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Phase 3A COPY > COTE Peer Teaching > Flashcards

COTE Peer Teaching Flashcards

1
Q

List 6 possible causes of falls in elderly people.

A
  • Drugs (sedatives, alcohol)
  • MSK eg. OA of hip
  • Syncope (vasovagal, cardiogenic, arrhythmias)
  • Stroke / TIA
  • Hypoglycaemia
  • Visual impairment
  • Dementia
  • Poor environment
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2
Q

What are the 3 main features of Parkinson’s?

A
  • Tremor
  • Bradykinesia
  • Rigidity (lead-pipe; cog wheel)
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3
Q

List 3 differential features of a Parkinsonian tremor.

A
  • Slow (pill-rolling)
  • Worse at rest
  • Asymmetrical
  • Reduced on distraction
  • Reduced on movement
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4
Q

What is the underlying pathophysiology of Parkinson’s?

A

Loss of dopaminergic neurons in the substantia nigra.

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5
Q

What class of drugs is normally combined with L-Dopa to prevent peripheral side effects? (re: Parkinson’s).

A

L - Dopa Decarboxylase inhibitor (Carbidopa or Benserazide)

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6
Q

Name 3 complications of L-dopa therapy (re: Parkinson’s patients).

A
  • Postural hypotension on starting treatment
  • Confusion
  • Hallucinations
  • L-dopa induced dyskinesias
  • On-off effect: fluctuations in motor performance between normal function (on) and restricted mobility (off).
  • Shortening duration of action of each dose (i.e. end-dose deterioration, where dyskinesias become more prominent at the end of the duration of action.
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7
Q

A patient presents with confusion. What should you ask about in their history?

A
  • Premorbid personality
  • PMHx
  • Medications
  • Social circumstances
  • Any past similar episodes
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8
Q

Describe ‘dementia’.

A
  • Chronic illness
  • Progressive course
  • Preserved attention
  • Consciousness preserved
  • Irreversible
  • No underlying medical cause
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9
Q

Describe ‘delirium’.

A
  • Acute onset
  • Fluctuating course
  • Inattention
  • Altered level of consciousness
  • Usually reversible
  • Associated with underlying medical cause
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10
Q

What causes delirium?

A

‘DELIRiUM’

  • Drug use (introduction, dose adjustments)
  • Electrolyte and physiological abnormalities
  • Lack of drug (withdrawal)
  • Infection
  • Reduced sensory input (blind, deaf, changing environment)
  • Intracranial problems (stroke, post-octal, meningitis, subdural haemorrhage)
  • Urinary retention + faecal impaction
  • Myocardial (MI, Arrhythmia, HF)
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11
Q

How would you manage a patient with delirium?

A
  • Treat the cause
  • Manage environment
  • Soft lighting
  • Clocks and calendars
  • Sleep hygiene (promote night time sleep)
  • Avoid multiple rooms / ward moves
  • Minimise provocation
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12
Q

Give a summary of ‘Vascular Dementia’.

A
  • Step-wise progression

- Caused by problems with the blood supply to brain

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13
Q

Give a summary of ‘Alzheimer’s Dementia’.

A
  • Most common type of dementia
  • Progressive
  • Loss of ability to learn, process and retain new information
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14
Q

What would a patient with Alzheimer’s’ brain look like on CT / MRI?

A

Atrophic :(

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15
Q

What is the pathophysiology of Alzheimer’s?

A
  • Neurofibrillary tangles
  • Loss of neurons
  • Aggregation of beta-amyloid plaques
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16
Q

What is the management for Alzheimer’s?

A
  • Supportive
  • AChE inhibitors
  • Memantine
17
Q

What is a ‘Comprehensive Geriatric Assessment’ designed to do?

A
  • Identify health problems + establish a management plan in older patients with frailty.
18
Q

What domains does a ‘Comprehensive Geriatric Assessment’ take into account?

A
  • Physical health
  • Mental health
  • Social aspects
  • Functional aspects
  • Environment
19
Q

Who might be involved in the Comprehensive Geriatric Assessment team?

A
  • Geriatrician
  • Nurses
  • Pharmacist
  • OT
  • Physio
  • SALT
  • Dietitian
  • Social worker
    etc
20
Q

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

A
  • Pressure ulcers
  • Dehydration
  • Rhabdomyolysis
21
Q

What investigations should you do if you suspect / see a pressure ulcer on admission?

A
  • CRP, ESR
  • WCC
  • Swabs
  • Blood cultures
  • X-ray for bone involvement
22
Q

How would you manage a pressure ulcer?

A
  • Antibiotics
  • Wound dressing
  • Pain relief
  • Debridement if grade 3/4
23
Q

Define ‘osteoporosis’.

A

Decreased bone mineral density due to imbalance between remodelling and resorption

24
Q

List some risk factors for osteoporosis.

A
  • Smoking
  • Early menopause
  • Steroid use
  • Underweight
  • Inactivity
  • Alcohol
  • ALL ELDERLY PEOPLE
25
Q

Which fractures are most common in people with osteoporosis?

A
  • Spinal
  • Hip
  • NOF
26
Q

How is osteoporosis diagnosed?

A

DEXA scan

27
Q

What does the ‘FRAX’ score assess?

A

The risk of a 10 year fragility fracture

28
Q

How is osteoporosis managed?

A

Bisphosphonates

29
Q

How might a patient present if they have Vitamin C deficiency?

A
  • Bleeding from gums

- Extensive bruising on legs (unrelated to falls)

30
Q

How might Vitamin C deficiency be managed?

A
  • Correct the deficiency -> MDT approach to malnourishment
31
Q

How is Nutritional Status assessed?

A
  • Using the ‘MUST’ screening tool

- > Malnutrition Universal Screening tool

32
Q

What is ‘Refeeding Syndrome’?

A
  • Metabolic disturbances as a result of reinstating nutrition to patients who are starved / severely malnourished.
33
Q

List some biochemical features of refeeding syndrome.

A
  • Hypophosphataemia
  • Hypokalaemia
  • Thiamine deficiency
  • Abnormal glucose metabolism
34
Q

List some complications of ‘Refeeding syndrome’.

A
  • Cardiac arrhythmias
  • Convulsions
  • Cardiac failure
35
Q

How should you manage / treat ‘Refeeding syndrome?’

A
  • Monitor blood biochemistry

- Commence re-feeding with guidelines

36
Q

What are the four ‘I’s of Geriatric Giants?

A
  • Immobility
  • Incontinence
  • Incompetence
  • Impaired homeostasis

Phase 3A COPY (19 decks)

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