Geris Flashcards
Manoeuvre to diagnose BPPV?
Dix-Hallpike manoeuvre
Manoeuvre to treat BPPV?
Epley manoeuvre
Causes of delirium?
PINCH ME
Pain
Infection
Nutrition
Constipation
Hydration
Medication
Electrolytes
Examples of drugs which can cause delirium?
Steroids, opioids, benzodiazepines, anticholingeric
Different types of delirium?
Hyperactive, hypoactive, mixed
Non-pharmacological management of delirium?
24 hour clock
Keep environment the same
Bring familiar objects and photos
Help them eat and drink regularly
Talk calmly in short sentences
First line treatment for mild-moderate Alzheimers?
Acetylcholinesterase inhibitors e.g. donepezil/galantamine/rivastigmine
Second line treatment for Alzheimers?
NMDA receptor antagonist e.g. memantine
Which risk score used for pressure sores?
Waterlow score
Delirium risk assessment tool?
4 AT test
Alertness, AMT4, attention, acute change
AMT4 questions?
Age, DOB, place, year
Genetic risk factors for Alzheimer’s disease?
Apolipoprotein E mutation
Mutations in the amyloid precursor protein
Which blood tests included in a confusion screen?
FBC
U+E
LFTs
Coagulation/INR
Calcium
B12/folate
Glucose
TFTs
Blood cultures
Non-blood tests for confusion screen?
Urine MC+S
Sputum culture
Chest xray
ECG
Antidote for dabigatran?
Idarucizumab
Antidote for NOACs?
Andexanet alfa
Antidote for warfarin?
Vitamin K
First line drugs for Parkinson’s?
Levodopa + decarboxylase inhibitor
e.g. carbidopa/benserazide
Drug classes used for Parkinson’s?
Levodopa
COMT inhibitors
Dopamine agonists
MAOBs
Antiemetic used in parkinsons and why?
Domperidone - doesn’t cross the BBB
Examples of COMT inhibitors and mechanism?
Entacapone, tolcapone
Stops breakdown of levodopa
Examples of dopamine receptor agonists?
Ropinirole, bromocriptine, cabergoline, rotigotine
Examples of MAOBs and mechanism?
Selegiline, rasagiline
Prevent breakdown, increases circulating dopamine
Which tool is used in deciding whether to start new medications?
START - screening tool to alert doctors to the right treatment
What is the FRAX assessment?
Risk assessment for 10-year risk of developing osteoporosis-related fracture
Elements included in FRAX score?
Age, gender, BMI
Prev fracture
Parental hip fracture
Smoking
Corticosteroids
Rheumatoid arhtritis
Alcohol
Femoral neck BMD (DEXA)
What is a DEXA T score?
Score of bone mass based on young reference population
DEXA T score classifications?
> -1.0 = normal
-1.0 - -2.5 = osteopenia
< -2.5 = osteoporosis
What is the tool for discontinuing medications?
STOPP - screening tool of older persons’ prescriptions
Identifies medications where risks outweigh benefits
What tool is used to assess frailty of a patient?
PRISMA-7
What is included in the PRISMA-7 questionnaire?
Age
Gender
Health problems
Assistance required
Walking aid use
Which medications associated with significant increase in mortality in dementia patients?
Antipsychotics
Difference between Lewy body dementia and Parkinson’s disease dementia?
In Lewy body, dementia precedes motor symptoms
In Parkinson’s, motor symptoms precedes cognitive
Usually within ~1 year of each other
How long should warfarin be given for in an uncomplicated DVT?
6 months
Symptoms of digoxin toxicity?
N+V+D
Confusion
Yellow-green vision
Arrhythmias
Precipitating factors for digoxin toxicity?
Hypokalaemia
Renal failure
Pressure ulcer grading?
1 - Erythema, intact skin
2 - Partial thickness skin loss
3 - Full thickness skin loss
4 - Extensive destruction, tissue necrosis, or damage to muscle, bone or supporting structures
Main risk factors for osteoporosis?
Female gender
Age
Corticosteroid use
Smoking + alcohol
Low BMI
Fhx
Non-pharmacological management of osteoporosis?
Lifestyle - diet, smoking, alcohol
Exercise - weight bearing/strength training
Medical management of osteoporosis?
1st line - Bisphosphonates
2nd line - denosumab
Calcium and vitamin D supplementation
How long bisphosphonates taken for?
Oral - 5 yeas
IV - 3 years
Mechanism of bisphosphonates?
Inhibit osteoclast-mediated bone resorption
Main risk factors of bisphosponates?
Increased risk of atypical stress fractures
Otseonecrosis of the jaw
Oesophageal reactions
Acute phase response
Classic sign of hip fracture?
Shortened and externally rotated leg
Possible locations of hip fracture?
Intracapsular or extracapsular
Test for diagnosing heart failure?
NT-proBNP blood test
BNP
What is BNP?
B-type natriuretic peptide
Hormone produced by left ventricle in response to strain
Features of chronic heart failure?
Dyspnoea, Orthopnoea
Paroxysmal nocturnal dyspnoea
Wheeze, cough
Weight loss (cardiac cachexia)
Bibasal crackles
Oedema
Raised JVP, hepatomegaly
Chronic heart failure drug management?
1st line - ACEi and BB
2nd line - aldosterone agonist, SGLT2 inhibitors
3rd line - digoxin, ivabradine, sacubitril-valsartan
Which heart failure should SGLT2 inhibitors be used in?
HF with reduced ejection fraction
Which vaccines should heart failure patients be offered?
Annual influenza
One-off pneumococcal
NYHA classification for chronic heart failure?
I - no symptoms, no limitation
II - mild symptoms, slight limit to physical activity
III - moderate symptoms, comfortable at rest but less than ordinary activity results in symptoms
IV - severe symptoms, unable to carry out physical activity without discomfort, symptoms present even at rest
3 groups of LUTS in men?
Voiding, storage and post-micturition
Medical management for voiding symptoms in men?
Mod/severe - alpha-blocker (tamulosin/alfuzosin)
Enlarged prostate - 5-alpha reductase inhibitor (finasteride)
If both - dual therapy
U&Es in rhabdomyolysis?
Hyperkalaemia - breakdown of skeletal muscle = leakage of intracellular potassium
Postural hypotension definition?
Fall of blood pressure within 3 minutes of standing
Systolic = 20mmHg
Diastolic = 10mmHg
What are the 4 criteria a patient needs to meet to demonstrate capacity?
Understand the decision
Retain the information long enough to make the decision
Weigh up the pros and cons
Communicate their decision
What is a best interest meeting?
Deciding treatment decisions for patients that lack capacity taken in their best interest, taking into account their individual wishes and values
What is lasting power of attorney (LPA)?
LPA = person legally nominates a person to make decisions on their behalf if they lack mental capacity
- LPA only comes into effect if the patient lacks the capacity to decide for themselves
What are deprivation of liberty safeguards (DoLS)?
Application made by a hospital or care home for patients who lack capacity to allow them to provide care and treatment
Whilst in hospital/CH the pt is under control and is not able to leave.
“Deprived of their liberty”
Which score estimates stroke risk following TIA?
ABCD2
Factors in ABCD2?
Age
BP
Clinical features
Duration
Diabetes
Investigations for myeloma?
Bence-Jones proteins
Serum electropheresis
X-ray findings in myeloma?
Lytic lesions
Complications of myeloma?
AKI
Anaemia
Neutropenia
Thrombocytopenia
Hyperviscosity
5-HT3 agonists?
Ondansetron
Palonosetron
5-HT3 side effects?
QT prolongation