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Year 4 Geriatrics > Questions > Flashcards

Questions Flashcards

1
Q

pathognomic of alzheimers

A

amyloid plaques and tau proteins

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2
Q

features: pseudodementia

A
  • short duration of dementia
  • equal effect on long and short term memory
  • amnesia conercing specific events (often emotional)
  • loss of social skills
  • equal effect on long and short term memory
  • loss of social skills in early illness
  • patient often answers “i don’t know” to questions as opposed to guessing
  • makes little effort in performing tasks
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3
Q

def: pseudoparkinsonism

A

primarily associated with cognitive defecits in older patietns with depression

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4
Q

def: vascular dementia

A

syndromes of cognitive impairment caused by cerebrovascular disease

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5
Q

presentation: vascular dementia

A

progressive stepwise deterioration in cognition usually occuring over months to years

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6
Q

delirium causes mnemonic

A

Common causes of delirium can be remembered using the mnemonic DELIRIUMS:

D - Drugs and Alcohol (Anti-cholinergics, opiates, anti-convulsants, recreational)
E - Eyes, ears and emotional
L - Low Output state (MI, ARDS, PE, CHF, COPD)
I - Infection
R - Retention (of urine or stool)
I - Ictal
U - Under-hydration/Under-nutrition
M - Metabolic (Electrolyte imbalance, thyroid, wernickes
(S) - Subdural, Sleep deprivation

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7
Q

test for delirium

A

4AT

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8
Q

pressure ulcer score tool

A

waterlow score

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9
Q

cognitive impairment screening tool

A

cognitive impairment

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10
Q

nutrition screening tool

A

MUST

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11
Q

fitness of elderly scoring tool

A

rockwood frailty score

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12
Q

oral to subcut morphine ration

A

2:1

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13
Q

pain medication causing seizures

A

tramadol

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14
Q

seizure thrashold lowering drugs

A
  • Antibiotics: Imipenem, penicillins, cephalosporins, metronidazole, isoniazid
  • Antipsychotics
  • Antidepressents: Bupropion, Tricyclics, Venlafaxine
  • Tramadol
  • Fentanyl
  • Ketamine
  • Lidocaine
  • Lithium
  • Antihistamines
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15
Q

med for aggressive patient who has not resolved with de-escalation technique

A

PO/IM haloperidol

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16
Q

subdural hyperdense unilateral area on CT

A

subdural haemorrhage

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17
Q

RF: subdural

A
  • advancing age >65
  • bleeding disorders or anticoagulant therapy
  • chronic alcohol use
  • recent trauma
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18
Q

presentation: subdural haemorrhage

A
  • headache
  • nausea/vomiting
  • confusion
  • diminished eye/verbal/motor response
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19
Q

phases of subdural haemorrhage

A

In the hyperacute phase (<1 hour) the clot may appear as a relatively isodense lesion, with underlying cerebral oedema. Note that patients with a SDH rarely present in the hyper-acute phase.

In the acute phase (<3 days) the classic appearance is of a crescent-shaped homogeneously hyperdense extra-axial collection over the affected hemisphere.

In the sub-acute phase (3 days to 3 weeks) there is organisation of the clot, and the density of the clot falls. The haematoma will therefore appear more isodense compared to the adjacent cortex, making identification more difficult. Contrast-enhanced CT or MRI can aid identification. There may be associated mass effect causing midline shift and sulcal effacement.

In the chronic phase (>3 weeks) the haematoma becomes hypodense relative to the adjacent cortex.

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20
Q

def: subdural haemorrhae

A

collection of venous blood accumulating in potential space between dura mater and arachnoid mater

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21
Q

dopmaine agonist monitoring

A

impulsivity

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22
Q

what medication should not be prescribed in parkinsons?

A

haloperidol

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23
Q

pattern of lewy body dementia

A

fluctuating worsening condition

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24
Q

def:Lewy body dementia

A

porgressive, complex and challenging condition caused by abnormal portein called Lewy bodies inside brain cells

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25
Q

clinical features: Lewy bpdy dementia

A
  • characterised by alpha-synuclein cystoplasmic inclusions (lewy bodies) in substantia nigra, paralimbic and neocortical areas
  • associated with Parkinsons disease
  • highly sensitive to neuroleptics causing seterioration in parkinsonism
    *
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26
Q

3 core features: Lewy body dementia

A
  1. flucuating cognition
  2. parkinsonism
  3. visual hallucinations
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27
Q

scanning:Lewy body dementia

A

dopamine uptake scanning

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28
Q

Early movement signs: parkinsons

A

tremor
bradykinesia
rigidity
postural impairment

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29
Q

pathophysiology: parkinsons

A
  • low levels dopamine in basal ganglia (movement structures)
  • due to death of dopamine neurons in substantia nigra
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30
Q

hallmark brain sign of parkinsons

A

<50% domapine neurons in substantia nigra

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31
Q

tx: parkinsons

A

L-dopa crosses blood brain barrier to synthesise dopamine

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32
Q

effect of L-dopa treatment in parkinsons

A
  • increases dompaine levels to improve movement-related problems
  • does not affect neurodegenration of parkinsons
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33
Q

cardinal features: parkinsons

mnemonic TRAP

A

Tremor
Rigidity
Akenesia (bradykinesia)
Postural instability

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34
Q

cardinal features: parkinsons

mnemonic TRAP

A

Tremor
Rigidity
Akenesia (bradykinesia)
Postural instability

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35
Q

craiofacial symptoms: parkinsons

A
  • hypomimia
  • dysphagia
  • hypophonia
  • blurred vission and eyelid apraxia
  • shuffling, festination and freezing gait
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36
Q

how to test bradykinesia: parkinsons

A

finger-thumb testing
quaking hand movements
feet stoming

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37
Q

desribe parkinsons tremor

A

resting
high amplitude, low frequency

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38
Q

RFs: parkinsons

A
  • increased age
  • high intake dairy products
  • pesticides
  • cancer
  • traumatic brain injury
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39
Q

gene identified in Parkinsons

A

LRRK2

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40
Q

protective factors: parkinsons

A

tobacco
coffee intake (cafffeine)
high uric acid levels
physical activity

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41
Q

diagnosis: parkinsons

A

badykinesia PLUS at least one of:
tremor, rigidity or postural instability

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42
Q

non-motor signs and symptoms: parkinsons

A
  • olfactory - hyposomia (can preceed motor symptoms couple of years)
  • cognitive impairment (memory)
  • psychiatric - hallucinations, depression
  • autonomic dysfunction - postural hypotension
  • pain - shoulder girdle from bradykinesia
  • fatigue - usually during day
  • sleep disturbance (REM sleep)
  • speech- quiet voice
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43
Q

medical initiation treatment: parkinsons

A
  • levodopa and decarboxylase inhibitor
  • dopamine agonist
  • MAOI
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44
Q

advjuvant treatment: parkinsons

A
  • COMT inhibitor (entacapone - decreases peripheral levodopa breakdown)
  • amantadine
  • apomorphine
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45
Q

describe parkinsons tremor

A
  • 4-6Hz
  • pill rolling
  • worse at rest
  • asymmetrical
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46
Q

describe parkinsons regidity

A

lead pipe
cogwheel

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47
Q

describe parkinsons bradkinesia

A

micrographia
hypomimia
festinating gait
reduced arm swing

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48
Q

tx: parkinsons not impacting life

A

MAO-B - selegline or dopamine agonist - ropinirole or rotigotine

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49
Q

when is selegiline contraindicated in non-life impacting parkinsons treatment

A

SSRI

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50
Q

tx: parkinsons symptoms impacting life

A

levodopa + dopa-decarboxylase inhibitor (carbidopa)

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51
Q

side effects: levodopa and carbidopa in parkinsons

A
  • N+V
  • postural BP
  • oedema
  • confusion
  • visual hallucinations
  • red urine
  • drowsiness
  • dyskinesia
  • wearing off
  • freezinf
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52
Q

what happens in Levodopa dose is missed in parkinsons

A

neuroleptic malignant syndrome

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53
Q

what is neuroleptic malignant syndrome?

A

life-threatening neurologic emergency associated with the use of antipsychotic (neuroleptic) agents and characterized by a distinctive clinical syndrome of mental status change, rigidity, fever, and dysautonomia (fast HR, irregular HR and tachypnoea)

54
Q

what is neuroleptic malignant syndrome?

A

life-threatening neurologic emergency associated with the use of antipsychotic (neuroleptic) agents and characterized by a distinctive clinical syndrome of mental status change, rigidity, fever, and dysautonomia (fast HR, irregular HR and tachypnoea)

55
Q

tx: daytime sleepiness parkinsons

A

medafinil

56
Q

tx: REM parkinsons

A

melatonin or clonazepam

57
Q

tx: orthostatic hypotension parkinsons

A

fludrocortisone

58
Q

tx: restless leg syndrome parkinsons

A

gabapentin

59
Q

tx: essential tremor

(essential tremor - symmetrical and postural, improves with alcohol)

A

propranolol

60
Q

def: essential tremor

A

symmetrical, postural and improves with alcohol

61
Q

def: drug induced parkinsonism

A

bilateral, subacute, postural tremor

62
Q

causes: drug induced parkinsonism

A
  • antipsychotics
  • antiemetics
  • valproate
  • fluoxetine
  • CCBs and
  • amiodarone
63
Q

tx: dopamine psychosis

A

, olanzapine, quetiapinedrug withdrawal - slowly
reduce stimuli
antipsychotic agents - clozapine

64
Q

signs of hedonistic dopamine dysregulation syndroem

A
  • OCD - punding (repetitive/mindless behaviours - dimantiling, DIY, collecting, sorting) or walkabout
  • Risk behaviour - grandiose business plans
  • appetite alterations (weight loss or food cravings)
  • hypomania/ psychosis
  • gambling
  • hypersexuality
65
Q

Braak’s hypothesis of Parkinsons

A

stage 1 - changes in dorsal nucleus and olfactory bulb
stage 2 - lewy body formation in pons and medulla
stage 3 and 4 - motor symptoms
stage 5 and 6 - cognitive and dementia signs

66
Q

4 types of parkinson plus syndromes

A
  1. progressive spuranuclear palsy
  2. mutiple system atrophy
  3. corticobasal degenration
  4. lewy body dementia
67
Q

features: progressive supranuclear palsy parkinson’s plus syndrome

A

vertical gaze palsy with parkinsonism

68
Q

features: mustiple system atrophy PPS

A

postural hypotension, incontinence and impotence plus parkinsonism

69
Q

features: cortico-basal degeneration PPS

A

parkinsonism and spontaneous activity or affected limb or akinetic rigidty of limb

70
Q

features: lewy bosy dementia PPS

A

parkinsonism plus fluctuations in cognitive impairment and visual hallucinations often before parkinsonism features occur

71
Q

what can be given instead of haloperidol in parksinsons

A

lorazepam

72
Q

drugs to review in elderly (STOPP/START)

A
  • Diuretics
  • Antidepressants
  • Antipsychotics
  • Hypnotics
  • Digoxin
  • NSAIDs
  • Hypotensive agents
  • Drugs for Parkinson’s disease
73
Q

causes of transient incontinence

DIAPPERS

A
  • delirium
  • infection
  • atrophic urethritis/vaginitis
  • pharmaceutical
  • psychological
  • excessive urinary output
  • reduced mobility
  • sstool impaction
74
Q

symptoms: overactive bladder syndrome

A
  • sudden desire to void
  • often have nocturia
  • frequent, periodic incontinentepisodes (wet OAB)
  • may not be incontinent (dryOAB)
75
Q

how is detrusor overactivity demonstrated

A

urodynamics

76
Q

def: reflex urinary incontinence

A
  • sudden loss of control of bladder
  • no prior awareness of need to micturate
  • neurological problem (MS, parkinsons, brain tumour, spinal cord injuries)
77
Q

def: stress incontinence

A
  • when standing, physical activity, coughing or laughing causes urine leakage
  • usually due to weakness in pelvic floor/sphincter damage
78
Q

def: urethral obstruction - overflow incontinenec

A
  • common in eldery men
  • post void dribbling
    *
79
Q

causes: urethral obstruction

A

neuro: spinal cord lesions
non-neuro: prostate enlargement, urethral stricture, adrenergic agonist medications, tumours

80
Q

def: functional incontinence

A

lower urinary tract intact
poor mobility, poor dexterity, poor cognition

81
Q

def: mixed incontinence

A

any incontinence causes in combination

82
Q

drugs causing incontinence

A
  • diuretics
  • anticholinergics - esp haloperidol - cause retention
  • opiates - constipation - overflow incontinence
  • alcohol and caffeine
  • alpha blocks - relax bladder outlet
  • alpha agonists - urinary retention causing overflow
83
Q

examination: incontinence

A
  • functional status
  • cognitive status
  • neuro
  • rectal exam - prostate size
  • pelvic exam - cystocele, rectocele, atrophic vaginits
84
Q

inv: incontinece

A
  • MSSU
  • post void residual volume
  • uroflowometry
  • cystometry
  • vaginal cytology
  • urodynamics
  • U+E, CA, serum glucose
85
Q

tx: OAB

A
  • bladder training and prompted voiding
  • anti-muscarinics - oxybutanin, derifenacin
  • mirabegron - beta 3 agonist
86
Q

tx: stress incontinence

A

weight loss
treat cough
pelvic floor excercises
duloxetine and oestrogern
surgery

87
Q

def: stroke

A

acute neurological event due to cerebrovascular pathology >24hrs

88
Q

RFs: stroke

A
  • HTN
  • smoking
  • AF
  • DM
  • hyperlipiaemia
  • anticoagulation
89
Q

what does ischaemic strokw look like on CT

A

hypodense

90
Q

causes: ischaemic stroke

A

emboli from
AF
infective endocarditis
valve disorder
air embolus
fat embolus

91
Q

causes: haemorrhagic stroke

A

sponaneous
aneurysm rupture
SAH

92
Q

haemorrhagic stroke on CT

A

hyperdense

93
Q

management: stroke

A
  • urgent CThead to exclude bleed
  • FBC, U+E, ESR, glucose
  • BP
  • NBM until formal SALT test
  • ECG
  • echo
  • carotid artery dopplers
    *
94
Q

tx: ischaemic stroke

A
  • admit to stroke unit
  • alteplase (0.9mg/kg to 90mg max) lysis within 4.5 hours
  • thrombectomy within 24 hours
  • aspiri 300mg for 2 weeks
  • mechanical leg compressors rahter than prophylactic clexane
95
Q

what should be done before first dose 300mg aspirin after ischaemix stroke

A

rescan after 24 hours before aspirin dose in case of haemhorrage

96
Q

tx: haemhorragic stroke

A

BP control 140-150mmHg
stop and reverse anticaogulants

97
Q

longterm tx: stroke

A

atorvastatin 80mg
clopidogrel 75mg
physio
OT
SALT

98
Q

indication: carotid endarterectomy

A

if>50% after TIA

99
Q

what is contraindicatcated 10-14 days post stroke/TIA

A

anticoagulation

100
Q

bamford stroke classification

A

TACS - ALL 3 of 1. unilateral weakness (and/or sensory defecit) of the face, arm and leg 2. homonymous hemianopia 3. higher cerebral dysfunction (dysphasia, visuospatial disorder)
PACS - 2 of the TACS
LACS - one of 1. pure motor, 2. pure sensory, 3. sensori-motor, 4. ataxic hemiparesis
POCS - one of: 1. cranial nerve palsy and contralateral motor/sensory defecit 2. bilateral motor/sensory defecit 3. conjugate eye movement disorder (gaze palsy) 4. cerebellar dysfunction - ataxia, nystagmus or vertigo and 5. isolated homonymous hemianopia or cortical blindness

101
Q

TACS

A

TACS - ALL 3 of 1. unilateral weakness (and/or sensory defecit) of the face, arm and leg 2. homonymous hemianopia 3. higher cerebral dysfunction (dysphasia, visuospatial disorder)

102
Q

PACS

A

2 of 3 of 1. unilateral weakness (and/or sensory defecit) of the face, arm and leg 2. homonymous hemianopia 3. higher cerebral dysfunction (dysphasia, visuospatial disorder)

103
Q

LACS

A

one of 1. pure motor, 2. pure sensory, 3. sensori-motor, 4. ataxic hemiparesis

104
Q

POCS

A

one of: 1. cranial nerve palsy and contralateral motor/sensory defecit 2. bilateral motor/sensory defecit 3. conjugate eye movement disorder (gaze palsy) 4. cerebellar dysfunction - ataxia, nystagmus or vertigo and 5. isolated homonymous hemianopia or cortical blindness

105
Q

scoring tools for risk stratification after stroke

A

CHA2DS2VASc
CHF
Hypertension
Age >75 2
DM
Stroke 2
Vascular disease
Age 65-74
Sex

HASBLED
Hypertension
Abnormal liver/renal fnx
Stroke
Bleeding tendency
Labile INR
Age >65
Drugs (aspirin or NSAIDs or alcohol)

106
Q

contraindications: thrombolysis in stroke

A
  • bleed
  • seziures at presentation
  • HTN >180/100
  • NIHSS >25
  • LP in past week
  • stroke/head injury in past 3 months
  • surgery trauma within past 2 weeks
107
Q

alteplase dosing in stroke

A

0.9mg/kg upo to 90mg

108
Q

delirium casues mnemonic

A

PINCH ME
pain
infection
nutrition
constipation
hydration
medication
environment

109
Q

screening for delirium

A

4AT

110
Q

Rockwood frailty scoring

A

1 - very fit (fittest for their age)
2 - well (no active disease but less fit than 1 seasonally active
3 - managing well - medical problems well controlled, not regularly active
4 - vulnerable - not dependent for daily things, symptoms limit activities “slowed up”
5 - mildly frail - more evident slowing and need help with high order IADLs - finances, transport, heavy housework etc - shopping and walking outside alone, meal prep and housework impaired
6 - moderatley frail help with all outside activities and keeping house. help with bathing and minimal assistance dressing. problems with stairs
7 - severely frail - completely dependent for personal care (not high risk dying within 6 months)
8 - very severely frail - completely dependent and approaching wend of life - couldn’t recover from minor illness
9 - terminally ill - approaching end oflife - life expectancy <9months

111
Q

certification of life extinct

A
  1. no heart sounds after 3 mins ausc
    1. no breath sounds
  3. no respiratory effort
  4. no central pulse
  5. pupils fixed and dilated
  6. no response to stimuli/pain
112
Q

what scan is used in perkinsons

A

DaT

113
Q

def: dementia

A

gradual decline in 2+ areas of cognition (memory, personality, behaviour) that affects ADLs

114
Q

screening tool and score for dementia

A

MMSE 24/30 or less suggestive
Addenbrooks <85 suggests cognitive impair

115
Q

def: Alzheimer’s dimentia

A

global, progressive, amnesia, aphasia, agnosia, apraxia, apathy
worse in evening (sundowning)

116
Q

RFs: alzheimers dimetnia

A
  • HTN
  • DM
  • FHx
  • Doen’s
  • brain injury
  • female
  • > 65yrs
117
Q

pathophys: alzheimers dimentia

A

amyloid and tau proteins (plaquesand neurofibrillary tangles) in cortex and hippocampus

118
Q

tx: alzheimer’s dimentia

A

acetylcholinesterase inhibitors(donezepil, galantamins, rivastigmine)
memantinein severe

119
Q

def: vascular dimentia

A

step-wise, rapid, preserved personality/insight, focal neurology

120
Q

criteria for vascular dimentia

A

NINDS-AIREN

121
Q

RFs: vascular dimentia

A

IHD, smoking, DM, obesity, Af

122
Q

causes of vascular dimentia

A

accumulation of strokes or TIAs

123
Q

def: Lewy body dementia

A

fluctuating cognition, lucid periods, visual hallucinations, prkinsonism, lack of REM sleep

124
Q

pathophys: LB dementia

A

alpha synuclein ubiquitin aggregation in sustantia nigra

125
Q

tx: LB dementia

A

acetylcholinesterase inhibitors
memantine

126
Q

def: frontotemporal dementia

A

personality/speech affected first
disinhibited
onset <65yrs
autosomal dominant

127
Q

pathophys frontotemporal dementia

A

atrophy of frontotemproal lobes - knife blade appearance (Picks dx

128
Q

tx: frotnotemporal dementia

A

none available

129
Q

def Charles Bonnet syndrome

A

Charles Bonnet Syndrome presents with visual hallucinations in a patient with bilateral visual loss, typically secondary to glaucoma or cataracts. Importantly, the patient has insight and no other psychiatric or cognitive symptoms.

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Q

what abx to avoid in epilepsy

A

ciprofloxacin

Year 4 Geriatrics (2 decks)

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