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Medicine Block Year 3 > Geriatrics > Flashcards

Geriatrics Flashcards

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1
Q

What is a comprehensive Geriatric Assessment?

A

A multidimensional, interdisciplinary
diagnostic process to determine the medical, psychological, and functional
capabilities of a frail older person in order to develop a coordinated and
integrated plan for treatment and long-term follow-up

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2
Q

What are the domains of a CGA ?

A

Problem list
Medication Review
Nutritional Status
Functional Capacity ( activities , gait , activity status)
Mental health
Social circumstances ( visitors, partners etc )
Environment ( accessibility, safety , transport facilities )

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3
Q

What is polypharmacy?

A

When a patient is on 6 or more medications at once. Many can have interactions and affect the patient negatively.

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4
Q

What does proper prescribing technique involve?

A

Check for drug allergies
Check for potential interactions
Write drug in CAPITALS
Ensure dose, fz, times, start date, route of administration are clearly identified
Write ‘Units’
Print name and sign

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5
Q

What is a Home First Form?

A

Its a referal to Social Services to access for funding or a package of care for older patients being discharged. A social worker will then be allocated to the patient.

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6
Q

What are falls classifies into ?

A

Syncopal ( loss of consciousness )
Non-syncopal

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7
Q

What is the process for history taking of a fall?

A

Before the fall - how did they fall, what were they doing, where where they, any dizziness/ palpitations/ sweating/ tachycardia/ chest pain/ SOB

During - what could they hear, any loss of consciousness, any injuries

After - how long did they take to recover, how did they feel after

Has is ever happened before?
Medication History

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8
Q

What investigations should be done for a fall?

A

CVS Exam + ECG + Lying/Standing BP
Neurological Exam
Muscoskeletal Exam
Mobility Assessment

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9
Q

What is it important to access in elderly falls patients?

A

Osteoporosis risk - DEXA scan
Those over 75 with fracture from minor trauma should be started on osteoporosis medication

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10
Q

What is the treatment for osteoporosis?

A

Bisphonates ( e.g Alendronate )
HRT

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11
Q

How does Lewy-Body Dementia present?

A

Periods of intermission and relapse of symptoms
Visual hallucinations
Can present with Parkinsonism symptoms present after cognitive decline

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12
Q

How does Alzheimer’s Dementia present?

A

Insidious onset with slow progression
Behavioural problems common
Hippocampal atrophy

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13
Q

How does Vascular Dementia present?

A

Step wise progression
Vascular disease risk factors ( Smoking, high cholesterol, male )

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14
Q

How does Frontotemporal Dementia present?

A

Early onset ( <65 )
Social disinhibition
Apathy
Executive dysfunction
Family history common
Hyperorality ( increased cigarette use )

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15
Q

How does Parksinson’s with Dementia present?

A

Typical Parkinsonian features ( resting tremor, bradykinesia, rigidity)
They precede Alzhemer’s symptoms by over a year

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16
Q

What is mixed dementia?

A

Alzheimer’s and Vascular

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17
Q

What are first line for mild/moderate Alzheimer’s Dementia? and 2 examples?

A

Acetylcholinesterase inhibitors e.g Donepazil / Rivastigamine

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18
Q

What drug class is contraindicated for both Parkinson’s and Lewy-Body Dementia patients? Give 2 examples of these

A

Dopamine antagonists e.g Metoclopramide or Haloperidol

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19
Q

What is the only treatment for Vascular Dementia?

A

Modify risk factors ; e.g stop smoking, reduce weight

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20
Q

What is Delirium?

A

Delirium is an acute confusional state, with a sudden onset and fluctuating
course. It develops over 1-2 days and is recognised by a change in
consciousness either hyper or hypoalert and inattention.

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21
Q

How do you differentiate between Delirium and dementia?

A

Take collateral history and

4AT Test ( Dementia Screening tool )

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22
Q

Whar are the common causes of acute confusion / delirium ?

A

THINK DELIRIUM

Trauma
Hypoxia
Infection
Neck of femur fracture
smoKer

Drugs
Environment ( new , scary )
Lack of sleep
Imbalances ( electrolytes )
Retention ( urinary / constipation )
Increased age
Uncontrolled pain
Medical conditions ( Hypoglycaemia, UTI, Liver Failure, Endocrine disorders )

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23
Q

What drugs can cause delirium?

A

Sedatives
ACEi
B-Blockers
Anticholinergics
Hypoglycaemics
Opiates

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24
Q

How do you manage a patient with acute confusion?

A

Treat underlying cause
Orientate to time and place
Pharmacological intervention is they are a harm to themselves or others

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25
What are the types of incontinence?
Stress - when coughing/ laughing Urge - frequent feeling of needing to void, nocturnal incontinence is common Overflow - due to retention/obstruction , seen in BPH Functional - due to cognitive impairment
26
How do you conduct a continence exam?
Bladder and Bowel diary review Abdo Exam Urine Dipstick Mid-Stream Urine Sample DRE External genitalia review Post-Micturition Bladder Scan
27
What is first line management for dealing with urinary incontinence?
Reducing caffeine intake Pelvic floor exercises Bladder training
28
What pharmacological interventions can be used for urinary incontinence after lifestyle modifications fail?
Anticholinergics e.g Oxybutynin ( not well tolerated by older patients ) B3 Agonist e.g. Mirabegron
29
What is the worst side effects of urinary incontinence drugs in older people?
Postural hypotension - increases risk of falls
30
How does faecal incontinence happen as we get older?
Anal sphincter can gape due to haemorrhoids and chronic constipation
31
What is the most common cause of faecal incontinence?
Faecal impaction with overflow diarrhoea
32
Why are older people more likely to be constipated?
They cannot exert the same amount of intra-abdominal pressure and muscle tension to push out constipated stool Malnutrition Dehydration
33
What do you do in the assessment for faecal incontinence?
DRE Stool type assessment ( hard/ soft)
34
How can faecal impaction be fatal?
Stercoral perforation Ischaemic Bowel
35
What is the management for foecal impaction?
Soft impaction - bulk-forming laxatives (Isphagula Husk), add osmotic (Lactulose) if still constipated Hard impaction - stool softener laxatives ( (Docusate Sodium) or stimulant laxatives (Senna) Use an enema Manual evacuation should be utilised in difficult cases ( risk of perforation )
36
What are TIAs?
Transient ischaemic attacks are focal neurological deficits due to blockage of blood supply to a part of the brain (focal brain dysfunction) lasting less than 24 hours
37
What is the ABCD2 score?
Risk assessment tool to predict the short-term risk of stroke after a TIA
38
What are the factors in the ABCD2 score?
Age BP Cinical features Duration of symptoms Diabetes y/n Score >4 indicates high risk
39
What is the management for a TIA?
Aspirin 300mg daily immediately Seen by TIA Clinic or Stroke Physician asap Treat HTN and Hypercholesterolemia
40
What is a crescendo TIA?
Two or more TIAs in a week ( high stroke risk )
41
What is a stroke?
Stroke can be defined as a sudden onset of a focal neurological deficit lasting more than 24 hours or with imaging evidence of brain damage
42
What are the two types of stroke?
Ischaemic ( due to in situ thrombi, emboli or hypoxia ) Haemorrhagic
43
What is used to classify stroke vascular territory?
Bamford Classification TACS ( Total Anterior Circulation Stroke ) PACS ( Partial Anterior Circulation Stroke LACS ( Lacunar Stroke ) POCS ( Posterior Circulation Stroke )
44
What are the two rapid assessment tools for a patient with suspected stroke?
FAST - Face ( droop ), Arm ( weakness) , Speech ( slurred) , Time ( to call 999 ) ROSIER - helps ED staff distinguish between stroke and mimic stroke
45
What is NIHSS ?
Clinical Stroke Assessement tool - documents neurological status of acute stroke patient Scores on levels of consciousness, language, neglect, visual-field loss, extra-ocular movement, motor strength, ataxia, dysarthria and sensory loss
46
What is the management for an ischaemic stroke?
Thrombolysis e.g Alteplase Then started on Aspirin 300mg daily for two weeks , then a long term anti-thrombotic treatment should be initiated
47
What is the management for a haemorrhagic stroke?
Lower BP ( Labetolol STAT ) Reversal of coagulopathy ( IV Vitamin K 5mg and prothrombin complex concentrate ) Surgery only if 1) Hydrocephalus present 2) Lobar Haemmorhage and GCS >9 3) Cerebellar Haemorrhage
48
What are the restrictions on driving following a TIA or a stroke?
No driving for a month, can after as long as there is no permanent neurological defect If you have crescendo TIAs no driving for 3 months and must be accessed by doctor prior to driving again
49
Patients with stable neurological symptoms from their TIA or stroke who have 50-99% carotid stenosis should receive what?
Referal for Carotid Endarterectomy within 1 week of symptoms Undergo the surgery within 2 weeks of symptoms
50
What are patients with severe MCA infarct at risk of?
Malignant MCA Syndrome Should be referred for a Decompressive Hemicranectomy within 24 hours if any deterioration takes place
51
What is Malignant MCA Syndrome?
Rapid neurological deterioration due the effects of space occupying oedema following infarct of MCA
52
What are the requirements for a decompressive hemicraniectomy?
Under 60 CT infarct of atleast 50% MCA NIHSS score > 15
53
What can mimic a stroke?
Seizure Space occupying lesion Hemiplegic migraine Multiple Sclerosis
54
What is the CHADS-VASC 2 Score?
Determines stroke risk in patients with Atrial FIbrillation
55
What are both the HAS-BLED and ORBIT scores used for?
Predicts the risk of bleeding on anticoagulation for patients with Atrial Fibrillation
56
What are the divisions of Anticoagulants?
Warfarin Vs DOACs ( Apixiban, Rivoraxaban, Edoxaban )
57
What are some complex decisions needed to be made in severe stroke patients?
DNAR Enteral feeding ( NG/PEG tube )
58
When should Haloperidol be used to sedate a patient?
Verbal and Non-verbal deescalation has not worked Danger to themselves or others AND cause of the delirium is known
59
What should be used to sedate patients with known Parkinsonism?
IM Lorazepam
60
What tool accesses frailty?
PRISMA-7
61
What tool indicated the risk of pressure sores in patients?
Waterlow Score
62
When should antibiotics be used for pressure sores?
Signs of infection only ( warm, pus )
63
What is the STOPP-START tool
For polypharmacy patients. Identifies medications whee risk outweighs the therapeutic benefits. Identifies medications patient could benefit from being added or swapped into their current list.
64
What do the SALT team do ?
Help when patients have poor swallow Can recommend thicker fluids / soft diets
65
What are alternative feeding methods available for patients with a poor swallow?
Hand feeding NG / PEG tube ( enteral ) IV nutrition ( Paraenteral )
66
What are patients with a poor swallow at risk of?
Aspiration Pneumonia - food can enter the trachea and block airway , leading to pneumonia
67
What is Mental Capacity?
A patients’s ability to make decisions regarding their own health. Ability to understand, retain, communicate and weigh up their choices.
68
What is a best interest decision?
When a decision regarding a patient’s health is made of their behalf , when they are deemed to not have capacity.
69
What is Advance Care Planning?
When decisions about a patient’s health and future health are made whilst they have capacity to do so.
70
What is a RESPECT form?
A form about what kind of treatment the patient would want in an emergency . Usually done for palliative care patients.
71
What are the common consequences of falls?
Fractures ( Hip, Wrist, Ankle ) Severe Bleeds Head Injuries Soft tissue injury Psychological repurcussions
72
What type of drug Memantine?
NMDA antagonist
73
Which parts of the brain are affected by Alzheimer's?
Cortex Hippocampus
74
What is second line for Alziemers?
Memantine
75
What is a short term side effect of Levodopa?
Abnormal dreams
76
What is the Triad of Parkinsons?
Resting tremor Bradykinesia Rigidity
77
What is the correct dose for breakthrough pain relief?
1/6 of their current dose i.e they're regularly on 15mg Morphine b.d, they should be started on 5mg (30/6) as required .
78
What is the best medication for Postural Hypotension?
Midodrine Midodrine is an alpha-1-adrenergic receptor agonist. Activation of alpha-1-adrenergic receptors leads to an increase in vascular tone and an increase in blood pressure
79
What is delirium tremens?
Severe alcohol withdrawal happens 3-4 days after last drink Rapid onset of confusion Tremor Sweating Visual hallucinations
80
What are the 4 hallmarks of delirium?
1) acute onset with fluctuating course 2) inattention 3) disorganised thinking 4) altered level of consciousness
81
What signs are associated with increased oestrogen in the context of liver cirrhosis?
Oestrogen-> increased vascularisation Palmar Erythema Spider naevi Gynecomastia
82
What does anisocytosis mean?
Mixed RBC cell size
83
What does anisocytosis with a normal MCV in the context of Coeliacs imply?
Mixed anaemia Iron - micro Folate/B12 = macro Averages to a normal MCV
84
What is a Ceiling of Care?
This means that doctors should engage with the patient, those close to them and the healthcare team in order to determine what level of treatment is appropriate to give to a specific patient towards the end of their life. Some treatments can be limited by a ceiling of care plan e.g CPR, limiting what ventilation may be given (e.g. non-invasive, invasive or none), and limiting life-prolonging drugs (e.g. antibiotics). In addition, the decision not to provide artificial nutrition (e.g. via PEG tube) may be taken.
85
What is an advance statement?
An Advance Statement is sometimes called a "Statement of Wishes and Care Preferences". It allows an individual to make general statements about their wishes, beliefs, feelings and values and how these influence their preferences for their future care and treatment.
86
What is an advance decision?
An Advanced Decision, short for Advanced Decision to Refuse Treatment, is a legally binding document. Its purpose is to ensure that an individual can refuse a specific treatment(s) that they do not want to have in the future.
87
What is prescribed first line to help with terminal secretions of a palliative patient?
Hyoscine hydrobromide or hyoscine butylbromide

Medicine Block Year 3 (12 decks)

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