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Phase 2 > Integrative > Flashcards

Integrative Flashcards

1
Q

List important factors in a falls history

A 
How
LOC? - feelings before, during, after
Injuries sustained
Pain
Headache
Long lie
\+ collateral
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2
Q

List risk factors for falls

A 
Previous fall
Age >80
Female
Visual impairment
Medication (B-blockers, diuretics, opioids, insulin)
Gait disorder (PD, cerebellar, OA)
Poor footwear
Polypharmacy
Infection
Environment (loose rugs, wet floor, poor light, walking aids, cluttered home)
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3
Q

Describe the examination you would undertake in someone with a fall

A 
Temp. (infection)
MMSE/confusion screen (delirium)
Bruising
Postural BP (lying/standing)
Timed Up&Go Test
Turn 180 test
ECG (heart block)
Vision test, fundoscopy
Neurological exam, cranial nerve
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4
Q

Describe how to perform a lying/standing BP

A 
Lie down for 5 mins 
Take BP
Stand up for 1 min
Take BP 
Continue standing for 3 mins
Take BP

Positive if drop in systolic BP >20mmHg/drop in diastolic BP by 10mmHg with symptoms/systolic BP <90 when standing

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5
Q

List some investigations taken after a fall

A 
Bloods - FBC, U&amp;Es, LFTs, TFTs, B12, glucose)
Urinalysis
ABG
ECG/ECHO
CT head
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6
Q

List the management of falls

A

Referral to ED (injuries), AFU (medical cause of fall), OP falls clinic, community OT/PT, age concern
Falls assessment and bone health review - FRAX, DEXA, bisphosphonates
Medication review (e.g. NO TEARS, STOPP/START)

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7
Q

Describe the NO TEARS in a medication review

A 
Need/indication
Opinion of patient
Tests
Evidence/guideline change
ADRs/side effects
Risk reduction
Simplification/dosset box
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8
Q

List red flag symptoms of stroke

A 
Proceeded by a headache
Progressive neurology
Decreasing GCS
Falls
Systemic illness
No vascular RFs
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9
Q

List important factors in a stroke history

A

Onset (morning?)
Progression of symptoms
Symptoms - NIH stroke scale, FAST
Associated features - raised ICP

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10
Q

What examination would you perform in a patient with a stroke?

A

Neurological examination

NIH stroke scale

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11
Q

List differentials for a stroke

A 
SAH
Bell's palsy
Brain tumour
Brain abscess
Hemiplegic migraine
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12
Q

List risk factors for a stroke

A 
CVS RFs (smoking, hypercholesterolaemia, hyperlipidaemia)
AF
Post partum
PFO
COCP use
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13
Q

What is a stroke?

A

Sudden onset of focal neurological deficit attributable to a vascular cause

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14
Q

Describe a stroke classification system

A

Bamford/Oxford Stroke Classification
TACS = all three of: unilateral weakness (+/- sensory deficit) of face, arm and leg + homonymous hemianopia + higher cortical dysfunction (dysplasia, visuospatial disorder)
PACS = two out of: unilateral weakness (+/-sensory deficit) of face, arm and leg + homonymous hemianopia + higher cerebral dysfunction
POCS = one of: cranial nerve palsy and contralateral motor/sensory deficit + bilateral motor/sensory deficit + conjugate eye movement disorder + cerebellar dysfunction + isolated homonymous hemianopia
LACS = one of: pure sensory stroke + pure motor stroke + sensori-motor stroke + ataxic hemiparesis

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15
Q

State the most likely cause of each different type of stroke

A 
TACS = cardiac emboli - affects areas of brain supplies by both ACA + MCA
PACS = large vessel disease - only part of anterior circulation is compromised 
POCS = cerebellar/brainstem - posterior circulation is compromised
LACS = small vessel disease - no loss of higher cerebral functions
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16
Q

Describe the blood supply of the brain

A

ACA - anteromedial cerebrum (frontal, medial)
MCA - lateral cerebrum (frontal, lateral, parietal, temporal)
PCA - medial and lateral posterior cerebrum (occipital)

17
Q

Describe the acute assessment of a stroke

A

Ix - CT head, clotting, U&Es, cholesterol

Mx - O2 if sats <94%, thrombosis, HTN management

18
Q

State the management of a stroke that presents in <4.5h

A

Thrombolysis with alteplase

Aspirin 300mg

19
Q

Describe the management of an acute stroke

A 
Aspirin 300mg OD for 14 days
Clopidogral 75mg
Consider thrombolysis
Maintain BP <130/80
Statin
Transfer to stroke unit
Advice smoking cessation
20
Q

List complications of stroke

A 
Seizures
Stroke extension
Disability +incontinence
Recurrence
Depression
Cognitive decline
Infections
21
Q

Define the ABCD2 score and what is it used for

A 
= to determine the risk of stroke in the days following a TIA
Age >60:
<60 = 0
>60 = 1
BP >140/90
<140/90 = 0
>140/90 = 1
Clinical features:
No speech disturbance or unilateral weakness = 0
Speech disturbance with no unilateral weakness = 1
Unilateral weakness = 2
Duration of symptoms
<10 mins = 0
10-59 mins = 1
>60 mins = 2
Diabetes
No diabetes = 0
Diabetes = 1
0-3 = low, 4-5 = moderate, 6-7 = high
22
Q

List important lifestyle changes to tell a patient following a stroke

A

No driving for 1mo
Smoking cessation
No LMWH

23
Q

Describe the pathophysiology of Parkinson’s Disease

A

Low dopamine in substantia nigra in the basal ganglia (controls movement)

24
Q

What is Parkinson’s Disease?

A

A degenerate, progressive disease affecting the basal ganglia

25
Q

List the clinical features of Parkinson’s

A

Motor features:
Bradykinesia - facial immobility, difficulty initiating movement
Postural instability - festinating gait
Tremor - resting, pill rolling
Rigidity - cogwheel (upper)/leadpipe (lower)
Non motor features:
Depression
Sleep disturbance - restless legs, REM
Autonomic dysfunction - increased sweating, drooling, constipation
Falls

26
Q

Describe the classical gait of a person with Parkinson’s

A 
Stooping
Slow to initiate walking
Shortened stride
Shuffling, festinating
Decreased arm swing
Pedestal turning
27
Q

List investigations for Parkinson’s

A

Clinical diagnosis
Test for Wilson’s if <50
CT head or DaTSCAN if pyramidal/cerebellar, ?diagnosis

28
Q

List management options for Parkinson’s

A 
Levodopa (dopamine precursor) + carbidopa (decarboxylase inhibitor)
Bromocriptine (dopamine agonist)
Entacapone (COMT inhibitor)
Selegilene (MAO-B inhibitor)
Amantadine (antiviral)
PT/OT/speech therapy
SSRI
29
Q

List ADRs for levodopa

A 
Nausea
Vomiting
Confusion
Chorea
Ineffective
30
Q

List differentials for Parkinson’s (other causes of Parkinsonism) and the symptoms they cause

A

Multiple systems atrophy - autonomic, ataxia, falls
Supranuclear palsy - balance/movement disorder, failure of vertical gaze
Lewy body dementia - nocturnal wandering, visual hallucinations
Drug induced parkinsonism - symmetrical, young, dopamine agonist/lithium/AED/metoclopramide
Vascular - sudden onset, LL>UL, MRI diagnosis

31
Q

List the types of patients at risk of malnutrition

A

Elderly
Oncology
Intentional weight loss
Acute illness

32
Q

List risk factors of refeeding syndrome

A

Very low BMI
Unintentional weight loss >10-15% body weight in 3-6 months, little/no nutritional intake >5-10 days, low electrolytes prior, alcohol/drug (insulin, chemo, antacids, diuretics) abuse

33
Q

What is refeeding syndrome?

A

Low phosphate, magnesium, potassium
Thiamine deficiency
Sodium and water retention

34
Q

Describe the management of refeeding syndrome

A 
Baseline bloods
Daily bloods
Regular ECG
Feed slowly
Reflace fluid
Pabrinex --> thiamine PO
Vit. B12
Multivitamins
35
Q

What is advanced care planning?

A

The process of conversation to discuss possible future situations and understand patient preferences e.g. preferred place of care/death, DNACPR, ADRT, power of attorney, anticipatory medication

36
Q

Describe the pathophysiology of dying

A

Respiratory secretions
Decreased brain perfusion - drowsy, delirium
Decreased cardiac function - thready pulse, cool, mottled
Decreased renal perfusion - low urine output
Decreased metabolic rate - low oral intake, fatigue

37
Q

Describe how to verify death

A

Unresponsive
No central pulse, heart sounds or respiratory effort for 2 mins
Pupils fixed and dilated

Phase 2 (11 decks)

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