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CP2 > HCOLL > Flashcards

HCOLL Flashcards

1
Q

What does BPSD stand for?

A

Behavioural and psychological symptoms of dementia

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2
Q

what percentage of Dementia is Alzheimer’s

A

62%

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3
Q

What are the four theories of Alzheimer’s

A

1) Decreased Ach synthesis
2) Beta amyloid plaques
3) Tau Y
4) inflammation

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4
Q

does Lobular and Hippocampal size increase or decrease in dementia?

A

Decreases

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5
Q

Does ventricular size increase or decrease in dementia

A

Increases

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6
Q

What are three examples of Ach inhibitors

A

1) Donzepil
2) Rivastigmine
3) galantamine

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7
Q

What is an example of a glutamate inhibitor for the treatment of dementia?

A

Memantine

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8
Q

What are the two types of vascular dementia

A

Acute vs Multi infarct

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9
Q

What type of deterioration is seen in vascular dementia

A

Step wise

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10
Q

What percentage does vascular dementia make up compared to others?

A

17%

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11
Q

what is problematic in vascular dementia

A

BPSD

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12
Q

What is management based on in vascular dementia?

A

Control of risk factors

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13
Q

In lewy Body dementia does a patient fluctuate day to day or is it a step wise deterioration?

A

Fluctuates day to day

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14
Q

What should you not give to patients with Lewy body dementia?

A

Antipsychotics

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15
Q

Why should you avoid antipsychotics in dementia

A

They lower D2 so can make symptoms a lot worse.

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16
Q

Name 3 tests that can be done for the frontal battery assessment

A 
conceptualization
Lexical fluency ( as many word beginning with 'S')
Luria hand test 
conflicting instructions 
go no go
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17
Q

What changes can be seen in patients with FTD?

A

Profound personality changes

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18
Q

What are the three types of FTD

A

1) Behavioural Variant frontotemporal
dementia
2) Semantic Dementia
3) Progressive nonfluent aphasia

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19
Q

What can be used in the diagnosis of dementia?

Name 3,

A

ACE-r (addenbrookes)
MOCA
Neuropsychological testing

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20
Q

What forms of scanning can be used in the diagnosis of dementia?

A

CT/MRI- SPECT
PET
DAT

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21
Q

Name 4 Behavioural symptoms to BPSD

A 
Agitation
Restlessness
Apathy 
Aggression
Shouting
Screaming
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22
Q

Name 4 psychological symptoms of BPSD

A 
Anxiety
Depression 
Insomnia
Hallucinations
Delusions
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23
Q

Define Delirium

A

Acute confusional state

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24
Q

Name a minimum of 3 intracranial causes of delirium

A 
Neurodegenerative
Space occupying 
Infarction
epilepsy
CBV
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25
Q

Name a minimum of 3 systemic causes of Delirium

A

Drugs
endocrine
sepsis
infection

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26
Q

What are the differences between dementia and delirium

A

Dementia is : Gradual, progressive, normal consciousness,

Delirium: Acute
fluctuations, impaired consciousness.

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27
Q

Define osteoporosis,

A

When bone formation and reabsorption become uncouples and result in bone loss.

28
Q

What are some of the clinical features of osteoporosis?

A

Asymptomatic,
Pain or loss of height due to kyphosis caused by fragility fractures
Features of underlying disease (eg cushings)

29
Q

Name Secondary causes of osteoporosis in relation to

1) Endocrine
2) drugs
3) inflammatory
4) genetic

A

1) Cushings, hyperthyroid, hyperparathyroid, prolactinoma, diabetes, hypergonadism.
2) Steroids, sex hormone antagonist, lithium, anticonvulsants, heparin
3) RA, ankylosing spondylitis, IBD
4) Marfans, osteogenesis imperfecta, Turners

30
Q

Describe the results of a dexa scan

A

> -1 Normal
-1 to -2.5 Osteopenia
-2.5 Osteoporosis

31
Q

For younger patients (<50) what score should you use rather than the dexa score

A

Z score >-2 standard deviations suggests significant bone loss.

32
Q

What is FRAX

A

Tool to evaluate the risk of fractures in patients

33
Q

What investigations can be used in identifying osteoporosis. (7)

A

Renal function (Decreased creatinine clearance in women with primary osteoporosis)
Bone profile (Calcium, VitD, phosphat, PTH)
Thyroid function
Bone turnover (tests urine)
Multiple myeloma screen ( ESR, Bence jones proteins, )
TTG
Cortisol/oestradiol/PSA

34
Q

Name 3 forms of management for osteoporosis

A

Lifestyle modifications

  • +Ca intake,
  • +Weight bearing exercises
  • Smoking cessation
  • Alcohol Reduction
35
Q

How do bisphosphonates work? can you give 2/3 examples.

A

Alendronic acid (Alendronate)
Risedronate
Zoledronate,

They cause osteoclast apoptosis.

36
Q

What drug can increase bone growth

A

Teriparatide.

37
Q

What is the second line management of osteoporosis

A

SERM (selective oestrogen receptor modulators)

Denosumab- Monoclonal antibody, inhibits osteoclasts by blocking RANK L.

38
Q

What are the bone resorption markers?

How much should a normal person have of the first one?

A

Collagen Type 1 Cross-linked C-telopeptide
(CTX) (healthy person 300-400 pg/ml)

Collagen Type 1 Cross-linked N-Telopeptide (NTX)

Pyridinoline (PYD)

39
Q

what does PTH and Calcium do in the conditions and what is the cause?
a) Primary hyperparathyroidism
b)Secondary hyperparathyroidism
C) tertiary hyperparathyroidism

A

A) +PTH +Calcium Parathyroid adenoma
B) +PTH +Calcium Physiological response to low calcium
C) ++PTH +calcium Autologuys PTH (eg CKD)

40
Q

What are the four types of incontinence

A

Urge/Detrusor overactivity
Stress
Overflow
Functional

41
Q

Name 5 causes of urge incontinence

A 
Too much alcohol or caffeine
Poor fluid intake
Constipation
UTIs 
Tumours
Neurological conditions 
Drugs
42
Q

What are 3 causes of stress incontinence

A

Damage during childbirth
Increased IAP
Elhors danlos syndrome

43
Q

What are the two main causes of overflow incontinence?

A

Detrusor failure- Neuro medication induced, diabetes, spinal surgery,

Obstruction- Enlarged Prostate, Bladder stones, Urethral stricture

44
Q

Give 5 examples of functional incontinence

A 
Inability to communicate the need for the toilet,
Sedation,
Unfamiliar surroundings
Cognitive impairment 
Clothing
45
Q

What are the reversible causes of incontinence?

Hint: Diapers

A 
D Delirium 
I Infection
A Atrophic Urethritis/Vaginitis  
P Pharmacy 
E Excessive urine output (diabetes, Hypercalcemia) 
R Restricted mobility
S Stool Impaction
46
Q

What can fecal incontinence be a symptom of? (give 5/6 examples)

A 
Fecal loading
Prolapse
Hemorrhoids
Sphincter injury
Dementia 
Lower GI cancers
47
Q

Give examples (min 4/6) of medications that can cause incontinence

A 
Alpha blockers
Loop Diuretics 
Ace inhibitors
Anticholinergics
Some antidepressants
Sedatives
48
Q

GIve 4 examples of drugs and how they work for treating urinary incontinence.

A 
Antibiotics (for UTI)
Oxybutynin (Antimuscarinic)  
Tolterodine (antimuscarinic) 
Trospium 
(antimuscarinic)
49
Q

What drug can be used for IBS

A

Mebeverine

50
Q

Define a pressure ulcer

A

A pressure ulcer is localised injury to the skin and / underlying tissue over a bony prominence as a result of pressure, or
pressure in
combination
with shear

51
Q

What is the blanch test in pressure sore assessment

A

Apply pressure to red area should go white then red. If stays white then sign of reduced blood flow,

52
Q

Define a Category 1 pressure ulcer

A

Non blanchable erythema,

Intact skin with non blanchable redness over a body prominence

53
Q

Define a Category 2 pressure ulcer

A

Partial thickness with loss of dermis, presents with a shallow open ulcer. May also present as an intact or ruptured serum filled blister

54
Q

Define Category 3 pressure ulcer

A

Full thickness tissue loss, Fat may be visible but not muscle or bone.

55
Q

Define Category 4 pressure ulcer

A

Full thickness loss, Ulcers extend into muscle and supportive tissue. Osteomyelitis likely.

56
Q

Define unstageable pressure ulcers

A

Actual depth of star can’t be established because of slough

57
Q

What tool can be used to risk assess pressure ulcers?

A 
Braden Risk assessment tool
Score <16 high risk
17-20 Medium risk
21-23 Low risk 
(takes into account sensory perception, moisture, activity, mobility, nutrition)
58
Q

What tool can be used in the assessment for malnutrition

A

Malnutrition universal screening tool (MUST)

59
Q

Define a TIA

A

Neurological deficit of CVD that lasts <24hrs

60
Q

What is Amaurosis Fugax?

A

Painless Temporary loss of vision (like a curtain descending)

61
Q

What is the cause of Amaurosis Fugax

A

Temporary reduction in blood flow to retinal artery, ophthalmic artery or ciliary artery.

Due to atherosclerosis in carotid AA, Giant cell arteritis, polycythemia rubra vera

62
Q

Define a TACS Stroke

A 
All of these:
Higher dysfunction
-Dysphagia
-decreased level of consciousness
-Visuospatial neglect 
-Astereognosis or apraxia

Homonymous Hemianopia

Motor / sensory deficit

63
Q

Define a PACS stroke

A 
2/3 of these:
Higher dysfunction
-Dysphagia
-decreased level of consciousness
-Visuospatial neglect 
-Astereognosis or apraxia

Homonymous Hemianopia

Motor / sensory deficit

64
Q

Define a LACS stroke (4 Parts)

A

any of these

Pure motor
Pure sensory
Sensory motor
Ataxic hemiparesis

65
Q

Define a POCS stroke

A

Any of these

CN palsy AND contralateral motor or sensory deficit

Bilateral motor / sensory deficit

Conjugate eye movement problems

Cerebellar dysfunction

Isolated homonymous hemianopia

CP2 (3 decks)

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