Brainscape's Knowledge GenomeTM

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


See full index

Phase 3a > Geriatrics PTS > Flashcards

Geriatrics PTS Flashcards

1
Q

Define Frailty

A
  • State of increased vulnerability resulting from ageing associated decline in functional reserve
  • Across multiple Physiological systems
  • Resulting in compromised ability to cope with everyday or acute stressors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the 4 components of the comprehensive geriatric assessment?

A
  • Medical assessment
  • Functional assessment
  • Psychological assessment
  • Social and environmental assessment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the medical assessment made up of?

A
  • Doctor, nurse, pharmacist, dietician, SALT
  • Problem list, comorbidities, medication review, nutritional statues
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What mades up the functional assessment?

A
  • OT, PT, SALT
  • Assesses ADLs, activity, exercise status, gait, balance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the psycological assessment comprised of?

A
  • Doctor, nurse, OT, psychologist
  • Cognitive status testing, mood/depression testing (PHQ-9 questionnaire)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the social and environmental assessment comprised of?

A
  • OT and social worker if needed
  • Informal support needs and assets, care resource eligibility, home safety
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the features of delirium?

A
  • Acute onset
  • Fluctuating course
  • Inattention
  • Altered level of consciousness
  • Usually reversible
  • Associated with underlying medical cause
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the features of dementia?

A
  • Chronic illness
  • Progressive course
  • No clouding of consciousness
  • No underlying/reversible cause
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What assessment tool is used for delirium?

A

4-AT

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

What causes delirium?

A
  • Infection
  • Drug use - withdrawal or new medications interaction
  • Reduced sensory input - blind, deaf, changing environment
  • Intracranial problems - stroke, seizures, haemorrhage
  • Electrolyte imbalances
  • Constipation
  • Urinary retention
  • Heart problems - MI, arrhythmia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How is delirium managed?

A
  • Treat underlying cause
  • Manage the environment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

6 ways to alter environment to help delirium

A
  • Clocks and calendars to maximise orientation
  • Ensure hearing aids/glasses are worn
  • Photos of family members
  • Consistency of staff members
  • Quiet bay/side room if possible
  • Sleep hygiene
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the complications of a long lie following a fall?

A
  • Pressure ulcers
  • Dehydration
  • Rhabdomyolysis
  • Hypothermia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How do you investigate pressure ulcers?

A
  • CRP, ESR
  • WCC
  • Swabs
  • Blood cultures
  • X-ray for bone involvement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How are pressure ulcers managed?

A
  • Antibiotics
  • Wound dressing
  • Pain relief
  • Debridement if grade 3/4
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is osteoporosis?

A
  • Decreased bone mineral density due to imbalance between remodelling and resorption
  • Increases risk for fractures - particularly spine, hip and neck of femur
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

7 risk factors for osteoporosis

A
  • Smoking
  • Early menopause
  • Steroid use
  • Underweight
  • Inactivity
  • Alcohol
  • Elderly
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How is osteoporosis managed?

A
  • Bisphosphonates - Zoledronate, Alendronate
  • IV once a year or oral once a week (on an empty stomach sit upright for half an hour after)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the tool used to assess multi-nutritional status?

A

MUST screening tool (malnutrition universal screening tool)

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

What is refeeding syndrome?

A
  • Metabolic disturbances as a result of reintroduction of nutrition to patients who are starved/severely malnourished
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the biochemical features of refeeding syndrome?

A
  • Hypophosphataemia
  • Hypokalaemia
  • Thiamine deficiency
  • Abnormal glucose metabolism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are some complications of re-feeding syndrome?

A
  • Cardiac arrhythmias
  • Coma
  • Convulsions
  • Cardiac failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How is re-feeding syndrome treated?

A
  • Monitor blood biochemistry (phosphate, glucose, sodium, potassium)
  • Commence re-feeding with guidelines
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Risk factors for pressure ulcers

A
  • Peripheral vascular disease
  • Immobility/long lie
  • Dehydration
  • Obesity
  • Malnourishment
  • Old age
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Environmental causes of falls in elderly people

A
  • Loose rugs
  • Pets
  • Furniture
  • Unstable footwear
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Power/balance causes of falls in elderly people

A
  • Inactivity leading to muscle weakness
  • Dizziness/loss of balance/ loss of proprioception (vertigo)
  • Pain, MS, osteoarthritis
  • Previous fall leading to decreased confidence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Cardiovascular causes of falls in elderly people

A
  • Vasovagal syncope
  • Situational syncope (micturition)
  • Postural hypotension
  • Myocardial infarction
  • Arrhythmia
  • Dehydration/shock
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Neurological causes of falls in elderly people

A
  • Stroke
  • PD
  • Gait disturbance
  • Visual impairment
  • Peripheral neuropathy
  • Myopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are some medications that increase risk of falls in elderly people?

A
  • Benzodiazepines (sedative)
  • Diuretics
  • Anti-hypertensives
  • Antidepressants
  • Antipsychotics
  • Polypharmacy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Miscellaneous causes of falls in elderly people

A
  • Infection/sepsis
  • Delirium
  • Hypoglycaemia
  • Incontinence
  • Alcohol (intoxication, neuropathy, Korsakoff’s/Wernicke’s)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

5 features of a Parkinsonian tremor

A
  • Pill rolling
  • Worse at rest
  • Reduced on distraction
  • Reduced on movement
  • Asymmetrical
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is the underlying pathophysiology of Parkinson’s?

A

Loss of dopaminergic neurones in the substantia nigra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Whagt class of drug is normally combined with L-dopa therapy to prevent peripheral side-effects?

A

Carbidopa - a dopa-decarboxylase inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

5 complications of L-dopa therapy

A
  • Development of choreiform movements (L-dopa induced dyskinesia)
  • Become tolerant to the medication
  • Confusion
  • Hallucinations
  • Postural hypotension
35
Q

6 cardiac conditions gthat may cause an embolic CVA

A
  • Atrial fibrillation
  • Infective endocarditis
  • Atrial-septal defect/ patent foramen ovale
  • Mitral regurgitation
  • Aortic or mitral valve disease
  • Valve replacement
36
Q

6 Stroke investigations

A
  • ECG
  • CT head
  • Carotid artery Doppler - carotid artery stenosis can cause ischaemic stroke
  • Lipid profile - could have hypercholesterolaemia whihc is a RF for stroke
  • Clotting screen - show increased risk of thrombosis or haemorrhage
  • Echocardiogram - exclude cardiac sources of emboli
37
Q

What ABCD2 score is considered “high risk” for a stroke and what should be done?

A

≥ 4 = high risk

Aspirin – 300mg daily – started immediately
Specialist referral within 24 hours of onset of symptoms
Secondary prevention measures (statins, antihypertensives)

Crescendo TIAs (two or more episodes in a week) should be treated as high risk, regardless of ABCD2 score

38
Q

What should be done for someone with an ABCD2 score of ≤ 3?

A

Specialist referral within 1 week of symptom onset, including decision or brain imaging
If vascular territory or pathology is uncertain – refer for brain imaging

39
Q

What are the components of the GCS?

A
  • Best eye opening response
  • Best verbal response
  • Best motor response (how well they localise pain)
40
Q

Causes of delirium

A
  • Infection
  • Polypharmacy
  • Urinary retention
  • Constipation
  • Dehydration
  • Electrolyte imbalance
  • Medication withdrawal
  • Stroke
  • MI
  • B12 deficiency
41
Q

Non-invasive investigations for delirium

A
  • Full blood count
  • ECG to exclude MI
  • U&Es
  • Urine dipstick to exclude UTI
  • Chest X ray to exclude pneumonia
42
Q

Causes of hyponatraemia

A

Dilutional effect
- Heart failure
- SIADH
- hypervolaemia
- NSAIDS
- Oliguria renal failure

Sodium loss
- Addison’s
- D&V
- Osmotic diurese (DM, diuretic excess)
- Severe burns
- Acute renal failure

43
Q

Symptoms of hypocalcaemia

A
  • Muscle cramps/spasms
  • Tetany
  • Seizures
  • Parathesia
  • Carpopedal spasm
  • Laryngospasm/ brochospasm
44
Q

Symptoms of hypercalcaemia

A

BONES, STONES, MOANS, GROANS
- Bone pain, fractures
- Renal stones
- Drowsiness
- Muscle weakness
- Depression
- N&V
- Constipation, abdo pain

45
Q

What MMSE score supports a diagnosis of dementia?

A

<25

46
Q

List cognitive assessment tools

A
  • MMSE
  • CP-COG
  • Addenbrooke’s
  • 6-CIT
  • AMT
  • MOCA
47
Q

Types of dementia and their key features

A

Alzheimer’s – Agnosia, Apraxia, Amnesia, Aphasia

Vascular dementia – stepwise progression of symptoms following ischaemic brain injury

Lewy body dementia – sleep behaviour disorder, falls, impaired consciousness, visual hallucinations, Parkinsonism

Frontotemporal dementia– memory fairly preserved, extreme personality changes and disinhibition

48
Q

Blood tests to exclude treatable causes of dementia?

A
  • B12, thiamine and folate levels
  • Thyroid function
  • FBC looking for anaemia
  • Syphilis serology
  • LFTs
49
Q

What is Donepezil and what types of dementia can it be used to treated?

A

Acetylcholinesterase inhibitor (others are rivastigmine and galatamine)

Can only be used to treat Alzheimer’s

Alternative medication – NMDA-receptor antagonist – blocks glutamate (memantine)

50
Q

What are the 2 subtypes of delirium?

A

Hyperactive - agitated, inappropriate behaviour, hallucinations

Hypoactive - lethargy, reduced concentration

51
Q

What are some risk factors for delirium?

A

Old age
Cognitive impairment
Frailty/multiple comorbidities
Significant injuries (e.g. hip #)
Functional impairment
History of alcohol excess
Sensory impairment (deaf, blind)
Poor nutrition
Lack of stimulation
Terminal phase of illness

52
Q

How does delirium present?

A

Acute behavioural change

Disorganised thinking/altered perception

Altered level of consciousness

Falling

Loss of appetite

53
Q

What bedside tests would you do for someone with delirium?

A

O2 sats
BP
Temperature
ABG/VBG

54
Q

What investigations would you do for someone with delirium?

A

FBC, LFT, U&E
CRP/ESR
Sputum culture
Folate, B12
HbA1C
TFT
CXR, ECG, urinalysis

55
Q

How do bisphosphates work?

A

Inhibition of osteoclasts

56
Q

List 3 adverse effects of bisphosphonates?

A

Oesophagitis

Osteonecrosis of the jaw

Increased risk of atypical stress fractures of the proximal femoral shaft in patients taking alendronate

57
Q

How are DEXA scan scores interpreted?

A

-1 to +1 = healthy
- 1 to -2.5 = osteopenia
≤ -2.5 = osteoporosis
≤ 2.5 and a current fragility fracture = severe osteoporosis

58
Q

What are the components of the FRAX scoring system?

A

Parent hip fracture
Height and weight (BMI)
Smoking
Alcohol >3 units a day
Steroids
Previous hip fracture
Femoral neck bone mineral density
Female gender
Age
RA
Secondary osteoporosis

59
Q

How is malnutrition diagnosed?

A

BMI < 18.5 kg/m2

Unintentional weight loss >10% in the last 3-6 months

BMI < 20kg/m2 plus unintentional weight loss >5% within the last 3-6months

60
Q

What are some causes of malnutrition?

A

Inadequate nutritional intake (starvation)
Increased nutrient requirements (cancer, sepsis, injury)
Inability to utilise ingested nutrients (malabsorption)
Increased loss (vomiting, diarrhoea)
Combination of all of them

61
Q

What tests are important to be done before commencing feeds in malnutrition?

A
  • U&Es
  • LFTs
  • ECG
62
Q

What are some clinical features of re-feeding syndrome?

A

CVS – arrythymias
GI – abdo pain, constipation, vomiting, anorexia
MSK – weakness, myalgia, rhabdomyelosis, osteomalacia
Resp - SOB, ventilator dependence, respiratory muscle weakness
Neuro – weakness, paraesthesia, ataxia
Metabolic – infections, thrombocytopenia, haemolysis, anaemia
Other – liver failure, Wernicke’s encephalopathy

63
Q

When looking at best interests, what needs to be considered?

A

Whether the person is likely to regain capacity and can the decision wait
How to encourage and optimise the participation of the person in the decision
The past and present wishes, feelings, beliefs and values of the person and any other relevant factors
Views of other relevant people (family members etc.)

64
Q

What is the role of an advanced directive?

A

Allows people who understand the implications of their choices to state their treatment wishes in advance

They can authorise specific procedures

They can refuse treatment in a predefined future situation

65
Q

What makes an advanced refusal of treatment legally binding?

A

The person is an adult
The person was competent and fully informed when making the decision
The decision is clearly applicable to current circumstances
There is no reason to believe that they have since changed their mind

66
Q

What factors would mean the advanced directive had less of a legal binding?

A

If there is and advanced REQUEST for treatment

This does not have the same legal binding as a refusal of treatment

But if it’s the patient’s known wish to be kept alive then reasonable efforts (nutrition, hydration) should be made

67
Q

What is deprivation of liberty?

A

Occurs when a person does not consent to care or treatment
i.e. they cannot consent to the treatment/care but they are having it anyway

For example a person with dementia who is not free to leave a care home and lacks capacity to consent to this

68
Q

What is a lasting power of attorney?

A

A document which a person can use to nominate someone else to make certain decisions on their behalf when they are unable to do so themself

It can be financial/about estate, or medical/health decisions

To be valid – it needs to be registered with the Office of the Public Gaurdian

69
Q

What is the role of an independent mental capacity advocate (IMCA)?

A

Commisioned from independent organisations by the NHS and local authorities to ensure the MCA is being followed

Role = support and represent the people who lack capacity and do not have anyone else to represent them in decisions (i.e. about long-term accommodation or serious medical treatment)

70
Q

What is the definition of postural hypotension?

A

A drop of >20/10 mmHg within 3 minutes of standing

Occurs in 30% of patients over 70

71
Q

What are some causes of postural hypotension?

A

Medications – diuretics, antihypertensives, antidepressants, polypharmacy
Cardiac – aortic stenosis, arrythmias, MI, cardiomyopathy, CHF, anaemia
Endocrine – diabetes insipidus, hypoadrenalism, hypothyroid, hypo anything..
Neuro – PD and PD+ syndromes
Blood loss, dehydration, shock

72
Q

How does postural hypotension present?

A

Asymptomatic
Falls/syncope
Dizziness
Light-headedness
Blurred vision
Weakness
Fatigue
Palpitations
Headache

73
Q

How is postural hypotension investigated?

A

Lying and standing blood pressure

Investigate for medical causes – medication review, blood tests

74
Q

How is postural hypotension managed?

A

Drink lots of water
Avoid large meals and alcohol
Exercises
Stand slowly
Sleep with head raised
Pharmacological – fludrocortisone, midodrine (autonomic dysfunction only)

75
Q

How are pressure ulcers classified?

A

Grade 1 – non-blanching erythema with intact skin
Grade 2 – partial thickness skin loss involving epidermis, dermis or both (abrasion/blister)
Grade 3 – full-thickness skin loss involving damage/necrosis of sub-cut tissue
Grade 4 – extensive loss, destruction/necrosis of muscle, bone or support structures
Unstageable – depth unknown, base of ulcer covered by debris

76
Q

What are the 2 major metabolic components of calcium homeostasis?

A
  • Vitamin D
  • Parathyroid hormone
77
Q

What is the role of vitamin D?

A

Increase Ca2+ absorption in the gut

Increased Ca2+ release from the bone

78
Q

Where is parathyroid hormone released from and what triggers it’s release?

A

Secreted from the chief cells of the parathyroid gland

In response to low serum Ca2+ levels (detected by calcium sensor cells in the parathyroid glands)

79
Q

What is the role/actions of parathyroid hormone?

A

Acts to increase Ca2+ levels

Causes increased osteoclast activity
Increases intestinal Ca2+ absorption
Increases vitamin D activation
Increases renal tubule re-absorption of Ca2+

80
Q

How is osteoporosis defined?

A

Reduction in bone mineral density
And micro-architectual deterioration of bone tissue

With a conseqent increase in bone fragility and susceptibility to fracture
BMD > 2.5 SDs below the mean is diagnostic
T score < -2.5

81
Q

Where are 4 common sites for osteoporosis related fractures?

A

Thoracic vertebrae – fractures here may lead to kyphosis and loss of height

Lumbar vertebrae

Proximal femur

Distal radius (Colles’ fracture)

82
Q

How would you investigate someone with suspected osteoporosis?

A

DEXA scan – T value < -2.5

Radiology – XR demonstrating fractures

Serum biochemistry – calcium, phosphate, alkaline phosphatase (normal)

Check for secondary causes – thyrotoxicosis, myeloma, hyperparathyroidism, malabsorption

83
Q

What T score would be seen in someone with osteopenia?

A

-1 to -2.5

If > - 1 then normal

84
Q
A

Phase 3a (11 decks)

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