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Geriatrics > Summary > Flashcards

Summary Flashcards

1
Q

Common differentials: My mum keeps forgetting things and its getting worse

A

Dementia

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2
Q

Doctor my husband has been confused the last few days and hes had a temperature

A

Delirium

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3
Q

Good Morning doctor my dad has been started on some new medication for his parkinsons disease and hes become confused

A

Delirium

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4
Q

Ive been getting dizzy and finding myself on the floor

A

Syncope

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5
Q

Ive been getting dizzy and finding myself on the floor

A

BPPV

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6
Q

My mother has fallen three times this last year

A

Falls

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7
Q

My mother has fallen and hurt her hip

A

Fracture neck of femur and osteoporosis

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8
Q

I just sit in the chair, it’s too much effort to do anything

A

Immobility

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9
Q

Yesterday my right hand went dead and I could not get my words out but I feel ok now

A

TIA

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10
Q

Yesterday my right hand went dead and I could not get my words out , today my right arm still feels weak

A

Stroke

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11
Q

Frailty phenotype

A

Edmonton
Rockwood
Clinical

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12
Q

Mr Smith has been in hospital for a long time. He is in poor health and has been referred to palliative care.

A

DNACPR

Integrated

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13
Q

My patient is confused and I dont know how to discuss treatment

A

Capacity

Lasting Power of Attorney

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14
Q

Mr Jones comes in and tells you, I dont think I can cope with looking after my wife anymore

A

Supporting Carers

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15
Q

When the paramedics found me they said I was stone cold

A

hypothermia

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16
Q

The shaking in my hand is getting worse and no one can read my writing now

A

Parkinson’s Disease

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17
Q

I have been stuck in bed for a long time now and nobody has turned me over

A

Pressure sore

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18
Q

I have lost control of my waterworks

A

Urinary incontinence

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19
Q

Elderly patients with depression which assessment tool

A

Brief assessment depression cards general depression scale Hamilton Cornell score

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20
Q

Elderly patients requiring a proper assessment for functions which assessment tool

A

Barthel index

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21
Q

Dr I suddenly started feeling dizzy

A

Vestibular neuronitis

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22
Q

Doctors suddenly started feeling dizzy

A

Labyrinthitis

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23
Q

Doctor I have been dizzy for a very long time now

A

Middle ear infection

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24
Q

Doctor lately feels like the room has been spinning

A

Vertebrobasilar insufficiency

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25
Q

Doctor I don’t know why but lately I’ve been feeling more dizzy than normal my medication has been changed recently could that be the cause

A

Yes

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26
Q

Ok. Thank you for telling me doctor what medication may potentially be causing my dizziness

A

Any medication targeting your blood such as blood pressure medication and blood thinners like aspirin

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27
Q

Hi doctor yesterday I felt faint and lost consciousness my friend was with me at the time and she said she saw my leg jerking does this mean I definitely have epilepsy

A

No

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28
Q

Oh ok Dr I thought that if you lost consciousness and your legs were jerking that definitely meant you had epilepsy if that’s not the reason then what what’s the cause

A

Syncope can present similarly to an epileptic seizure

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29
Q

A transient loss of consciousness or otherwise known as fainting is typically caused by

A

A temporary reduction in blood flow to the brain otherwise known as syncope

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30
Q

What is a vasovagal syncope

A

A transient loss of consciousness caused by emotional distress or orthostatic stress

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31
Q

Hi Dr I receiving the other day and the next thing I knew I was on the floor do you know what could have caused it

A

Carotid sinus hypersensitivity

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32
Q

Hi Dr it was a really hot day yesterday and I hadn’t drank a lot

the next thing I knew I was on the floor it only lasted a second and then I felt fine after I had a drink of water what could have caused it

A

Orthostatic hypotension specifically volume depletion

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33
Q

What causes orthostatic hypotension

A

Volume depletion medication neurological problems

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34
Q

Hi Dr I have had problems with fainting and I was wondering if this could be to do with my heart

Could you explain to me if this is possible

A

The three main heart problems that may cause this

Are problems with the rhythm of your heart problems with the structure of your heart and then blood pressure and blood clots

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35
Q

The consultant asks you which investigations do you definitely want to do if you believe the patient could be having a cardiac syncope

A

Check blood pressure and check for heart rhythm problems with an ECG

36
Q

Sinus node dysfunction causing cardiac syncope treatment

A

Remove beta blocker

37
Q

Aortic stenosis cardiac syncope treatment

A

Valve replacement

38
Q

Postural hypotension medication treatment

A

Fludrocortisone

39
Q

Postural hypotension medication apart from fludrocortisone

A

Midodrine

40
Q

What does midodrine do to the blood vessels in the peripheries

A

Causes of vasoconstriction

41
Q

Sally has recently been diagnosed with vasovagal syncope what advice can you give her to help managed each acute episode

A

Avoid standing for prolonged periods of time in overheated conditions also try slow deep breaths when the symptoms start and then try passive counter pressure manoeuvres such as Crossing your legs

42
Q

Hi Dr I recently fainted and I’ve been given a diagnosis of syncope does this mean I can’t drive

A

Yes

43
Q

Hi Dr do I need to tell the DVLA that I recently had an episode of syncope if I do what will happen

A

Yes you will not be allowed to drive for a month

44
Q

As a 4th year medical student how can you ensure that you cover broadly the potential causes for a fall in an elderly person

A

Make sure to include a thorough systems review and thorough past medical history

45
Q

If you could only do an examination of one system on a Falls patient which one should you choose and why

A

Neurological examination

To rule out any neurological problems

46
Q

Which special test to do you need to add to your neurological examination of a Falls patient

A

Timed get up and go test to assess balance and gait

47
Q

Doctor what do you want me to do for this get up and go test

A

From a sitting position get up and walk 3Metres then turn around and come back to the chair

48
Q

How long should a normal get up and go test take

A

Less than 13.5 seconds

49
Q

What should you do if a Falls patient takes longer than 13.5 seconds to complete a timed get up and go test

A

Refer to physiotherapy

50
Q

What special tests do you need to add on to your cardiovascular examination for somebody who you suspect may have postural hypotension

A

Take a lying and standing blood pressure

51
Q

Doctor can you talk me through what you want me to do for this test for my postural hypotension

A

I need you to lie down for 10 minutes then I’ll take your blood pressure then I need you to stand up after 3 minutes I’ll take your blood pressure again

52
Q

How do you know if a patient definitely has postural hypotension

A

If they’re lying to standing blood pressure shows a drop of greater than 20 mm Mercury systolic

53
Q

Even if a patient who has had a fall states that they haven’t hurt their hip if they are elderly what investigation should you definitely order

A

X-ray of the hip

54
Q

What investigations do you need to order to check for osteoporosis

A

Liver function tests calcium and phosphate estimated glomerular filtration rate vitamin D level and parathyroid hormone level

55
Q

X-ray shows extracapsular fracture normal management for this type of hip fracture

A

Reduction and internal fixation another word for dynamic hip screw

56
Q

You suspect patient may have osteoporosis which type of scan do you need to refer them to to check

A

DXA scan

57
Q

Which osteoporosis medication has the best evidence

A

Denosumab given subcutaneously every 6 months or zoledronic acid given as an annual infusion

58
Q

What would you expect to see on inspection of a patient with a hip fracture

A

Shortened and externally rotated hip

59
Q

You strongly suspect that a patient has a hip fracture however because she has severe osteoporosis you can’t see any abnormality in the x-ray what should be your next line investigation

A

MRI

60
Q

Alternative to MRI for suspected hip fracture which doesn’t appear on X-ray

A

CT scan of the hip

61
Q

What is a transient ischaemic attack

A

Describe the situation where blood flow to the brain is cut off for sufficient time such that you see symptoms that typically resolve within 24 hours

Symptoms may include lim weakness or problems with Vision

Poor blood flow to the brain is typically secondary to some kind of clot

62
Q

What is a stroke in simple terms

A

A stroke describes the situation whereby your brain suddenly doesn’t receive enough oxygen and as a result of that certain parts of the brain get damaged depending on the part of the brain that gets damaged will affect which symptoms you present with

63
Q

Apart from stroke what are the conditions may explain sudden onset neurological symptoms

A

Migraine brain tumour Todd’s paresis hypoglycemia

64
Q

DANISH P stroke presentation suggest what type of stroke

A

Cerebellar stroke

65
Q

Doctor what age am I more at risk of having a stroke

A

65 years or older

66
Q

Hi Dr was sitting watching TV when suddenly I noticed I couldn’t move my left leg or my left arm my partner said that my speech was slurred

A

Total anterior circulation ischemia which correlates to the internal carotid artery or middle cerebral artery

67
Q

Hi Dr I was out walking the dog when suddenly I noticed I can move my right arm and my friend who was with me at the time noticed that my speech was slurred

A

Partial anterior circulation ischemia correlating to an occlusion of a branch of the middle cerebral artery

68
Q

Isolated homonymous hemianopia

A

POCI

Posterior circulation infarct

69
Q

Lacunar syndrome subdivisions

A

Purely sensory purely motor sensorimotor ataxic hemiparesis

70
Q

Dr what is the cut-off time for thrombolysis in an ischemic stroke

A

4 and a half hours

71
Q

Which subtype of stroke has the highest 12 months recurring statistics

A

Posterior circulation infarct

72
Q

Which type of stroke has the highest early 12 months of occurrence

A

PACI partial anterior circulation infarct

73
Q

What is the cut-off blood pressure reading for which thrombolysis is contraindicated

A

185/110

74
Q

If a patient had the stroke more than four and a half hours ago what medical management should you start

A

Aspirin 300 mg once a day

75
Q

What is the cut-off time for thrombectomy

A

6 hours following the onset of a stroke

76
Q

After finishing a full examination of a patient you suspect had a stroke which member of the MDT must you refer the patient to you

A

Speech and language therapist for assessment of swallowing

77
Q

If a stroke patient has difficulty swallowing how can you administer the nutrition in the first instance

A

Nasogastric tube

78
Q

How long would a patient have to receive the nutrition by nasogastric tube before you should consider switching to a
PEG percutaneous endoscopic gastrostomy

A

Two weeks

79
Q

What type of mattress should a stroke patient be placed on the when admitted into hospital to prevent pressure sores

A

Air mattress

80
Q

If a patient has ongoing atrial fibrillation when they have a stroke how long would you need to delay anticoagulant treatment for

A

10 days

81
Q

Consultant asks new witch scoring system correlates to TIA risk

A

Abcd2 score

82
Q

If a patient scores four or more on the abcd2 score what should be the next step

A

I admission and investigation within 24 hours of their symptoms

83
Q

If you suspect a patient has had a transient ischemic attack how long are they banned from driving

A

One month

84
Q

What are the key investigations to run on a patient who you suspect might have had a TIA

A

Carotid Doppler and carotid endarterectomy

85
Q

Name the key secondary prevention medications following a TIA

A

Clopidogrel warfarin blood pressure medication cholesterol medication

86
Q

What is the gold standard investigation for swallowing problems

A

Video fluoroscopy

Geriatrics (12 decks)

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