ACH Flashcards
(187 cards)
1
Q
What is osteoporosis?
A
- A condition involving a significant reduction in bone density, making bones weaker and prone to fractures.
2
Q
What is osteopenia?
A
- A less severe decrease in bone density compared to osteoporosis.
3
Q
How is osteoporosis diagnosed?
A
- Diagnosis is made using a T-score from a DEXA scan, with a T-score of less than -2.5 indicating osteoporosis.
4
Q
What are the main risk factors for osteoporosis?
A
- Age, post-menopausal women, low BMI, low calcium and vitamin D intake, smoking, alcohol, and chronic diseases like rheumatoid arthritis.
Note not obesity
5
Q
What is the T-score for osteoporosis on a DEXA scan?
A
- A T-score of less than -2.5 is diagnostic for osteoporosis.
6
Q
What role does hormone replacement therapy (HRT) play in osteoporosis?
A
- HRT is protective against osteoporosis, especially in post-menopausal women.
7
Q
What is the first-line treatment for osteoporosis?
A
- Bisphosphonates, such as alendronate, risedronate, or zoledronic acid.
8
Q
What is the recommended calcium intake for osteoporosis management?
A
- At least 1000mg of calcium daily.
9
Q
What is the recommended vitamin D intake for osteoporosis management?
A
- 400-800 IU of vitamin D daily.
10
Q
What is the role of bisphosphonates in osteoporosis treatment?
A
- They reduce bone resorption by inhibiting osteoclast activity, helping to strengthen bones.
11
Q
What are common side effects of bisphosphonates?
A
- Reflux, oesophageal erosions, atypical fractures, osteonecrosis of the jaw.
12
Q
What is the management for patients on long-term corticosteroids?
A
- Bisphosphonates are recommended for patients on long-term steroids, and calcium and vitamin D supplementation.
13
Q
How often should bisphosphonate treatment be reassessed?
A
- After 3-5 years, with a repeat DEXA scan to guide further treatment.
14
Q
What is the FRAX tool used for?
A
- It is used to assess the 10-year fracture risk and guide decisions on DEXA scanning and treatment.
15
Q
What are the key lifestyle modifications for managing osteoporosis?
A
- Increase physical activity, maintain a healthy weight, stop smoking, reduce alcohol consumption.
16
Q
What age groups should be assessed for osteoporosis?
A
- All women over 65, all men over 75, and anyone over 50 with risk factors or previous fractures.
17
Q
What is the role of a DEXA scan in osteoporosis diagnosis?
A
- DEXA scans measure bone mineral density and provide the T-score for diagnosis.
18
Q
What is chondrocalcinosis?
A
- Calcification in cartilage, often seen on X-ray in conditions like Pseudogout, but not specifically in osteoporosis.
19
Q
Why are falls a major concern in the elderly?
A
- Increased risk of fractures, hospitalisation, loss of independence, and mortality.
20
Q
What are the common causes of falls in the elderly?
A
- Poor balance, muscle weakness, cognitive impairment, medications, environmental hazards, and vision problems.
21
Q
Which 5 types of medications Should you check for when doing a falls assessment.
A
- Sedatives
- antihypertensives
- antidepressants
- antipsychotics
- opioids
22
Q
What intrinsic factors contribute to falls?
A
- Age-related muscle loss, cognitive decline, sensory deficits, and chronic conditions (e.g., Parkinson’s, stroke).
23
Q
What extrinsic factors contribute to falls?
A
- Slippery floors, poor lighting, loose rugs, clutter, and improper footwear.
24
Q
How does vision impairment contribute to falls?
A
- Reduced depth perception, poor contrast sensitivity, and slower adaptation to light changes.
25
How does postural hypotension contribute to falls?
- A sudden drop in blood pressure on standing can cause dizziness and fainting.
26
What is the Timed Up and Go (TUG) test?
- A quick test to assess mobility and fall risk by timing a patient walking a short distance.
27
What role does muscle weakness play in falls?
- Weak lower limb muscles lead to poor balance and instability.
28
Which chronic conditions increase fall risk?
- Parkinson’s, stroke, arthritis, diabetes (neuropathy), and dementia.
29
How can home modifications reduce falls?
- Installing grab bars, improving lighting, removing trip hazards, and using non-slip mats.
30
What footwear is best to prevent falls?
- Well-fitted, supportive shoes with non-slip soles.
31
What role does vitamin D play in fall prevention?
- Helps improve muscle strength and bone health, reducing fall-related fractures.
32
Why is polypharmacy a risk for falls?
- Increases the likelihood of drug interactions, dizziness, and sedation.
33
How can exercise help prevent falls?
- Strengthens muscles, improves balance, and enhances coordination.
34
What balance exercises are recommended for fall prevention?
- Tai Chi, gait training, and strength exercises (e.g., leg raises, sit-to-stand exercises).
35
How can caregivers assist in fall prevention?
- Supervision, mobility aids, medication review, and encouraging physical activity.
36
What is a multifactorial falls risk assessment?
- A comprehensive evaluation of medical, environmental, and functional risks for falls.
37
When should an elderly person be referred for a falls assessment?
- If they have recurrent falls, difficulty walking, or risk factors such as dizziness or visual impairment.
38
What are key interventions to reduce fall-related injuries?
- Hip protectors, walking aids, home modifications, medication review, and strength training.
39
What is the acronym used as a framework for a falls Hx?
DAME (Drugs, Ageing related, Medical causes, Environmental)
40
Dizziness differentials?
Vertigo, presyncopal, unsteady, mixed, transient loss of conscioussness
41
Common precipitating events to acute confusion?
Infection
Metabolic - hypercalcaemia, Hypo/hypergylcaemia, dehydration
Change of environment
Pain
Withdrawal
Constipation
Significant medical event
42
First line sedative for acute confusion?
Haloperidol 0.5mg
-care if they have parkinsons as can make symptoms worse
43
Definition of postural hypotension?
change in >20 mmHg on standing
44
45
What is the typical onset of delirium?
- Acute, sudden onset (hours to days)
46
What is the typical onset of dementia?
- Gradual onset over months to years
47
What is the typical onset of depression?
- Gradual onset over weeks to months
48
What is the course of delirium?
- Fluctuating course (waxing and waning) - Often reversible with treatment
49
What is the course of dementia?
- Slowly progressive - Irreversible
50
What is the course of depression?
- Variable, often episodic - Periods of normal cognition between episodes
51
How is attention affected in delirium?
- Severely impaired - Difficulty focusing and maintaining attention
52
How is attention affected in dementia?
- Generally preserved in early stages - Can decline in later stages
53
How is attention affected in depression?
- Generally preserved - May appear distracted due to low mood
54
How is consciousness affected in delirium?
- Altered level of consciousness - Can fluctuate between drowsiness and hyperalertness
55
How is consciousness affected in dementia?
- Usually clear until late stages
56
How is consciousness affected in depression?
- Clear consciousness
57
How does delirium affect cognition?
- Global cognitive impairment - Acute changes in memory, orientation, and language
58
How does dementia affect cognition?
- Memory impairment, especially recent memory - Progressive decline in executive function
59
How does depression affect cognition?
- Difficulty with concentration - Slower processing - Memory intact on deeper questioning
60
What are common causes of delirium?
- Infection - Medication changes - Metabolic disturbances - Dehydration - Hypoxia - Postoperative states
61
What are common causes/types of dementia?
- Alzheimer’s disease - Vascular dementia - Lewy body dementia - Frontotemporal dementia
62
What are common causes of depression in the elderly?
- Social isolation - Chronic illness - Loss of independence - Bereavement - Medication side effects
63
Is delirium reversible?
- Yes, if the underlying cause is treated
64
Is dementia reversible?
- No, but progression may be slowed with treatment
65
Is depression reversible?
- Yes, with appropriate treatment (e.g., therapy, medication, lifestyle changes)
66
How is delirium managed?
- Treat the underlying cause (e.g., infection, dehydration) - Optimise environment (e.g., lighting, reducing noise) - Avoid sedating medications unless necessary
67
How is dementia managed?
- Cognitive enhancers (e.g., donepezil for Alzheimer’s) - Supportive care - Address behavioural symptoms - Caregiver support
68
How is depression managed?
- Antidepressants (e.g., SSRIs) - Cognitive behavioural therapy (CBT) - Social support and lifestyle changes
69
New acue confusion Hx questions?
Danger to themselves, falls, NEWS, pain, BM, Drugs, Eating and drinking, Weeing and pooing, Hearing aids, Infection, alcohol
70
What can you ask NOK to fill out to help with delerium?
Hospital passport
71
Which cognitive tests can be used to asses delirium?
4AT, Confusion Assessment method (CAM), AMT
72
Described 4AT test?
1. Alertness (0 or 4)
2. AMT (Age, DOB, Place & Year)
3. Attention (Months backwards)
4. Acute and fluctuating course.
4 or above = possible delirium.
73
Describe CAM?
Derlirium is likely if: presence of acute confuison with fluctuation, inattention and either disorganised thinking or altered level of consiousness.
74
Pharmacological management of delirium? (Use only if needed)
Haloperidol, Risperidone, Lorazepam.
75
Contraindications to haloperidol?
Cardiac issues esp Long QT, Parkinsons, Lewy body
76
Types of delirium?
Hypoactive, hyperactive and mixed
77
Steps if ?UTI in elderly?
1. Do not perform dipstick
2. SEPSIS,
3. NEWS,
4. Catheter? Check
5. Check other causes of delirium
78
What score should be considered in a confused elderly patient?
Their anticholinergic burden
79
Examples of highly anticholinergic medicines (ACB = 3)
-Tricyclics
-Chlorphenamine (piriton) and Diphenhydramine (Nytol)
-Antimuscarinic (oxybutynin)
80
What is delirium?
- Acute confusional state.
- Acute and fluctuating course of inattention
- Includes disorganised thinking or altered consciousness.
81
How does delirium differ from dementia?
- Delirium: Acute onset, fluctuating course, impairment of consciousness, worse at night, agitation, abnormal perception.
- Dementia: Progressive, gradual onset, stable consciousness, persistent cognitive decline.
82
What tool is used to assess delirium?
- 4AT (Alertness, AMT4, Attention, Acute & fluctuating course).
83
What are the 4AT assessment components?
- Alertness: Normal = 0, Abnormal = 4.
- AMT4 (Age, DOB, Birthplace, Year): No mistakes = 0, 1 mistake = 1, 2+ mistakes = 2.
- Attention (months backwards): >7 correct = 0, <7 correct = 1, untestable = 2.
- Acute & fluctuating course: No = 0, Yes = 4.
84
How is 4AT scored?
- 1-3: Cognitive impairment
- 4+: Probable delirium.
85
What is the mnemonic for causes of delirium?
PINCH ME (Pain, Infection, Constipation/urinary retention, Hydration/metabolic, Medications, Environment).
86
How can infection cause delirium?
- Systemic infections (UTI, pneumonia, sepsis) can trigger acute confusion.
87
What metabolic disturbances can contribute to delirium?
- Hypoglycaemia, hypercalcaemia, dehydration, renal/liver dysfunction.
88
What medications can cause delirium?
- Benzodiazepines, opioids, anticholinergics, alcohol withdrawal.
89
How does the clinical presentation of delirium fluctuate?
- Worse at night.
90
- Periods of lucidity followed by confusion.
91
What are common perceptual disturbances in delirium?
- Illusions and hallucinations.
92
What is a key attention deficit in delirium?
- Poor attention and distractibility.
93
What bedside tests are useful in delirium?
- U&E, FBC, LFTs (dehydration, liver/renal function, infection).
94
What imaging may be required in delirium?
- CT head (to rule out brain pathology).
95
What is the first-line management of delirium?
- Treat the underlying cause.
96
When should sedatives be used in delirium?
- If patient remains severely agitated or distressed despite treatment.
97
What is the first-line sedative for delirium?
- Haloperidol 0.5mg (except in Parkinson’s).
98
What sedative is used in Parkinson’s disease?
- Lorazepam (avoid haloperidol).
99
What is the first-line treatment for constipation in delirium?
- Lifestyle changes (fluids, fibre).
100
What is the first-line laxative for constipation?
- Bulk-forming laxatives (ispaghula husk).
101
What is the second-line laxative for constipation?
- Osmotic laxatives (macrogol).
102
What laxative is preferred for opioid-induced constipation?
- Macrogol
- Senna
103
What red flag symptoms should be considered in constipation?
- Blood in stool, weight loss, persistent symptoms.
104
What are pressure ulcers?
- Ulcers that develop in patients who are unable to move certain body parts due to illness, paralysis, or old age.
- Often occur over bony prominences (sacrum/heel).
105
What are the risk factors for pressure ulcers?
- Malnourishment
- Incontinence
- Lack of mobility
- Pain
- Diabetes
- Thin skin
106
How are high-risk patients for pressure ulcers identified?
- Screened using the WATERLOW score.
107
How are pressure ulcers managed?
- Avoid soap.
- Use moist wound dressings with hydrogels.
- Only use antibiotics if there are surrounding signs of cellulitis.
108
What is urinary incontinence?
- Loss of bladder control leading to involuntary leakage of urine.
- Common in elderly females.
109
What are the main types of urinary incontinence?
- Overactive Bladder/Urge Incontinence – Sudden urge to urinate followed by leakage. - Stress Incontinence
– Leaking small amounts when stressed (e.g., coughing, sneezing).
- Overflow Incontinence
– Due to bladder obstruction (e.g., adhesions, BPH, cancer).
- Functional Incontinence
– Unable to reach the bathroom due to conditions like dementia, frailty, or sedatives.
110
What are the initial investigations for urinary incontinence?
- Urine dipstick to rule out infection.
- Bladder diaries to track voiding patterns. - Rule out diabetes/infection.
111
How is urge incontinence managed?
- Bladder retraining.
- Antimuscarinics (e.g., oxybutynin).
- If confusion risk present → beta-3 agonist (mirabegron) preferred.
112
How is stress incontinence managed?
- Pelvic floor training.
- If ineffective, consider surgical intervention.
- If surgery unsuitable → duloxetine.
113
What is Parkinson’s disease?
A progressive neurodegenerative condition characterized by asymmetrical tremor, rigidity, and bradykinesia. Average onset is 65 years.
114
What is the pathophysiology of Parkinson’s disease?
Degeneration of dopaminergic neurons in the substantia nigra and basal ganglia.
115
What are the risk factors for Parkinson’s disease?
Family history, male sex.
116
How does Parkinson’s disease typically present?
Unilateral symptoms:
-Fine resting tremor (improves with voluntary movement) -Bradykinesia (slow movements, difficulty initiating)
-Rigidity (cogwheel)
- Psychiatric symptoms (depression, psychosis, dementia),
-shuffling gait with reduced arm movement, hypophonia, hypomimia, micrographia, REM sleep disorder, impaired olfaction.
117
What postural finding is seen in Parkinson’s disease?
Postural hypotension (>20 mmHg fall in BP on standing). Managed with fludrocortisone.
118
What are some important differential diagnoses for Parkinson’s disease? aka parkinsons plus conditions
- Progressive Supranuclear Palsy (Parkinsonism + postural instability)
- Drug-induced Parkinsonism → Caused by antipsychotics,
- Multi-System Atrophy → Parkinsonism + autonomic dysfunction
- Lewy Body Dementia → Triad of visual hallucinations, fluctuating cognition, parkinsonism
119
How is Parkinson’s disease diagnosed?
Clinical diagnosis. If unclear, SPECT scan can be used.
120
What is the first-line treatment for Parkinson’s disease?
Levodopa (taken with a decarboxylase inhibitor e.g., carbidopa or benserazide). Example: Co-beneldopa = levodopa + benserazide.
121
When might dopamine agonists or MAO-B inhibitors be used first-line instead?
If motor symptoms are not the main problem.
122
What are the side effects of levodopa?
- Time-sensitive dosing
- Common: Dry mouth, weight loss, palpitations, psychosis. BP hypotension.
- Less common: Dyskinesia (involuntary movements), end-of-dose wearing off, on-off phenomenon (fluctuations in motor response).
123
What are second-line treatment options if symptoms persist or dyskinesia develops?
- Dopamine Agonists (e.g., bromocriptine, ropinirole) → Can cause excessive sleepiness, hallucinations, impulse control disorder.
- MAO-B Inhibitors (e.g., selegiline) → Inhibits dopamine breakdown.
- COMT Inhibitors (e.g., entacapone) → Inhibits dopamine breakdown enzyme.
124
How are other Parkinson’s symptoms managed?
- Excessive daytime sleepiness → Adjust medication +/- modafinil.
- Orthostatic hypotension → Midodrine or fludrocortisone.
- Drooling → Glycopyrronium.
- Acute dystonia + stiffness → Dopamine agonist patch.
125
What is a cerebrovascular accident (CVA)?
A CVA is a sudden interruption of blood supply to brain tissue, leading to motor weakness, sensory deficit, dysphasia, dysphagia, and ataxia.
126
What are the two main types of CVA?
1. Ischaemic (85%): Thrombotic (from carotid) or Embolic (due to AF).
2. Haemorrhagic (15%): Includes ICH or SAH, more likely to present with LOC, headache, nausea, and vomiting.
127
What are the specific risk factors for ischaemic CVA?
Atrial Fibrillation (AF)
128
What are the specific risk factors for haemorrhagic CVA?
AVM, Aneurysm, and Anticoagulation
129
What are the three criteria in the Oxford Stroke Classification?
Criteria:
1. Unilateral hemiparesis and/or hemisensory loss of face, arm & leg
2. homonymous hemianopia
3. higher cognitive dysfunction (i.e dysphasia, neglect)
130
Which arteries are involved in a TACI (Total Anterior Circulation Infarct) and which of the three oxford criteria are present ?
middle and anterior cerebral arteries.
all 3
1. Unilateral hemiparesis and/or hemisensory loss of face, arm & leg
2. homonymous hemianopia
3. higher cognitive dysfunction (i.e dysphasia, neglect)
131
What is the definition of LACI (Lacunar Infarct)?
LACI involves perforating arteries supplying structures like the internal capsule, thalamus, and basal ganglia.
It is associated with hypertension
It presents with 1 of the following:
unilateral weakness
sensory deficit
ataxic hemiparesis.
132
What are common clinical features of a stroke in the ACA (Anterior Cerebral Artery) territory?
Contralateral hemiparesis and sensory loss, with lower extremity > upper extremity involvement.
133
What are common clinical features of a stroke in the MCA (Middle Cerebral Artery) territory?
Contralateral hemiparesis and sensory loss, with upper extremity > lower extremity involvement, aphasia, and contralateral homonymous hemianopia.
134
What are common clinical features of a stroke in the PCA (Posterior Cerebral Artery) territory?
Contralateral homonymous hemianopia with macular sparing and visual agnosia.
135
What are the clinical features of Weber's syndrome? (midbrain supplying branches (paramedian) of PCA)
- Ipsilateral
- CN III palsy (ptosis, dilated/mydriasis, fixed pupil, down gaze)
- Contralateral
- face/limb weakness.
136
What is Wallenberg syndrome (lateral medullary syndrome)?
It is caused by a stroke in the Posterior Inferior Cerebellar Artery (PICA)
Ipsilateral
* nystagmus
* ataxia
* facial pain
* temperature loss
* Horner’s syndrome
Contralateral
* limb pain
* temp loss
**Dysphagia**
137
What is the most common initial imaging for a suspected stroke?
CT head non-contrast to rule out haemorrhage.
138
How does an ischaemic stroke appear on a CT scan?
Hypodense areas (dark) and hyperdense artery.
139
What is the first-line management for ischaemic stroke within 4.5 hours?
Aspirin 300mg for 2 weeks
Thrombectomy and thrombolysis (IV alteplase) within 4.5 hours
<6 hours thrombectomy
140
What are some contraindications for thrombolysis in ischaemic stroke?
Contraindications include:
INR > 1.7
uncontrolled hypertension
intracranial neoplasm
previous intracranial bleed
surgery within 2 weeks
pregnancy
active bleeding
GI hemorrhage within the last 3 weeks.
141
What secondary prevention strategies are used for stroke?
- Clopidogrel 75mg or aspirin + MR dipyridamole
- Statins if cholesterol > 3.5
- Anticoagulation for AF after 2 weeks with warfarin, dabigatran, or apixaban
- Carotid endarterectomy for stenosis > 70%.
142
What is the Barthel Index used for in stroke management?
The Barthel Index is used to assess disability and functional independence after a stroke.
143
What is the role of SALT assessment after a stroke?
The SALT assessment is used to evaluate swallowing and speech functions after a stroke.
144
Symtoms that make haemorrhagic stroke more likely to present ?
LOC, headache, N+V
145
Partial anterior circulation infarct (PACI) involves which arteries and how many oxford criteria present?
smaller anterior circulation arteries
2 criteria present
146
Posterior circulation infarct (POCI) involves which arteries and how many oxford criteria present?
PCA, Pontine arteries, Cerebellar arteries, Vertebrobasilar
1 + of following syndromes
-cerebellar
-brainstem
-homonymos hemianopia
-loc
147
anterior inferior cerebellar artery stroke
called pontine syndrome
ipsilateral
* CNVII (facial weakness)
* CNVIII (hearing loss, nystagmus)
* facial sensory loss
Contralateral
* limb and temp loss
* vertigo
148
basilar stroke symptoms?
locked in syndrome
quadriplegia with consiousness and eye movment
149
cerebellar stroke symptoms?
- if in vermis → little/no limb involvement
- if in hemisphere → limb involvement
Dysdiadokinesia
Ataxia
Nystagmus
Intention Tremor
Slurred Speech
Hypotonia
- Lacunar → either:
- isolated hemiparesis
- hemisensory loss
- hemiparesis with ataxia
150
what do you need to rule out if ?stroke
hypoglycaemia
151
which scores used to determine likelihood of stroke?
rosier
152
secondary prevention of stroke if AF present?
anticoag after 2 weeks with
-warfarin
-dabigatran
-DOAC
153
mx of haemorrhagic stroke?
neurosurgical consult
bp control
154
haemorragic stroke
pt on warfarin
what do u give?
Phytomenadione (vitamin K)
155
identifying features of parkinsons plus conditons?
Multiple system atrophy
Early autonomic dysfunction --> postural hypotension, urinary incontience
Progressive supra nuclear palsy --> vertical gaze palsy, poor response to L dopa
Corticobasal degeneration --> rigidity with apraxia (unable to perform tasks when asked).
Dementia with Lew Body --> early cognitive impairment with prominent hallucinations and REM sleep disorder.
156
Score used to asses frailty?
PRISMA-7
157
Parkinsons vs LBD - how to distinguish in a Q?
How long have symptoms been going on for - if a long time then hallucinating likely PDD
if all happened recently - LBD
If psych happened before movement - LBD
158
Which drugs do we not give pts with dementia?
antipsychotics
159
What sort of drug is haliperidol?
antipsychotic
160
If an elderly person is hallucinating in the question - awnser is likely
Lewy body
(unless this comes AFTER PDD symptoms)
161
Breakthrough (PRN) doses are usually what fraction of the 24 hour dose?
1/6-1/10 of the 24
162
If you need to reverse warfarin ASAP - what do you give?
Vit K and 4-factor prothrombin
163
What is a subdural haematoma?
A subdural haematoma is characterised by the accumulation of venous blood in the potential space between the dura mater and arachnoid mater of the brain.
164
Which anti-emetic do you give pts with Parkinsons?
Domperidone
they deserve champgne
165
What ant-emetic makes Parkinson's symptoms worse?
Metoclopramide
Metoclopramide Makes Parkinson’s Move Poorly
(its a dopamine antagonist)
166
What changes to vision occur with temporal vs parietal lobe strokes?
Temporal - superior homonymous hemianopia
Parietal - inferior homonymous quadrantanopia
167
What is Broca's dysarthria?
Broca's dysphasia is also known as expressive dysphagia and is characterised by difficulties in expressing and producing language.
Usually patients will exhibit making great effort when speaking
Broca broken speech
168
What does Charles Bonnet syndrome presents with?
vivid visual hallucinations
169
Expressive aphasia is characterised by?
It isis strongly associated with damage to where??
difficulty producing meaningful speech
dominant left frontal lobe.
170
Clumsy hand syndrome is due to a lesion where?
internal capsule
171
Meds we give to treat postural hypotension?
Fludrocortisone
a corticosteroid used to treat PH and addisons
Helps retain sodium
172
Which laxative do you give for opiod induced constipation?
docusate
senna
movicol
173
Broca's area, responsible for fluent speech production, is located where?
the inferior frontal gyrus
174
RF for haemorrhagic stroke?
haemorrhagic stroke include hypertension, anticoagulation, and sympathomimetic
175
CT scan findings haemorrhagic vs ischaemic stroke?
haemorrhagic - hyperdense
ischaemic - hypodense
176
Patient is having a haemorrhagic stroke - which medication do you check if they are on?
Warfarin
consider Vit K
177
which cranial nerve is not contralateral?
trochlear
178
What is DOLS?
A means to protect the rights of patients who lack capacity who are detained in a hospital or care home
--> For patients lacking capacity in a hospital or care home who wish to leave but present a risk to themselves or others
179
hallucinations but pt knows they are not real?
charles-bonnet syndrome
180
drugs that reduce seizure threshold?
- antipsychotics (haloperidol)
- abx (penicillin, cephalosporins, isoniazid, metronidazole)
- antidepressants - tricyclics, venlafaxine, bupropion
- tramadol
- fentanyl
- ketamine
- lidocaine
- lithium
- antihistamines
181
commmon drugs causes of delerium?
benzo
opiates
antiparkinsonian
TCA
digoxin
BB
steroids
antihistamines - chlorphenamine
182
confusion screen
MSU
FBC, ESR, CRP (anaemia)
TFT
Calcium
Renal function (AKI)
B12 and folate
LFT
then more specialist
CT/MRI
LP
EEG
183
if you see pancytopaenia in elderly pt, consider?
myelofibrosis
you can get hepatosplenomegaly
poikilocytes (tear shaped rbc) on blood film
dry tap on bone marrow aspirate (dry due to fibrosis)
184
AKA in pt just taken trimethoprim?
can cause a pseudo AKI - dont panic
185
which abx for aspiration pneumonia?
IV beta lactam (co amox) + IV metrondiazole
186
pt is restless and has a suprapubic mass - what are you thinking?
urinary retention
maybe amityptilline
oxybutynin
187
ECG for hypOthermia?
j wave
