Geriatrics, Public Health and General Practice Flashcards
What is vasovagal syncope?
“Simple faint”
Transient LOC caused by transient global cerebral hypoperfusion, commonly relating to emotional response - fear, anxiety, disgust
- Also may happen due to prolonged standing
What drugs commonly trigger orthostatic hypotension?
Tamsulosin (BPH)
Antihypertensives
Diuretics
TCAs
Antipsychotics
Alcohol
What are the three criteria for defining syncope?
- Loss of consciousness
- Transient - no need to intervene for patient to recover
- Caused by global cerebral hypoperfusion - reduction in blood pressure
What do the European Society of Cardiology states syncope is characterised by?
Rapid onset;
Short duration (=<20 seconds);
Spontaneous and complete recovery
What is reflex syncope?
Neurally mediated syncope due to an inappropriate autonomic reflex in response to a trigger
e.g. vasovagal syncope
What is postural (orthostatic) syncope?
Variety of symptoms (Initial, classical and delayed orthostatic hypotension), with syncope dependent on standing up
- Results from insufficiency of the baroreceptor response
What are the causes of orthostatic hypotension?
- Autonomic nervous failure secondary to drugs
- Hypovolaemia
- Primary autonomic nervous failure - e.g. Parkinson’s, Lewy body dementia
- Secondary autonomic nervous failure - e.g. diabetes, uraemia, spinal cord lesions
Would Transient ischaemic attack typically involve LOC?
No;
Instead features transient neurological deficits such as visual disturbance, speech disturbance or limb weakness/sensory disturbance
What is the most common dementia subtype?
Alzheimer’s dementia - 50% of all dementia diagnoses
What is the pathophysiology of Alzheimer’s dementia?
Amyloid plaques + Neurofibrillary Tangles:
- Amyloid plaques - clumps of beta-amyloid and degenerating bits of neurons and other cells
- Neurofibrillary tangles - bundles of twisty filaments within neurons, mostly from tau protein - reduction in transmission of information and eventually brain cell death
What are the symptoms of Alzheimer’s dementia?
- Usually begin after the age of 60
- Most common presenting symptom in memory loss, with evidence of varying changes in planning, reasoning, speech and orientation
- Can effect all areas of the brain; many functions and abilities can be impacted upon and eventually lost
What is the disease course of Alzheimer’s dementia?
Progresses steadily over time
What are the radiological features of osteoarthritis (OA)?
LOSS
L - Loss of joint space
O - Osteophytes
S - Subchondral cysts
S - Subchondral sclerosis
What is the pulse rhythm of AF?
Irregularly irregular pulse
What is stress incontinence?
Involuntary leakage of urine on effort or exertion, or on sneezing or coughing
- Due to an incompetent sphincter
What investigations may be performed in patients with incontinence?
Urine dipstick - UTI
Review drug Hx - Drugs may worsen urinary incontinence - e.g. ACEi
Urinary diary - patient recording time and volume of fluid intake and micturition for a minimum of three days
Urodynamic studies - Cytometry to assess bladder function
What is the management of stress incontinence?
Pelvic floor muscle exercises - three month trial of eight contractions three times a day
Duloxetine
Surgery
What are the different parts of a death certificate?
Part 1 describes main events leading to death:
- 1a) caused by 1b) caused by 1c)
Part 2 describes disease of conditions attributing to death but not part of the direct sequence leading to it
After a fall, when is it necessary to provide an urgent CT Head?
In adults sustaining head injury and any of the following risk factors, CT head must be performed within 1 hour:
1. GCS < 13 in A&E
2. GCS less than 15 2hrs post-injury in A&E
3. Suspected open or depressed skull fracture
4. Any sign of basal skull fracture
5. Post-traumatic seizure
6. Focal neurological deficit
7. More than 1 episode of vomiting
What is a mild cognitive impairment?
The transitional state between cognitive changes of normal ageing and fully developed clinical features of dementia
What are the two subtypes of Mild cognitive impairment?
Amnestic (Including memory impairment)
Non-amnestic (Other non-memory cognitive domains impaired)
When is MCI diagnosed?
When a patient has a cognitive symptom abnormal for their age and not attributable to dementia
- Patients should still be able to carry out normal daily functional activities
What is delirium?
A state of confusion (Acute confusional state), usually caused by underlying medical or surgical problems e.g. UTI constipation, often starting suddenly in elderly patients and usually resolving once underlying precipitant resolves
What can cause delirium?
CHIMPS PHONED:
Constipation
Hypoxia
Infection
Metabolic disturbance
Pain
Sleeplessness
Prescriptions
Hypothermia/pyrexia
Organ dysfunction - hepatic or renal
Nutrition
Environmental changes
Drugs - over the counter, illicit, alcohol, smoking
What constitutes a confusion screen?
- Bloods:
- FBC
- U&Es
- LFTs
- Coagulation/INR
- TFTs
- Calcium
- B12/folate/haematinics
- Glucose
- Blood cultures - Urinalysis
- Imaging
- CT Head, CXR