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MIND AND MOVEMENT > Ageing And Complex Health > Flashcards

Ageing And Complex Health Flashcards

1
Q

What is included in a comprehensive geriatric assessment

A 
Medical diagnoses
Review of meds
Social circumstances
Assessment of cognition and mood
Functional ability
Environmental assessment
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2
Q

Fried’s phenotype of frailty

A 
Grip strength 
Activity levels
Weight loss
Fatigue 
Walking speed

Frailty is associated with death, institutionalisation, adverse outcomes and falls

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3
Q

Falls history

A

Before the fall- what were they doing, what was the time of day, symptoms before the fall, why do they think they fell

During- LOC, bite tongue, incontience, injured themselves

After the fall- how did they get help, could they get up, complications such as long lie, fracture, head injury

Vision, cognition, other PMH, osteoporotic risk factors
DAME! Drugs, ageing, medical conditions, environment

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4
Q

Drug causes of falls

A 
Polypharmacy
Anti hypertensives
Sedatives
Opioids
Psychotropics
Glicliazide- hypoglycaemia
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5
Q

Age related causes of falls

A 
Vision changes 
Cognitive decline
Gait abnormalities
Osteoarthritis 
Postural instability 
Sarcopenia 
Reduction in baroreceptor sensitivity
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6
Q

Medical causes

A

Cardiac - hypotension, arrhythmia
Neuro disease eg Parkinson’s, stroke, neuropathy
Cataracts

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7
Q

Environmental causes of fall

A

Walking aids
Inappropriate footwear
Carpets
Home hazards

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8
Q

What is vertigo

A

Sensation of room spinning.
Causes include BPPV, Menieres disease, vestibular neuritis, acoustic neuroma
Central causes migraine, brain stem ischaemia, cerebellum stroke, MS

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9
Q

Short spells of vertigo (up to one minute), settles spontaneously, occurs on movement of head eg in and out of bed or looking up or turning quickly

A

Diagnosis BPPV
Diagnosed by Dix Hallpike manoeuvre
Treat with Epley

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10
Q

Patient feels lightheaded, associated with pallor, sweating, often when pt is standing

A

Pre syncopal.
Suggest a cerebral hypoperfusion due to hypotension. Often postural hypotension

Do lying and standing BP. Check meds

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11
Q

Examine patient presenting with dizziness

A

Neuro
Eye sight
BP
Cardio resp- pulse, JVP, heart sounds, peripheral oedema, chest sounds
MSK- examine hands, hip exam, knee exam, ankle, gait

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12
Q

Tests after a fall

A 
FBC
TFTs, B12
HbA1c
Bone profile 
Urea and electrolytes
ECG- arrhythmia
CK- only if there way long lie and query rhabdomyolysis
Urine dip if urinary symptoms 
CT brain if head injury and LOC, anti coag use or neuro deficit
Echo is HF symptoms 
Tilt table only if syncope 
CXR if chest symptoms
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13
Q

Assess osteoporosis risk

A

FRAX tool. Assesses ten year fracture risk.

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14
Q

First line osteoporosis treatment

A

Bisphosphonates, calcium, vit D supplements

Alendronic acid 70mg weekly.

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15
Q

Confusion assessment tools

A

AMTS10 quick cognitive assessment
Addenbrookes - dementia tool
MOCA good sensitivity but time consuming
MMSE

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16
Q

Things that can lead to confusion

A 
Change in environment
Subdural haematoma or intracranial bleeds
Hip fracture
Constipation!
Pain
Low BP
Dehydration 
Previous delirium 
Recent surgery 
Poor sleep
Any infection
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17
Q

Tests and tools assessing confusion and delirium

A

Confusion assessment method (acute onset, fluctuating course, imattention, disorganised thoughts, altered consciousness)
4AT- alterness, attention, acute, AMT4

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18
Q

Things to review if patient delirious

A 
FNC
UE
review for sepsis- do obs
Fluid intake 
Constipation
 MSU
 ECG
CXR
calcium
 Blood cultures if think sepsis
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19
Q

How to treat delirium

A

Identify and manage underlying cause
Ensure effective communication
De-escalate if distressed- use familiar staff or family. Do not move
Consider short term haloperidol or olanzapine if patient is at risk or risk of hurting others
Ask about alcohol intake

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20
Q

Prognosis of delirium

A

Two thirds recover (1/3 quickly, 1/3 slowly)
One third do not recover completely
It is associated with with numerous negative outcomes- longer hospital stays, increased incidence of dementia, increased complications such as falls and pressure ulcers, increased rate of admission to long term care, more likely to die

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21
Q

Prevention of delirium

A

Good lighting, clear signage, reorientation, reduce chance of dehydration and constipation, hypoxia, try to make person mobile ASAP, infection, meds review, assess pain, ensure good nutrition, heating and visual aids, try encourage good sleep

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22
Q

Steps of a medication review

A 
Identify objectives of drug therapy
Identify which drugs are essential 
Does the patient have any unnecessary drugs
Are all objectives being achieved
Are there any ADR or at risks ADRs
Drug cost effective 
Is the patient taking the meds
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23
Q

What are the features of Parkinsonism

A

Bradykinesia- slowness of initiating voluntary movements. Difficulty in sustaining repetitive movements

Rigidity - involuntary increase in muscle tone. Present through range of movement

Tremor- rhythmic involuntary movements eg pill rolling

Postural instability

24
Q

Causes of parkinonism

A

Idiopathic
Drug induced- cyclizine, haloperidol, prochlorperazine, metoclopramide
Vascular Parkinson’s - small strokes in basal ganglia

25
Q

Features of drug induced Parkinsonism

A

Usually symmetrical onset

Treatment- stop or reduce meds. Liase with psych

26
Q

Features of vascular Parkinsonism

A

Extreme shuffling gait but preserved arm swing
Tremor less common
Approx 50% levodopa

27
Q

Features of idiopathic Parkinson’s

A 
Gradual onset
Unilateral initially and one side always worse
Unilateral and fine tremor
Hypophonia
Micrographia
Freezing gait

Treatment- levodopa or dopamine agonist and physical activity and therapy

28
Q

Essential tremor

A 
On action 
Symmetrical
Alcohol improves it
FH
Coarse tremor
Jaw tremor
Leg tremor
No evidence of bradykinesia or gait disturbance 
Non specific beta blockers eg propanolol can be effective in reducing tremor
29
Q

Scans done to determine whether essential tremor or PD

A

DAT scan can show decreased dopamine uptake

Not often indicated unless trouble distinguishing between essential tremor and PD

30
Q

Tremor worse on movement

A 
Essential tremor
Dystonic tremor
Exaggerated physiological tremor
Hyperthyroidism 
Dystonic tremors
31
Q

Intention tremor

A

Cerebellum disorders.

32
Q

Dementia with Lewy Bodies

A

Triad of dementia, Parkinsonism, visual hallucinations

Fluctuations in alertness

Shared care with psychiatry, neurology and geriatrics

33
Q

Progressive supranuclear palsy

A

Early falls, truncate rigidity, vertical gaze palsy
Reduction in midbrain volume on MRI
Requires early speech and language review

34
Q

Normal pressure hydrocephalus

A

Triad of dementia, gait disorder and bladder instability

Diagnostic lumbar puncture and CSF removal then ventriculoperitoneal shunt

35
Q

Three steps to diagnosing Parkinson’s disease

A

1- diagnosis of a parkinsonian syndrome
2- exclusion criteria
3- supporting evidence eg unilateral tenor, preofessige, persistent asymmetry, good response to levodopa

If wanting second opinion, do not try levodopa as this could mask symptoms

36
Q

Treatment of Parkinson’s disease

A

Co beneldopa
Levodopa with benserazide which acts as a dopa decarboylase inhviitor so stops the additional creation of dopamine outside of the brain therefore more dopamine for the brain and less systemic side effects eg nausea

Second line is dopamine agonist. These are not desirable as can cause hallucinations and behavioural problems eg gambling, overeating, hyper sexuality

37
Q

What is the MUST score

A

Malnutrition universal screening tool
Five step screening tool to identify adults who are malnourished, at risk of malnutrition or are obese

  1. Measure height and weight to get BMI
  2. Note percentage unplanned weight loss and score using tables
  3. Establish acute disease effect and score
  4. Add scores from steps 1- 3 to obtain risk of malnutrition
  5. Use management guidelines and or local policy to develop care plan
38
Q

Grading of ulcers

A

1 non blanchable erythema. Skin intact

  1. Partial thickness loss- abrasion or clear blister
  2. Full thickness skin loss. Sub cut fat may be visible
  3. Muscle or bone or tendons exposed
39
Q

How to prevent pressure ulcers

A

SKINS

 support surface needs to be adequate
Keep or moving
Incontinence (manage) 
Nutrition and hydration 
Skin inspection to Detect early signs
40
Q

How to identify stroke, in community and in A&E

A

Community - FAST

A&E- Rosier score

41
Q

If stroke suspected, what should you do

A

CT ASAP to look fo signs of haemorrhage. CT angiography can also help.
Take full history
Thrombolysis alteplase if under 4.5 hours

42
Q

Thrombolysis check list

A

Symptoms of acute stroke
Onset in last 4.5 hours
Measurable deficit on NIHSS
Absence of haemorrhage on scan

43
Q

Follow up after thrombolysis

A

CT scan after 24 hours to check that there has been no haemorrhage following thrombolysis
Do NIHSS again to see if there is an improvement
Refer to physio and OT

44
Q

Unilateral weakness of face, arm and leg
Homonymous hemianopia
Higher cerebral dysfunction - dysphasia

A

Total anterior circulation stroke

45
Q

Two of :
unilateral weakness of face, arm leg
Homonymous hemianopia
Higher cerebral dysfunction

A

Partial anterior circulation syndrome

46
Q

One of:
Unilateral weakness of face, arm leg
Pure sensory stroke
Ataxic hemiparesis

And no evidence of higher cerebral dysfunction

A

Lacunae syndrome

47
Q

One of
Cerebellum or brainstem syndromes
Loss of consciousness
Isolated homonymous hemianopia

A

Posterior circulation syndrome

48
Q

Risk factors for haemorrhagic stroke

A 
Hypertension
Cerebral amyloid angiopathy
Aneurysms eg with poly cystic kidney disease
Cerebral arteriovenous malformations
Brain tumours
49
Q

If TIA, what tool should be used to assess stroke risk

A

ABCD2
Age over 60
Blood pressure >140/90
Clinical features max 2 points (2 for unilateral weakness, 1 speech difficulty)
Duration (2 for over 60, 1 for 10-59, 0 for less than 10)
Diabetes 1

Max 7 points

4 or Above is high risk of stroke

50
Q

Following TIA, what makes a stroke highly likely

A

ABCD2 score of over 4
AF
Multiple TIAs

51
Q

DVLA And TIA

A

If normal driver
Stop driving immediately
No driving for four weeks
No need to inform DVLA

52
Q

DVLA and stroke

A

No driving for four weeks and must tell DVLA. after the four weeks, need reassessing

53
Q

Differential for TIA

A 
Syncope
Atypical seizure
Migraine
Temporal arteritis 
Retinal haemorrhage or detachment
Hypoglycaemia
Labyrinthine disorders
54
Q

Test ps after TIA diagnosis

A

ECG to check for AF
carotid Doppler, do carotid endarterectomy is over 70% occluded leading to symptoms
FBC, UE, LFT, lipids, blood glucose, BMI

55
Q

If AF present with TIA..

A

Do CHADS2VASC and HASBLED to assess clot and bleeding risk

56
Q

Headache, weakness in left side developed over 30 mins. Drowsy. FAST positive

A

Likely to be a haemorrhage. Still get CT

57
Q

Risk factors for stroke

A

a HTN, peripheral vascular disease, ischaemia heart disease, smoking, diabetes , AF, combined pill, clotting disorders, vasculitis, carotid stenosis

MIND AND MOVEMENT (6 decks)

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