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Phase 4 > Gerrys > Flashcards

Gerrys Flashcards

1
Q

what is frailty?

A

health state related to aging in which multiple body systems gradually lose their built in reserves

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2
Q

what is the phenotype model of frailty? (5)

A

unintentional weight loss
weakness
exhaustion
low levels of activity
slow gait

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3
Q

what is the cumultive deficit model of frailty?

A

a count of health deficits which accumulate increasing the risk of deterioration and death. Can be calculated in a frailty index

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4
Q

what are 5 possible physiological markers of frailty?

A

raised inflammatory markers
raised insulin and glucose
low albumin
raised D dimers and alpha antitrypsin
low vit d

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5
Q

what are 4 interventions for frailty?

A

physical activity
protein-calorie suplementation
Vitamin D supplementation
Polypharmacy prevention

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6
Q

what are the 5 domains of the comprehensive geriatric assessment?

A

physical health
mental health
functional ability
social circumstance
environment

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7
Q

what is meant by 2 stage mental capacity test?

A

stage 1 - is there an impairment or disturbance in mental functioning?

stage 2 - does the person lack capacity?

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8
Q

what are the 4 components of capacity?

A

understand information
retain information
weigh up
communicate decision

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9
Q

what are the 4 pillars of medical ethics?

A

non-maleficence
autonomy
justice
beneficence

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10
Q

what are 4 different types of justice?

A

legistlative (legal)
rights based
distributive

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11
Q

what are 7 different types of elder abuse?

A

physical
financial
psychological
neglect
sexual
discrimination
institutional

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12
Q

what is elder abuse?

A

a single or repeated act or lack of appropriate action occuring in any relationship where there is an expectation of trust which causes harm or distress to an older person

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13
Q

what are 5 causes of secondary osteoporosis?

A

rheumatoid arthritis
hyperthyroid/parathyroid
premature menopause <45
chronic malabsoption/malnutrition
chronic liver disease

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14
Q

what are 7 intrinsic risk factors for falls?

A

female
neurological disease
cognitive decline
visual deficit
muscle weakness
impaired proprioception
impaired vestibular system

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15
Q

what are 5 extrinsic risk factors for falls?

A

polypharmacy
bifocals
walking aids
poor footwear
home hazards

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16
Q

what are 4 complications of long lies?

A

rhabdomyolysis
hypothermia
pneumonia
pressure sores

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17
Q

what is classed as polypharmacy?

A

> 4 drugs

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18
Q

what investigations should be done after a fall?

A

ECG - arrythmias/cardiac causes
Lying and standing BP

FBC - anaemia, infection
U+E - dehydration, rhabdo, drug clearance
CK - long lie
Bone biochem - serum Ca2+, phosphate vit D, PTH
Tilt table test
ECHO

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19
Q

what is postural hypotension?

A

drop >20mmHz systolic or >10mmHz diastolic

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20
Q

what medication can help venous return in orthostatic hypotension?

A

fludrocortisone

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21
Q

what is the link between alcohol and urinary incontinence?

A

causes polyuria, frequency and delerium

22
Q

what is the link between ACEI and incontinence?

A

causes cough => stress incontinence

23
Q

what is the link between anticholinergics and urinary incontinence?

A

urinary retention and overflow incontinence

24
Q

what is the link between diuretics and urinary incontinence?

A

frequency, polyuria, urgency

25
Q

what is the link between opiates and urinary incontinence?

A

delerium, sedation, constipation, urinary retention

26
Q

what is the link between tricyclic antidepressants and urinary incontinence?

A

urinary retention and overflow incontinence

27
Q

what are 5 side effects of duloxetine?

A

difficulty sleeping
headache, dizziness, blurred vision
GI upset - constipation/diarrheoa/sickness
dry mouth
sexual problems

28
Q

what are the 5 components of the complete geriatric assessment?

A

Physical health
mental health
function
social circumstances
Environment

29
Q

what are 2 risk assessments for nutrition in the elderly?

A

Malnutrition universal screening tool (MUST)

Mini nutritional assessment

30
Q

how to calculate a MUST score?

A

BMI - 18.5-20 (1), <18.5(2)
Wt loss score - 5-10% (1), >10% (2)
+2 => if acutely unwell

31
Q

what is the management for a medium risk MUST score?

A

document dietary intake for 3 days

32
Q

what is the management for a high risk MUST score?

A

refer to dietition, nutritional support team
set goals to improve and increase overall nutrition
Monitor

33
Q

what are 13 causes of malnutrition in the elderly? Mneumonic

A

MEALS ON WHEELS

Medication
Emotion (depression)
Annorexia/Alcohol
Late life paranoia
Swallowing problems

Oral and dental disorders
No money

Wandering (dementia)
Hyperthyroid
Enteric problems
Eating problems
Low salt/cholesterol diet
Social problems

34
Q

what are 8 symptoms of refeeding syndrome?

A

arrythmia, HTN, CHF
abdo pain, constipation, vomiting
Musc weakness, myalgia, rhabdo
SOB, resp muscle weakness

35
Q

what is the pathophysiology of refeeding syndrome?

A

chronic malnutrition leads to protein catabolism
total body phosphate depletion despite normal serum phosphate
intro of carbs leads to anabolic state which unmasks phosphate deplesion leading to drop in serum phosphate leading to arrythmia

36
Q

what is the management for malnutrition?

A

refeeding
social support

37
Q

What is inappropriate prescribing?

A

prescribing contraindicated drugs
prescribing inappropriate dose/duration
Prescribing drug with likely adverse affect
failure to use drug that could improve outcome

38
Q

what are the risks of polypharmacy?

A

increased risk of side effects
increased risk of drug-drug interactions
therapuetic cascade
increased risk of failure to review medications properly

39
Q

what are 6 non-blood investigations for falls?

A

ECG
Lying and standing BP
ECHO
tilt table test
24 hour tape
Imaging (for injury)

40
Q

what are 5 bloods for falls?

A

FBC - anaemia, infection
U+E - dehydration, rhabdo, drug clearance
CK - rhabdo
Bone biochem - serum calcium, phosphate, vit D, PTH
TFTs - thyroid disease

41
Q

what is carotid sinus hypersensitivity?

A

in elderly people when the carotid sinus is stimulated at its bifurcation this can cause bradycardia and a reduction in BP leading to ventricular pause and fall in BP >50mmHg associated with syncope

42
Q

what is sick sinus syndrome?

A

arrythmia due to disfunction of sinus node often caused by ischemic changes which causes bradycardia, arrythmia and dropped beats leading to syncope, fatigue and SOB

43
Q

what are the 3 different types of delirium?

A

hyperactive
hypoactive
mixed

44
Q

what are 6 risk factors for delirium?

A

dementia
comorbidities
physical frailty
older age
sensory impairment (blind/deaf)
polypharmacy

45
Q

what are 7 causes of delirium? mneumonic

A

PINCH ME

Pain
Infection
Nutrition
Constipation
Hydration

Medication
Environment

Also - alcohol withdrawal, metabolic disturbance

46
Q

what are 4 key features of delirium?

A

disturbance of consciousness (inattention)
changes in cognition or perceptual disturbance
develops over short period of time and fluctuates
hx suggests underlying medical cause

47
Q

what medication can be used if a delirious patient is aggitated?

A

1 - haloperidol 0.5mg

48
Q

what medication should be used in an aggitated patient with parkinsons or lewy body dementia?

A

lorazepam

49
Q

what screening test can be used to screen for delirium?

A

4AT

50
Q

what is the 4AT test?

A

for delirium

Alertness
Age, DOB, Place, Year
Attention - months backwards
Acute change or fluctuating course

Phase 4 (22 decks)

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