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Phase 3a > Geriatrics, Public Health and General Practice > Flashcards

Geriatrics, Public Health and General Practice Flashcards

1
Q

What is vasovagal syncope?

A

“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

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2
Q

What drugs commonly trigger orthostatic hypotension?

A

Tamsulosin (BPH)
Antihypertensives
Diuretics
TCAs
Antipsychotics
Alcohol

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3
Q

What are the three criteria for defining syncope?

A
  1. Loss of consciousness
  2. Transient - no need to intervene for patient to recover
  3. Caused by global cerebral hypoperfusion - reduction in blood pressure
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4
Q

What do the European Society of Cardiology states syncope is characterised by?

A

Rapid onset;
Short duration (=<20 seconds);
Spontaneous and complete recovery

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5
Q

What is reflex syncope?

A

Neurally mediated syncope due to an inappropriate autonomic reflex in response to a trigger
e.g. vasovagal syncope

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6
Q

What is postural (orthostatic) syncope?

A

Variety of symptoms (Initial, classical and delayed orthostatic hypotension), with syncope dependent on standing up
- Results from insufficiency of the baroreceptor response

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7
Q

What are the causes of orthostatic hypotension?

A
  1. Autonomic nervous failure secondary to drugs
  2. Hypovolaemia
  3. Primary autonomic nervous failure - e.g. Parkinson’s, Lewy body dementia
  4. Secondary autonomic nervous failure - e.g. diabetes, uraemia, spinal cord lesions
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8
Q

Would Transient ischaemic attack typically involve LOC?

A

No;

Instead features transient neurological deficits such as visual disturbance, speech disturbance or limb weakness/sensory disturbance

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9
Q

What is the most common dementia subtype?

A

Alzheimer’s dementia - 50% of all dementia diagnoses

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10
Q

What is the pathophysiology of Alzheimer’s dementia?

A

Amyloid plaques + Neurofibrillary Tangles:

  1. Amyloid plaques - clumps of beta-amyloid and degenerating bits of neurons and other cells
  2. Neurofibrillary tangles - bundles of twisty filaments within neurons, mostly from tau protein - reduction in transmission of information and eventually brain cell death
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11
Q

What are the symptoms of Alzheimer’s dementia?

A
  • 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
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12
Q

What is the disease course of Alzheimer’s dementia?

A

Progresses steadily over time

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13
Q

What are the radiological features of osteoarthritis (OA)?

A

LOSS

L - Loss of joint space
O - Osteophytes
S - Subchondral cysts
S - Subchondral sclerosis

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14
Q

What is the pulse rhythm of AF?

A

Irregularly irregular pulse

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15
Q

What is stress incontinence?

A

Involuntary leakage of urine on effort or exertion, or on sneezing or coughing
- Due to an incompetent sphincter

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16
Q

What investigations may be performed in patients with incontinence?

A

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

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17
Q

What is the management of stress incontinence?

A

Pelvic floor muscle exercises - three month trial of eight contractions three times a day
Duloxetine
Surgery

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18
Q

What are the different parts of a death certificate?

A

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

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19
Q

After a fall, when is it necessary to provide an urgent CT Head?

A

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

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20
Q

What is a mild cognitive impairment?

A

The transitional state between cognitive changes of normal ageing and fully developed clinical features of dementia

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21
Q

What are the two subtypes of Mild cognitive impairment?

A

Amnestic (Including memory impairment)
Non-amnestic (Other non-memory cognitive domains impaired)

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22
Q

When is MCI diagnosed?

A

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

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23
Q

What is delirium?

A

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

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24
Q

What can cause delirium?

A

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

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25
Q

What constitutes a confusion screen?

A
  1. Bloods:
    - FBC
    - U&Es
    - LFTs
    - Coagulation/INR
    - TFTs
    - Calcium
    - B12/folate/haematinics
    - Glucose
    - Blood cultures
  2. Urinalysis
  3. Imaging
    - CT Head, CXR
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26
Q

What are the clinical features of hyperactive delirium?

A

Agitation
Delusions
Hallucinations
Wandering
Aggression

27
Q

What are the clinical features of hypoactive delirium?

A

Lethargy
Slowness with everyday tasks
Excessive sleeping
Inattention

28
Q

What is the classic triad of Charles-Bonnet syndrome?

A

Intact cognition
Ocular Pathology
Visual Hallucination

29
Q

Which type of dementia is associated with hallucinations?

A

Lewy-body dementia

30
Q

What are elementary hallucinations?

A

Visual hallucinations in the form of flashes of light

31
Q

What are Lilliputian hallucinations?

A

Visual hallucinations with associated micropsia
- Often occur in those suffering from delirium

32
Q

What is osteoarthritis and how does it occur?

A

Dysfunctional ‘wear and repair’ process within the joint
An initial imbalance in cartilage homeostasis leads to cartilage degradation, remodelling of bone and associated inflammation of the joint
As the cartilage thins, due to excessive release of degradative enzymes from chondrocytes, subchondral sclerosis occurs, and further subchondral cysts and osteophytes are formed.

33
Q

What are the clinical features of osteoarthritis?

A

Joint pain
Stiffness: typically, worse after activity and at the end of the day
Limitation in day-to-day activities

34
Q

How are inflammatory vs non-inflammatory arthropathies distinguished?

A

In inflammatory arthropathies, joint stiffness improves with activity and stiffness typically lasts longer than 30 minutes in the morning.
In non-inflammatory arthropathies there is worsened stiffness after activity

35
Q

What would the usual stepwise approach of arthritis treatment be?

A

First-line: topical non-steroidal anti-inflammatory drugs (NSAIDs)
Second-line: paracetamol and topical analgesia
Third-line: NSAID, paracetamol and topical capsaicin
Fourth-line: opioid, NSAID, paracetamol and topical capsaicin

Then: Corticosteroid injections for acute exacerbation of pain despite regular use of analgesics

36
Q

What conservative management approaches would be necessary before pharmacological treatment of osteoarthritis?

A

Education and advice about their condition
Exercise: both muscle strengthening and general aerobic fitness
Weight loss (if overweight or obese)

37
Q

What could the surgical management be for osteoarthritis?

A

After conservative and medical management -> joint replacement (arthroplasty) or fusion of the joint (arthrodesis)

38
Q

What are the side effects of weak opioids?

A

Reduction in bowel motility -> constipation
Drowsiness
Pruritis

39
Q

What are the non-pharmacological treatments for Alzheimer’s disease?

A

Activities promoting wellbeing
Group cognitive stimulation therapy
Consider group reminiscence therapy and cognitive rehabilitation

40
Q

What is the pharmacological management for Alzheimers’s disease?

A

First line - Donepezil, galantamine, rivastigmine
Second line - memantine

41
Q

What type of drug is donepezil, galantamine, and rivastigmine?

A

Acetylcholinesterase inhibitor

42
Q

What type of drug is memantine?

A

NMDA receptor antagonists

43
Q

What is memantine used for?

A
  1. Moderate Alzheimer’s who are intolerant of, or have a contraindication to, acetylcholinesterase inhibitors
  2. As an add-on drug to acetylcholinesterase inhibitors for patients with moderate or severe Alzheimer’s
  3. Monotherapy in severe Alzheimer’s
44
Q

When is donepezil contraindicated?

A

In bradycardia

45
Q

What factors would implicate delirium more than dementia?

A
  1. Impairment of consciousness
  2. Fluctuation of symptoms - worse at night, periods of normality
  3. Abnormal perception
  4. Agitation, fear
  5. Delusions
46
Q

What radiological findings would be present upon CT head in Alzheimer’s disease?

A

Atrophy of the cortex and hippocampus

47
Q

What are the predisposing factors for delirium?

A
  1. Age > 65 years
  2. Background of dementia
  3. Significant injury e.g. hip fracture
  4. Frailty or multimorbidity
  5. Polypharmacy
48
Q

How would you differentiate between Parkinson’s dementia and Lewy body dementia with Parkinson’s symptoms?

A

Parkinsonism in Lewy Body dementia -> manifest same time or after onset of dementia

Dementia in Parkinson’s -> Presents 1 year after onset of Parkinson’s symptoms

49
Q

Are antipsychotics appropriate to use in dementia?

A

Should be considered with caution - can increase mortality in dementia patients

50
Q

What is the START tool?

A

Screening tool to alert doctors to right treatment

  • Used in patients with multiple morbidities to decide if a new treatment will be beneficial
51
Q

What is the STOPP-START criteria?

A

Outline of medications to withdraw in the elderly. Looks at which drugs are inappropriate in over 65s
e.g. TCAs in patients with dementia

52
Q

What is the waterlow score?

A

Screening tool to determine patients at risk of developing pressure ulcers

53
Q

What constitutes a grade 1 pressure ulcer?

A
  1. Non-blanching erythema of skin
  2. Discolouration of skin, warmth, oedema, induration, hardness
54
Q

What constitutes a grade 2 pressure ulcer?

A
  1. Partial thickness skin loss involving epidermis or dermis, or both
  2. Ulcer superficial, presents clinically as abrasion or blister
55
Q

What constitutes a grade 3 pressure ulcer?

A
  1. Full thickness skin loss involving damage to or necrosis of SC tissue
  2. May extend down to, but not through underlying fascia
56
Q

What constitutes a grade 4 pressure ulcer?

A
  1. Extensive destruction, damage or tissue necrosis to:
  2. Muscle, bone or supporting structures with/without full thickness skin loss
57
Q

How would pressure ulcers be managed?

A
  1. Moist environment - hydrocolloid dressings, hydrogels (No soap)
  2. Systemic antibiotics only on clinical basis - e.g. evidence of cellulitis
  3. Tissue viability referral
  4. Surgical debridement
58
Q

Which type of dementia can present in a stepwise manner?

A

Vascular dementia
- Sudden progression between symptoms corresponding to new vascular events between stable periods

59
Q

How is frailty assessed?

A

PRIMSA-7

60
Q

What is the PRISMA-7?

A

Seven questions regarding:
- Age
- Sex
- Health problems
- Help at home
- Mobility
- Social support

3 or more yes answers indicates risk of frailty

61
Q

What would the first line investigation be in dementia?

A

Blood screen for underlying causes:
1. FBC
2. U&Es
3. LFTs
4. ESR/CRP
5. Calcium
6. Glucose
7. TFTs
8. Vit B12 and folate

62
Q

What are the symptoms of digoxin toxicity?

A

GI disturbance, dizziness, confusion, blurry or yellow vision, arrhythmia

63
Q

Which drugs cause anticholinergic side effects?

A

TCAs
Antipsychotics - clozapine, olanzapine
Anti-arrhythmics - procainamide
Antihistamines
Amantadine
Anti-emetics - prochlorperazine

64
Q

What are the typical anticholinergic side effects?

A

Dry eyes and mouth
Hypotension
Delirium
Constipation
Urinary retention
Arrhythmias (QT prolongation)
Hypothermia

Phase 3a (6 decks)

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