MD3 RAPP Flashcards
What defines a mild cognitive impairment over dementia?
Mild cognitive impairment does not impact function
mx for mild cognitive impairment?
- improve CVD risk factors as these are same as dementia
- medicolegal - will + POA
- retest 12 months
What are the two medications that may be used to slow dementia?
donepezil and rivastigmine commonly.
irritability and change in sleep pattern on top of prior cognitive impairment should ring alarm bells for?
delirium
Define delirium.
An acute and fluctuating change in cognition often featuring inattention.
Screening tool for delirium?
4AT
Ix for delirium screen?
SCRUBS mnemonic
Scan brain (sometimes)
CXR
Rationalise meds
Urine
Bloods - FBE, UEC, CMP, LFT, TFT, CRP
Scan bladder
Why do LFTs in suspected delirium?
to rule out hepatic encephalopathy
What is the molecular pattern responsible for alzheimers?
Amyloid beta plaques and neurofibrillary tangles
Is memory impacted in vascular dementia?
It can be or it can be spared. More typical is slow info processing and personality change.
Mx for vascular dementia?
CVD management to prevent further strokes.
Lew Body dementia is unique due to what defining feature?
Visual hallucinations
2 main types of fronto-temporal dementia and their classic signs.
fronto - behavioural change
temporal - primary progressive aphasia
Do cholinesterase inhibitors work for front-temporal dementia?
no
Brain imaging can be useful in declines in cognition to rule out?
space occupying lesions and brain bleeds (subdural in oldies)
Key finding on MRI in Alzheimers?
Hippocampi atrophy
Key MRI finding in vascular dementia?
Microhemarrohages
Triad for normal pressure hydrocephalus?
falls
ataxia
incontinence
Key to venous ulcer management?
compression (check for PVD first by ABI)
Most important mx for falls?
exercise
NOF mx principles
- operate early
- mobilise early
key for mx for neuropathic ulcers?
- remove pressure eg. orthotics
- beware osteomyelitis
Mild traumatic brain injury is also known as?
concussion
Name two unique features of traumatic brain injury compared to other ABIs?
- diffuse axonal injury (sheared axons)
- post-traumatic amnesia !!!
Only sign you will see on initial CT of ischemic stroke?
hyperdense artery sign
All spinal patients should have what intervention?
IDC - risk of retention
All acute quadreplegics should have what intervention?
NGT - huge aspiration risk
Which Ix and medication are used in many spinal patients with bladder issues?
urodynamics and oxybutynin
Which bacteria causes bladder stones in spinal bladders?
proteus - need to treat always
Virtually every spinal patient should on which medicines for their constipation?
coloxyl - morning
senna - night
First line treatment for spasticity?
Baclofen
Pain in spinal patients is typically treated with which agents?
= neuropathic pain
- amytriptyline
- pregabalin
First step in managing geriatric depression?
rule out organic causes
Safe anti-depressant option in geris?
Mirtazepine
One reason why tricyclics are poor options for geris?
orthostatic hypotension
also QT elongation
SSRIs may cause _____ or _____ in conjunction with other medications.
SIADH or serotonin syndrome
Mx option for refractive geri depression?
ECT
Main ECT side effect?
memory loss (short term)
Pharm mx for serotonin syndrome?
benzos
Dementia risk factors?
- CVD risks
- hearing/visual impairment
- TBI
What is the anti-psychotic of choice for Lewy Body Dementia?
Quetiapine
‘incongruent affect’ is code for ?
psychotic disorders
Immediate pharm mx for mass compressing spine?
dexamethasone
Why are LFTs relevant to bone mets?
ALP up in bone mets
Scan for PE?
CTPA
Opioid breakthrough dose?
1/6th of regular.
max paracetamol dose in adults?
4g in 24hrs
Side effects of opioids?
constipation, confusion, sedation, nausea, dry mouth.
Best opioid for renal disease?
fentanyl
Cyclizine is great for N+V caused by?
vestibular n+v
Switch from metaclopramide to donperidone if….
noticing EPSE caused by metaclopramide (or pre-exisiting EPSE)
Convert oral morphine to subcut.
Subcut is 1/3 of dose of oral.
3 steps following pt death.
- call death same day, get chosen funeral services involved.
- Report to GP
- Bereavement resources to family
What is a pancoast tumour?
Apical lung tumour causing shoulder pain, radiculopathy and Horner’s syndrome.
Which stroke type is typically sensory only?
thalamic
The main risk of diuretics in geris?
dehydration
Right parietal stroke causes what type of presentation?
hemineglect
What is an antalgic gait?
weird gait due to pain
2 main falls rehab goals:
2 main falls risks:
strength and balance
bleed and fracture
serum osmolality is the key ix in which geriatric presentation?
HHS (hyperosmolar hyperglycemic syndrome)
Which cognitive screen is best for non-english speakers?
RUDAS
2 key features of Wernicke’s Korsakoff?
No new memory laying + ophthalmogplegia
Slow release K+ tablet?
Clorvescent
two med classes used for neuropathic pain?
Anti convulsants eg. pregabalin and gabapentin
Anti-depressants - duloxetine and amitryptaline
post-void residual level that is classified as retention?
over 300ml
