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COTE Flashcards

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1
Q

RF for pressure ulcers

A
  • Age
  • Immobility
  • malnourishment
  • Dehydration
  • Sensory impairment
  • obesity
  • Urinary/feacal incompitence
  • Reduced tissue perfusion
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2
Q

What are the geriatric giants?

A 
Immobility (falls) 
Instability, 
Impotence (confusion) 
Incontinence, 
Impaired intellect 
Iatrogenesis
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3
Q

What are the causes for delirium?

A 
Drugs  
Electrolyte imbalance 
Lack of drug 
Intracranial problems (stroke/TIA)  
Reduced sensory input 
Infections  
Urinary retnetion and fecal impaction 
Myocardial (MI/AF/arrhythmias)
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4
Q

What are the differences between dementia and delirium?

A

Dementia

  • Has a longer time frame months/years
  • Short term memory problems
  • Can also have problems with languages, remembering words and speech issues
  • Inattention
  • No underlying medical cause

Delirium

  • Shorter duration of symptoms days/weeks
  • Acute confusion
  • Altered levels of consciousness
  • Can have delusions
  • Due to another cause - infection usually
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5
Q

How could you try to prevent pressure ulcers?

A
  • Trying to mobilise quickly
  • Moving position regularly
  • Pressure redistributing marrress
  • Barrier creams
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6
Q

What treatments can you give to improve bone health?

A
  • VD replacement
  • Calcium supplements
  • Bisphosphonates - alendronate
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7
Q

Give 6 causes of falls in elderly people?

A
  • Postural hypotension (secondary to antihypertensives)
  • Dementia
  • Neuodegenerative diseases - Parkinsons and peripheral neuopathy
  • Hypoglycaemia
  • Poor environment - rugs/poo lighting
  • Visual impairment
  • Syncope (vasovagal, caridogenic and arrhythmias)
  • MSK (OA of the hip)
  • Medications (sedatives/alcohol)
  • Stroke/TIA
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8
Q

List 3 features of the tremor in Parkinson’s disease

A

Slow (pin-rolling)
Worse at rest
Asymmetrical
reduced on distraction/movement

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9
Q

A 78 year old man presents having had an episode of left leg weakness this afternoon. He has had a TIA
What score system could you use to estimate his risk of stroke in the next few days?

A 
ABCD2 
Age >60 = 1 
BP >140/90 = 1 
Clinical features: 
- Unilateral weakness = 2 
- Speech disturbance without weakness = 1 
Duration of symptoms 
- >1 hr = 2 
- 10-59m = 1 
Diabetes = 1
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10
Q

Explain the scoring system on the ABCD2 score

A

> 6 = 8.1% risk of stroke within2 days - 33% in the next week
4-5 = 4.1% risk
4 points should be seen by a specialist in 2 days
All suspected TIAs should be seen within 7 days

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11
Q

What is the immediate management of a ?TIA

A

ABCD score and see a specialist accordingly

Aspirin 300mg daily with PPI if required

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12
Q

What is the long term plan/secondary prevention for a person with a TIA?

A 
Lifestyle changes 
Clopidogrel 75mg daily 
Statin 
Antihypertensives if required 
Warfarin/NOACs if: AF, mitral stenosis, dilated cardiomyopathy or recent MI
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13
Q

Name 4 cardiac conditions that could cause an embolic CVA

A 
Atrial fibrillation
MI causing mural thrombus
Infective endocarditis
Aortic or mitral valve disease
Patent foramen ovale
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14
Q

You do a CT head on a patient who has had a CVA. What colour would the following be?
A) heamorrhage
B) Vascular occlusion

A

A) Heamorrhage = white on CT

B) Vascular occlusion = darker on CT

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15
Q

A patient who has had a CVA has had an ECG and CT head - what other Ix would you request?

A

Clotting screen - indicates risk of thrombosis or haemorrhage
Syphilis screen
Echo - excludes cardiac sources of emboli
Carotid doppler - excludes internal carotid stenosis

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16
Q

Explain how a person with Bradykinesia due to Parkinson’s disease would present

A

Slow, shuffling gait
Reduced arm swing
Difficulty initiating movement

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17
Q

A 57 year old man presents with a ‘shaking hand’, he also says he feels a bit slow at times but he is still managing fine at his work in a shop. You suspect that he has parkinsons. How would you treat this patient?

A

He is young and his symptoms are not having a significant impact on his life yet - wouldn’t treat yet.
If he got worse - start
- Dopamine agonist = Ropinirole, Bromocriptine

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18
Q

What are the SE of dopamine agonists?

A

Postural hyoptension
Impulse control problems
Hallucinations
Bromocriptine and cabergolline can cause pulmonary, retroperitoneal and cardiac fibrosis so require echo, ESR, creatinine, & CXR before initiation

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19
Q

What medication is Levodopa prescribed with to prevent the peripheral SE of dopamine?

A

Dopa decarboxylase inhibitor

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20
Q

If someone had a thomobotic stroke - where could the thrombosis be?

A

Carotid arteries

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21
Q

What are the risk factors for a stroke?

A

Age, HTN
Smoking, DM
HLD, AF

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22
Q

List some of the causes of hyponatriamia

A

Sodium loss: D&V, DM, Diuretic excess, Addisons, severe burns
Dilution effect: HF, SIADH, NSAIDs (promote water retention), organic renal failure

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23
Q

Give symptoms of hypocalcaemia

Study These Flashcards
A

Muscle cramps
Tetany
Carpopedal spasm (wrist flexion and fingers drawn together)
Paraesthesia (fingers/toes/around mouth)
Seizures
Long QT
(what would calcium do? - allows muscle relaxation)

24
Q

Give symptoms of hypercalcaemia

Study These Flashcards
A

BONES, STONES, MOANS, GROANS
Bone pain & fractures
Renal Stones - colic and impriment - polyuria, polydipsia, dehydration (nephrogenic diabetes insipidus)
Moans - drowsiness, delirium, impaired cognition
Groans - N&V&C, wt loss, abdo pain

Shot QT, HTN, Arrhythmias

25
Give examples of tests that can be used to screen for dementia
* Mini mental state exam (MMSE) * General Practitioner assessment of cognition (GPCOG) * 6 item cognitive impairment test (6CIT) * Abbreviated mental test score (AMT) * Montreal cognitive assessment (MoCA) * Addenbrookes cognitive examination III (ACE-III)
26
What score of the MMSE would support a dementia diagnosis?
<25
27
How would a person with frontotemporal dementia present?
``` Personality change Socially inappropriate behaviour Poor judgement Apathy and decreased motivation Poor exectutive function Insidious onset - 50s-60s ```
28
What are the symptoms of a person with levy body dementia?
``` Fluctuation cognition Visual hallucinations Neuroleptic sensitivity Shuffling gait Increased tone Tremors Falls ```
29
What are the symptoms of Alzheimers?
Memory loss Language deficits Impaired visuospatial skills Later behavioural symptoms
30
What bloods could you do to rule out organic causes of dementia?
TFT Syphilis LFT (hepatic encephalopathy and alcoholism) VB12 and thiamine and folate levels
31
Give examples of acetylcholinesterase inhibitors
Donepezil Rivastigmine Galantamine
32
Give an alternate medication that can be used in Alzheimers
Memantine, a N-methyl-D-aspartate (NMDA)-receptor antagonist which blocks glutamate
33
What does a comprehensive medical assessment include?
Comprehensive Geriatric Assessment includes: * Medical (problem list, comorbidities, medication review and nutritional screen) * Mental (cognition, mood & anxiety, fears) * Functional (ADL, gait & balance, activity/exercise) * Social and environmental (support from family/friends, social network, care resource eligibility, home safety and facilities, transport facilities)
34
What is delirium?
Acute fluctuating syndrome of disturbed consciousness, attention, cognition and perception
35
What are the two different types of delirium?
Hyperactive  agitation, inappropriate behaviour, hallucinations Hypoactive  lethargy, reduced concentration
36
O/E what are you looking for in a person with dementia?
Clinical examination - Respiratory conditions, for example chest infection, pulmonary embolus, heart failure, or chronic obstructive pulmonary disease. - Cardiovascular conditions, for example myocardial infarction and heart failure. - Abdominal conditions, for example acute abdomen, constipation, faecal loading (carry out a rectal exam if possible if impaction is suspected), urinary retention, and urinary tract infection. - Musculoskeletal conditions, for example hip fracture. - Neurological conditions, for example stroke, subdural haematoma, epilepsy, encephalitis, or drug intoxication. - Skin conditions, for example infection, pressure sores, or ulcers. - Electrolyte imbalance such as dehydration, acute kidney injury, hypercalcaemia, or hyponatraemia. - Endocrine and metabolic disorders such as cachexia, thiamine deficiency, or thyroid dysfunction. - Sensory impairment, for example impacted ear wax, ill-fitting or non-functioning hearing aids, and spectacles. - Pain — look for non-verbal signs of pain, particularly in people with communication difficulties.
37
Describe a comprehensive geriatric assessment
An interdisciplinary diagnostic process to determine the medical, psychological and functional capability of someone who is frail and old The aim is to develop a coordinated, integrated plan for treatment and long-term support
38
What would make some one high risk for a fracture?
``` Glucocorticoid therapy Age >75 Previous hip/vertebral fractures Further fractures on treatment High risk on FRAX scoring T score ```
39
How do bisphosphonates work?
MAO of bisphophonates: Incorporated into the bone matrix and accumulate in osteoclasts when they resorb bone. This inhibits the osteoclasts and causes apoptosis - protects bones by reducing the amount of bone resorption Osteoclasts: bone resorption Osteoblasts: bone formation
40
What are the long term SE of bisphosphonates?
oesophageal reactions: oesophagitis, oesophageal ulcers (especially alendronate) osteonecrosis of the jaw increased risk of atypical stress fractures of the proximal femoral shaft in patients taking alendronate
41
Explain the femoral neck T score
``` T score -1 to +1 = healthy -2.5 to -1 = osteopenia >-2.5 = osteoporosis >-2.5 + fracture = severe osteoporosis ```
42
What are the consequences of malnutrition?
``` Impaired immunity imparied wound healing muscle mass loss Impaired skin integrity Prolonged hospital stays ```
43
What does the assumptions and requirements does the mental capacity act have?
Assume capacity – person assumed to have capacity until proven otherwise Maximise decision-making capacity – all practical support to help a person make a decision should be given   Freedom to make seemingly unwise decisions – an apparently unwise decision in itself does not prove incapacity Best interests – all decisions taken on behalf of the person must be in their best interests   Least restrictive option – when making a decision on another person’s behalf, the alternative that achieves the necessary goal and interferes the least with the person’s rights and freedom of action must be chosen.
44
Assessment, 28 days, not renewable an Approved Mental Health Professional (AMHP) + 2 Dr’s One of the doctors should be 'approved' under Section 12(2) of the Mental Health Act + 1 Dr who knows the patient (GP) a) Section 4 b) Section 5(2) c) Section 5(4) d) Section 2 e) Section 3
Assessment, 28 days, not renewable an Approved Mental Health Professional (AMHP) + 2 Dr’s One of the doctors should be 'approved' under Section 12(2) of the Mental Health Act + 1 Dr who knows the patient (GP) = section 2
45
Similar to another section, allows a nurse to detain a patient who is voluntarily in hospital for 6 hours a) Section 4 b) Section 5(2) c) Section 5(4) d) Section 2 e) Section 3
``` Section 5(4) similar to section 5(2), allows a nurse to detain a patient who is voluntarily in hospital for 6 hours ```
46
72-hour assessment order used as an emergency, when a section 2 would involve an unacceptable delay a) Section 4 b) Section 5(2) c) Section 5(4) d) Section 2 e) Section 3
72-hour assessment order used as an emergency, when a section 2 would involve an unacceptable delay a) Section 4
47
Treatment for up to 6 months, can be renewed a) Section 4 b) Section 5(2) c) Section 5(4) d) Section 2 e) Section 3
Section 3
48
A patient who is a voluntary patient in hospital can be legally detained by a doctor for 72 hours a) Section 4 b) Section 5(2) c) Section 5(4) d) Section 2 e) Section 3
Section 5
49
A court order can be obtained to allow the police to break into a property to remove a person to a Place of Safety a) Section 135 b) Section 136
a) section 135
50
Someone found in a public place who appears to have a mental disorder can be taken by the police to a Place of Safety a) Section 135 b) Section 136
b) section 136
51
What should be considered when making a decision in someones best interests?
Whether the person is likely to regain capacity and can the decision wait How to encourage and optimise the participation of the person in the decision The past and present wishes, feelings, beliefs, values of the person and any other relevant factors Views of other relevant people
52
What is DOL?
DoL occurs when a person does not consent to care or treatment, for example, a person with dementia who is not free to leave a care home and lacks capacity to consent to this
53
What is lasting power of attorney?
“A document which a person can nominate someone else to make certain decision on their behalf (for example on finances, health and personal welfare) when they are unable to do so themselves”. To be valid, it needs to be registered with the Office of the Public Guardian
54
What is a Independent mental capacity advocate (IMCA)? What is their role?
Commissioned from independent organisations by the NHS and local authorities to ensure that MCA is being followed Role of IMCA: support and represent people who lack capacity and they do not have anyone else to represent them in decisions about changes in long-term accommodation or serious medical treatment. They can also be present for decisions regarding care reviews or adult protection.
55
Give examples of drugs that can cause delirium
``` BDZ NSAIDs Lithium TCA H2 blockers - ranitidine ```

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