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3a follow up > Geris > Flashcards

Geris Flashcards

1
Q

Manoeuvre to diagnose BPPV?

A

Dix-Hallpike manoeuvre

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2
Q

Manoeuvre to treat BPPV?

A

Epley manoeuvre

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3
Q

Causes of delirium?

A

PINCH ME
Pain
Infection
Nutrition
Constipation
Hydration
Medication
Electrolytes

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4
Q

Examples of drugs which can cause delirium?

A

Steroids, opioids, benzodiazepines, anticholingeric

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5
Q

Different types of delirium?

A

Hyperactive, hypoactive, mixed

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6
Q

Non-pharmacological management of delirium?

A

24 hour clock
Keep environment the same
Bring familiar objects and photos
Help them eat and drink regularly
Talk calmly in short sentences

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7
Q

First line treatment for mild-moderate Alzheimers?

A

Acetylcholinesterase inhibitors e.g. donepezil/galantamine/rivastigmine

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8
Q

Second line treatment for Alzheimers?

A

NMDA receptor antagonist e.g. memantine

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9
Q

Which risk score used for pressure sores?

A

Waterlow score

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10
Q

Delirium risk assessment tool?

A

4 AT test
Alertness, AMT4, attention, acute change

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11
Q

AMT4 questions?

A

Age, DOB, place, year

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12
Q

Genetic risk factors for Alzheimer’s disease?

A

Apolipoprotein E mutation
Mutations in the amyloid precursor protein

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13
Q

Which blood tests included in a confusion screen?

A

FBC
U+E
LFTs
Coagulation/INR
Calcium
B12/folate
Glucose
TFTs
Blood cultures

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14
Q

Non-blood tests for confusion screen?

A

Urine MC+S
Sputum culture
Chest xray
ECG

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15
Q

Antidote for dabigatran?

A

Idarucizumab

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16
Q

Antidote for NOACs?

A

Andexanet alfa

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17
Q

Antidote for warfarin?

A

Vitamin K

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18
Q

First line drugs for Parkinson’s?

A

Levodopa + decarboxylase inhibitor
e.g. carbidopa/benserazide

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19
Q

Drug classes used for Parkinson’s?

A

Levodopa
COMT inhibitors
Dopamine agonists
MAOBs

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20
Q

Antiemetic used in parkinsons and why?

A

Domperidone - doesn’t cross the BBB

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21
Q

Examples of COMT inhibitors and mechanism?

A

Entacapone, tolcapone
Stops breakdown of levodopa

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22
Q

Examples of dopamine receptor agonists?

A

Ropinirole, bromocriptine, cabergoline, rotigotine

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23
Q

Examples of MAOBs and mechanism?

A

Selegiline, rasagiline
Prevent breakdown, increases circulating dopamine

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24
Q

Which tool is used in deciding whether to start new medications?

A

START - screening tool to alert doctors to the right treatment

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25
Q

What is the FRAX assessment?

A

Risk assessment for 10-year risk of developing osteoporosis-related fracture

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26
Q

Elements included in FRAX score?

A

Age, gender, BMI
Prev fracture
Parental hip fracture
Smoking
Corticosteroids
Rheumatoid arhtritis
Alcohol
Femoral neck BMD (DEXA)

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27
Q

What is a DEXA T score?

A

Score of bone mass based on young reference population

28
Q

DEXA T score classifications?

A

> -1.0 = normal
-1.0 - -2.5 = osteopenia
< -2.5 = osteoporosis

29
Q

What is the tool for discontinuing medications?

A

STOPP - screening tool of older persons’ prescriptions

Identifies medications where risks outweigh benefits

30
Q

What tool is used to assess frailty of a patient?

A

PRISMA-7

31
Q

What is included in the PRISMA-7 questionnaire?

A

Age
Gender
Health problems
Assistance required
Walking aid use

32
Q

Which medications associated with significant increase in mortality in dementia patients?

A

Antipsychotics

33
Q

Difference between Lewy body dementia and Parkinson’s disease dementia?

A

In Lewy body, dementia precedes motor symptoms
In Parkinson’s, motor symptoms precedes cognitive

Usually within ~1 year of each other

34
Q

How long should warfarin be given for in an uncomplicated DVT?

A

6 months

35
Q

Symptoms of digoxin toxicity?

A

N+V+D
Confusion
Yellow-green vision
Arrhythmias

36
Q

Precipitating factors for digoxin toxicity?

A

Hypokalaemia
Renal failure

37
Q

Pressure ulcer grading?

A

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

38
Q

Main risk factors for osteoporosis?

A

Female gender
Age
Corticosteroid use
Smoking + alcohol
Low BMI
Fhx

39
Q

Non-pharmacological management of osteoporosis?

A

Lifestyle - diet, smoking, alcohol
Exercise - weight bearing/strength training

40
Q

Medical management of osteoporosis?

A

1st line - Bisphosphonates
2nd line - denosumab
Calcium and vitamin D supplementation

41
Q

How long bisphosphonates taken for?

A

Oral - 5 yeas
IV - 3 years

42
Q

Mechanism of bisphosphonates?

A

Inhibit osteoclast-mediated bone resorption

43
Q

Main risk factors of bisphosponates?

A

Increased risk of atypical stress fractures
Otseonecrosis of the jaw
Oesophageal reactions
Acute phase response

44
Q

Classic sign of hip fracture?

A

Shortened and externally rotated leg

45
Q

Possible locations of hip fracture?

A

Intracapsular or extracapsular

46
Q

Test for diagnosing heart failure?

A

NT-proBNP blood test
BNP

47
Q

What is BNP?

A

B-type natriuretic peptide
Hormone produced by left ventricle in response to strain

48
Q

Features of chronic heart failure?

A

Dyspnoea, Orthopnoea
Paroxysmal nocturnal dyspnoea
Wheeze, cough
Weight loss (cardiac cachexia)
Bibasal crackles
Oedema
Raised JVP, hepatomegaly

49
Q

Chronic heart failure drug management?

A

1st line - ACEi and BB
2nd line - aldosterone agonist, SGLT2 inhibitors
3rd line - digoxin, ivabradine, sacubitril-valsartan

50
Q

Which heart failure should SGLT2 inhibitors be used in?

A

HF with reduced ejection fraction

51
Q

Which vaccines should heart failure patients be offered?

A

Annual influenza
One-off pneumococcal

52
Q

NYHA classification for chronic heart failure?

A

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

53
Q

3 groups of LUTS in men?

A

Voiding, storage and post-micturition

54
Q

Medical management for voiding symptoms in men?

A

Mod/severe - alpha-blocker (tamulosin/alfuzosin)
Enlarged prostate - 5-alpha reductase inhibitor (finasteride)

If both - dual therapy

55
Q

U&Es in rhabdomyolysis?

A

Hyperkalaemia - breakdown of skeletal muscle = leakage of intracellular potassium

56
Q

Postural hypotension definition?

A

Fall of blood pressure within 3 minutes of standing
Systolic = 20mmHg
Diastolic = 10mmHg

57
Q

What are the 4 criteria a patient needs to meet to demonstrate capacity?

A

Understand the decision
Retain the information long enough to make the decision
Weigh up the pros and cons
Communicate their decision

58
Q

What is a best interest meeting?

A

Deciding treatment decisions for patients that lack capacity taken in their best interest, taking into account their individual wishes and values

59
Q

What is lasting power of attorney (LPA)?

A

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
60
Q

What are deprivation of liberty safeguards (DoLS)?

A

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”

61
Q

Which score estimates stroke risk following TIA?

A

ABCD2

62
Q

Factors in ABCD2?

A

Age
BP
Clinical features
Duration
Diabetes

63
Q

Investigations for myeloma?

A

Bence-Jones proteins
Serum electropheresis

64
Q

X-ray findings in myeloma?

A

Lytic lesions

65
Q

Complications of myeloma?

A

AKI
Anaemia
Neutropenia
Thrombocytopenia
Hyperviscosity

66
Q

5-HT3 agonists?

A

Ondansetron
Palonosetron

67
Q

5-HT3 side effects?

A

QT prolongation

3a follow up (7 decks)

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