HCOLL Flashcards
What does BPSD stand for?
Behavioural and psychological symptoms of dementia
what percentage of Dementia is Alzheimer’s
62%
What are the four theories of Alzheimer’s
1) Decreased Ach synthesis
2) Beta amyloid plaques
3) Tau Y
4) inflammation
does Lobular and Hippocampal size increase or decrease in dementia?
Decreases
Does ventricular size increase or decrease in dementia
Increases
What are three examples of Ach inhibitors
1) Donzepil
2) Rivastigmine
3) galantamine
What is an example of a glutamate inhibitor for the treatment of dementia?
Memantine
What are the two types of vascular dementia
Acute vs Multi infarct
What type of deterioration is seen in vascular dementia
Step wise
What percentage does vascular dementia make up compared to others?
17%
what is problematic in vascular dementia
BPSD
What is management based on in vascular dementia?
Control of risk factors
In lewy Body dementia does a patient fluctuate day to day or is it a step wise deterioration?
Fluctuates day to day
What should you not give to patients with Lewy body dementia?
Antipsychotics
Why should you avoid antipsychotics in dementia
They lower D2 so can make symptoms a lot worse.
Name 3 tests that can be done for the frontal battery assessment
conceptualization Lexical fluency ( as many word beginning with 'S') Luria hand test conflicting instructions go no go
What changes can be seen in patients with FTD?
Profound personality changes
What are the three types of FTD
1) Behavioural Variant frontotemporal
dementia
2) Semantic Dementia
3) Progressive nonfluent aphasia
What can be used in the diagnosis of dementia?
Name 3,
ACE-r (addenbrookes)
MOCA
Neuropsychological testing
What forms of scanning can be used in the diagnosis of dementia?
CT/MRI- SPECT
PET
DAT
Name 4 Behavioural symptoms to BPSD
Agitation Restlessness Apathy Aggression Shouting Screaming
Name 4 psychological symptoms of BPSD
Anxiety Depression Insomnia Hallucinations Delusions
Define Delirium
Acute confusional state
Name a minimum of 3 intracranial causes of delirium
Neurodegenerative Space occupying Infarction epilepsy CBV
Name a minimum of 3 systemic causes of Delirium
Drugs
endocrine
sepsis
infection
What are the differences between dementia and delirium
Dementia is : Gradual, progressive, normal consciousness,
Delirium: Acute
fluctuations, impaired consciousness.
Define osteoporosis,
When bone formation and reabsorption become uncouples and result in bone loss.
What are some of the clinical features of osteoporosis?
Asymptomatic,
Pain or loss of height due to kyphosis caused by fragility fractures
Features of underlying disease (eg cushings)
Name Secondary causes of osteoporosis in relation to
1) Endocrine
2) drugs
3) inflammatory
4) genetic
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
Describe the results of a dexa scan
> -1 Normal
-1 to -2.5 Osteopenia
-2.5 Osteoporosis
For younger patients (<50) what score should you use rather than the dexa score
Z score >-2 standard deviations suggests significant bone loss.
What is FRAX
Tool to evaluate the risk of fractures in patients
What investigations can be used in identifying osteoporosis. (7)
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
Name 3 forms of management for osteoporosis
Lifestyle modifications
- +Ca intake,
- +Weight bearing exercises
- Smoking cessation
- Alcohol Reduction
How do bisphosphonates work? can you give 2/3 examples.
Alendronic acid (Alendronate)
Risedronate
Zoledronate,
They cause osteoclast apoptosis.
What drug can increase bone growth
Teriparatide.
What is the second line management of osteoporosis
SERM (selective oestrogen receptor modulators)
Denosumab- Monoclonal antibody, inhibits osteoclasts by blocking RANK L.
What are the bone resorption markers?
How much should a normal person have of the first one?
Collagen Type 1 Cross-linked C-telopeptide
(CTX) (healthy person 300-400 pg/ml)
Collagen Type 1 Cross-linked N-Telopeptide (NTX)
Pyridinoline (PYD)
what does PTH and Calcium do in the conditions and what is the cause?
a) Primary hyperparathyroidism
b)Secondary hyperparathyroidism
C) tertiary hyperparathyroidism
A) +PTH +Calcium Parathyroid adenoma
B) +PTH +Calcium Physiological response to low calcium
C) ++PTH +calcium Autologuys PTH (eg CKD)
What are the four types of incontinence
Urge/Detrusor overactivity
Stress
Overflow
Functional
Name 5 causes of urge incontinence
Too much alcohol or caffeine Poor fluid intake Constipation UTIs Tumours Neurological conditions Drugs
What are 3 causes of stress incontinence
Damage during childbirth
Increased IAP
Elhors danlos syndrome
What are the two main causes of overflow incontinence?
Detrusor failure- Neuro medication induced, diabetes, spinal surgery,
Obstruction- Enlarged Prostate, Bladder stones, Urethral stricture
Give 5 examples of functional incontinence
Inability to communicate the need for the toilet, Sedation, Unfamiliar surroundings Cognitive impairment Clothing
What are the reversible causes of incontinence?
Hint: Diapers
D Delirium I Infection A Atrophic Urethritis/Vaginitis P Pharmacy E Excessive urine output (diabetes, Hypercalcemia) R Restricted mobility S Stool Impaction
What can fecal incontinence be a symptom of? (give 5/6 examples)
Fecal loading Prolapse Hemorrhoids Sphincter injury Dementia Lower GI cancers
Give examples (min 4/6) of medications that can cause incontinence
Alpha blockers Loop Diuretics Ace inhibitors Anticholinergics Some antidepressants Sedatives
GIve 4 examples of drugs and how they work for treating urinary incontinence.
Antibiotics (for UTI) Oxybutynin (Antimuscarinic) Tolterodine (antimuscarinic) Trospium (antimuscarinic)
What drug can be used for IBS
Mebeverine
Define a pressure ulcer
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
What is the blanch test in pressure sore assessment
Apply pressure to red area should go white then red. If stays white then sign of reduced blood flow,
Define a Category 1 pressure ulcer
Non blanchable erythema,
Intact skin with non blanchable redness over a body prominence
Define a Category 2 pressure ulcer
Partial thickness with loss of dermis, presents with a shallow open ulcer. May also present as an intact or ruptured serum filled blister
Define Category 3 pressure ulcer
Full thickness tissue loss, Fat may be visible but not muscle or bone.
Define Category 4 pressure ulcer
Full thickness loss, Ulcers extend into muscle and supportive tissue. Osteomyelitis likely.
Define unstageable pressure ulcers
Actual depth of star can’t be established because of slough
What tool can be used to risk assess pressure ulcers?
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)
What tool can be used in the assessment for malnutrition
Malnutrition universal screening tool (MUST)
Define a TIA
Neurological deficit of CVD that lasts <24hrs
What is Amaurosis Fugax?
Painless Temporary loss of vision (like a curtain descending)
What is the cause of Amaurosis Fugax
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
Define a TACS Stroke
All of these: Higher dysfunction -Dysphagia -decreased level of consciousness -Visuospatial neglect -Astereognosis or apraxia
Homonymous Hemianopia
Motor / sensory deficit
Define a PACS stroke
2/3 of these: Higher dysfunction -Dysphagia -decreased level of consciousness -Visuospatial neglect -Astereognosis or apraxia
Homonymous Hemianopia
Motor / sensory deficit
Define a LACS stroke (4 Parts)
any of these
Pure motor
Pure sensory
Sensory motor
Ataxic hemiparesis
Define a POCS stroke
Any of these
CN palsy AND contralateral motor or sensory deficit
Bilateral motor / sensory deficit
Conjugate eye movement problems
Cerebellar dysfunction
Isolated homonymous hemianopia
