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Meddygaeth B > Old Age Medicine > Flashcards

Old Age Medicine Flashcards

1
Q

What are the 4 measurements of Fried’s phenotype of frailty?

A

Grip strength
Fatigue
Walking speed
Activity levels

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2
Q

What components are needed in falls history?

A 
Previous falls
Circumstances surrounding the fall
Preceding symptoms
Vision, cognition and continence
Osteoporosis risk factorsl
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3
Q

What are the causes of falls grouped into?

A

D- drugs
A- aging
M- medical causes
E-environmental

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4
Q

Define sarcopenia

A

Decreased muscle mass

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5
Q

Define delerium

A

An acute onset of confusion with a change in alertness (agitated or hyperalert)

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6
Q

What are the two validated tools for assesing confusion

A

Confusion assesnent method (CAM) ( is ICD 10 for delerium)

The 4AT

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7
Q

What is CAM positive?

A

Acute onset and fluctuating course
PLUS
Inattention
And EITHER
Disorganised thinking (disorganised speech)
OR
altered level of consiousness (hyperalert/hypoalert)

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8
Q

If delerium is not remedied by de-escelation techniques what medicatuons may be used?

A

Short term haloperidol or olanzapine (1 week)

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9
Q

What conditions contraindicate the use of antipsychotics for treatment of delerium?

A

Parkinsons/ lewy body dementia

Use lorazepam instead

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10
Q

What is the prognosis for patients with delerium?

A

1/3 recover quickly
1/3 recover slowly
1/3 do not completely recover

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11
Q

What blood test must you always do for delerium

A

Serum calcium

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12
Q

What are the 4 components of the 4 AT exam?

A

Alertness
AMT4 (age, date of birth, current year and location)
Attention (count months backwards from december)
Acute and fluctuating course

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13
Q

Define the triad of parkinsonism

A

Resting tremour
Bradykinesia
Rigidity
(Postural and gait instability)

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14
Q

Define essential tremor

A

A tremor that is worse on movement, may be present in legs and jaw and is usually familial. No bradykinesia or gait disorder

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15
Q

What is the treatment for essential tremor?

A

A non specific beta-blocker - PROPRANOLOL

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16
Q

What type of tremors are worse on movement?

A 
Essential tremor
Dystonic tremor
Exaggerated physiological tremor
Hyperthyroidism
Drug induced
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17
Q

What conditions have intention tremors?

A

Cerebellar disorders

18
Q

What is the average age of onset for parkinsons disease?

A

60 yrs, more common in males

19
Q

What are the stages of parkinsons?

A

Pre-diagnosis
Diagnosis/maintenance- no motor complications
Complex- on/off motor and cognitive problems
Palliative- poor drig response, may need PEG tube, dementia common

20
Q

What are the first line treatments for parkinsons?

A

Ropinirole 250mg TDS
Co-Beneldopa (Modpar) 62.5mg TDS
Rasagaline 1mg daily

21
Q

What type of medication is ropinirole?

A

A non-ergot derived dopamine agonist.

Others are Pramipexole and rotigotine (transdermal patch)

22
Q

What type of medication is co-Beneldopa (Madopar)

A

A combination of levodopa a prodrug and DOPA decarboxylase inhibitor

23
Q

What type of drug is rasagaline?

A

A monoamine-oxidase-B inhibitor.

Not as good as dopamine agonists and levodopa

24
Q

Common side effects of levodopa are?

A

Postural hypotension
Nausea and vomiting
Dyskinesia
Impulsive and compulsive behaviour

25
Q

What is the main hallmark of idiopathic parkinson’s disease?

A

Hemiparkinsonism. Early stages have asymmetrical symptoms

26
Q

What are the grades of pressure ulcers?

A

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

27
Q

What are recognized complications of thrombolysis in acute stroke?

A

6% risk of haemorrhage (2-3% considered life threatening)

7% risk of angioedema

28
Q

How is stroke diagnosed?

A

Clinically! In early stages CT is normal

29
Q

What medication is the only licensed treatment for acute stroke?

A

Alteplase a recombinant tissue plasminogen activator
0.9mg per kg in IV infusion over 1 hour
Requires close monitoring for physiological/ neurological change

30
Q

How long do you have to thrombalyse someone post stroke?

A

4.5 hours, if uncertain backdate to when patient knew he was well

31
Q

What must happen before patient diagnosed with stroke is given thrombolysis?

A

Blood test (do BMs), CT, Specialist review and final decision

32
Q

Define stroke

A

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%

33
Q

What is the most common system for stroke classification?

A

The Oxford stroke classification AKA Bamford classification

34
Q

How is a total anterior circulation stroke (TACS) diagnosed?

A

Three of:
Unilateral weakness/ sensory deficit of face, arm and leg
Homonymous hemianopia
Higher cerebral dysfunction (dysphasia, visuospatial fisorder)

35
Q

How is partial anterior circulation stroke (PACS) diagnosed?

A

Two of:
Unilateral weakness/ sensory deficit of face, arm and leg
Homonymous hemianopia
Higher cerebral dysfunction (dysphasia, visuospatial fisorder)

36
Q

How is posterior circulation syndrome (POCS) diagnosed?

A

One of:
Cerebellar or brain stem syndromes
Loss of consciousness
Isolated homonymous hemianopia

37
Q

How is lacunar syndrome (LACS) diagnosed?

A

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

38
Q

What is the algorithm for assessing risk of stroke following TIA?

A

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

39
Q

What is ABCD2 scoring meaning?

A 
0-3 = 1% at 2 days
4-5= 4% at 2 days
6-7= 8% at 2 days
40
Q

What is the pneumonic for causes of delirium?

A

PINCH ME
Pain​
INfection​
Constipation and urinary retention​
Hydration​
Medication (medications taken and mediation withdrawal including alcohol)​
Environment

Meddygaeth B (9 decks)

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