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NV - Phase 3A > COTE > Flashcards

COTE Flashcards

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1
Q

Define frailty.

A

State of increased vulnerability resulting from age-ing associated decline in functional reserve, across multiple physiological systems, resulting in compromised ability to cope with everyday or acute stressors.

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2
Q

What are the 4 components of the comprehensive geriatric assessment?

A

Medical assessment
Functional assessment
Psychological assessment
Social and environmental assessment

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3
Q

What is the medical assessment comprised of?

A

Doctor, nurse, phrmacist, dietician, SALT

problem list, comorbidities, medication review, nutritional states

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4
Q

What is the functional assessment comprised of?

A

OT, PT, SALT

assesses ADLs, activity, exercise satus, gait, balance

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5
Q

What is the psychological assessment comprised of?

A

Doctor, nurse, OT, psychologist

cognitive status testing, mood/depression testing (PHQ-9 questionnaire)

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6
Q

What is the social and environmental assessment comprised of?

A

OT and social worker if needed

informal supprt needs and assets, care resource eligibility, home safety

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7
Q

What are the features of delirium?

A 
Acute onset
fluctuating course
inattention 
altered level of consciousness
usually reversible 
associated with underlying medical cause
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8
Q

What are the features of dementia?

A

Chornic illness
progressive course
no clouding of consciousness
no underlying/reversible cause

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9
Q

Name an assessment tool used for delirium.

A

4-AT

Mini Mental State Exam

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10
Q

What causes delirium?

A

PINCHES-ME

Pain
Infection
Nutrition
Constipation and urinary retention
Hydration
Endocrine and electrolytes
Stroke
Medication and alcohol 
Environmental
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11
Q

Name some ways in which the environment can be altered to help delirium.

A 
Clocks and calendars to maximise orientation
ensure hearing aids/glasses are worn
photos of family members
consistency of staff members
quiet bay/side room if possible
sleep hygiene
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12
Q

Who makes up the comprehensive geriatric assessment team?

A

geriatrician
social worker
physiotherapist
occupational therapist

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13
Q

What are the complications of a long lie following a fall?

A

pressure ulcers
dehydration
rhabdomyolysis
hypothermia

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14
Q

How are pressure ulcers managed?

A

antibiotics
wound dressing
pain relief
debridement if grade3/4

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15
Q

What is osteoporosis?

A

Decreased bone mineral density due to imbalance between remodelling and resorption.
Increased risk of fractures - esp spine, hip and NOF

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16
Q

What are the risk factors for osteoporosis?

A 
smoking
early menopause
steroid use
underweight
inactivity 
alcohol
all elderly people
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17
Q

How is osteoporosis managed?

A

bisphosphonates (zoledronate, alendronate)

can be given IV once a year
or oral once a wekk - on an empty stoach + sit upright for half an hour after as it can cause oesophagitis

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18
Q

What is a tool used to assess nutritional status?

A

MUST screening tool - malnutrition universal screening tool

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19
Q

What is re-feeing syndrome?

A

Metabolic disturbances as a result of reintroduction of nutrition to patients who are starved/severely malnourished

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20
Q

What are the biochemical features of refeeding syndrome?

A

hypophosphataemia
hypokalaemia
thiamine deficiency
abnormal glucose metabolism

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21
Q

What are some complications of re-feeding syndrome?

A

cardiac arrhythmias
coma
convulsions
cardiac failures

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22
Q

How is re-feeding syndrome treated?

A 
monitor blood biochemistry 
commence re-feeding with guidelines 
recognise electrolyte changes 
monitor glucose and Na levels 
supportive care
refer to nutritional support team/dietician
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23
Q

Name 3 treatments can that improve bone health.

A

bisphosphonates
vitamin D and calcium supplements
exercise - impact exercise like walking (not swimming)

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24
Q

What are some environmental causes of falls in elderly people?

A 
loose rugs
pets
furniture
unstable footwear
poor lighting
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25
What are some power/balance causes of falls in elderly people?
inactivity leading to muscle weakness dizziness/loss of balance/loss of proprioception (vertigo) Pain/MS - osteoarthritis previous fall leading to decreased confidence
26
What are soem cardiovascular causes of falls in elderly people?
``` vasovagal syncope (fainting) situational syncope - micturition (old men at night time) postural hypotension myocardial infarction arrhythmia dehydration/shock ```
27
What are some neurological causes of falls in elderly people?
``` stroke PD gait disturbance visual impairment peripheral neuropathy myopathy e.g. statin or steroid myopathy ```
28
What are some medications that increase risk of falls in elderly people?
``` benzodiazepines diuretics anti-hypertensives antidepressants antipsychotics polypharmacy ```
29
What are some other causes of falls in elderly people?
``` infection/sepsis delirium hypoglycaemia incontinence alcohol - intoxication, neuropathy, W-K ```
30
What are the 3 main features of Parkinson's disease?
bradykinesia rigidity resting tremor
31
List 3 differentiating features of a Parkinsonian tremor.
``` pill rolling worse at rest reduced on distraction reduced on movement worse on one side (asymmetrical) ```
32
What is the underlying pathophysiology of Parkinson's?
loss of dopaminergic neurones in the substantia nigra
33
What class of drug is normally combined with L-dopa therpay to prevent peripheral side-effects?
Carbidopa - a dopa-decarboxylase inhibitor.
34
Name 3 complications of L-dopa therapy.
``` choreiform movements - L-dopa induced dyskinesia tolerance to meds confusion hallucinations postural hypotension on starting tx ```
35
Name 4 cardiac conditions that may cause an embolic CVA.
``` atrial fibrillation infective endocarditis atrial-septal defect/patent foramen ovale mitral regurgitation aortic or mitral valve disease valve replacement ```
36
What investigations would you undertake in someone with a suspected ischaemic stroke?
``` CT head ECG Carotid artery doppler - check for carotid artery stenosis Lipid profile Clotting screen Echocardiogram ```
37
What ABCD2 score is considered "high risk" for a stroke and what should be done?
>= is high risk Aspirin 300mg daily stat specialist referral within 24 hours of onset of symptoms secondary prevention measures - statins, antihypertensives
38
What are the components of the GCS?
1. best eye opening response 2. best verbal response 3. best motor response (how well they localise pain)
39
List 4 causes of hyponatraemia.
dilutional effect - heart failure, SIADH, hypervolaemia, NSAIDs (promote water retention), oliguira renal failure Sodium loss - Addison's disease, diarrhoea and vomiting, osmotic diuresis (DM, diuretic excess), severe burns, diurteic stage of acute renal failure
40
Name 4 symptoms of hypocalcaemia.
``` muscle cramps/spasms tetany seizures paraesthesia carpopedal spasm laryngospasm, bronchospasm ```
41
Name 4 symptoms of hypercalcaemia.
Bones, stone, moans and groans. ``` bone pain, fractures renal stones colic, polyuria, polydipsia, dehydration drowsiness/coma muscle weakness depression nausea, vomiting, weight loss, anorexia constipation, abdo pain ```
42
What MMSE score supports a diagnosis of dementia?
<25
43
What cognitive tools can be used to assess dementia?
``` 4AT MMSE GP-COG Addenbrook'es 6-CIT AMT MOCA ```
44
Name 4 different types of dementia and their key features.
Alzheimer's - agnosia, apraxia, amnesia, aphasia, insidious onset and gradual progression Vascular dementia - stepwise progression following ischaemic brain injury Lewy Body dementia - sleep behaviour disroder, falls, impaired consciousness, visual hallucinations, Parkinsonism Frontotemporal dementia - memory fairly preserved, extreme personality changes and disinhibition
45
List 4 blood tests you would do to exclude treatable causes of dementia?
``` vitamin B12, thiamine and folate levels thyroid function FBC looking for anaemia syphilis serology (neurosyphilis) LFTs (hepatic encephalopathy, alcoholism) ```
46
What is Donepezil and what types of dementia can it be used to treat?
Acetylcholinesterase inhibitor (other examples are rivastigmine and galantamine) can only be used to treat Alzheimer's Alternative medication - NMDA-receptor antagonist - blocks glutamate (memantine)
47
What are the two subtypes of delirium?
Hyperactive --> agitated, inappropriate behaviour, hallucinations Hypoactive --> lethargy, reduced concentration
48
What bedside tests would you do for someone with delirium?
O2 sats BP Temperature ABG/VBG
49
What investigations would you do for someone with delirium?
``` FBC, U&E, LFT CRP/ESR Sputum culture Folate, B12 HbA1c TFT CXR, ECG, urinalysis ```
50
What is the guidance on long-term usage of bisphosphonates?
Treatment should be reassessed after 5 years - updated FRAX and DEXA ``` Keep treating if considered high risk: age >75 previous hip/vertebral fracture s further fractures on treatment high risk on frax score dexa scan T score ```
51
How do bisphosphonates work?
inhibition of osteoclasts
52
List 3 adverse effects of bisphosphonates.
oesophagitis osteonecrosis of the jaw increased risk of atypical stress fractures of the proximal femoral shaft in patients taking alendronate
53
How are DEXA scan score interpreted?
-1 to +1 = healthy -1 to -2.5 = osteopenia < -2.5 = osteoporosis < -2.5 and current fragility fracture = severe osteoporosis
54
What are the components of the FRAX scoring system?
``` parent hip fracture height and weight smoking alcohol >3 units a day steroids previous hip fracture femoral neck BMD female gender age RA secondary osteoporosis ```
55
How is malnutrition diagnosed?
BMI<18.5 unintentional weight loss >10% in last 3-6 months BMI<20 + unintentional weight loss >5% within 3-6 months
56
What are some clinical features of re-feeding syndrome?
CVS - arrhythmias GI - abdo pain, constipation, vomiting, anorexia MSK - weakness, myalgia, rhabdomyolysis, osteomalacia Resp - SOB, ventilator dependance, respiratory muscle weakness Neuro - weakness, paraesthesiae, ataxia Haematological - infections, thrombocytopenia, haemolysis, anaemia liver failure wernicke's encephalopathy
57
What is a lasting power of attorney?
A document which a person can use to nominate someone else to make certain decisions on their behalf when they are unable to do so themselves It can be financial/about estate or medical/health decisions To be valid it must be registered with the Office of the Public Guardian
58
What is the definition of postural hypotesion?
a drop of >20/10 mmHg within 3 minutes of standing
59
What are some causes of postural hypotension?
meds - diuretics, antihypertensives, antidepressants, polypharmacy cardiac - aortic stenosis, arrhythmias, MI, cardiomyopathy, CHF, anaemia endocrine - diabetes insipidus, hypoadrenalism, hypothyroid Neuro - PD and PD+ syndromes blood loss, dehydration, shock
60
What is the pharmacological management of postural hypotension?
fludrocortisone, midodrine
61
How are pressure ulcers classified?
Grade 1- non-blanching erythema with instact skin Grade 2 - partial thickness skin loss involving epidermis, dermis or both Grade 3 - extensive loss, destruction/necrosis of the muscle, bone or support structures
62
What is the role of vitamin D?
increase Ca2+ absorption in the gut increased Ca2+ release from the bone basically trying to get calcium into the blood, just like PTH hormone
63
Where is parathyroid hormone released from and what triggers its release?
Secreted from the chief cells of the parathyroid gland in response to low serum Ca2+ levels
64
What are 4 common sites for osteoporosis related fractures?
1. thoracic vertebrae - lead to kyphosis and loss of height 2. lumbar vertebrae 3. proximal femur 4. distal radius (Colles' fracture)
65
Give some examples of cortical and subcortical dementia.
cortical - Alzheimer's disease, Lewy Body dementia, frontotemporal dementia subcortical - PD dementia, Huntington's disease dementia, LBD, alcohol-related dementia, AIDS dementia
66
What are the typical symptoms of cortical dementia?
memory impairment dysphasia - language deficit visuospatial impairment - apraxia problem solving and reasoning deficit
67
What are the typical symptoms of subcortical dementia?
``` psychomotor slowing impaired memory retrieval depression apathy executive dysfunction personality change language preserved - unlike in cortical ```
68
Which 3 genes have been linked to the development of early onset Alzheimer's disease?
1. APP gene 2. Presenillin 1 3. Presenillin 2 autosomal dominant inheritance pattern
69
Which gene has been linked to late onset Alzheimer's disease?
Apolipoprotein E (ApoE)
70
Describe the macroscopic pathological changes seen on CT in Alzheimer's disease?
shrunken brain - diffuse cerebral atrophy increased sulcal widening enlarged ventricles
71
Describe the microscopic pathological changes seen in Alzheimer's disease.
neuronal loss neurofibrillary tangles amyloid plaques
72
Which neurotransmitters are affected in Alzheimer's?
acetylcholine noradrenaline serotonin somatostatin
73
What are the microscopic pathological features in frontotemporal dementia?
ubiquitin and tau deposits

NV - Phase 3A (7 decks)

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