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4th year medicine > medicine for older people > Flashcards

medicine for older people Flashcards

1
Q

medications which increase risk of falls

A 
diazepam
sertraline 
doxazosin 
zopiclone 
risperidone 
gliclazide
amitriptyline (tricyclic, neuropathic pain - strong anticholinergic effect)
codeine 
oxybutynin
diuretics - for first month then returns to normal with reduced fracture risk
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2
Q

management of faller

A
  • fraxx risk - bisphosphonates
  • review medications
  • physio
  • treat hypotension
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3
Q

anticholinergic burden

A

cholinergic drugs help cognition like Alzheimers
anti-cholinergics have negative effects on cognition
anticholinergic burden is a build up of the effects from using multiple anticholinergics

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4
Q

most common cause of incontinence

A

faecal loading

stool typically soft not hard

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5
Q

most common cause of faecal incontinence

A

faecal loading

  • stool typically soft not hard
  • in rectum
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6
Q

constipation

A

not been more than 3 times in a week

treatment: laxatives

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7
Q

focal impaction

A

hard stool
immobile
building up in colon
can have diarrhoea

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8
Q

faecal incontinence and constipation - investigations

A

examination
PR - to differ faecal loading or impaction
AXR

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9
Q

overactive bladder syndrome treatment

A 
physio 
behaviour changes:
- caffeine restriction 
eight loss
timed voiding 
medications:
- anticholinergics:
solifenacin 5mg OD
tolterodine 
trospium chloride 
avoid oxybutinin (crosses BBB- decrease cognition)

consider mirabegron in elderly with cognitive impairment
- side effects: HTN

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10
Q

stress urinary icontinence treatment

A

physio

fluoxetine

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11
Q 
elderly 
fall 
sudden onset dizziness and nausea 
nystagmus on right lateral gaze *
past pointing on the right *
power is preserved
A

cerebellar stroke

nystagmus
past pointing

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12
Q

medication to slow cognitive decline

A

galantamine

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13
Q 
fall
gradual onset of weakness in both legs over few days 
increased tone in both legs
reduced power in all leg muscles 
brisk reflexes *
bilateral upgoing planters *
A

spinal cord compression

brisk reflexes
upgoing plantars

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14
Q

treatment for reducing fracture risk

A

if over 75: osteoporosis

bisphosphonate (alendrotnic acid) + calcium/vitamin D

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15
Q

reduced power in all limbs
generalised muscle wasting - especially in hands
fasciculations *
sensation intact

A

motor neurone disease

fasciculations

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16
Q 
alcoholic 
hypotension 
perifollicular haemorrhages over limbs 
gingival hyperplasia
loosening teeth

what is the most likely micronutrient deficiency

A

ascorbic acid (vit C deficiency)

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17
Q

alcoholic:

  • hypotension
  • perifollicular haemorrhages over limbs
  • gingival hyperplasia
  • loosening teeth

what is the most likely micronutrient deficiency ?

A

ascorbic acid (vit C deficiency)

18
Q

when can bisphosphonates not be used

A

renal impairment

19
Q

when can bisphosphonates not be used for fracture risk?

alternative?

A

renal impairment

denosumab

20
Q 
90yrs 
fall 
gradual onset bilateral weakness in legs over 3 days 
increased tone 
reduced power
brisk reflexes 
reduced sensation 
up going plantars*
A

spinal cord compression

21
Q

fall

clinical feature associated with frailty

A

unintentional weight loss over the last few years

22
Q

dementia definition

A

group of progressive neurodegenerative brain disorders

cause global decline in cognition and memory function

interferes with social/ professional activity leading to death

23
Q

dementia diagnosis - investigations

A

obs and examination (CVS & neuro)

exclusion of:
- delirium 
- depression 
- drugs 
bloods:
- FBC (anaemia/infection)
- U&Es (dehydration, renal failure, hyponatraemia)
- glucose
- TFT
- LFT (alcohol misuse/ dementia, Korsakoffs)
- B12 & folate
- calcium 
- HIV test

cognitive assessment:

  • MMSE (<26 abnormal)
  • MOCA
  • addenbrooke’s

collateral hx

septic screen

CT or MRI head if:

  • unusual presentation
  • first onset psychotic symptoms
  • prior to anti-dementia medication
24
Q

general early features of dementia

A
  • loss of RECENT MEMORY
  • impairment of judgment
  • alteration in personality
  • disorientation in time and space

manifests as: missed appointments, anxious or irritable, depression

25
Q

general later features of dementia

A

language:

  • expressive aphasia
  • followed by receptive aphasia (doesn’t understand meaning)

social:

  • deterioration in personal hygiene
  • behavioural changes become problematic (wandering, aggression, disinhibited behaviour)

incontinence

26
Q

Alzheimers disease pathology

A

most common form of dementia

  • symmetrical atrophy - HIPPOCAMPUS affected early
  • beta amyloid plaques
  • neurofibrillary tangles
  • loss of acetylcholine
27
Q

risk factors for Alzheimers disease

A
  • AGE
  • women
  • familial early onset dementia: presenilin 1 &2 gene, beta-amyloid precursor protein (APP) gene
    later onset linked to Apo-E4 (>65)
  • vascular risk factors
  • downs syndrome
  • diabetes
  • binge drinking
  • obesity
28
Q

Alzheimer’s clinical presentation

A

4A’s

  • AMNESIA: recent memory loss
  • APHASIA: word finding problems, speech muddled and disjointed
  • AGNOSIA: recognition problems e.g. faces
  • APRAXIA: inability to carry out skilled tasks despite normal motor function e.g. dressing
29
Q

Alzheimer’s management

A

mild/ moderate:

  • acetylcholinesterase inhibitors:
  • -> galantamine
  • -> donepezil - oral
  • -> rivastigmine - patches

moderate/ severe:

  • NMDA receptor antagonist
  • -> memantine
  • drugs to treat behavioural and psych symptoms
  • BP, cholesterol check
30
Q

vascular dementia types

A

small vessel disease - most common

  • large vessel/ multi-infarct - step wise progression
  • strategic infarcts e.g. thalamic
  • vasculitis e.g. neurosyphilis
31
Q

vascular dementia risk factors

A

large vessel:

  • FHx
  • HTN
  • vascular disease
  • cardiac disease

small vessel:

  • above +
  • diabetes
  • vasculitis related disease
32
Q

vascular dementia presentation

A

stepwise progression + abrupt onset

  • step- sudden deterioration with infarct
  • multiple small infarcts cause smoother progression
  • one large strategic infarct e.g. thalamus can cause dementia
  • symptoms reflect sight of lesion - ‘patchy cognitive impairment’
  • relative preservation of personality and insight
  • fluctuations in severity
33
Q

vascular dementia

investigations

A
  • signs of CVD, DM, heart disease
  • Hachinski Ischaemia Score (7 or more)
  • brain CT
34
Q

vascular dementia

management

A
  • control vascular risk factors
  • aspirin
  • acetylcholinesterase inhibitors have no benefit unless mixed (AD) dementia
35
Q

Lewy body dementia

pathology

A

Lewy body - alpha-synuclein with ubiquitin

Parkinson’s disease lewy bodies in brain stem (basal ganglia)

36
Q

Lewy body dementia

presentation

A

core features:

  • fluctuating confusion (day to day)
  • marked variation in alertness
  • vivid visual hallucinations
  • parkinsonian symptoms

supportive features:

  • repeated falls
  • syncope
  • neuroleptic sensitivity (NO ANTIPSYCHOTICS)

common in this condition:

  • falls
  • postural hypotension
  • REM sleep disorder
  • restless legs
37
Q

Lewy body investigations and management

A

investigations:
- +ve DAT test - support

management:

  • social
  • antiparkinsonian drugs
  • AVOID PHENOTHIAZINES (antipsychotic) –> neuromalignant syndrome
38
Q

differentials to NMS

A
  • serotonin syndrome

- in Parkinson’s disease when a dopaminergic drug is stopped it can present like NMS

39
Q

Parkinson’s disease diagnosis

A

Parkinsonism:

  • BRADYKINESIA + 1 or more:
  • muscular RIGIDITY
  • low freq TREMOR
  • postural INSTABILITY

extra symptoms:

  • pill rolling tremor
  • shuffling gait
  • mask-like blank expression
  • cog wheel rigidity
  • apathy (reduced interest & motivation)
  • stooped posture
  • sleep disorders
  • bladder dysfunction
  • constipation - can make the symptoms worse
supportive criteria:
>/=3 for definitive 
- unilateral onset 
- rest tremor
- persistent asymmetry 
- excellent response to levodopa 
- levodopa response >5yrs 
- clinical course >10rs
40
Q

what Hz is the pill rolling tremor at

A

4-6Hz

41
Q

investigations and management of Parkinson’s disease

A

investigations:
- DAT - dopamine transmission scan - DA reuptake

conservative:

  • refer to specialist quickly
  • inform DVLA
  • active planning
  • sleep hygiene

medical:

  • LEVO-DOPA
  • -> combined with madapor (co-beneldopa) or sine met (co-caredopa) (prevent peripheral conversion)

4th year medicine (8 decks)

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