Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

OPIC > Geriatric medicine > Flashcards

Geriatric medicine Flashcards

(91 cards)

Start Studying
1
Q

what are the side effects of donepezil, galantamine and rivastigmine?

A

diarrhoea, nausea and vomiting, excess salivation, urinary incontinence and bradycardia

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

how does lewy body dementia classically present?

A

REM sleep disorder, history of falls (secondary to motor problems) and hallucination

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

what cardiac investigation should be done before commencing a patient on an anticholinesterase inhibitor? what are the contraindication?

A

ECG
-prolonged QT interval, bradykinesia <50, second or third degree heart block

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

what are some aspects of non-pharmacological management of dementia patients?

A

psychoeducation/information giving, carer support, support groups and advance care planning

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

what is the classic triad of normal pressure hydrocephalus?

A

gait disturbance, dementia and urinary incontinence

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

what are the most common conditions leading to charles bonnet syndrome?

A

age related macular degeneration, cataract and glaucoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What investigations are done for osteoporosis?

A

DEXA scan and calcium and vitamin D levels. (Women over 75 with fragility fractures have presumptive diagnosis of osteoporosis without need for DEXA scan)

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

What is the cut off T-score for osteoporosis?

A

-2.5

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

If a patient has severe osteoporosis which is not explained just by being post menopausal, what tests should be done?

A

Thyroid function, calcium, parathyroid, bone turnover markers. Also myeloma screen

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

What is first like management for osteoporosis?

A

Alendronate with vitamin D and calcium supplements

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

You want to start a patient on Adcal-D3 for bone protection but they cannot manage to swallow large tablets. What is an alternative?

A

Provide them with a dissolvable preparation of Adcal-D3 to improve compliance

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

What do different T scores suggest?

A

Greater than -1 = healthy bone
-1 to -2.5 = osteopenia
Less than -2.5 = osteoporosis

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

What is the AMTS?

A

Abbreviated mental test score is a ten point test to rapidly assess elderly patients for presence of cognitive impairment. A score of 6 or less suggests delirium or dementia

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

How should patinets be advised to take alendronate?

A

Administered once a week. Taken on an empty stomach while sat upright for thirty minutes with a full glass of water. Do not eat for thirty minutes after taking the tablet

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

If someone is unable to tolerate bisphosphonates, what alternative medication can be given?

A

Denosumab

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

Where are the common location of fragility fractures?

A

Vertebrae, hips, wrists

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

What is the recommended therapeutic plasma concentration of digoxin?

A

1-2 micrograms/l

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

What are some common symptoms of digoxin toxicity?

A

Nausea, vomiting, diarrhoea, visual disturbances, hallucinations and drowsiness

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

Can APTT be used to measure effects of warfarin as well as INR?

A

No APTT is a measurement of the anticoagulant effect of unfractionated heparin

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

What is the recommended INR range for a patient receiving warfarin for the prevention of a stroke?

A

2-3

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

What investigations are likely to be done when someone presents with confusion?

A

FBC- anaemia? infection?
U+Es
Calcium
LFTs
TFTs
Blood glucose
Drug levels
Urinalysis
CXR/sputum cultures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are some non-pharmacological ways we can support people with dementia with their memory?

A

Calendars, clocks, spoken reminders, labelling cupboards/rooms and life story books

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What are some non-pharmacological ways we can support people with dementia who are wandering?
Door alarms, sensor mats, GPS tracking
26
What are some non-pharmacological ways we can support people with dementia with their ADLs?
Visual prompts, verbal cues and encouragement, carers/POC, adaptive cutlery
27
What are some environmental adaptations OTs can put in place to help dementia patients?
Alarmed dossett boxes, stair rails, bathing equipment
28
What are some of the causes of delirium to initially screen for? (Using pneumonic PINCH ME)
Pain Infection Constipation Dehydration Medication Environment
29
If a patient is not able to verbalise their pain, what can be used to help assess their pain?
Abbey pain scale
30
What are some delirium screening tests?
SQiD, CAM, 4AT
31
What is the non-pharmacological management of stress incontinence?
Pelvic floor exercises
32
What is the non-pharmacological management of urge incontinence?
Decaffeinated drinks, bladder training
33
What are some ways to reduce the distress of a patient with delirium?
Get them to speak to relative, assess and manage their pain, distracting techniques
34
What are Non-pharmacological ways that patients can help manage postural hypotension?
Withdraw any offending medication Rise slowly from laying to sitting to standing Avoid straining, coughing and prolonged standing in hot weather Cross legs while standing Raise head of bed Small meals and coffee in the morning Exercise Increase salt and water intake
35
What is the definition of positive postural blood pressure test?
A drop in systolic BP by 20mmHg or A drop below 90mmHg systolic on standing or A drop in diastolic BP of 10mmHg with symptoms
36
What medications are commonly used for postural hypotension?
Fludrocortisone, midodrine
37
What is cognitive impairment?
A disturbance of higher cortical functions like memory, language, attention, thinking and judgement
38
What is the ICD 10 definition of dementia?
- cognitive impairment which is enough to impair ADLs - problems with processing information, maintaining and directing attention - clear consciousness - symptoms for over 6 months
39
What does BPSD stand for?
Behavioural and psychological symptoms of dementia
40
Why do patients often need an ECG before starting a cholinesterase inhibitor?
They can cause bradycardia
41
What are common side effects of cholinesterase inhibitors used for dementia?
Headache, GI upset (nausea, vomiting, diarrhoea), agitation
42
What are side effects of NMDA antagonists used in dementia?
Headache, drowsiness, sedation, imbalances/falls
43
What are the four main clusters of BPSD?
Affective, apathetic, hyperactive, psychotic
44
What are features of hyperactive symptoms in dementia?
Hyperactive- aggression, disinhibition, resisting care, lability, night time disturbance
45
What are features of psychotic symptoms in dementia?
Hallucinations and delusions
46
What are features of affective symptoms in dementia?
Depression, hoarding, crying, wandering, anxiety
47
What are features of apathetic symptoms in dementia?
Reduced motivation and appetite, indifference
48
What are some features of early stage dementia?
Forgetfulness/memory problems are predominant cognitive abnormality Subtle change in mood and behaviour Minimal effect on day to day activities
49
What are some features of mid-stage dementia?
Memory problem more prominent and other cognitive difficulties emerge More marked changes in behaviour Difficulty with complex tasks but still managing ADLs Awareness of disability begins to diverge from reality
50
What are some features of late stage dementia?
Severe and pervasive memory problems with other major cognitive disabilities Marked changes in behaviour Severe disability, inability to complete basic aspects of personal care requiring constant supervision
51
What is seen on structural brain imaging with Alzheimer’s disease?
Volume loss in the medial temporal lobe, posterior cingulate and precincts, loss of pes hippocampi
52
What is seen on structural brain imaging with vascular dementia?
May be evidence of infarcts, bleeds, white matter ischaemia
53
What is seen on structural brain imaging with FTD?
Frontotemporal atrophy
54
What is seen on structural brain imaging with alcoholic dementia?
Age-disproportionate cortical and WM atrophy
55
What are risk factors for delirium?
Fracture on admission, cognitive impairment, age, severity of illness admitted for, vision impairment, infection
56
Which common dugs can lead to drug-induced delirium?
Psychotropic drugs (antidepressants/psychotics, benzos), anti parkinsonian, anti cholinergic, opiates, diuretics
57
How is CAM (confusion assessment method) used to assess likelihood of delirium?
Diagnosis of delirium by CAM requires an acute onset and fluctuation course, inattention and either disorganised thinking or altered level of consciousness
58
What is the immediate action for patients with delirium?
Focused history and exam + collateral history Identify and treat underlying causes Does patient meet SIRS criteria and need sepsis 6 screen? Cognitive assessment Medication review Put in high visibility bed
59
What are some non-neurodegenerative causes of dementia?
Infection: HIV, syphillis Prion disease: CJD Inflammatory: vasculopathies, sarcoidosis, autoimmune Metabolic: poorly controlled endocrine disease, vitamin deficiencies Genetic: APP, CADASIL, C9ORF72
60
Is faecal incontinence ever normal with ageing?
No it’s always abnormal and almost always curable
61
What is the most cause of faecal incontinence?
Faecal impaction with overflow accounts for 50%
62
If a patient with faecal incontinence is found to have reduced anal sphincter tone and reduced sensation, where might the pathology be?
Spinal cord pathology
63
Why might elederly patients be more at risk of faecal incontinence?
With age, rectum becomes more vacuous and anal sphincter can gape from haemorrhoids or chronic constipation More likely to become constipated as they cannot exert the same amount of intrabdominal pressure
64
Can only hard stool cause faecal impaction?
Soft stool can fill the rectum and lead to faecal impaction
65
Can a patient be faecal loaded even if not stool is felt on DRE?
The impaction can be higher than the rectum
66
How can constipation be fatal?
There is a risk with chronic constipation that it can lead to stercoral perforation and ischaemic bowel
67
If stool is hard will stimulant be the appropriate management for their constipation?
No stool will require softening
68
What is some advice which can be trialled by patients with postural hypotension before starting medication?
Drinking plenty of fluids, when standing from sitting dorsiflex the feet first then rise slowly and cross their legs once up, compression stockings
69
What s meant when it is said capacity is time and decision specific?
Time- a patient may have capacity at one time of the day and not another or may not have capacity during an acute illness but have it once it resolves Decision- they may have capacity to decide if they want personal care/blood tests but dont have consent for more complex decisions like about where to live
70
What are the five principles of the mental capacity act?
Presumption of capacity All practical steps taken to allow autonomy Allow unwise decisions Least restrictive option Best interest
71
What is the two staging capacity test?
Stage 1- is there impairment of the mind Stage 2- a) understanding info (b) retaining info (c) weighing up info (d) communicating their decision
72
What is lasting power of attorney?
73
What is a lasting power of attorney?
A form which gives someone the power to make decisions for another person who lacks mental capacity. They would have had to complete this form while they have capacity
74
What is a deputy appointed by the court of protection?
This is someone appointed by the court of protection to make decisions about someone else who lacks capacity. This is similar to power of attorney but can be challenged by court of protection
75
What is a public guardian?
They are able to take action when there are concerns around an attorney or deputy
76
What is an advanced decision to refuse treatment?
Advance decisions are decisions a patient makes about not wanting a certain treatment later when they no longer have capacity. If they want to refuse life-sustaining/saving treatment then this will need to be signed by patient and a witness
77
What is an IMCA?
An independent mental capacity advocate is someone appointed to act on someone’s behalf to help make decisions for them
78
What is a deprivation of liberties safeguards?
This needs to be completed when a patient in a hospital or care home if needing to be deprived of their liberties or if they lack capacity to consent to their care and treatment in order to keep them safe from harm
79
What is DNACPR?
A decision to not attempt CPR which is made by the patient and/or their doctor/healthcare team
80
What are some precipitating factors of delirium?
New illness (e.g infection, urinary retention, constipation), falls, pain, poor oral intake, medication, sensory impairment
81
What investigations may be necessary following history and examination of a patient with suspected delirium?
Urinalysis, sputum culture, FBC, folate and B12, U+Es, HbA1c, calcium, LFTs, ESR/CRP, drug levels, TFTs, CXR, ECG
82
How can we manage delirium?
Correct any precipitating factors, optimise treatment for co-morbidities, de-escalation techniques, re-orientation strategies (reminding patient when and where they are, visible clocks), normalise their sleep wake cycle (stop napping, encourage bright light exposure in the day)
83
What are some risks of giving medication to reduce agitated behaviour with delirium?
Haloperidol increases risk of ischaemic stroke and confusion, also if they have PD it will worsen their motor symptoms Lorazepam is sedating so can increase their risk of falls
84
What are some preventable causes of dementia?
Normal pressure hydrocephalus, malnutrition, alcoholism, depression, medications
85
What are pharmacological treatments for Alzheimer’s dementia?
Acetylcholinesterase inhibitors: Donepezil, rivastigmine, galantamine NMDA receptor antagonist: memantine
86
What are signs of right sided heart failure?
Raised JVP, hepatomegaly and ankle oedema
87
How long after hip fracture surgery is a patient allowed to weight bear?
Immediately post-operatively
88
How long can it take for BPH treatment with finasteride before results are seen?
6 months
89
When is internal fixation used for a hip fracture?
Intracapsular NOF fracture with good pre-morbid status
90
What will blood tests show in osteoporosis?
Normal ALP Normal Calcium Normal Phosphate Normal PTH
91
What classification system is used to classify neck of femur fractures?
The garden classification system

OPIC (3 decks)

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