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Week 3 Flashcards

1
Q

Why do we age?

A
  • Genetic control - telomeres shorten
  • Accumulation of damage - cells aren’t completely able to get rid of toxins
  • Neuroendocrine - over time, loses sensitivity to negative feedback
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2
Q

Define frailty

A

A state of increased vulnerability to poor resolution of homeostasis after a stressor event as a consequence of age-related decreased physiological reserves

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3
Q

What are the different models of frailty?

A

1) Phenotypical model
2) Cumulative deficit model
3) Clinical frailty scale

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4
Q

What is the Electronic frailty index (eFI)?

A
  • Primary care
  • 36 domains
  • mild/moderate/severe
  • highlight patients that may need further review
  • prompt advanced care planning/end of life discussion
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5
Q

What screening tests for frailty are used in secondary care?

A
  • PRISMA 7
  • Mobility access
  • Polypharmacy
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6
Q

What are some cognitive screening tests and cognitive assessment tools?

A

Cognitive screening tests:

  • six-item cognitive impairment test (6CIT)
  • Mini mental state examination (MMSE)
  • 4AT

Cognitive assessment tools:

  • Montreal Cognitive Assessment (MoCA)
  • Addenbrooke’s Cognitive Examination (ACE3)
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7
Q

What are the 5 principles of the Mental Capacity Act (2005)?

A

1: the presumption of capacity
2: support the individual
3: unwise decision
4: best interests
5: least restrictive option

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8
Q

What is confusion?

A

An inability to think clearly and/or rapidly, which is characterised by:

  • difficulty understanding a situation
  • disordered or unclear thoughts
  • disorientation and/or memory loss
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9
Q

Which neurotransmitter is thought to play an important role in sundowning?

A

Acetylcholine

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10
Q

Which nucleus of the hypothalamus plays a key role in controlling diurnal rhythm?

A

Suprachiasmatic nucleus

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11
Q

Which two neurotransmitters control the sleep-wake cycle?

A

Acetylcholine and histamine

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12
Q

What are the three scales used to diagnose an acute confusional state?

A
  • DSM
  • CAM
  • 4AT
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13
Q

What is empirical therapy?

A

“best guess” - therapy started without a confirmed diagnosis

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14
Q

What drugs would you treat a UTI with in secondary healthcare?

A

Co-amoxiclav

Ciprofloxacin

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15
Q

How would you treat multi-drug resistant UTIs?

A

Ertapenem

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16
Q

What is the conjunctiva?

A

Conjunctiva is an epithelial layer that covers the sclera (white of the eye).
Extends from the border of the cornea, and is continuous along the inner surfaces of the upper and lower eyelids

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17
Q

What are conjunctival fornices?

A

Conjunctival fornices are regions where the conjunctiva reflects from the sclera onto the inner eyelid. Foreign bodies/contact lenses can get stuck here.

There are superior and inferior fornices.

18
Q

What innervates orbiculares oculi?

A

CN VII, it closes the eye in a sphincter-like fashion.

19
Q

What would you find deep to the orbicularis oculi muscle?

A

Deep to the orbiculares oculi muscle, you will find the tarsal plates of the eyelid (superior & inferior). Formed by dense fibrous connective tissue.

All eye muscles innervated by CN III except SO and LR.

Superior tarsal muscle stretches between the LPS and the superior tarsal plate. Helps to open eye with the LPS. Superior Tarsal muscle is innervated by postganglionic sympathetic fibres from the superior cervical ganglion. Apical lung tumour can compress sympathetic chain.

20
Q

What is the arterial supply to the orbit/eyeball?

A

Majority of arterial supply to the orbit/eyeball is by the ophthalmic artery - a branch of the ICA, given off immediately after the cavernous sinus

21
Q

What is the nerve supply to the eyelids?

A 
CN V1 (supraorbital foramen)
CN V2 (infraorbital foramen)
22
Q

What is the orbital septum?

A

Orbital septum is attached to periosteum around orbital margin. Orbital septum limits spread of infection.

23
Q

What is periorbital cellulitis?

A

Infection in front of the orbital septum

24
Q

What is orbital cellulitis?

A

Infection behind the orbital septum

25
What is the eyeball surrounded by?
Eyeball is surrounded by a fascial sheath (Tenon's fascia/fascia bulbi). Fully separates the eyeball from the orbital fat. Fascia bulbs runs from optic nerve to corn-scleral junction. Fascia reflects onto muscles as the muscular fascia. Local anaesthetic can be injected into this space. (Sub-Tenon's anaesthesia) for ophthalmic procedures.
26
What are check ligaments?
Check ligaments are anterior thickenings of fascia covering the lateral and medial rectus muscles. Check ligaments may limit eyeball abduction and adduction.
27
What helps to form the suspensory ligament of the eye?
The sheaths of inferior oblique and inferior rectus help to blend and form the suspensory ligament of the eye (Lockwood's). (like a hammock under the eye).
28
Which skull bones contribute to the bony orbit?
- Frontal - Zygoma - Maxilla - Greater wing of sphenoid - Ethmoid - Lacrimal
29
What are the three layers of the eyeball?
- Sclera - Choroid (vascular) - Retina (neural)
30
What is papilloedema?
True papilloedema is a swollen optic nerve head due to raised intracranial pressure
31
What is the sclera?
Sclera is the white of the eye formed by collagen and glycosaminoglycans. Vessels and nerves pass through the sclera.
32
What is the cornea?
Anteriorly, the sclera is replaced by the transparent cornea. Cornea is avascular and gets its nutrients by diffusion. Cornea is not aneural. Protrudes anteriorly. Nourishment from lacrimal glands and vascular beds nearby. Majority made from type 1 collagen. Responsible for optic power of the eye.
33
What is the uvea?
Uvea/uveal tract is the continuous vascular lining of the eye consisting of the: choroid, ciliary body and iris.
34
What is uveitis?
Inflammation of vascular network; associated with autoimmune disorders; different parts can be affected
35
What causes the pupil to dilate?
Dilator pupillae Sympathetic From superior cervical ganglion, hitchhikes along CN Va to target
36
What causes the pupil to constrict?
Sphincter pupillae Parasympathetic CN III via ciliary ganglion
37
What is the lens?
The lens is a flexible, transparent, biconvex structure. Parasympathetics (CN III) cause contraction of the ciliary muscle. Bathed anteriorly in aqueous humour. Lens contacts the vitreous humour posteriorly.
38
Where is aqueous humour produced?
Aqueous humour is produced in the posterior chamber by the ciliary epithelium. Fills anterior and posterior chambers and provides nutrient and removes metabolic waste from the avascular cornea.
39
What is the trabecular meshwork?
Aqueous humour is constantly produced, and recycled. Fluid drains into Canal of Schlemm via the trabecular meshwork. The Canal of Schlemm has some resistance to reabsorption so there is some pressure in the anterior eye, allowing nutrients to be absorbed by diffusion. If there is a blockage in the Canal of Schlemm, the pressure increases, as can happen in glaucoma.
40
What is glaucoma and what are the different types?
Glaucoma causes damage to the retina/optic nerve and visual loss. Can be caused by an increase in intraocular pressure - although not always. Chronic open angle glaucoma (COAG) - reduced flow through trabecular meshwork. Slow and painless. Angle closure glaucoma - Iridocorneal angle differences (iris contacts trabecular mesh). Can be painful.
41
What is vitreous humour?
Vitreous humour fills the main part of the eye located posterior to the lens. - Mostly water and glycosaminoglycans - The centre is more liquid, the periphery is gel-like - Contacts the retina, lens and ciliary body - Ageing results in vitreous liquefaction with posterior detachment resulting in visual floaters - Vitreous shrinkage with age can pull on retina resulting in retinal detachment.
42
How far does the retina go and what is it made up of?
Retina runs very anteriorly in the eye, up to the ora errata near to the ciliary body. Retina has multiple cell layers, including a pigment layer and photoreceptor layer. Blind spot occurs where the optic nerve passes out of the eye (optic disc/papilla)

AC1 (9 decks)

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