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Ageing and Complex Health Flashcards

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1
Q

What tool can be used to estimate risk of fractures

A

FRAX tool - estimates 10 year fracture risk and guides whether or not to initiate treatment

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2
Q

Treatment for osteoporosis

A

Bisphosphonate - Alendronic acid 70mg once weekly

Calcium and Vitamin D supplements

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3
Q

Risk factors for osteoporosis

A 
Female
Small/thin
Menopause
Inactivity
Smoking
Alcohol
Steroids
Low Ca/VitD
White/Asian
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4
Q

What mneumonic can be used to categorise causes of falls

A 
DAME
D - drugs
A - ageing 
M - medical
E - environmental
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5
Q

Medications that can increase the risk of falls

A 
Polypharmacy
Anti-hypertensives
Sedatives
Opioids
Psychotropics
Anti-hyperglycaemics
Alcohol
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6
Q

What ageing-related changes can increase risk of falls

A 
Vision deterioration
Cognitive decline
Abnormal gait
OA
Decreased baroreceptor sensitivity
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7
Q

Which medical conditions can increase the risk of falls

A 
Hypotension
Postural hypotension
Arrhythmias
Parkinson's disease
Stroke
Neuropathy
Cataracts
Epilepsy
BPPV
UTI/infection
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8
Q

What environmental causes of falls could you ask patients about

A

Walking aids
Footwear
Home hazards

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9
Q

Elderly patients who get dizzy when looking up indicates what pathology

A

Vertebrobasilar insufficiency

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10
Q

Peripheral (ear) causes of vertigo

A

Benign paroxysmal positional vertigo (BPPV)
Menieres disease
Vestibular neuritis
Acoustic neuroma/vestibular schwannoma

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11
Q

Central (neuro) causes of vertigo

A

Migraine
Brainstem ischamia
Cerebellar stroke
Multiple sclerosis

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12
Q

What test is used to diagnose BPPV

A

Dix-hallpike manoeuvre

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13
Q

What is used to treat BPPV

A

Epley manoeuvre

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14
Q

Typical history of BPPV

A

Short spells of vertigo (5-30 seconds), settle spontaneously, happen with head movement and lying down

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15
Q

Typical history of menieres disease

A

Intermittent attacks of vertigo, fluctuating hearing loss, fluctuating tinnitus
Get symptoms before the attack and vomiting

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16
Q

What causes menieres disease

A

Increased pressure in the inner ear

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17
Q

Difference in symptoms between vestibular neuronitis and labyrinthitis

A

People with labyrinthitis also get hearing loss and tinnitus

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18
Q

Symptoms of both vestibular neuronitis and labyrinthitis

A

Usually following URTI/viral illness
Sudden severe vertigo
Nausea and vomiting
Balance and concentration difficulties

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19
Q

The labyrinth (inner ear) contains what two main structures

A 
Cochlea
Vestibular system (semicircular canals)
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20
Q

Acoustic neuroma symptoms

A

Unilateral hearing loss
Tinnitus
Vertigo
Headache

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21
Q

What is an acoustic neuroma

A

Benign tumour of the vestibulocochlear nerve

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22
Q

BP drop needed to diagnose postural hypotension

A 
Systolic drop of 20+
OR
Diastolic drop of 10+
OR 
Systolic drops to < 90
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23
Q

Bedside investigations for a fall

A 
Obs - HR, BP, RR, Sats, Temp
Lying + standing BP
Urine dip
ECG
Cognitive screening - e.g. AMT
BM
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24
Q

Differentials for confusion

A 
Delirium
Stroke
TIA
SOL
Cerebral bleed
Dementia
Constipation
Dehydration
Recent surgery
Environmental
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25
Causes of delirium
``` Dehydration Electrolyte disturbances Infection - UTI, pneumonia Urinary retention Constipation Medication/drug toxicity or withdrawal Lack of sleep Hypoglycaemia Stroke/subdural haemorrhage Hypoxic states ```
26
Definition of delirium
Acute onset of disturbed consciousness/cognitive function/perception that has a fluctuating course
27
What are the 3 types of delirium
Hyperactive Hypoactive Mixed
28
Management of delirium
``` Treat underlying cause Reassurance Reorientation to their environment Calm Establish normal sleeping pattern Close monitoring ```
29
What questions are asked in the AMT 4 (abbreviated mental test 4)
Age DOB Current year Current location
30
What are the 4 components of the 4 AT test
Alertness AMT 4 - age, DOB, year, location Attention - name the months backwards Acute + fluctuating course
31
What are the 4 components of CAM (confusion assessment method)
Acute onset + fluctuating course Inattention/counting backwards Disorganised thinking/incoherent Altered level of consciousness
32
Which lobe of the brain contains brocas area
Frontal lobe
33
What is brocas area responsible for
Language production
34
Which lobe of the brain contains Wernicke's area
Temporal lobe
35
What is Wernicke's area responsible for
Language comprehension
36
The ACA supplies which part of the brain
Frontal and parasaggital region
37
The MCA supplies which part of the brain
Lateral part of the frontal and parietal lobe, superior temporal lobe
38
The PCA supplies which part of the brain
Occipital lobe, inferior temporal lobe, thalamus
39
Signs of an MCA stroke in the dominant hemisphere (left in most people)
Brocas/Wernickes/conduction aphasia
40
Signs of an MCA stroke in the non-dominant hemisphere (right in most people)
Hemineglect to the contralateral side (left)
41
Is the leg or arm more affected in an ACA stroke
Leg
42
What visual defect is caused by a PCA stroke
Homonymous hemianopia with macula sparing
43
Which parts of the brain do the vertebrobasilar arteries supply
Brainstem | Cerebellum
44
Which parts of the brain do the lacunar arteries supply
Basal ganglia Internal capsule Thalamus Pons
45
Risk factors for ischaemic stroke
``` HTN DM IHD Smoking Carotid stenosis AF Polycythaemia Sickle cell Thrombophilia ```
46
Risk factors for haemorrhagic stroke
``` HTN Aneurysms AV malformations Vascular brain tumours Anticoagulation Alcohol Smoking Stress ```
47
What is the NIHSS
National Institute of Health Stroke Scale - scores stroke severity and monitors improvement
48
The Oxford Stroke Classification applies only to which type of stroke
Ischaemic
49
Criteria for a TACS (total anterior circulation stroke)
ALL OF: Unilateral weakness/decreased sensation of face, arm, leg Homonymous hemianopia Higher cerebral dysfunction - dysphasia, visuospatial disorder
50
Criteria for a PACS (partial anterior circulation stroke)
TWO OF: Unilateral weakness/decreased sensation of face, arm, leg Homonymous hemianopia Higher cerebral dysfunction - dysphasia, visuospatial disorder
51
Criteria for a LACS (lacunar stroke)
``` ONE OF: Unilateral weakness +/- sensory deficit - arm/leg+arm/al 3 Pure sensory/motor/mixed Ataxic hemiparesis WITH NO HIGHER CEREBRAL DYSFUNCTION ```
52
Criteria for a POCS (posterior circulation stroke)
ONE OF: Cranial nerve palsy + contralateral decreased motor/sensation Bilateral decreased motor/sensation Conjugate eye movement - horizontal gaze palsy Cerebellar dysfunction - vertigo, nystagmus, ataxia Isolated homonymous hemianopia
53
Name some stroke mimics
``` Seizure Sepsis Hypoglycaemia Bell's palsy Migraine MS SOL Transverse myelitis/cord disease MND Polyneuropathies ```
54
What is the window for thrombolysis following an ischaemic stroke
Within 4.5 hours from symptom onset
55
Which medication is used in post-stroke thrombolysis
Alteplase
56
Which stroke patients do we start on anticoagulants
Those with AF
57
What is dysarthria
Unclear articulation of speech
58
What is expressive aphasia
They know what they want to say but they can't say it
59
What is receptive aphasia
Their words are incomprehensible but they are unaware of it
60
Changes to speech in patients with MS
Slurred/scanning/staccato speech
61
Changes to speech in patients with Parkinson's disease
Dysrhythmic, monotonous
62
Describe Wernicke's aphasia
General comprehension deficits, word retrieval deficits, semantic paraphrasias, semantic content of language damaged but production in tact. Speech is fluent but lacks content. Patients lack awareness of their speech difficulties.
63
Describe Broca's aphasia
Deficits in speech production, rhythm + syntactic comprehension. Speech is slow and halting but with good semantic content. Comprehension usually good. Patients are aware of their language difficulties.
64
Describe conduction aphasia
Normal speech production and comprehension but impaired ability to repeat words
65
TIA definition
Acute onset of focal neuro dysfunction related to a vascular territory that leave no permanent damage, symptoms often improved before they even have time to present. <24 hours to complete recovery
66
Definition of crescendo TIA
2 or more episodes in one week
67
What does the ABCD2 score assess
Risk of stroke within 2 days following a TIA
68
TIA differentials
Stroke Migraine Ophthal causes of vision loss - retinal haemorrhage, retinal detachment Hypoglycaemia Atypical seizures Inner ear disorders can mimic posterior circulation TIA
69
What does the CHADSVASc score assess
Risk of stroke in AF patients
70
Causes of TIA
Embolus - carotids, heart Vasculitis Infective endocarditis
71
Risk factors for TIA
``` Carotid stenosis HTN DM IHD Smoking AF Polycythaemia Thrombophilias ```
72
What is the definition of malnutrition
A state of nutrition in which deficiency or excess of energy, protein and other nutrients causes measurable adverse effects on tissue or body form or function and clinical outcome
73
Causes of oropharyngeal dysphagia
Neuro - stroke, MS, trauma, tumour Infectious - mucositis from chemo, candida Muscular - myasthenia gravis, dermatomyositis Structural - cricopharyngeal stricture, pharyngeal pouches, oropharyngeal tumour
74
Causes of oesophageal dysphagia
``` Function Achalasia Motility disorders - stroke, muscular disease Tumour Oesophagitis Stricture/rings/webs Mediastinal mass ```
75
Causes of malnutrition
Increased needs - surgery, illness Increased loss - D+V, fever, wounds, burns Decreased intake - appetite, dysphagia, practical issues
76
What score can be used to assess for malnutrition
MUST score
77
What 3 main things does the MUST score take into account
BMI Unplanned weight loss Acute illness/no intake for 5 days
78
A MUST score of ? is managed by observation and encouragement
1
79
A MUST score of ? is managed by treatment +/- dietician referral
2+
80
TPN is given via which vessel
Central SVC line
81
PPN (partial parenteral nutrition) is given via which vessel
A peripheral venous line
82
5 main feeding tube options
``` Nasogastric Nasoduodenal Nasojejunal Gastrostomy Jejunostomy ```
83
Common indications for parenteral nutrition
Mechanical dysphagia Neurological dysphagia Global neurological deficits Increased nutritional requirements - e.g. malabsorption states such as CF or Crohn's disease
84
How can you check the positioning of an NG tube
Aspirate stomach fluid and check pH with litmus | X-ray
85
What are the 4 grades of pressure ulcers
1 - skin intact but erythematous 2 - partial thickness skin loss 3 - full thickness skin loss 4 - destruction of underlying muscle/bone/fascia
86
Risk factors for pressure ulcers
``` Decrease mobility Decreased circulation Poor nutrition DM Smokers High or low BMI Medical equipment in prolonged contact with skin ```
87
Areas at high risk of pressure ulcers
Heels, hips, buttocks, elbows, back of head
88
What is continuing health care
Arrangement for free care outside of the hospital - arranged and funded by the NHS
89
What are the 3 main types of care home
Residential - personal care only Nursing - personal and nursing care Specialist care home for dementia - only if prominent behavioural/pscyh disorders associated with their dementia
90
What are the 6 categories of elder abuse
``` Physical Financial Psychological Sexual Discriminatory Neglect/acts of omission ```
91
What are the 4 categories of risk factors for abuse
The victim The perpetrator The relationship Environmental
92
What is pharmacodynamics
What the drug does to the body
93
What is pharmacokinetics
What the body does to the drug
94
What 4 main processes are involved in pharmacokinetics
Absorption Distribution Metabolism Excretion
95
What is the definition of polypharmacy
5+ drugs
96
Examples of prescribing cascades
Codeine - constipation - senna Amlodipine - oedema - diuretic Statin - muscle pain - analgesia
97
What tool can be used in medication reviews
STOPP/START toolkit
98
Lewy bodies are made up of which protein
alpha-synuclein protein
99
Patho of Parkinson's disease
Lose of dopaminergic neurones in the substantia nigra and lewy body build up --> decreased dopamine delivery to the basal ganglia --> decreased excitatory input to cortical areas of motor control
100
Symptoms in the Parkinsonism triad (+ pentad)
1. Resting tremor 2. Bradykinesia 3. Rigidity 4. Postural/gait instability
101
Differentials for tremor
``` Parkinsonism Essential Cerebellar Hyperthyroidism Medication induced Flapping Alcohol withdrawal ```
102
Character of parkinson's disease tremor
Fine, unilateral/asymmetrical, worse at rest
103
Character of essential tremor
Coarse, worse on movement, improved by alcohol, often FH
104
Character of cerebellar tremor
Intention tremor
105
What causes a tremor that is worse on movement
Essential Hyperthyroidism Medication induced
106
Causes of a flapping tremor
Liver disease | CO2 retention
107
Differentials for Parkinonsim
Idiopathic PD Vascular parkinsonism Lewy body dementia Medication induced - antipsychotics, metoclopramide MSA - multisystem atrophy (early autonomic features) PSP - progressive supranuclear palsy Normal pressure hydrocephalus
108
Motor features of Parkinson's disease
``` Bradykinesia Akinesia (freezing) Resting tremor Pin rolling tremor Micrographia Low blink rate Hypophonia Parkinsonian gait Rigidity Normal reflexes Difficulty turning in bed Decreased facial expression ```
109
Describe a Parkinsonian gait
Stooped posture Shuffling Reduced arm swing
110
Non-motor features of Parkinson's disease
``` Constipation Urinary urgency Uncontrolled saliva production Swallowing difficulties Back pain Poor sleep Vivid dreams/nightmares Short term memory and recall loss Anxiety Depression ```
111
How can you elicit bradykinesia in a patient with PD
Ask them to repeatedly pinch their fingers together or tap their foot
112
How can you elicit/exaggerate tremor in a patient with PD
Ask them to move their other arm up and down repeatedly
113
Which two enzymes break down dopamine in the synapse
MAO (monoaminde oxidase) | COMT (catechol-o-methyltransferase)
114
Which enzyme breaks down dopamine in the periphery
DOPA Decarboxylase
115
Name of a DOPA decarboxylase inhibitor
Carbidopa | Benserazide
116
Name of a COMT inhibitor
Entecapone
117
Name of an MAO inhibitor
Rasagaline
118
How do we treat essential tremor
Beta-blockers
119
2 problems that can occur after having use levodopa/Parkinon's meds for a long time
On-off phenomena | Peak dose dyskinesias

Finals (32 decks)

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