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OPIC > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

Name four things in a Falls History you would want to know about pre-fall

A

Any dizziness/light headedness
Any cardiac symptoms
Any weakness
Any previous near misses

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2
Q

Name four examinations you could do in a falls patient

A

Functional assessment of mobility (how do they mobilise etc)
CVS exam (inc lying and standing BP immediately, at 3 minutes and at 5 minutes)
Neurological Exam
Musculoskeletal Exam

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3
Q

Name two specific tests involved in falls risk assessments

A

Timed Up and Go

Turn 180

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4
Q

What is the Timed Up and Go test?

A

Time the person getting up from their chair without using their arms, walking three metres, turning around and returning to seat

Can use a walking stick if they normally mobilise with one

> 15 seconds is deemed to be a high falls risk

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5
Q

What is the Turn 180 test?

A

Asked to stand and turn 180

> 4 steps taken requires further assessment

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6
Q

Falls risk assessments should be carried out via Nerve Centre within 6 hours of admission. Who gets a standard falls risk assessment?

A

Over 65

Under 65 with clinically judged falls risk

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7
Q

Falls risk assessments should be carried out via Nerve Centre within 6 hours of admission. Who gets an enhanced falls risk assessment?

A

Admitted following a fall
2 or more falls in past 12 months
Previous inpatient fall at UHL

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8
Q

Name five causes of Syncopal Falls

A 
Vasovagal
Situational 
Postural Hypotension 
Autonomic Failure
Carotid Sinus Hypersensitivity
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9
Q

Name three causes of Non Syncopal Falls

A

Poor Vision
Muscle Weakness
Labyrinthitis

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10
Q

Other than the two specific tests in a falls risk assessment, what else does it comprise of?

A

Comprehensive History and Exam
Medication Review
Psychological (fear of falling)

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11
Q

FRAX is a tool used to estimate the ten year fracture probability risk. Who qualifies to be evaluated?

A

All women >65 and all men >75

If other risk factors can consider in <65

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12
Q

Name some of the parameters of the FRAX tool

A 
Sex
Weight
Height
Previous #
Smoking
Alcohol 
Steroids 
Parenteral Nutrition 
T and Z Score
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13
Q

Define Osteoporosis

A

Low bone mass and deterioration of architecture leading to reduced bone strength and increased fracture risk

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14
Q

Describe the mnemonic ‘SHATTERED’ for Osteoporosis

A 
Steroids
Hyperthyroidism 
Alcohol 
Tobacco
Thin 
Early Menopause
Renal Failure 
Erosive Bone Disease
Dietary Insufficiency
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15
Q

Using a DEXA scan, two scores can be produced: Z score and T Score. What is the T Score?

A

Number of standard deviations from the mean bone density of a healthy person (30y old and same sex)

> -1.5 - normal

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16
Q

Using a DEXA scan, two scores can be produced: Z score and T Score. What is the Z Score?

A

Number of standard deviations from the mean bone density of same age and sex

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17
Q

Name three conservative managements for Osteoporosis

A

Quit Smoking
Increase weight bearing exercises
Calcium and Vitamin D Rich Diet

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18
Q

What is the first line medical management for Osteoporosis?

A

Bisphosphonates (Alendronic Acid)

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19
Q

What should you inform patients about Bisphosphonates

A

Stay upright and wait 30 minutes before food after taking one

Side effects include GI Upset and Jaw Osteonecrosis

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20
Q

Name four contraindications to Bisphosphonate therapy

A

Achalasia
Stomach Ulcers
eGFR<30
Cognitive Impairment (won’t follow instructions)

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21
Q

If wanting to give a patient Bisphosphonates but unable to take orally, what could you prescribe?

A

IV Zolendronate

Yearly infusion
Requires good Creatinine Clearance

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22
Q

Name two other medical management options for Osteoporosis

A

Teriparatide (Recombinant PTH)

Denosumab (MAB reducing bone reabsorption - subcutaneous biannually)

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23
Q

Name two side effects of Teriparitide

A

Dizziness

Tachycardia

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24
Q

Name two side effects of Denosumab

A

Red/Dry/Itchy Skin

Blisters

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25
Q

What is classed as Polypharmacy?

A

Taking 5 or more medications at any one time

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26
Q

What is the STOPP tool?

A

Screening Tool for Older Persons Prescription

Aims to reduce incidence of medicine related adverse events

Can be in relation to single drugs or classes (check in BNF ‘caution’ boxes)

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27
Q

What is the START tool?

A

Screening Tool to Alert the Right Treatment

Prevents omissions of indicated appropriate medications

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28
Q

Name 6 other pharmacy considerations in older people’s prescriptions

A

Forms of Medicine (is a liquid form more appropriate?)

Are some symptoms just manifestations of ageing (dont require treatment?)

Patients are more sensitive to medications

Pharmacokinetics (clearance ability)

Review regularly

Simplify regimes

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29
Q

What are the four components of an incontinence history

A
  • Defining the type of incontinence
  • Defining the causes and precipitants
  • Excluding other pathology
  • Assessing the severity and impact on patient’s life
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30
Q

How could you determine the type of incontinence?

A

Any triggers?
Constant vs Intermittent Leakage
Amount of Urine Lost

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31
Q

What information can help determine the cause of incontinence?

A

Exclude UTIs/Calculi

Whether frequency is worse during day or at night

Factors worsening urge

Reversible causes (eg look at medication list)

Risk factors for stress (high parity, large babies etc)

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32
Q

What factors in an incontinence history would lead you to think of other pathological causes?

A 
Haematuria
Pain
Acute Onset
Obstructive symptoms
Neurological symptoms
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33
Q

How can you assess the impact of incontinence on a patient?

A
  • Standardised Pad Test (better than subjective for measuring volume)
  • What lifestyle changes/restrictions the patient now has
  • Urogenital Distress Inventory
  • Incontinence Impact Questionnaire
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34
Q

What features of incontinence are you looking for on an ABDO exam?

A

Palpable bladder after voiding

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35
Q

What features of incontinence are you looking for on an PELVIC exam?

A
  • Atrophic Vaginal Mucosa
  • Stress/Cough Test
  • Organ Prolapse
  • Pelvic Floor Contraction (rated out of 5 using Oxford System)
  • Pelvic Mass/Tenderness
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36
Q

What features of incontinence are you looking for on a RECTAL exam?

A

Constipation and Tone

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37
Q

What features of incontinence are you looking for on a NEUROLOGICAL exam?

A

Change in Perineal Sensation/Anal Tone

Lower limb neuro exam

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38
Q

What features of incontinence are you looking for on a CARDIAC exam?

A

Volume Status

Signs of Heart Failure

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39
Q

Describe the normal parameters of voiding

A
  • Number of day time voids - 3 to 5 hourly
  • Total urine - 1500 to 2000mls
  • Largest single void - 300 to 600mls
40
Q

How can you interpret a bladder diary/frequency volume chart?

A

Frequent small volume - OABS, Detrusor Overactivity

Frequent large volume - Polyuria

Frequent small volume with low urine output - fluid restriction

Nocturnal - Ageing, OSA, Cardiac Failure

41
Q

Describe the procedure of a bladder scan

A
  • Patient is asked to void (volume measured)
  • Probe placed 3cm above pubic symphysis

Volume <100ml is normal
Volume >200ml requires further investigations
Volume >500ml requires urgent discussion

42
Q

Describe the Bristol Stool Chart

A 
1 - Hard Lumps like nuts
2 - Sausage shaped but lumpy 
3 - Sausage shaped with cracks on 
4 - Smooth Sausage shaped 
5 - Soft blobs with clear cut edges
6 - Fluffy with ragged edges
7 - Watery
43
Q

What has to be present in a urine dip for UTI to be a possibility?

A

Leukocyte Esterase

Nitrates

44
Q

Give three risk factors for Stress Incontinence

A

Pelvic Surgery
Child Birth
Oestrogen Deficient States

45
Q

Define Stress Incontinence

A

Involuntary urination upon increase in intra-abdominal pressure due to weak pelvic floor

46
Q

Describe the conservative management of Stress Incontinence

A

Lose Weight
Pelvic Floor (8 contractions tds)
Stop Smoking
Reduce Caffiene

47
Q

How can Stress Incontinence be investigated?

A

Exclude infection
Frequency Volume Chart (normal)
Urodynamics

48
Q

Describe the medical management of Stress Incontinence

A

Serotonin and Noradrenaline Reuptake Inhibitor - Duloxetine (increases pudendal nerve activity and sphincter pressure)

49
Q

Describe the surgical management of Stress Incontinence

A

Burch Colposuspension (sutures between coopers and paravaginal)
Periurethral Bulking
TVT

50
Q

Define Urge Incontinence

A

Presence of urgency in the absence of other pathology

Normally due to Detrusor Overactivity and associated with Nocturia/Frequency

51
Q

Name three risk factors for Urge Incontinence

A

MS
Spina Bifida
Pelvic Surgery

52
Q

Name three investigations of Urge Incontinence

A

Exclude infection
Frequency Volume (increased)
Urodynamic (Detrusor Overactivity)

53
Q

Describe the conservative management of Urge Incontinence

A

Avoid Caffiene and Alcohol

Bladder Retraining

54
Q

Describe the medical management of Urge Incontinence

A
  • Oxybutinin (Antimuscarinic preventing bladder contraction)
  • Solifenacin (Antimuscarinic)
  • Mirabegron (B3 Agonist promoting relaxation)
  • Tamsulosin/Doxazosin (Promotes prostate relaxation and bladder emptying)
55
Q

Name two contraindications to Antimuscarinic medication for Urge Incontinence

A

Myasthenia Gravis

Closed Angle Glaucoma

56
Q

Name four containment products for Incontinence

A
  • Absorbent Pads
  • Absorbent Bed/Chair Pads
  • Penile Sheaths
  • Catheterisation (short term, long term, suprapubic, intermittent)
57
Q

Define Functional Incontinence

A

Unable to reach the toilet in time due to cognitive/physical problems

58
Q

Name three causes of Faecal Incontinence

A

Faecal Impaction (and overflow diarrhoea)

Sphincter dysfunction (haemorrhoids, obstetric tears)

Impaired sensation

59
Q

What is Faecal loading?

A

Smearing

Small amounts of type 1 stool or copious amounts of 6/7

60
Q

Name two complications of Faecal Loading

A

Urinary Retention

Stercoral Perforation

61
Q

How is Faecal Incontinence Managed?

A

Enemas, Stool Softeners, Stimulants

Manual Evacuation (perforation risk vs benefit)

Always coprescribe constipating drugs with laxatives

62
Q

How would you investigate Chronic Diarrhoea?

A

Bowel Imaging
Stool Culture
Exclude Impaction/Causative Medication
Dietary Review

63
Q

How would you manage Chronic Diarrhoea?

A

Consider low dose loperamide (if not then break and accelerate)

64
Q

What are Pressure Sores?

A

Persistently red/blistered/necrotic skin that can lead to exposure of underlying structures, caused by shear pressure/forces over bony prominence (most common in immobility)

65
Q

Name the 5 most common areas for Pressure Sores

A 
Occiput
Heel
Malleolus 
Ischium 
Greater Trochanter
66
Q

Name four risk factors for Pressure Sores

A

Alzheimers
Diabetes
Hip Fractures
Parkinsons

67
Q

What is the Braden Score for Pressure Sores?

A

Each item is scored between 1 and 4

The lower the score the greater their risk

Sensory perception, Moisture, Activity, Mobility, Nutrition, Fraction/Shear

68
Q

What is the Waterlow Score for Pressure Sores?

A

Scoring system for risk of Pressure Sores

BMI, Continence Level, Skin Appearance, Mobility, Sex, Age, Tissue Malnutrition, Neurological Deficit, Major Surgery

10+ at risk
15+ high risk
20+ very high risk

69
Q

How are Pressure Sores assessed?

A

Using medical photography and ruler measurements
Cause of Ulcer
Site/Location
Dimensions

70
Q

Describe Stage 1 Pressure Sores

A

Non blanchable erythema of intact skin

May appear blue/purple on darker skin

71
Q

Describe Stage 2 Pressure Sores

A

Partial thickness, loss of epidermis/dermis/both

Normally an Abrasion/Blister

72
Q

Describe Stage 3 Pressure Sores

A

Full thickness skin loss which may extend down to underlying fascia

73
Q

Describe Stage 4 Pressure Sores

A

Extensive destruction/Tissue Necrosis/Damage to muscle or bone

Extremely difficult to heal, high infection risk

74
Q

Describe Stage 5 Pressure Sores

A

Unstageable

Base of ulcer is covered by slough so depth is undetermined

75
Q

When do Pressure Sores require specialist services?

A

Extensive Superficial Ulcers
Grade 3/Grade 4 pressure ulcers
Deteriorating

76
Q

Name 6 mainstays of Pressure Sore management

A 
Repositioning 
Managing other conditions which may delay healing
Pressure relieving support 
Wound dressing 
Pain relief 
Infection Control
77
Q

Why might Debridement help tissue healing?

A

Devitalised tissue slows tissue healing

Can be autolytic/mechanical/surgical

78
Q

What is a Comprehensive Geriatric Assessment?

A

Holistic approach to the elderly patient

Encompasses physical/functional/social/environmental/psychological and medication review

79
Q

Name 6 things examined in the Physical Assessment of the Elderly patient

A 
Sensory Loss
Feet and Footwear
Gait and Balance
Lying and Standing BP
Joints
Weight and Nutrition
80
Q

What is assessed in a Psychological Assessment of the Elderly Patient?

A

Mood and Cognition

81
Q

What is assessed in the Functional Assessment of the Elderly Patient?

A

1) What can and what does the person actually do
2) How recently has it changed

Nottingham Extended ADLs
Timed Up and Go
Assess timescale of change

82
Q

How is a Medication Review carried out?

A

Full drug history

For each drug: 
Are you good at remembering to take?
Can you swallow okay?
What are you most concerned about with tablets?
Do you think it works?
Any SE?

STOPP-START

83
Q

Name four side effects of Parkinson’s medication

A

Impulse control disorders
Excess Daytime Sleepiness
Excess Drooling

If not taken - Neuroleptic Malignant Syndrome

84
Q

What should you base the Clinical Frailty Scale on?

A

What their level of function was two weeks ago

85
Q

Define Postural Hypotension

A

Systolic drop >20mmHg on standing (or drop below 90mmHg)

86
Q

Give four causes of Postural Hypotension

A

Diabetes
Dehydration
Drugs
MSA

87
Q

How is Postural Hypotension measured?

A

Lying Down and Measured

Standing immediately, after one minute and after three minutes

88
Q

What is the Falls Prevention Programme?

A

Combination of therapy and education to help prevent and limit damage caused by falls

89
Q

When should Osteoporosis be managed?

A

If score is <= -2.5 then treat

If not, modify risk factors, treat underlying conditions and review in 2 years

90
Q

What is Shared Decision Making?

A

Integrates patient and clinical choice

Seek Participation
Explore and compare treatment options
Assess values and preferences
Reach a decision together
Evaluate decision
91
Q

What are the four questions of Shared Decision making?

A

What are the benefits?
What are the risks?
What are the alternatives?
What if we do nothing?

BRAN

92
Q

What is an Advanced Directive?

A

Legal document written at time when patient is of sound mind
Refers to specific treatments
Must be witnessed
Can refuse medication but can’t request

93
Q

According to the Mental Capacity Act, when can Advance Directives be overruled?

A
  • If they are withdrawn when patient is of sound mind
  • If three is strong belief that current situation would’ve changed wishes
  • Overruled by LPA
94
Q

What happens if someone loses capacity but doesn’t have a Lasting Power of Attorney?

A
  • Referred to the court of protection and assigned one for welfare and one for finances
95
Q

Can an LPA overrule an advanced directive?

A

If the Advanced Directive was made after someone was appointed LPA - no

If the Advanced Directive was made before someone was appointed LPA - yes

96
Q

What are the four sections from Gold Standard Framework for Advanced Care Planning?

A
  • What is important to you in your life at the moment
  • What WOULD you like to happen to you if you became unwell
  • What WOULDN’T you like to happen if you became unwell
  • Who would you like (if you would like) someone to speak on your behalf

OPIC (6 decks)

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