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PHASE 3A > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

What is the criteria for diagnosing postural hypotension?

A

A systolic drop of >20mmHg or diastolic drop >10 mmHg within 3 minutes of standing from a sitting position

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2
Q

What are the results on imaging of vascular dementia?

A

MRI- infarcts and white matter hyperintensities

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3
Q

What is the characteristics of Alzheimer’s Disease histologically?

A

Characterised by beta amyloid depositions and neurofibrillary tangles composed of TAU proteins

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4
Q

What class of medications is contraindicated when prescribing sildenafil for erectile dysfunction?

A

Nitrates

Can cause severe hypotension

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5
Q

What medication can be prescribed in postural hypotension although not regularly done?

A

Fludrocortisone or Midodrine (alpha 1 agonist)

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6
Q

List the 4 cardinal Sx of Parkinson’s disease?

A

Lead pipe rigidity
Bradykinesia
Pill rolling tremor (resting)
Postural instability

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7
Q

What factors should be assessed in frailty and what questionnaire can be utilised to help make a diagnosis?

A

Gait speed
self reported health
PRISMA-7 Questionnaire

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8
Q

What are the side effects of L dopa?

A

Postural hypotension
Nausea and vomiting

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9
Q

Side effect of MAO-B inhibitors?

A

Serotonin syndrome

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10
Q

What medications are used in the treatment of Parkinson’s disease?

A

L-dopa
Dopamine agonists (ropinorole, bromocriptine)
MAO-B inhibitors (seligline)
COMT inhibitors (talcapone)

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11
Q

What clinical score can be used to determine severity of frailty?

A

Rockwood

  • Level of independence
  • Physical activity
  • Cognitive status
  • Functional status

1–3: Not frail (fit, well, or managing well)
4: Vulnerable (pre-frail)
5–9: Various degrees of frailty, with 9 indicating terminal illness.

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12
Q

List the different types of laxative giving an example for each?

A

Stimulant - senna, basocodyl
Bulk forming - isphagula husk
Osmotic - macrogrol, lactulose
Stool softener - docusate sodium

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13
Q

List 4 causes of postural hypotension

A

Medications
Dehydration - hypovolemia
Autonomic dysfunction
Adrenal insufficiency
Sepsis
Alcohol

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14
Q

What is osteoporosis

A

A systemic skeletal disease characterised by low bone mass and microarchitectural deterioration therefore increase in bone fragility and susceptibility to fractures

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15
Q

List three endocrine disease that contribute to osteoporosis

A

Cushings
Hyperthyroidism
Hyperparathyroidism
Male hypogonadism

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16
Q

Rf for osteoporosis

A

‘SHATTERED FAMILY’
Steroid use
Hyperthyroidism/Hyperparathyroidism
Alcohol and smoking
Thin (BMI <22)
Testosterone deficiency
Early menopause
Renal/liver failure
Erosive/inflammatory bone disease
Diabetes
Family Hx

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17
Q

What abnormal finding can be found in cross section of bone in osteoporosis

A

Fewer trabecular in spongy bone
Thinning of cortical bone
Widening Haversian canals

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18
Q

Gs Ix for osteoporosis and results

A

Dexa scan- t score of -2.5 or less

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19
Q

What 2 areas are commonly affected in osteoporosis that the dexa scan focuses on

A

Lumbar spine
hip

Hip

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20
Q

What is a t score

A

Standard deviation that is compared to gender matched young adult mean

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21
Q

What criteria are listed in the FRAX assessment tool

A 
Sex 
Weight 
Height 
Previous fracture
Corticosteroid use 
Current smoking 
Parent fractured hip 
Alcohol
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22
Q

Other than dexa scan what other Ix can be done in osteoporosis

A 
X-ray of wrist, spine, hip- of fracture suspected 
MRI spine 
Bone profile- calcium, phosphate, alp 
Vit d levels 
TFTs
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23
Q

Tx for osteoporosis

A

Rx- lifestyle advise (stop smoking, diet, regular exercise)
1st line Rx- bisphosphoneates + vit d and calcium
2nd line- Desonumab, HRT, Teriparatide

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24
Q

What advice should be given for bisphosphonates

A

Take whole (swallow) with plenty water while standing or sitting on empty stomach at least 30 minutes beofre breakfast and stay upright after taking ~30 mins

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25
What are the adverse effects of bisphosphonates?
oesophagitis oesophageal ulcers osteonecrosis of the jaw
26
What t score is indicative of osteopaenia
t score of -1 to -2.5
27
What t score is indicative of osteoporosis
t score of less than -2.5
28
What factors is the Z score adjusted for?
Gender, ethnicity and age
29
What is OA
Is a non inflammatory degenerative joint pain characterised by the deterioration of articulate cartilage and new bone formation
30
List 5 symptoms of OA
Joint stiffness Joint pain - associated w/ activity Bone enlargements Crepitus Restricted range of motion
31
What joints are affected in OA
PIP DIP Carpometacarpal joint
32
What signs of OA
Heberdens nodes- DIP Bouchard nodes- Pip squaring of carpometacarpal Joint
33
Signs on X-ray in OA
Loss of joint space Osteophytes Subarticular sclerosis Subchondral cysts
34
Tx for OA
Cx- lose weight, exercise, braces, physio/occupational therapy Rx- oral paracetamol/topical NSAIDs, NSAIDS Sx- osteotomy, arthroplasty, arthroscopy, fusion of joints
35
Rf for OA
Female Increasing age Trauma bone Early menopause FHx Obesity
36
What sign is seen in patients with NOF?
Shortening and external rotion of the affected hip
37
List 3 rf for falls
Postural hypotension Polypharmacy Vsion problems >65 Balance/gait problems
38
What physical tests may you perform in a person presenting with falls?
Turn 180 test or timed up and go test
39
List 5 medications that can cause postural hypotension?
Nitrates Diuretics Anticholinergic medications Antidepressants Beta Blockers L-Dopa ACEI
40
List 3 drugs that could be associated with falls?
Benzodiazepines Antipsychotics Opiates Codeine Digoxin
41
What other condition is polymyalgia rheumatica associated with?
GCA
42
List 5 features of polymyalgia rheumatica?
Shoulder/hip girdle stiffness (usaully in morning) Reduced appetite WL Malaise Low grade fever
43
What is BPPV?
characterised by sudden episodic attacks of vertigo by changes in head position
44
What is the cause of BPPV?
Detachement of otholiths from the utricle in the inner ear
45
What is the diagnostic test for BPPV?
Dip-Hllpike manoeuvre
46
What is the mx of BPPV?
Epley Manouevre
47
What would be the murmur associated with AS
Ejection Systolic
48
What would be the murmur associated with AR
Early diastolic murmur
49
What would be the murmur associated with MS
Rumbling mid diastolic
50
What would be the murmur associated with MR
Pansystolic
51
What non-pharmacological stratergies should be trialled in managing a patient with delerium?
Provide a quiet environement with good lighting Maintaing a regular sleep-wake cycle Regular orientation and reassurance Ensuring patient glasses and hearing aids are used if needed
52
List 3 RF for pressure sores?
Immobility Sensory impairment Malnourishment Older age Surgery- Incontinence
53
What clinical score is used to screen patinets who at risk of developing pressure sores?
Waterlow score
54
How can pressure sores be avoided?
Barrier creams Pressure redistribution Repositioning Regular skin assessment
55
What is the management of pressure sores?
Moinst wound environement- Hydrocoloid dresssings Surgical debridement Antibiotics if signs of infection
56
WHat is the START tool
Suggests medications that may provide additional benefits
57
WHat is the STOPP tool
Used to assess which drugs can be potentially discontinued in elderly patients undergoing polypharmacy
58
WHat metabolic disturbances can be seen in refeeding syndrome?
Hypophosphataemia Hypokalaemia Hypomagnesia Thiamine deficiency Abnormal glucose metabolism
59
WHta are the potential complications of refeeding syndrome?
Cardiac arrythmias Coma Convulsions Cardiac Failure
60
List primary prevention for strokeS?
Smoking cessation COntrol HTN Control Hypercholestraemia Control diabetes Encourage actuve lifestyle
61
List secondary prevention for strokes?
72 Hour ECG to look for paroxsyml AF CAROTID DOPPLER bp eCHO
62
List the initial mx of ischaemic stroke>
Aspirin 300mg Thrombolysis w/ alteplase if less than 4.5 hours Control BP
63
List 3 RF for ischaemic stroke
Hypertension Hypercholestraemia Diabetes Smoking AFIB Carotid stenosis
64
List 3 RF for haemorrhagic strokes?
AVM Aneursyms Anticoagulants
65
Which abx should be avoided in old patients w/ epilepsy as it could lower seizure threshold?
Ciprofloxacin
66
list a short term and long term se of levodopa?
short- abnormal dreams long- on and off states
67
List 2 sx of pseudodemnetia?
repsonds to answers with 'i dont know' symtopms of depression
68
MOA of bisphosphonates?
Inhibit osteoclastic bone resorption
69
What are the common sites for pathological fractures in OP?
distal radius proximal humerus proximal femur (NOF fracture) Pelvis Vertebrae
70
What is the tool used to screen patients for malnutrition?
The Malnutrition Universal Screening Tool (MUST)
71
What is hyperthermia?
Defined as a core temperature over 40 degrees with CNS dysfunction
72
Name some risk factors for hyperthermia.
Older age, impaired cognition, pre-existing dehydration, obesity
73
What is hypothermia defined as?
Core body temperature <35 degrees Celsius Mild hypothermia: 32-35°C Moderate or severe hypothermia: < 32°C
74
What can rapid re-warming on an individual in hypothermia cause>
Distributive shock and Peripheral Vasodilation
75
What blood results are most consistent with Osteoporosis?
Normal calcium Normal phosphate Normal alkaline phosphatase Normal PTH
76
What laxative is generally given first line?
Bulk forming laxative - ispaghula
77
What laxative is generally given second line?
Osmotic laxative such as macrogol
78
What to do if a patient with Osteoporosis taking Alendronate has significant upper GI side effects?
Switch to Risedronate or Etidronate
79
What is malignant hyperthermia?
Inherited autosomal dominant condition seen after administration of anaesthetic agents characterised by hyperpyrexia and muscle rigidity Excess calcium ion release from skeletal muscle
80
What is Benign Paroxysmal Positional Vertigo (BPPV)?
A medical condition characterized by sudden, episodic attacks of vertigo induced by changes in head position.
81
What is the gold standard investigation for BPPV?
Dix-Hallpike Manoeuvre, where the patient is rapidly lowered to the supine position with an extended neck. A positive test recreates the symptoms of BPPV.
82
What is the first-line management for BPPV?
Epley manoeuvre, successful in around 80% of cases. It aims to move the detached otoliths out of the semi-circular canal and back to the utricle. Patients are also taught exercises to do at home, such as Brandt-Daroff exercises.
83
What is Mx for a post-menopausal woman who has an osteoporotic fracture?
Bisphosphonates Dont wait for DEXA

PHASE 3A (11 decks)

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