q

what medications can prevent delirium?

A
  • dexmedetomidine- sedative

- cholinesterase inhibitors- rivastigmine or donepezil

NP- Phase 3a Medicine (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions