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3a PTS - PM - ZTF > General Med/Geriatrics > Flashcards

General Med/Geriatrics Flashcards

(67 cards)

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1
Q

Definition of postural (orthostatic) hypotension

A

Systolic drop of at least 20 mmHg or a diastolic drop of at least 10 mmHg when going from sitting/lying to standing after 3 minutes of standing

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2
Q

Treatment options for orthostatic hypotension

A

Midodrine and Fludrocortisone

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3
Q

Factors favouring a non-epileptic attack (pseudoseizure) vs syncope or epilepsy

A

Gradual onset but sudden drop to floor
Arms flexing and extending, pelvic thrusting
Prolonged seizures (often >30 minutes)
Symptoms wax and wane
Much more common in females
Crying after seizure

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4
Q

2 factors favouring true epileptic seizures vs pseudoseizures

A

Tongue biting
Raised serum prolactin

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5
Q

Aortic dissection definition

A

Tear in the tunica intima of the wall of the aorta

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6
Q

Single biggest risk factor for aortic dissection

A

Hypertension

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7
Q

Associative symptoms of type A aortic dissection vs type B aortic dissection

A

Type A (originates in ascending aorta): chest pain
Type B (descending aorta): upper back pain

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8
Q

Type of chest/back pain felt in aortic dissection

A

Typically severe and ‘sharp, ‘tearing’ in nature’
Maximal at onset (DDx from myocardial infarction which has a build in intensity)

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9
Q

Pulse featured changes in aortic dissection (2)

A
  1. weak or absent carotid, brachial or femoral pulse
  2. variation (> 20) in systolic BP between arms
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10
Q

Aortic dissection investigations

A

Chest X-ray: widened mediastinum
CT angiography (gold-standard): false lumen
TOE: useful in unstable patients

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11
Q

Risk factors for DVT / PE

A

Immobility
Recent surgery
Long-haul travel
Pregnancy
Hormone therapy with oestrogen (COC / HRT)
Malignancy

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12
Q

VTE prophylaxis options and contraindications

A
  1. LMWH e.g. enoxaparin / deltaparin
    - contraindications: warfarin / DOAC
  2. Anti-embolic compression stockings
    - contraindications: PAD

Provoked: 3 months
Unprovoked: 6 months

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13
Q

Scoring system used to assess risk of PE

A

Wells score (risk factors e.g. recent surgery and clinical findings e.g. HR above 100 + haemoptysis)

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14
Q

4 symptoms of pulmonary embolism

A

SOB
Cough
Haemoptysis
Pleuritic chest pain

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15
Q

ABG results of pulmonary embolism

A

Respiratory alkalosis: low O2 causes raised respiratory rate which blows off extra CO2 = alkalosis / type 1 respiratory failure

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16
Q

Outcome of Wells score/Management of PE

A

Likely: perform CT pulmonary angiogram
Unlikely: perform a d-dimmer and if positive perform CTPA

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17
Q

Clinical signs PE

A

Tachycardia + tachypnoea with clear chest

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18
Q

1st line treatment PE with haemodynamic instability

A

Thrombolysis

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19
Q

2 most common causes of pericarditis

A

Idiopathic
Viral infection (HIV, CSV, EBV)

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20
Q

2 key presenting features of pericarditis

A

Pleuritic chest pain (often relieved by sitting forwards)
Low grade fever

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21
Q

Key auscultation finding in pericarditis

A

Pericardial friction rub (rubbing, scratching sound)

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22
Q

Investigation findings in pericarditis (bloods, ecg, echo)

A

Blood tests: raised inflammatory markers (WCC, CRP, ESR)
ECG: saddle-shaped ST-elevation, PR depression
Echo: can be used to diagnose pericardial effusion

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23
Q

Management of pericarditis

A

1st line: NSAIDs (aspirin or ibuprofen)

+ Colchicine (taken longer term to reduce risk of recurrence or symptoms beyond 14 days)

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24
Q

Treatment of paracetamol overdose and MOA

A

N-acetylcystine replenishes glutathione stores so that NAPQI can be converted to a less toxic product, preventing hepatocyte damage

within 8 hours of ingestion
divided into 3 consecutive IV infusions

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25
Time frame when activated charcoal can be used in paracetamol overdose management
Within 1 hour
26
Risk factors for hepatotoxicity outcome in paracetamol overdose
Chronic alcohol user HIV Anorexia P450 inducer drugs
27
Heparin overdose management in cases such as significant haemorrhage
Protamine sulphate *fully effective against unfractionated heparin and partially effective against LMWH*
28
LMWH MOA
Activates antithrombin III which inhibits factor Xa
29
B12 absorption
Binds to instrinsic factor (secreted from parietal cells in the stomach) Actively absorbed in the terminal ileum
30
3 causes of B12 deficiency
Pernicious anaemia (most common cause) - lack of intrinsic factor Vegan diet Crohn’s disease: either disease activity or following ileocaecal resection
31
B12 deficiency causes which type of anaemia
Megaloblastic macrocytic anaemia
32
Medication given in B12 deficiency
IM hydroxocobalamin
33
What should be treated first in B12 deficiency with folate deficiency
**Treat the B12 deficiency first** - giving patients folic acid when they have B12 deficiency can lead to **subacute combined degeneration of the cord** SCD of the cord = combined dorsal column and lateral corticospinal tracts affected
34
Secondary prevention ACS medications
Block An ACS Beta blocker ACEi Aspirin Clopidogrel Statin
35
Site of iron absorption
Duodenum and jejunum
36
Risk factors for osteoporosis
SHATTERED Steroids Hyperthyroidism Alcohol/smoking Thin (BMI <22) Testosterone deficiency (female) Early menopause Renal/liver failure Erosive or inflammatory disease (Rheumatoid arthritis, Ank Spond) Dietary Ca2+ deficiency / Did mum or Dad have it?
37
Gold standard investigation for diagnosing osteoporosis
DEXA scan T score of less than -2.5
38
Osteopenia DEXA results
T score -1 to -2.5
39
1st line treatment for osteoporosis
Alendronate
40
Indication for diagnosis of osteoporosis / treatment without a prior DEXA scan
following a fragility fracture in women aged 75 years or older
41
2nd line treatment for osteoporosis *25% of patients cannot tolerate alendronate due to GI problems*
Other bisphosphonates e.g. risedronate or etidronate
42
Polypharmacy definition
A single patient taking 5 or more medications daily
43
benign prostatic hyperplasia treatment
Tamsulosin (alpha blocker) *Common side effects = dizziness and sexual dysfunction*
44
How should alendronate be taken
Standing/sitting upright for at least 30 minutes after taking it Take it 30 mins before breakfast with plenty of water and on an empty stomach
45
contraindications to joint aspiration in a non-theatre setting
Joint prosthesis Bacteraemia Inaccessible joints Overlying infection in the soft tissue
46
LFT investigation alcoholic liver disease
AST level higher than ALT liver S > L (more soda than lime)
47
Screening test for malnutrition
MUST (malnutrition universal screening tool) - BMI - recent weight change - presence of acute disease
48
Scoring system for assessing the risk of a patient developing a pressure sore
Waterlow score - BMI - nutritional status - skin type - mobility - continence
49
4 risk factors for developing pressure ulcers
Malnourishment Incontinence Lack of mobility Pain (leads to reduction in mobility)
50
Falls risk factors
Vision problems Gait disturbances: diabetes, rheumatoid arthritis, Parkinson’s Polypharmacy (4+ medications) Incontinence > 65 Fear of falling Depression Postural hypotension Cognitive impairment
51
Medications that cause postural hypotension
***just recognise these and associate with falls in elderly*** Nitrates Diuretics Anticholingeric Antidepressants Beta-blockers L-dopa ACEi
52
Medications associated with falls *(due to mechanisms other than postural hypotension)*
*think **sedation*** Benzodiazepines/Zopiclone Antipsychotics Opiates Anticonvulsants Codeine Digoxin
53
Investigations to consider after a fall
**Bedside tests** e.g. basic obs, BP, **blood glucose**, urine dip, ECG **Bloods** e.g. **FBC**, U&E, LFT, bone profile **Imaging** e.g. CXR, **CT head**, echo
54
2 recommended tests from NICE to assess risk of further falls in elderly who have fallen in the last 12 months
Turn 180 Timed up and Go test
55
Falls criteria for **MDT assessment by qualified clinician** in patients over 65
**> 2 falls in last 12 months** Fall that requires medical treatment Poor performance or failure to complete Turn 180 or Timed Up and Go test *Falls individuals who do not meet this criteria should be reviewed **annually** and given advice*
56
4 management options for falls in the elderly
Strength and balance training (physiotherapist) Home hazard assessment / assessment to improve independence with ADLS (occupational therapist) Vision assessment Med review (pharmacist)
57
Rhabdomyolysis causes
Seizure Collapse/coma e.g. elderly patient who has collapsed at home and found hours later Crush injury McArdle’s syndrome Statins (esp if co-prescribed with clarithromycin) Ecstasy
58
rhabdomyolysis blood results
**Elevated creatinine kinase** Hypocalcaemia (myoglobin binds calcium) Elevated phosphate (released from myocytes) Hyperkalaemia (before AKI) Metabolic acidosis
59
Management of rhabdomyolysis
IV fluids *(to maintain good urine output)*
60
1st line sedative in delirium
Haloperidol or Olanzapine PD: if antipsychotics required urgently then use quetiapine or clozapine
61
How should frailty be assessed
1. Evaluation of gait speed 2. Self-reported health status 3. PRISMA-7 questionnaire (age, sex, health problems, assistance required and walking aid use)
62
4 palliative medications prescribed in end of life care and the symptoms they treat
Pain: morphine Respiratory secretions: hyoscine bromide Nausea: haloperidol Agitation: midazolam
63
Causes of weight loss and weakness in elderly
Frailty Aging COPD Malignancy Depression
64
Osteoporosis scoring system
Fraxx (BMI, smoking, alcohol, previous fracture)
65
Malnutrition
State in which a deficiency of energy, protein or other nutrients causes measurable effects on outcome Starvation, sepsis, malabsorption
66
4 prevention of pressure sores
Barrier creams Pressure redistribution Repositioning Regular skin assessment
67
Key parts of mental capacity act (5)
Assumed capacity Maximise decision making capacity Freedom to make unwise decisions Best interests Least restrictive option

3a PTS - PM - ZTF (8 decks)

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