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Older Patients > Conditions > Flashcards

Conditions Flashcards

1
Q

What are the two classification of falls?

A

-Syncopal and Non- syncopal

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2
Q

How would you take a history of a patient who has come in because of a fall?

A

-How did they fall?
-What were you doing before the fall?
-do you remember the fall?
-did you experience any cardiac symptoms at the time of the fall?
-Any loss of consciousness
-has this happened before?
-any weakness anywhere
-Any medications- sedatives
-how do they mobilise at home?

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3
Q

what examinations should you do on a patient who has had a recent fall?

A
  • CVS examination
    -ECG
  • MSK examination
    -Cranial nerve exam
    -lying and standing BP
    -Assess patients risk of osteoporosis- if they are over the age of 75- any fracture that is caused by minimal trauma- indicated osteoporosis- treat
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4
Q

Delirium V Dementia.

A

Delirium- this has a fluctuating course- and is acute onset-hypo- hyper active delirium
Dementia- has a more insidious onset and is gradual-

to differentiate between these two you need to use the 4AT test

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5
Q

What are the causes of Delirium?

A

Drugs
Encephalitis
Liver failure
Iv drugs
R
I
Urinary retention
M

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6
Q

What are the different types of dementia?

A

Lewy body- dementia- accompanied with hallucinations followed by parkinsons
Vascular- second most common- there is vascular disease
Alzheimers- This is insidious onset and is the most common
Parkinsons- starts off as motor problems then progresses into alzheimers
frontotemporal dementia- this is when there is dramatic behavioural change

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7
Q

What is the treatment for delirium?

A
  • first you treat the underlying cause
    -it can take up to 3 months for the patient to return to normal levels of functioning
    -then you can start them on medication
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8
Q

What is the treatment for dementia?

A

cholinesterase inhibitors
memantine

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9
Q

What are the types of incontinence?

A

stress incontinence
urge incontinence
OAB
functional incontinence
nocturnal incontinence

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10
Q

how to perform a complete continence examination?

A

-stop the caffeinated drinks
-Bowel habits
-full drug history
-ABDO exam
-Urine dipstick
-MSU
-PR exam- Prostate examinatio
-post mictruition scan
-External genitalia exam
-Bladder diary

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11
Q

What is the management for urinary incontinence?

A

-Pel-vic floor exercises
- changing drinking habits
-Changing diet
-CANNOT USE OXYBUTYNIN AND ANTICHOLINERGICS in older patients- this is because many drugs that stabilise the bladder can increase the risk of falls

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12
Q

What are the causes of faecal incontinence ?

A

As you age the anal sphincters ae not as good - because of chronic consitpation and haemorrhoids- THE RECTUM ALSO BECOMES MORE VACUOUS- also there is reduced intra abdominal pressure

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13
Q

What is faecal impaction?

A

This is when there is either hard or soft stool impacted into the rectum sometimes it can also be higher- if there are strong clinical signs of faecal impaction and the rectum is empty its probably impacted higher up.
Faecal impaction usually presents with constipation and then overflow diarrhoea

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14
Q

What is the treatment for faecal impaction?

A

-Soft stools- these can come out with stimulant laxatives and enemas
-Hard stools- these can come out using manual extraction ]

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15
Q

What are examinations you perfprm for faecal incontinence?

A

-ABDO exam
-Prostate exam
-Bladder exam- if the rectum is full there is an indication that the bladder will also be full
-any neurogenic dysfunction

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16
Q

What is the main complication of faecal impaction?

A

STERCORAL PERFORATION- this is when theres chronic impaction in the bowel and it starts exerting a pressure on the wall of the colon and it causes ischaemia and perforation

17
Q

What is the specific treatment for faecal impaction?

A

-If the stool isn’t in the rectum:
-oral laxatives- mix of stimulants and softner- senna and sodium docusate

18
Q

What is a red flag symptom in faecal incontinence- constipation?

A
  • this is when there is reduced anal tone and reduced sensation- suggests cauda equina- URGENT
19
Q

What are some red flag symptoms for Chronic diarrhoea?

A

-This would be weight loss, blood in stool, new change in bowel habit.

exclude FAECAL IMPACTION

20
Q

What is a transient ischaemic attack?

A

a blockage in a blood vessel causing neurological signs for less than 24 hours
ABCD2 score is a risk assessment measure used to determine if someone has an increased risk of stroke

21
Q

What is the treatment and management post TIA?

A

300mg Aspirin
-CT , blood tests
modify any risk factors- like hypertension, diabetes- maybe surgical intervention for carotid artery disease
-

22
Q

What is crescendo TIA? and how should it be managed?

A

it is when a patient has had repeated TIA- this patient should be treated as high risk for stroke

23
Q

What is a stroke?

A

This is when there is a sudden vascular event in the brain causing focal neurological signs which last more than 24 hours or with MRI signs of cerebral damage

24
Q

main classifcations for stroke

A

BRAMFORD
-FAST-
NIH- determines the prognosis?
-ROSIER SCALE (differentiating between stroke and mimic)
TOAST- this is for the underlying cause

25
Q

Types of stroke

A

PACS- partial anterior
TACS-total anterior- most severe
LACS-lacunar
POCS- posterior circulation

26
Q

What is the treatment for STROKE?

A

alteplase offered if stroke happened up to 4.5 hours ago
aspirin 300mg orally or enterally or rectum if dysphagic
-Patients who are neurologically stable and have carotic stenosis of 50-99% should according to NASCET be:
-offered surgery for carotic endarterectomy
-and undergo surgery within 2 weeks of symptoms of TIA or stroke - they MUST be fit to sit for surgery

27
Q

What should you do if a patient presents with middle cerebral infarction?

A

They are at risk of malignant middle cerebral artery syndrome- need urgent decompressive hemicraniotomy - if they are under 60 and CT scan suggestive of at least 50 % of MCA territory- and a MIHSS score equal to or more than 15

28
Q

What investigation do you have to do before starting a stroke patient on anti-coag?

A

-HAS-BLED AND CHADVASC

29
Q

What is malignant MCA syndrome?

A

This is when there is a MCA stroke which results in oedema and neurological deterioration.

30
Q

what is cardiac enderarterectomy?

A

This is when there is removal of the plaque within the artery

Older Patients (3 decks)

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