OPIC past paper questions Flashcards
Define delirium
- Impairment of cognition, disturbances of attention and conscious level, abnormal psychomotor behaviour, disturbed sleep-wake cycle.
- Onset is usually acute (hours/days).
- Caused by a physical condition
define dementia
PERSISTENT DISABLING COGNITIVE IMPAIRMENT
- Cognitive impairment: decline in both memory and thinking sufficient to impair activities of daily living (ADLs).
- Problems with the processing of incoming information - problems with maintaining and directing attention.
- Clear consciousness.
- Above syndrome present for >= 6 months
common types of dementia
- Alzheimers
- Frontotemporal
- Lewy body
- Vascular
- AIDS complex
cause of alzheimers
- RF: Genetic, smoker, HTN, high cholesterol
Pathophysiologyamyloid plaques (clumps of beta-amyloid) and neurofibrillary tangles (bundles of filaments within neurons, mostly made from tau protein).
cause of vascular dementia
- HTN
- high cholesterol
- smoking
- obesity
Stepwise decline
cause of lewy body dementia
Lewy body proteins (alpha-synuclein) are deposited in the brain.
These Lewy bodies are also present in Parkinson’s disease. In Parkinson’s they are mainly deposited in the substantia nigra, whereas they are more widespread in Lewy body dementia.
- visual hallucinations
Cause of frontotemporal dementia
- build up of tau proteins in the frontal lobe
- atrophy occurs due to deposition of abnormal proteins (often tau protein) within the lobes.
- There is thought to be a genetic component in about a quarter of cases.
Most common causes of delirium (3)
- Infection e.g. UTI, pneumonia
- Medications
- Withdrawal
- Constipation/ urinary retention
- Pain
- Change in environment
how you would adapt your history taking/information giving for a patient with cognitive impairment
- allow for extra time
- do appointment at beginning/end of day to make sure its quiet
- speka in plain way
- draw pictures or write down
- speak slowly
- low pitch
- home visit
- collateral history
- cognitive screening
Stuart is a 57 year old lorry driver who presents with a 6 month history of slowness of gait
and difficulty with writing. Fine hand movements are poor. In the past he has seen a
urologist with urgency of micturition and occasional incontinence. He is taking sildenafil
and an inhaler for asthma. On examination there is slowness of gait, facial hypomimia and
cogwheel rigidity in all 4 limbs. Bradykinesia of hand movement is present. There is no
tremor.
1) He is started on co careldopa but, when seen 4 months later, is not significantly
improved. The dosage is therefore increased. 3 months later he is still no better.
What does this suggest and what might be the reason for this?
Two scenarios
- Not parkinsons
- This suggests that his parkinsons is so advanced that he no longer has enough doperminergic neurones to be stimulated to release dopamaine therefore no substrate for co careldopa to work on and no change in symptoms
What is meant by on/off fluctuations in patients who are taking levodopa
preparations and why do they occur?
The “on-off” phenomenon in Parkinson’s disease (PD) refers to a switch between mobility and immobility in levodopa-treated patients, which occurs as an end-of-dose or “wearing off” worsening of motor function or, much less commonly, as sudden and unpredictable motor fluctuations
What is the Comprehensive Geriatric Assessment? List advantages and
disadvantages of using this approach.
Comprehensive geriatric assessment (CGA) is defined as a multidisciplinary diagnostic and treatment process that identifies medical, psychosocial, and functional capabilities of an older adult in order to develop a coordinated plan to maximize overall health with aging
It requires evaluation of multiple issues, including physical, cognitive, affective, social, financial, environmental, and spiritual components that influence an older adult’s health
positives
- thorough
- holistic
- patient centred
negatives
- could be hard to oprchestrate such a big MDT
- requires regular review
- expensives
- time consuming
main reason elderly are more prone to drug toxicity
- redcued renal function
- decreased body size, altered body composition (more fat, less water)
- drug interactions
Which medications should be used with particular care in the elderly?
- anticholinergics
- benzos
- antipsychotics
- NSAIDs
- SSRIs
- opioid
) Why should co-prescribing NSAIDs and ACE inhibitors be avoided?
Both nephrotoxic- can cause AKI
Name 3 classes of drugs that have been found to increase the risk of falls in older
patients
- rampiril
- morphine
- diazepam
- diuretics
Name 3 classes of drugs that have been found to increase the risk of falls in older
patients
- rampiril
- morphine
- diazepam
- diuretics
Describe your approach to assessment of someone who presents with recurrent
falls.
- fall history: before, during, after
- examination: gait, ecg, BP, peripheral neuroglogical
- blood tests: FBC, UandE, etc
- imaging: CT/MRI
- collateral history
- falls risk assessment
- eye checks/ ENT
- OT/PT assessment of at home
4 questions should an Advanced
Care Plan address?
• At this time in your life, what is important to you?
• What elements of care are important to you and what WOULD you like to
happen in future?
• What would you NOT want to happen? Is there anything that you worry
about or fear happening?
• Who would speak for you - your nominated proxy spokesperson or Lasting
Power of Attorney?
Give 3 barriers to carers accessing support
time
funding
lack of knowledge of service
guilty
Mr Lang is 83-year-old with a known diagnosis of vascular dementia. His wife died three
years ago and he was unable to cope alone at home. The couple had no other close family.
There is little doubt that his dementia has worsened. In particular, it affects his speech: he
has expressive dysphasia with obvious word-finding problems. Nevertheless, it is felt that
he can understand most things said to him. The GP is called in because Mr Lang looks
unwell: he is thin and is somewhat unkempt having spent a day in bed. During this time
he has developed urinary incontinence. Mr Lang is quite apathetic but complies with an
examination and the GP confirms that he has a chest infection. He is still able to swallow
and has been compliant with taking his medication.
What legal and ethical factors must the GP consider when developing a management
plan for this patient?
1) consideration of patients advanced plan and wishes
2) talk to patient and understand their wishes
3) least restrictive options
2) personal judgement of what you feel would be appropriate
Name 3 types of urinary incontinence and state how you would differentiate
between them.
1) Stress- on increase in pressure in abdomen e.g. coughing laughing
2) Urge- ‘key in the door scenario’
3) Mixed- features of both
4) neurological e.g. other neurological features- complete loss of continence and sensory loss in area
Name 3 types of urinary incontinence and state how you would differentiate
between them.
1) Stress- on increase in pressure in abdomen e.g. coughing laughing
2) Urge- ‘key in the door scenario’
3) Mixed- features of both
4) neurological e.g. other neurological features- complete loss of continence and sensory loss in area
pharcological approach to constipation
osmotic or stimulant laxative
