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HCOLL > HCOLL > Flashcards

HCOLL Flashcards

1
Q

What is the frail phenotype

A

Unintentional weight loss / sarcopenia
Weakness, exhaustion, slow walking
Low level physical activity
Falls, immobility, delirium, memory loss, incontinence

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2
Q

Epidemiology of dementia

A

7.1% of >65y
F>M
Age biggest RF

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3
Q

Aetiology of dementia

A

Neuronal loss: location in brain determines symptoms
Temporal lobe involvement = STM

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4
Q

Symptoms of dementia

A

Memory loss
Difficulty with higher cognitive processes: impaired executive function, apraxia, agnosia (difficulty recognising objects)
Impaired function
>6m

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5
Q

Types of dementia and their prevalence

A

Alzheimer’s : 50-75%
Vascular : 20%
LBD: 10-15%
FTD: 2%

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6
Q

Aetiology of Alzheimer’s disease

A

Characteristic beta amyloid plaques and neurofibrillary tangles

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7
Q

Symptoms of Alzheimer’s

A

Progressive memory loss that affects function
Forget names, people, places
Repeats self
Can’t remember new info
Misplace items
Confusion about time
Getting lost
Cant find words
Mood / behaviour problems

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8
Q

CT brain findings of alzheimers disease

A

Volume loss and enlarged ventricles

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9
Q

Pathogenesis of vascular dementia

A

Diseased blood vessels -> multiple small areas of ischaemia -> brain cell death

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10
Q

CT brain findings of vascular dementia

A

Small vessel ischaemic change

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11
Q

Aetiology of LBD

A

Lewy body protein deposits in the basal ganglia and thalamus

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12
Q

History of illness with LBD

A

Parkinsonism
Motor symptoms occur after or within 1 year of memory problems

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13
Q

Aetiology of FTD

A

Tau protein deposits in frontal and temporal lobes
Protein deposits cause brain cell death

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14
Q

History of illness with FTD

A

Earlier age onset (56-61) and 40% have family history
Slow onset
Progressive non fluent aphasia

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15
Q

DD of dementia

A
  • delirium
  • substance misuse
  • depression / psychosis
  • traumatic brain injury
  • metabolic (hypothyroid / B12)
  • meds (steroids / antidepressants)
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16
Q

Symptoms of vascular dementia

A

Problems with:
Memory, thinking, reasoning
Planning and organising
Decision making / problem solving
Concentrating
Following instructions
Slower thoughts

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17
Q

Early Symptoms of Lewy body dementia

A

Fluctuating memory loss
Hallucinations and delusions
Parkinsonism
REM sleep disorder
Falls

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18
Q

Later symptoms of LBD

A

Motor problems
Mood swings / short tempered
Speech and swallow problems

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19
Q

What does confusion screening bloods include

A

FBC
U&Es
LFT
TFT
Glucose
Calcium
B12
Folate

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20
Q

Medical management of dementia

A

Cholinesterase inhibitors (for mild / moderate alzheimers, LBD or Parkinson’s) -> donepezil, rivastigmine

NMDA receptor antagonists (for moderate alzheimers if intolerant to ACh or severe): Memantine

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21
Q

Psychological management of dementia

A

Interventions to promote cognition, independence and wellbeing
Group cognitive stimulation therapy
Group reminiscence
OT / cognitive rehab

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22
Q

What is hyperactive delirium

A

Agitation, confusion, hallucinations / delusions
Mood disturbance
Disturbed sleep

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23
Q

What is hypoactive delirium

A

Similar to depression
Withdrawn, not eating / drinking
Sleeping a lot
Hallucinations / delusions

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24
Q

Causes of delirium (DELIRIUM)

A

Drugs / dehydration
Electrolyte imbalance
Level of pain / lack of analgesia
Infection / inflammation
Respiratory failure
Impaction of faeces
Urinary retention
Metabolic / MI

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25
Q

Management of delirium

A

Reduce medications
Only use drugs if other interventions have failed and patient is a risk to themselves or others
Haloperidol
Lorazepam

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26
Q

Aetiology of Parkinson’s disease

A

Loss of dopamine producing cells in substantia nigra

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27
Q

Pre clinical signs of Parkinson’s

A

Symptoms dont manifest clinically until 80% of dopamine producing cells are lost
Depression
Anosmia
Constipation
REM sleep disorder
Postural hypotension

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28
Q

4 main symptoms for Parkinson’s diagnosis

A

Rigidity + bradykinesia
+/- postural instability
+/- resting tremor

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29
Q

Motor symptoms of Parkinson’s

A

Bradykinesia
Rigidity
Postural instability
Resting tremor

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30
Q

Non motor symptoms of Parkinson’s

A

Depression / anxiety
Psychosis
Cognitive impairment
Autonomic dysfunction

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31
Q

Suggestive features of progressive supranuclear palsy

A

Vertical gaze palsy
Frontal disinhibition
Not responsive to dopaminergic treatment

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32
Q

Suggestive features of Multi system atrophy

A

Prominent, autonomic features (postural hypotension, incontinence, impotence)
Cerebellar signs

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33
Q

Medical management of PD

A
  1. L-dopa mono therapy : time and dose critical
  2. Dopamine agonists patch eg rotigotine
  3. L-dopa dual therapy
  4. Treat non motor symptoms
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34
Q

Causes of acute urinary incontinence (DIAPERS)

A

Delirium
Infection
Atrophic urethritis and vaginitis
Pharmaceuticals / psychiatric
Excess urine output
Restricted mobility
Stool impaction

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35
Q

Medications causing urinary incontinence

A

CCBs, antidepressants, antipsychotics
A blockers
ACEis
Opioids
Sedatives
Diuretics

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36
Q

Cause of urge incontinence

A

Overactivity of detrusor muscle
Bladder over sensitivity
Abnormal neuro stimulation

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37
Q

Risk factors for urge incontinence

A

Idiopathic
Diuretics
UTIs
Caffeine / increased fluid intake
Alcohol / smoking
Constipation
Neurogenic

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38
Q

Medical management of urge incontinence

A

Anticholinergics : avoid oxybutynin as increases risks of falls / confusion
Botulinum toxin A
Intravaginal oestrogens

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39
Q

Cause of stress incontinence

A

Increased IAP
Weak pelvic floor and sphincter

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40
Q

Risk factors for stress incontinence

A

Urethral sphincter weakness (cannot withstand increased IAP)

  • pregnancy, obesity, age
  • previous vaginal delivery
  • prolapse / hysterectomy
  • muscular diseases
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41
Q

Medical management of stress incontinence

A

After pelvic floor training
Duloxetine increases sphincter activity
Injectable bulking agents

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42
Q

Surgical management of stress incontinence

A

Colposuspension

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43
Q

Cause of overflow incontinence

A

Chronic urinary retention
Obstruction to outflow
Detrusor muscle failure

44
Q

Risk factors for obstruction to outflow

A

Constipation
Pelvic surgery / strictures
BPH / prostate tumour
Bladder calculi

45
Q

Risk factors for detrusor failure

A

Neurological / DM
Medication

46
Q

Key investigations for all falls patients

A

Hx and examination - Gait, heart sounds, neuro, visual
ECG
Lying and standing BP

47
Q

Medical management of falls

A

Analgesia
Cognitive screen
Bone health assessment - FRAX score

48
Q

Common osteoporosis fractures

A

Neck of femur
Colles
Vertebral crush

49
Q

Aetiology of osteoporosis

A

Bone resorption (osteoclasts) > bone formation resulting in:
- gradual bone weakening
- increased risk of fracture
- back pain / kyphosis / loss of height

50
Q

Primary RF for osteoporosis

A

Age / female
Genetics
Low BMI
Calcium / vit D deficiency
Previous low trauma fracture

51
Q

Medical management of osteoporosis

A
  1. Bisphosphonates
  2. Denosumab (inhibits osteoclasts)
  3. Teriparatide (increase osteoblasts activity)
52
Q

Bisphosphonates counselling

A

Tablets or injections once weekly
Take with water
Sit upright 30min after
Empty stomach

53
Q

Side effects of Bisphosphonates

A

GI upset
Oesophageal ulcers
Jaw necrosis

54
Q

Features of a pressure ulcer

A

Base : if bone = osteomyelitis
Floor: necrosis / pus suggests infection

Edge: sloped = normal ulcer
Undermined edges = TB
Rolled up / everted = risk of malignancy

55
Q

Complications of pressure ulcers

A

Skin and soft tissue infection (cellulitis)
Bone infection (osteomyelitis)
SCC : chronic inflammation
Sinus tract formation : chronic inflammation
Sepsis

56
Q

Define ischaemic stroke

A

Blockage in the blood vessel stops blood flow

57
Q

Define haemorrhagic stroke

A

Blood vessel bursts leading to reduction in blood flow

58
Q

2 types of ischaemic stroke

A

Thrombotic : thrombosis from large vessel

Embolic: usually a blood clot can be fat, air or clumps of bacteria - can be caused by AF

59
Q

2 types of haemorrhagic stroke

A

Intracerebral haemorrhage

Subarachnoid haemorrhage

60
Q

Risk factors for ischaemic stroke

A

General CVD RF’s
AF

61
Q

RF’s for haemorrhagic stroke

A

Age
HTN
Arteriovenous malformation
Anticoagulation therapy

62
Q

RF for haemorrhagic stroke

A

Age
HTN
Arteriovenous malformation
Anticoagulation therapy

63
Q

Features of a stroke

A

Motor weakness
Speech problems
Swallowing problems
Visual field defects
Balance problems

64
Q

Symptoms of cerebral hemisphere infarcts

A

Contralateral hemiplegia
Contralateral sensory loss
Homonymous hemianopia
Dysphasia

65
Q

Symptoms of brainstem infarction

A

Quadriplegia
Lock in syndrome

66
Q

Symptoms of lacunar infarcts

A

Ataxia
Pure motor signs
Pure sensory sings
Mixed signs

67
Q

What are the initial symptoms in the oxford stroke classification

A
  1. Unilateral hemiparesis and / or hemisensory loss of face, arm, leg
  2. Homonymous hemianopia
  3. Higher cognitive dysfunction
68
Q

Arteries involved in total anterior circulation infarcts

A

Middle and anterior cerebral arteries

69
Q

Arteries involved in partial anterior circulation infarcts

A

Smaller arteries of anterior circulation eg upper or lower division of middle cerebral artery

70
Q

Arteries involved in lacunar infarcts

A

Perforating arteries around internal capsule, thalamus and basal ganglia

71
Q

Arteries involved in posterior circulation infarcts

A

Vertebrobasilar arteries

72
Q

What symptoms are more common in haemorrhagic stroke over ischaemic

A

Decrease in consciousness level
Headache
N&V
Seizures

73
Q

What is the FAST campaign

A

Face - has face fallen on one side? Can they smile
Arms - can they raise both arms and keep them there
Speech - slurred
Time - call 999 if any 1 of these signs

74
Q

Criteria for thrombolysis in ischaemic strokes

A

Patients present within 4.5hrs of onset
No prev intracranial haemorrhage, uncontrolled HTN, pregnancy

Then give aspirin 300mg and antiplatelet therapy

75
Q

Immediate management of TIA

A

Aspirin 300mg unless contraindicated

76
Q

Management of haemorrhagic strokes

A

Stop anticoagulation and antithrombotics
Lowered BP

77
Q

Management of acute ischaemic stroke

A

Blood glucose, hydration, o2 sats and temp maintained
BP should not be lowered unless being considered for thrombolysis
Aspirin 300mg
Anticoagulants after 14 days
Statin if cholesterol >3.5

78
Q

Absolute contraindications to thrombolysis

A

Previous intracranial haemorrhage
Seizure at time of stroke
Intracranial neoplasm
Suspected subarachnoid haemorrhage
Stroke / brain injury in prev 3 months
Lumbar puncture prev 7 days
GI bleeding prev 3w
Active bleeding
Oesophageal varices
Uncontrolled HTN

79
Q

Relative contraindications to thrombolysis

A

Pregnancy
Concurrent anticoagulation (INR >1.7)
Haemorrhagic diathesis
Active diabetic haemorrhagic retinopathy
Suspected intracardiac thrombus
Major surgery in prev 2 weeks

80
Q

When is thrombectomy indicated

A

Within 6h of onset
Together with thrombolysis (if within 4.5hrs)

In people who have confirmed occlusion of the proximal anterior circulation

81
Q

Secondary prevention of strokes

A

Clopidogrel
Aspirin

82
Q

Secondary prevention of strokes

A

Clopidogrel
Aspirin

83
Q

What is the rosier score for assessing stroke

A

Loss of consciousness -1
Seizure activity -1

New acute:
Asymmetrical facial weakness +1
Asymmetrical arm weakness +1
Asymmetric leg weakness +1
Speech disturbance +1
Visual field defect +1

Stroke likely if >0

84
Q

Symptoms caused by stroke in anterior cerebral artery

A

Contralateral hemiparesis and sensory loss
Lower extremity > upper

85
Q

Symptoms caused by stroke in anterior cerebral artery

A

Contralateral hemiparesis and sensory loss
Lower extremity > upper

86
Q

Symptoms caused by stroke in middle cerebral artery

A

Contralateral hemiparesis and sensory loss
Upper extremity > lower
Contralateral homonymous hemianopia
Aphasia

87
Q

Symptoms caused by stroke in the posterior cerebral artery

A

Contralateral homonymous hemianopia with macular sparing
Visual agnosia

88
Q

Symptoms caused by stroke in the posterior cerebral artery

A

Contralateral homonymous hemianopia with macular sparing
Visual agnosia

89
Q

Symptoms of Webers syndrome (branches pf posterior cerebral artery)

A

Ipsilateral CNIII palsy
Contralateral weakness of upper and lower extremity

90
Q

Symptoms of a stroke in the posterior inferior cerebellar artery

A

Ipsilateral: facial pain and temp loss
Contralateral: limb / torso pain and temp loss
Ataxia
Nystagmus

91
Q

Symptoms of a stroke in the posterior inferior cerebellar artery

A

Ipsilateral: facial pain and temp loss
Contralateral: limb / torso pain and temp loss
Ataxia
Nystagmus

92
Q

Symptoms of a stroke in the anterior inferior cerebellar artery

A

Ipsilateral: facial paralysis and deafness

93
Q

Symptoms of stroke in the basilar artery

A

Locked in sydnrome

94
Q

Symptoms of stroke in the retinal / ophthalmic artery

A

Amaurosis fugax

95
Q

Symptoms of lacunar strokes

A

Present with either isolated hemiparesis, hemisensory loss of hemiparesis with limb ataxia
Associated with HTN
Basal ganglia, thalamus and internal capsule

96
Q

What is waterlow score used for

A

To identify patients at risk of pressure sores

97
Q

What medications should be avoided in LBD

A

Neuroleptics
Especially risperidone and typical antipsychotics such as haloperidol

98
Q

CT findings in Alzheimer’s

A

Atrophy of the cortex and hippocampus

99
Q

How to differentiate between dementia with Lewy bodies and Parkinson’s disease dementia

A

In PD dementia the tremor, bradykinesia and rigidity will develop before dementia
In DLB the opposite

100
Q

Presentation of frontotemporal dementia

A

Social disinhibition
Family history

101
Q

How to differentiate between mania and FTD

A

Mania causes reduced appetite
FTD increases appetite

102
Q

What conditions is haloperidol contraindicated in

A

PD
LBD

103
Q

Define frailty

A

A state of impaired homeostasis leading to increased vulnerability to minor stressor events

104
Q

Most likely diagnosis for a middle aged adult with insidious onset dementia and personality changes

A

FTD

105
Q

Most likely diagnosis for a middle aged adult with insidious onset dementia and personality changes

A

FTD

106
Q

MOA of Memantine

A

NMDA receptor antagonism

107
Q

MOA of Memantine

A

NMDA receptor antagonism

HCOLL (1 decks)

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