Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

MIND AND MOVEMENT > Ageing And Complex Health > Flashcards

Ageing And Complex Health Flashcards

(57 cards)

Start Studying
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Drug causes of falls

A 
Polypharmacy
Anti hypertensives
Sedatives
Opioids
Psychotropics
Glicliazide- hypoglycaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Age related causes of falls

A 
Vision changes 
Cognitive decline
Gait abnormalities
Osteoarthritis 
Postural instability 
Sarcopenia 
Reduction in baroreceptor sensitivity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Medical causes

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Environmental causes of fall

A

Walking aids
Inappropriate footwear
Carpets
Home hazards

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Assess osteoporosis risk

A

FRAX tool. Assesses ten year fracture risk.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

First line osteoporosis treatment

A

Bisphosphonates, calcium, vit D supplements

Alendronic acid 70mg weekly.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Confusion assessment tools

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the features of Parkinsonism

Study These Flashcards
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

Study These Flashcards
A

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

25
Features of drug induced Parkinsonism
Usually symmetrical onset Treatment- stop or reduce meds. Liase with psych
26
Features of vascular Parkinsonism
Extreme shuffling gait but preserved arm swing Tremor less common Approx 50% levodopa
27
Features of idiopathic Parkinson’s
``` 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
Essential tremor
``` 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
Scans done to determine whether essential tremor or PD
DAT scan can show decreased dopamine uptake | Not often indicated unless trouble distinguishing between essential tremor and PD
30
Tremor worse on movement
``` Essential tremor Dystonic tremor Exaggerated physiological tremor Hyperthyroidism Dystonic tremors ```
31
Intention tremor
Cerebellum disorders.
32
Dementia with Lewy Bodies
Triad of dementia, Parkinsonism, visual hallucinations Fluctuations in alertness Shared care with psychiatry, neurology and geriatrics
33
Progressive supranuclear palsy
Early falls, truncate rigidity, vertical gaze palsy Reduction in midbrain volume on MRI Requires early speech and language review
34
Normal pressure hydrocephalus
Triad of dementia, gait disorder and bladder instability Diagnostic lumbar puncture and CSF removal then ventriculoperitoneal shunt
35
Three steps to diagnosing Parkinson’s disease
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
Treatment of Parkinson’s disease
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
What is the MUST score
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
Grading of ulcers
1 non blanchable erythema. Skin intact 2. Partial thickness loss- abrasion or clear blister 3. Full thickness skin loss. Sub cut fat may be visible 4. Muscle or bone or tendons exposed
39
How to prevent pressure ulcers
SKINS ``` support surface needs to be adequate Keep or moving Incontinence (manage) Nutrition and hydration Skin inspection to Detect early signs ```
40
How to identify stroke, in community and in A&E
Community - FAST | A&E- Rosier score
41
If stroke suspected, what should you do
CT ASAP to look fo signs of haemorrhage. CT angiography can also help. Take full history Thrombolysis alteplase if under 4.5 hours
42
Thrombolysis check list
Symptoms of acute stroke Onset in last 4.5 hours Measurable deficit on NIHSS Absence of haemorrhage on scan
43
Follow up after thrombolysis
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
Unilateral weakness of face, arm and leg Homonymous hemianopia Higher cerebral dysfunction - dysphasia
Total anterior circulation stroke
45
Two of : unilateral weakness of face, arm leg Homonymous hemianopia Higher cerebral dysfunction
Partial anterior circulation syndrome
46
One of: Unilateral weakness of face, arm leg Pure sensory stroke Ataxic hemiparesis And no evidence of higher cerebral dysfunction
Lacunae syndrome
47
One of Cerebellum or brainstem syndromes Loss of consciousness Isolated homonymous hemianopia
Posterior circulation syndrome
48
Risk factors for haemorrhagic stroke
``` Hypertension Cerebral amyloid angiopathy Aneurysms eg with poly cystic kidney disease Cerebral arteriovenous malformations Brain tumours ```
49
If TIA, what tool should be used to assess stroke risk
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
Following TIA, what makes a stroke highly likely
ABCD2 score of over 4 AF Multiple TIAs
51
DVLA And TIA
If normal driver Stop driving immediately No driving for four weeks No need to inform DVLA
52
DVLA and stroke
No driving for four weeks and must tell DVLA. after the four weeks, need reassessing
53
Differential for TIA
``` Syncope Atypical seizure Migraine Temporal arteritis Retinal haemorrhage or detachment Hypoglycaemia Labyrinthine disorders ```
54
Test ps after TIA diagnosis
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
If AF present with TIA..
Do CHADS2VASC and HASBLED to assess clot and bleeding risk
56
Headache, weakness in left side developed over 30 mins. Drowsy. FAST positive
Likely to be a haemorrhage. Still get CT
57
Risk factors for stroke
a HTN, peripheral vascular disease, ischaemia heart disease, smoking, diabetes , AF, combined pill, clotting disorders, vasculitis, carotid stenosis

MIND AND MOVEMENT (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions