Old Age Medicine Flashcards
What are the 4 measurements of Fried’s phenotype of frailty?
Grip strength
Fatigue
Walking speed
Activity levels
What components are needed in falls history?
Previous falls Circumstances surrounding the fall Preceding symptoms Vision, cognition and continence Osteoporosis risk factorsl
What are the causes of falls grouped into?
D- drugs
A- aging
M- medical causes
E-environmental
Define sarcopenia
Decreased muscle mass
Define delerium
An acute onset of confusion with a change in alertness (agitated or hyperalert)
What are the two validated tools for assesing confusion
Confusion assesnent method (CAM) ( is ICD 10 for delerium)
The 4AT
What is CAM positive?
Acute onset and fluctuating course
PLUS
Inattention
And EITHER
Disorganised thinking (disorganised speech)
OR
altered level of consiousness (hyperalert/hypoalert)
If delerium is not remedied by de-escelation techniques what medicatuons may be used?
Short term haloperidol or olanzapine (1 week)
What conditions contraindicate the use of antipsychotics for treatment of delerium?
Parkinsons/ lewy body dementia
Use lorazepam instead
What is the prognosis for patients with delerium?
1/3 recover quickly
1/3 recover slowly
1/3 do not completely recover
What blood test must you always do for delerium
Serum calcium
What are the 4 components of the 4 AT exam?
Alertness
AMT4 (age, date of birth, current year and location)
Attention (count months backwards from december)
Acute and fluctuating course
Define the triad of parkinsonism
Resting tremour
Bradykinesia
Rigidity
(Postural and gait instability)
Define essential tremor
A tremor that is worse on movement, may be present in legs and jaw and is usually familial. No bradykinesia or gait disorder
What is the treatment for essential tremor?
A non specific beta-blocker - PROPRANOLOL
What type of tremors are worse on movement?
Essential tremor Dystonic tremor Exaggerated physiological tremor Hyperthyroidism Drug induced
What conditions have intention tremors?
Cerebellar disorders
What is the average age of onset for parkinsons disease?
60 yrs, more common in males
What are the stages of parkinsons?
Pre-diagnosis
Diagnosis/maintenance- no motor complications
Complex- on/off motor and cognitive problems
Palliative- poor drig response, may need PEG tube, dementia common
What are the first line treatments for parkinsons?
Ropinirole 250mg TDS
Co-Beneldopa (Modpar) 62.5mg TDS
Rasagaline 1mg daily
What type of medication is ropinirole?
A non-ergot derived dopamine agonist.
Others are Pramipexole and rotigotine (transdermal patch)
What type of medication is co-Beneldopa (Madopar)
A combination of levodopa a prodrug and DOPA decarboxylase inhibitor
What type of drug is rasagaline?
A monoamine-oxidase-B inhibitor.
Not as good as dopamine agonists and levodopa
Common side effects of levodopa are?
Postural hypotension
Nausea and vomiting
Dyskinesia
Impulsive and compulsive behaviour
What is the main hallmark of idiopathic parkinson’s disease?
Hemiparkinsonism. Early stages have asymmetrical symptoms
What are the grades of pressure ulcers?
Grade 1- non blanchable erythema with intact skin
Grade 2- partial skin loss presenting as abrasion or blister
Grade 3- full thickness skin loss and damage to subcutaneous tissue
Grade 4- extensive destruction with involvement of underlying structure muscle, bone etc
What are recognized complications of thrombolysis in acute stroke?
6% risk of haemorrhage (2-3% considered life threatening)
7% risk of angioedema
How is stroke diagnosed?
Clinically! In early stages CT is normal
What medication is the only licensed treatment for acute stroke?
Alteplase a recombinant tissue plasminogen activator
0.9mg per kg in IV infusion over 1 hour
Requires close monitoring for physiological/ neurological change
How long do you have to thrombalyse someone post stroke?
4.5 hours, if uncertain backdate to when patient knew he was well
What must happen before patient diagnosed with stroke is given thrombolysis?
Blood test (do BMs), CT, Specialist review and final decision
Define stroke
A clinical syndrome when blood supply to a part of the brain is restricted, either by blockage aka ischaemic stroke 85% or by haemorrhagic stroke 15%
What is the most common system for stroke classification?
The Oxford stroke classification AKA Bamford classification
How is a total anterior circulation stroke (TACS) diagnosed?
Three of:
Unilateral weakness/ sensory deficit of face, arm and leg
Homonymous hemianopia
Higher cerebral dysfunction (dysphasia, visuospatial fisorder)
How is partial anterior circulation stroke (PACS) diagnosed?
Two of:
Unilateral weakness/ sensory deficit of face, arm and leg
Homonymous hemianopia
Higher cerebral dysfunction (dysphasia, visuospatial fisorder)
How is posterior circulation syndrome (POCS) diagnosed?
One of:
Cerebellar or brain stem syndromes
Loss of consciousness
Isolated homonymous hemianopia
How is lacunar syndrome (LACS) diagnosed?
No evidence of higher cerebellar dysfunction and
One of:
Unilateral weakness/ sensory deficit of face and arm, arm and leg or all three.
Pure sensory stroke
Ataxic hemiparesis
What is the algorithm for assessing risk of stroke following TIA?
A- age >60 =1
B- BP > 140/90mmHg =1
C- Clinical features unilateral weakness=2 speech disturbance =1
D1- Duration of symptoms >60=2 10-59=1 <10min=0
D2- Diagnosed with diabetes = 1
What is ABCD2 scoring meaning?
0-3 = 1% at 2 days 4-5= 4% at 2 days 6-7= 8% at 2 days
What is the pneumonic for causes of delirium?
PINCH ME
Pain
INfection
Constipation and urinary retention
Hydration
Medication (medications taken and mediation withdrawal including alcohol)
Environment
