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1. 4th year > Ageing > Flashcards

Ageing Flashcards

(67 cards)

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1
Q

what is the criteria of the 4AT

A 
alertness
AMT4
- age, DOB, location, year
attention
acute change/fluctuating course
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2
Q

when is delirium typically worse

A

at night

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3
Q

what bloods are done in a confusion screen

A 
normal bloods - FBC, U+E, LFT
also 
- B12/folate
- TFT
- glucose
- Bone profile (calcium)
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4
Q

how could you modify the environment of someone with delirium

A

quiet side room
familiar staff
visible clocks and calendars

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5
Q

1st line treatment of acute confusional state

A

Haloperidol

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6
Q

2nd line treatment of acute confusional state

A

lorazepam

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7
Q

acute confusional state in patient with parkinsons

A

lorazepam

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8
Q

2nd line acute confusional state in patient with parkinsons

A

quetiapine or clozapine

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9
Q

some medications that cause postural hypotension

A 
Nitrates
Diuretics
Anticholinergic medications
Antidepressants
Beta-blockers
L-Dopa
ACEI
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10
Q

bedside tests for falls

A 
basic obs 
LSBP
ECG
turn 180 test
timed up and go test
visual fields
hearing test
look at shoes
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11
Q

criteria of orthostatic hypotension

A

fall of SBP > 20 or DBP > 10 after 3 mins of standing

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12
Q

what are blood pressures taken in a LSBP

A

1st BP lying for 5 minutes
2nd BP standing for 1 minute
3rd BP standing for 3 minutes

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13
Q

what should you record in a LSBP aswell as blood pressure

A

any symptoms of light headed, palpitations, weakness, vision changes, pallor etc

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14
Q

what are some drugs to consider stopping in elderly in peptic ulcer disease

A

NSAIDs,warfarin and aspirin

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15
Q

what drug should be given in long term steroid treatment

A

bisphosphonates

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16
Q

when should a pressure ulcer be swabbed

A

only if evidence of surrounding cellulitis

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17
Q

how long does dementia have to be going on for in order to diagnose

A

6 months

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18
Q

most common dementia

A

alzheimers

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19
Q

dementia with stepwise progression and CVS risk factors

A

vascular

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20
Q

do people with vascular dementia tend to lose insight?

A

no vascular dementia insight usually spared

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21
Q

what can be used to differentiate Alzheimers from vascular

A

hackinski score

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22
Q

dementia with fluctuating symptoms with lucid periods and recurrent visual hallucinations

A

lewy body

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23
Q

dementia associated with parkinsons

A

lewy body

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24
Q

how do parkinsons and lewy body differ

A

parkinsons - parkinson symptoms first, cognitive at least a year after
lewy body - cognitive symptoms first or at same time as parkinsonism

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25
tx lewy body dementia
low dose levodopa
26
dementia with younger onset and personality changes and change in eating habits
frontotemporal
27
is insight spared in frontotemporal dementia
no tends to be lost early
28
inheritance of huntingtons
autosomal dominant
29
tx severe alzheimers
memantine
30
tx mild - moderate alzheimers
Rivastigmine, Donepazil, Galantamine
31
what kind of drugs are Rivastigmine, Donepazil, Galantamine
ACh esterase inhibitors
32
what kind of drug is memantine
NMDA antagonist
33
what is the triad of huntingtons
emotional, cognitive and motor disturbance
34
what is the motor disturbance in huntingtons
choreiform movements
35
potentially reversible cause of dementia with urinary incontinence, ataxia and cognitive impairment
normal pressure hydrocephalus
36
tx of normal pressure hydrocephalus
VP shunt
37
rapid onset of dementia in < 50s with ataxia, seizures, myoclonic jerks
mad cow disease
38
cognitive assessment in dementia (3)
MMSE MOCA ACE III
39
agitation and confusion treatment in terminal phase
midazolam
40
hiccups treatment in terminal phase
chlorpromazine
41
secretions treatment in terminal phase
hyoscine hydrobromide/butylbromide
42
sore mouth treatment in terminal phase
benzydamine hydrochloride
43
1st line nausea and vomiting treatment due to reduced gastric motility
metoclopramide - if not risk of SEs domperidone
44
nausea and vomiting that is chemically mediated e.g. post chemo
metoclopramide - if not at risk of SEs ondansetron
45
what GI situation should you avoid metoclopramide
``` post-gastric surgery bowel obstruction (but helpful in paralytic ileus) ```
46
what side effect of metoclopramide is particularly apparent in children and young people
EPSEs - oculogyric crisis
47
Nausea and vomiting due to intracranial disease treatment
cyclizine
48
headache/raised ICP from intracranial disease treatment
dexamethasone
49
vestibular causes of nausea and vomiting treatment
cyclizine
50
breakthrough dose of morphine calculation
1/6 daily dose
51
oral codeine to oral morphine
/ 10
52
oral morphine to SC morphine
/ 2
53
oral morphine to SC diamorphine
/ 3
54
how much should opiate be increased if increasing dose
by 30-50%
55
opioid of choice in mild- moderate renal disease
oxycodone
56
opioid of choice in severe renal disease
buprenorphine or fentanyl
57
oral morphine to oral oxycodone
divide by 1.5 - 2
58
oral oxycodone to SC diamorphine
divide by 1/5
59
max number of medications in a syringe driver
3
60
commonly used N+V drug in syringe driver
levomepromazine
61
tx bowel colic in end of life care
hyoscine butylbromide
62
4 main anticipatory drugs in end of life care
levomepromazine hyoscine butylbromide midazolam diamorphine
63
death verification - 6 steps
- Check for spontaneous movement, including respiratory effect - Check for reaction to voice and pain – sternal rub or supraorbital nerve - Palpate at least 2 major pulses for one minute - Inspect the eyes looking for dryness, fixed dilated pupils, absence of corneal reflexes and clouding of the cornea - Auscultate the heart and lungs for one minute - Remember to note if pacemaker/implantable device is present
64
reversal of opioid toxicity
naloxone
65
s/s opioid toxicity
``` jerky movements, myoclonus pin point pupils reduced resp rate drowsy hallucinations ```
66
tx breathlessness in palliative care
oral opioid
67
tx anxiety related breathlessness
lorazepam

1. 4th year (23 decks)

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