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Phase 3a > COTE > Flashcards

COTE Flashcards

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1
Q

What medications might someone with IHD be on

A 
Aspirin
Colpodogrel
Statin
ACEi
B blocker
Nitrate 
CCB
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2
Q

Name 5 geriatric giants

A 
Falls
Incontinence 
Confusion
Urinary symps
Chest pain+ SOB
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3
Q

What is meant by deconditioning

A

Process of physiological change following a period of inactivity. It results in functional losses in areas such as mental status, abilities to accomplish ADL.

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4
Q

What are the 4 key areas of assessment in the GCA

A

Medical
Psychological
Functional
Social and environmental

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5
Q

Three drugs for OAB

A

Fesoterodine
Tolterodine
Oxybutanin

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6
Q

Tx for nocturia

A

Desmopressin

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7
Q

Tx of urgency incontinence

A

Bladder training

Avoid caffeine

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8
Q

Tx of stress incontinence

A

Wt loss
Decrease caffeine
Bladder diary
Pelvic floor exercises

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9
Q

What are the 4 types of incontinence

A
  • Stress incontinence I.e when sneezing
  • Functional (not GU)
  • overflow/ over active bladder (OAB) commonly with prostatic enlargement
  • urgency incontinence (bladder size shrinks)
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10
Q

Treatment of overflow incontinence in BPH

A

Finasteride (it raises PSA)

Tamulosin

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11
Q

Symptoms of overactive bladder

A

F- frequency
U-urgency
N- nocturia

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12
Q

Cardiovascular causes of falls

A

Carotid sinus hypersensitivity
Vasovagal hypersensitivity
Orthosatic hypoT
Arrhythmia

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13
Q

Non cardiac causes of falls in the elderly

A

Iatrogenic
Vision
Gait problems
Fear of falling

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14
Q

What medications commonly cause falls

A

Benzos, antipsychotics , antiepileptics, antidepressants, sedatices, antihypertensives, pain killers I.e. codiene.

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15
Q

What issues might older people have with exercise regimens ?

A

Cognitive impairment may hinder adherence

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16
Q

How might orthostatic hyperT be treated

A 
Medication review 
Hydration 
Salt intake 
Education / life style advice I.e. get up slow 
OT - home risk assessment I.e rugs
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17
Q

Side effects of an ACEi

A

Cough
Dizziness
Rash / red itchy skin

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18
Q

Side effects of thiazides diuretics

A

Dizziness/ lightheaded
Blurred vision
Loss of appetite
Upset tummy

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19
Q

Side effects of antibiotics

A

Diarrhoea
N&V
Bloating and indigestion

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20
Q

What blood would your order for a dementia screen

A 
LFT
TFT
Ca++
Glucose
FBC(anaemia)
B12
Folate
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21
Q

What are the different types of dementia

A

Alzheimer’s
Vascular/mixed
Dementia w/ lewybodies
Frontotemporal

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22
Q

What is the common clinical presentation of someone with vascular dementia

A

Step wise decline
Gait and balance problems +cog decline
Associated with microhaemorrhages + mini cortical strokes
Problem with retrieval not laying down memories

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23
Q

What is the common clinical presentation of Lewy body dementia

A

Parkinson plus’s syndrome
Hallucinations
Cog impairment

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24
Q

Common clinical presentation of frontotemporal dementia

A

Marked executive function decline -I.e. in planning

Often lack insight

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25
Name 4 cognitive assessment tools
MMSE MOCA 6cit GPCOG
26
Pathological features of Alzheimer’s
Cortical atrophy Intracellular NF tangles Extra cellular plaques Accumulation of beta amyloid peptide (due to degradation of APP)
27
Define dementia
Chronic progressive neurodegen’ disorder not a normal part of the aging process irreversible changes in brain pathology Characterised by memory loss and impairment to ADL.
28
Bio markers of AD
Hyperphos tau in CSF | Increased A-beta42
29
Diagnostic criteria for AD
Progressive decline in memory and functioning for 6months + Episodic memory test provides objective evidence
30
Alzheimer’s exclusion criteria
Gait problems (vascular) Hallucinations (Lewy body) Another medical condition can explain symps Sudden onset
31
AD mimics
Major depression. Severe cerebrovascular disease Metabolic disorders Other dementias
32
What speech change might you see in AD
Semantically empty speech Frequent intrusions Repetitive errors
33
What staging is used in AD
Braak staging for spread of amyloid pathology
34
What investigations would you do in AD | And what would they show
Bloods MRI- cortical atrophy PET- APP degradation and beta amyloid accumulation CSF sample - hyperphos tau Episodic memory test - freq intrusions + repetition errors
35
Medication for dementia
ACEi Rivastigmine Donepazil Galantamine Protection from excess glutamate = memantine
36
Two drug classes for treating Alzheimer’s
1) ACEI | 2) NMDA receptor antagonist
37
Name an NMDA receptor antagonist used to treat Alzheimer’s
Memantine
38
Causes of behavioural and psychological symptoms of dementia (BPSD)
“Pinch me” ``` Pain Infection Nutrition Constipation Hydration Medication Environment ```
39
Key feature of lewybody dementia
Visual hallucinations
40
Key features of CJD dementia
``` Rapid progression (weeks to months) Motor symps- eventually unable to move and speak Mood changes ```
41
Key features of Frontotemporal dementia
Personality changes I.e. Apathy, lack of empathy, reduced humour, impulsive
42
Key features of Alzheimer’s
``` Short term memory loss Forgetting names/ events/ conversations/ appointments Getting lost Losing items Word finding difficulties ``` Most common over 65
43
Key features of Parkinson dementia
Emotional liability | Must have had motor symptoms 1year prior
44
Key features of vascular dementia
Step wise deterioration Change in executive function I,e, planning Vascular history
45
Which two dementias should you not give antipsychotics in
Lewy body dementia | Parkinson dementia
46
SE of thiazide diuretics in elderly
Hyponatremia = orthostatic hypertension
47
Drug interactions to avoid
``` ACEI and allopurinol Thiazide diuretics and amiodarone Warfarin and clarithromycin Statins and grapefruit Methotrexate and trimethoprim ```
48
Complications post stroke
``` VTE Post stroke pain Malignancy MCA syndrome Seizures Aspiration pneumonia ```
49
What investigations might you do post stroke
USS Doppler carotids Echo ECG / 24hours tape MRI
50
What is the secondary prevention Tx for stroke in AF
Stop anticoagulants (doac/ warfarin) transiently, aspirin for 14 days, start back on anticoagulant
51
When can you give aspirin and clopidogrel post stroke
After 24hour CT following thrombolysis | Or straight away if no thrombolysis
52
What is the management plan for someone coming in via ambulance ? Stroke
``` CT head - no haemorrhage and under 4 hours = thrombolyse Statin 24hour CT Aspirin and clopi ```
53
Why is LMWH contraindicated in high risk strokes
Risk of haemorrhagic transformation
54
What is AF caused by MV pathology called
Valvular AF
55
treatment of ischemic stroke + DVT/PE
LMWH
56
Example of LMWH
Dalteparin
57
Example of DOAC
Apixaban / riveroxiban
58
Causes of parenchymal haemorrhagic stroke
Trauma Hypertension Malignancy
59
Management of parenchymal haemorrhagic stroke
Lower bp- labetalol Tranexamic acid Reverse anticoags (octaplex/ vitk) Refer to neurosurgeon
60
Cause of SAH
AVM | Berry aneurism
61
Investigations for SAH
CT angiogram LP ECG- inverted Twaves ?ischemia
62
Vasospasm tx
Nimlodipine

Phase 3a (7 decks)

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