Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Phase 3a > COTE > Flashcards

COTE Flashcards

1
Q

Define frailty

A

State of increased vulnerability resulting from age-associated decline in functional reserve

across multiple systems

resulting in compromised ability to cope with everyday or acute stressors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the 4 geriatric giants?

A
  1. instability (falls)
  2. immobility
  3. intellectual impairment
  4. incontinence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is a comprehensive geriatric assessment?

A

MDT diagnostic process

Identifies health problems and establishes management plans in older patients with frailty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the 4 components of the comprehensive geriatric assessment?

A
  1. medical assessment
  2. functional assessment
  3. psychological assessment
  4. social and environmental assessment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How do the onset, features and causes of delirium and dementia differ?

A

acute onset + fluctuating course
inattention + altered level of consciousness
usually reversible
associated with underlying medical cause

chronic illness + progressive course
no clouding of consciousness
no underlying/reversible cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What assessment tool is used for delirium?

A

4-AT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What causes delirium?

A

Drugs - changing dose/introducing new ones/polypharmacy
Electrolyte imbalances
Lack of drugs - withdrawal
Infection
Reduced sensory input - blind, deaf, changing environment
IC problems - stroke, seizures, haemorrhage
Urinary retention + faecal impaction
Myocardial problems - MI, arrhythmia

dehydration, B12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How is delirium managed?

A

treat underlying cause
manage the environment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
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
Sleep hygiene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How is confusion investigated?

A

bloods (FBC, U&Es, LFTs, TFTs, CRP/ESR, folate/B12, HbA1C) - possible causes of infection/delirium

ECG - exclude MI
urine dipstick - exclude UTI
CXR - exclude pneumonia
sputum culture

stool chart - constipation?
nutrition/hydration
maximise orientation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

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

A

pressure ulcers
dehydration
rhabdomyolysis
hypothermia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How do you investigate pressure ulcers?

A

CRP, ESR
WCC
swabs
blood cultures
x-ray for bone involvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How are pressure ulcers managed?

A

antibiotics
wound dressing
pain relief
debridement if grade 3/4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is osteoporosis?

A

decreased bone mineral density due to imbalance between remodelling and resorption
> increases bone fragility and susceptibility to fracture

T score

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Most common fracture sites?

A

spine
hip
NOF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

RFs for osteoporosis?

A

SHATTERED
Steroids
Hyperthyroidism
Alcohol/smoking
Thin (BMI<22)
Testosterone deficiency
Early menopause
Renal/liver failure
Erosive or inflammatory bone disease (RA, Ank spond)
Dietary Ca2+ deficiency

all elderly!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How is osteoporosis managed?

A

bisphosphonates - zoledronate, alendronate

can be given IV once/yr or oral once/wk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the issues with real bisphosphonates? What is there a risk of?

A

have to have them on an empty stomach (first thing in morning) and stay upright for half an hr after taking them
due to risk of oesophagitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What tool is used to assess nutritional status?

A

MUST (malnutrition universal screening tool)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is re-feeding syndrome?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the biochemical consequences of re-feeding syndrome?

A

hypophosphataemia
hypokalaemia
thiamine deficiency
abnormal glucose metabolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the potential consequences of re-feeding syndrome?

A

4C’s:
cardiac arrhythmias
coma
convulsions
cardiac failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How is re-feeding syndrome treated?

A

monitor electrolytes/glucose
commence re-feeding with guidelines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

RFs for pressure ulcers?

A

age
immobility for long periods e.g. fracture, hospital stay
peripheral vascular diseases
dehydration
malnourishment
obesity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
How can pressure ulcers be prevented?
mobilise change position pressure redistributing mattresses barrier creams regular skin assessment
26
Name 3 treatments to improve bone health?
bisphosphonates vitamin D + Ca supplements exercise - impact e.g. walking, not swimming
27
Causes of falls in elderly people?
- Drugs - medications, alcohol - MSK - OA, MS, previous fall and decreased confidence, muscle weakness due to inactivity - CVS - syncope (vasovagal, situational), postural hypotension, MI, arrhythmia, dehydration - Neurological - stroke, PD, gait disturbance, visual impairment, peripheral neuropathy, myopathy, vertigo - Infection/sepsis - Hypoglycaemia - Dementia/delirium - Incontinence - Poor environment
28
What medications can increase the risk of falls in the elderly?
benzos (sedative), ADs, antipsychotics anti-hypertensives - ACEi, CCB, beta-blockers + diuretics polypharmacy
29
3 main features of Parkinson's?
bradykinesia rigidity - lead-pipe, cog-wheel resting tremor
30
Differentiating features of a parkinsonian tremor?
Pill rolling Worse at rest but reduced on distraction or movement Worse on one side (asymmetrical)
31
What is the underlying pathophysiology of Parkinson's?
Loss of dopaminergic neurones in the substantia nigra
32
What class of drug is normally combined with L-dopa therapy to prevent peripheral side-effects in Parkinson's?
Carbidopa – a dopa-decarboxylase inhibitor
33
Complications of L-dopa therapy?
Dyskinesia End-dose deterioration
34
What cardiac conditions can cause an embolic CVA?
AF IE atrial-septal defect/patent foramen ovale aortic/mitral valve disease, valve replacement
35
How does an ischaemic stroke compare to a haemorrhage stroke on CT?
ischaemic = black haemorrhage = white
36
How is a CVA investigated?
ECG + CT head consider: carotid artery doppler lipid profile clotting screen echo
37
What ABCD2 score is considered “high risk” for a stroke and what should be done?
4+ = high risk Aspirin – 300mg daily – started immediately Specialist referral within 24 hours of onset of symptoms Secondary prevention measures (statins, antihypertensives)
38
What are crescendo TIAs? How should they be treated?
2+ episodes in a week treated as high risk regardless of ABCD2 score
39
What should be done for someone with an ABCD2 score of ≤ 3?
Specialist referral within 1 week of symptom onset, including decision or brain imaging
40
What are the components of the GCS?
best eye opening response best verbal response best motor repose - how well they localise pain
41
Causes of hyponatraemia?
Dilutional effect – HF, SIADH, hypervolaemia, NSAIDS, oliguria, renal failure Sodium loss – Addison’s disease, D&V, osmotic diuresis (DM, diuretic excess), severe burns, diuretic stage of acute renal failure
42
Sx of hypocalcaemia?
Muscle cramps/spasms Tetany - carpopedal spasm, laryngospasm, bronchospasm Seizures Parasthesia
43
Sx of hypercalcaemia?
BONES - bone pain, fractures, muscle weakness STONES - renal stones/colic, polyuria, polydipsia, dehydration PSYCHIATRIC MOANS - depression, drowsiness/coma ABDOMINAL GROANS - N&V, weight loss, anorexia, constipation, abdominal pain
44
What cognitive assessments are often used?
GP-COG Addenbrooke's 6-CIT AMT MOCA
45
Name the 4 types of dementia and their key features?
Alzheimer's - agnosia, apraxia, amnesia, aphasia vascular - stepwise progression following ischaemic brain injury LBD - sleep disorder, falls, impaired consciousness, visual hallucinations, parkinonism Frontotemporal – memory fairly preserved, extreme personality changes and disinhibition
46
What are the key blood test to exclude treatable causes of dementia?
vitamin B12, thiamine, folate TFTs FBC - anaemia syphilis serology LFTs - hepatic encephalopathy, alcoholism
47
How is Alzheimer's treated?
AChEi - donepezil, rivastigmine, galatamine = only for alzheimer's alternative: NMDA-receptor antagonist (blocks glutamate) > memantine
48
2 subtypes of delirium?
Hyperactive > agitated, inappropriate behaviour, hallucinations Hypoactive > lethargy, reduced concentration = often missed
49
RFs for delirium?
old age CI, sensory impairment frailty, multiple comorbities significant injuries e.g. hip # functional impairment terminal phase of illness hx of alcohol excess poor nutrition lack of stimulation
50
How does delirium present?
Acute behavioural change Disorganised thinking/altered perception Altered level of consciousness Falling Loss of appetite
51
What factors indicate a patient is at high risk of # and need to be treated with bisphosphonates?
on steroids age >75 previous hip/vertebral fractures further fractures on treatment high risk on FRAX score DEXA scan T score
52
What is the action of bisphosphonates?
inhibition of osteoclasts
53
3 adverse affects of bisphosphonates?
Oesophagitis Osteonecrosis of the jaw Increased risk of atypical stress fractures of the proximal femoral shaft (alendronate)
54
How are DEXA scan scores interpreted?
-1 to +1 = healthy - 1 to -2.5 = osteopenia ≤ -2.5 = osteoporosis ≤ 2.5 and a current fragility fracture = severe osteoporosis
55
What are the components of the FRAX scoring system?
Parent hip fracture Height and weight (BMI) Smoking Alcohol >3 units a day Steroids Previous hip fracture Femoral neck bone mineral density Female gender Age RA Secondary osteoporosis
56
How is malnutrition diagnosed?
BMI < 18.5 kg/m2 Unintentional weight loss >10% in the last 3-6 months BMI < 20kg/m2 plus unintentional weight loss >5% within the last 3-6months
57
Causes of malnutrition?
Inadequate nutritional intake (starvation) Increased nutrient requirements (cancer, sepsis, injury) Inability to utilise ingested nutrients (malabsorption) Increased loss (vomiting, diarrhoea)
58
What tests should be done before commencing feeds in a patient who is malnourished?
U&Es, LFTs ECG
59
Clinical features of re-feeding syndrome?
CVS – arrythymias GI – abdo pain, constipation, vomiting, anorexia MSK – weakness, myalgia, rhabdomyelosis, osteomalacia Resp - SOB, ventilator dependence, respiratory muscle weakness Neuro – weakness, paraesthesia, ataxia Metabolic – infections, thrombocytopenia, haemolysis, anaemia Other – liver failure, Wernicke’s encephalopathy
60
When looking at best interests in a pt without capacity, what needs to be considered?
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 and values of the person and any other relevant factors Views of other relevant people (family members etc.)
61
What is the role of an advanced directive?
Allows people who understand the implications of their choices to state their treatment wishes in advance They can authorise specific procedures or refuse treatment in a predefined future situation
62
What makes an advanced refusal of treatment legally binding?
The person is an adult The person was competent and fully informed when making the decision The decision is clearly applicable to current circumstances There is no reason to believe that they have since changed their mind
63
What factors make an advanced directive less legally binding?
an advanced REQUEST for treatment - does not have same legal binding as a refusal but if it's pt's known wishes to be kept alive then reasonable efforts should be made
64
What is deprivation of liberty?
Occurs when a person does not consent to care or treatment e.g. pt with dementia who is not free to leave a care home and lacks capacity to consent to this
65
What is a LPoA?
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 Can be financial/about estate, or medical/health decisions To be valid – needs to be registered with the Office of the Public Guardian
66
What is the role of an independent mental capacity advocate?
Commissioned from independent organisations by the NHS/local authorities to ensure the MCA is being followed Support/represent its who lack capacity and do not have anyone else to represent them in decisions
67
Definition of postural hypotension?
A drop of >20/10 mmHg within 3 minutes of standing
68
Causes of postural hypotension?
Medications – diuretics, antihypertensives, antidepressants, polypharmacy Cardiac – aortic stenosis, arrythmias, MI, cardiomyopathy, CHF, anaemia Endocrine – diabetes insipidus, hypoadrenalism, hypothyroid, hypo anything.. Neuro – PD and PD+ syndromes Blood loss, dehydration, shock
69
How does postural hypotension present?
Asymptomatic Falls/syncope Dizziness, light-headedness Blurred vision Weakness, fatigue Palpitations Headache
70
How is postural hypotension investigated?
Lying and standing blood pressure Investigate for medical causes – medication review, blood tests
71
How is postural hypotension managed?
drink lots of water, avoid large meals and alcohol exercises stand slowly, sleep with head raised fludrocortisone, midodrine (autonomic dysfunction only)
72
How are pressure ulcers classified?
Grade 1 – non-blanching erythema with intact skin Grade 2 – partial thickness skin loss involving epidermis, dermis or both (abrasion/blister) Grade 3 – full-thickness skin loss involving damage/necrosis of sub-cut tissue Grade 4 – extensive loss, destruction/necrosis of muscle, bone or support structures Unstageable – depth unknown, base of ulcer covered by debris
73
What are the 2 major metabolic components of Ca homeostasis?
vitamin D PTH
74
What is the role of vit D?
increased Ca absorption in the gut increase Ca release from bone
75
Where is PTH realised and by what trigger?
Secreted from the chief cells of the PT gland In response to low serum Ca2+ levels (detected by calcium sensor cells in the PT glands)
76
What are the actions of PTH?
= increases Ca levels increases osteoclast activity increases intestinal Ca absorption increases vit D activation increases renal tubule re-absorption of Ca
77
4 common sites for osteoporosis related fractures?
thoracic vertebrae > kyphosis, loss of height lumbar vertebrae proximal femur distal radius - Colle's fracture
78
How would you investigate someone with suspected osteoporosis?
DEXA scan: T value
79
Why does urinary incontinence happen in old age?
urethral atrophy pelvic floor atrophy prostatic hypertrophy
80
What are the reversible and treatable causes of urinary incontinence?
reversible: - UTI - delirium - DMT2 - diuretics Treatable: - BPH - overactive bladder - stress incontinence
81
How should urinary incontinence be managed?
Depends on cause - overactive bladder > antimuscarinics + bladder retraining - dementia > regular toileting - stress incont. > pelvic floor exercises - BPH > antiandrogens, surgery - hypotonic bladder - intermittent catheter catheters
82
What can be given to treat nocturia?
desmopressin (careful in >65 > hypoNa+) drainage sheath
83
How should faecal incontinence caused by constipation/bowel obstruction be managed?
rehydration small + regular meals enema 2x daily until empty colonic washout laxatives - lactulose, senn, movicol
84
How is neurogenic faecal incontinence managed?
planned evacuation - loperamide then phosphate enema 2x/wk regular toileting + suppository
85
What is Paget's disease? What is the pathophysiology?
excessive bone turnover due to excessive activity of osteoblasts + clasts > patchy areas of high density (sclerosis) and low density (lysis) > enlarged and misshapen bones with structural problems mostly in axial skeleton
86
How does Paget's disease present?
bone pain + deformity fractures hearing loss
87
How does Paget's present on x-ray?
bone enlargement and deformity OP circumscripta - osteolytic lesions that appear less dense cotton wool appearance of skull - patchy areas of sclerosis and lysis v shaped defects in long bones - v shaped osteolytic bone lesions within healthy bone
88
How is Paget's detected on blood results?
raised ALP but normal LFTs normal Ca + P
89
How is Paget's managed?
bisphosphonates NSAIDs Ca + Vit D
90
What are the 2 key complications of paget's?
osteogenic sarcoma spinal stenosis + spinal cord compression - deformity in spine leads to narrowing + presses on nerves
91
Which tool can be used to assess frailty status?
PRISMA-7

Phase 3a (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions