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Geriatrics Flashcards

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1
Q

what proportion of geriatric patients with depression have comorbid alcohol abuse?

A

1/3

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2
Q

what are some more common symptoms in geriatric depression?

A
  1. lethargy
  2. anxiety
  3. physical/ somatic symptoms
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3
Q

which anti-depressant drug is good for patients who have previously had a heart attack?

A

sertraline

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4
Q

what are 4 drugs commonly prescribed in the elderly that can cause depression?

A
  1. centrally acting antihypertensives
  2. lipid soluble beta blockers
  3. benzodiazepines
  4. progesterone contraceptives
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5
Q

what are 3 risk factors for relapse of depression?

A
  1. more than 3 episodes of major depression
  2. episode in the last 12 months
  3. relapse after drug discontinuation
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6
Q

what are 7 risk factors for dementia?

A
  1. increased age
  2. female
  3. lower education
  4. african-american men
  5. genetics
  6. head injury
  7. mild cognitive impairment
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7
Q

how is mild cognitive impairment defined?

A

cognitive deficits greater than expected for a persons age

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8
Q

what are 4 protective factors for dementia?

A
  1. coffee
  2. fish
  3. decreased dietary fat
  4. increased physical activity
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9
Q

what score ranges must people score on MMSE for mild dementia?

A

20-24 / 30

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10
Q

what score ranges must people score on MMSE for moderate dementia?

A

13-20 / 30

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11
Q

what score ranges must people score on MMSE for severe dementia?

A

<12 / 30

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12
Q

what is delirium?

A

acute disturbance of consciousness, change in cognition and reduced ability to focus, sustain and shift attention

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13
Q

is delirium fluctuating or constant?

A

fluctuating

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14
Q

what are 4 factors that make delirium more likely?

A
  1. sensory impairment
  2. severe illness
  3. cognitive impairment
  4. high urea/ creatinine ratio (kidneys not working well)
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15
Q

what medications make delirium more likely?

A
  1. sedatives (EG diazepam)
  2. narcotics (EG codeine)
  3. anticholinergics (EG atropine)
  4. psychotropics (EG antidepressants)
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16
Q

what does the PINCH ME mnemonic for delirium stand for?

A 
P- pain
I- infection
N- nutrition
C- constipation
H- hydration
M- medication
E- environment
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17
Q

how do you measure delirium on the bedside?

A

confusion assessment method

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18
Q

what are the 5 criteria in the confusion assessment for delirium?

A
  1. acute onset
  2. fluctuating course
  3. inattention
  4. disorganised thinking
  5. altered consciousness
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19
Q

how do you manage delirium?

A

pharmacological management is poorly supported. approach patient calmly, reassure, consider unmet needs and treat causes, optimise vision and hearing, and optimise sleep

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20
Q

what is the clinical presentation of hypoactive delirium?

A
  1. apathy

2. quiet confusion

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21
Q

what is the clinical presentation of hyperactive delirium?

A
  1. agitation
  2. delusions
  3. disorientation
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22
Q

what should be included in the assessment of delirium?

A
  1. ABC
  2. GCS
  3. vital signs
  4. blood glucose
  5. cardio/ resp/ gi/ neuro exams
  6. confusion assessment method
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23
Q

what are 4 differentials for delirium?

A
  1. dementia
  2. depression
  3. bipolar
  4. schizophrenia
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24
Q

what should be included in the investigations for the assessment of delirium?

A
  1. bloods
  2. urine dipstick
  3. blood cultures
  4. ECG
  5. CXR
  6. head CT
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25
what medication can be used on patients with delirium who are aggressive?
haloperidol/ olanzapine
26
what is delirium tremens?
delirium caused by the rapid withdrawal from alcohol
27
how do you treat delirium tremens medically?
diazepam or chlordiazepoxide
28
what are 4 complications of drug induced delirium?
1. pressure sores 2. hospital acquired infections 3. fractures 4. progress to stupor/ coma/ death
29
what is functional incontinence?
inability to reach the toilet on time due to immobility or unfamiliar surroundings
30
what is stress incontinence?
leakage of urine on sneezing, coughing or general exertion
31
what is urge incontinence?
leakage of urine preceded by urge of micturition
32
what is overactive bladder syndrome and what causes it?
urge without urge incontinence, and is caused by detrusor overactivity
33
what is overflow incontinence and what causes it?
incontinence due to chronic bladder outflow obstruction and is due to prostatic disease
34
what condition can overflow incontinence lead to?
obstructive nephropathy
35
what is true incontinence?
continuous leakage of urine
36
what are 4 risk factors in women for incontinence?
1. pregnancy (vaginal birth) 2. diabetes mellitus 3. oral oestrogen therapy 4. high BMI
37
what are 4 risk factors in men for incontinence?
1. lower urinary tract symptoms 2. functional/ cognitive impairment 3. neurological disorders 4. prostatectomy
38
what should the assessment for incontinence in women include?
1. digital pelvic floor examination 2. vaginal exam 3. abdo/ pelvic/ neuro exam
39
what should the assessment for incontinence in men include?
1. digital rectal exam | 2. abdo/ pelvic/ neuro exam
40
what investigations should be included in assessing incontinence?
1. urine dipstick 2. renal function test 3. post void residual volume 4. urinary flow rates 5. ultrasound of kidneys
41
what are red flag symptoms for incontinence?
1. visible haematuria 2. microscopic haematuria >50y/o 3. persistent UTI >40y/o 4. palpable bladder after voiding 5. LUTS 6. renal impairment
42
how do you generally treat incontinence?
1. temporary containment products such as pads until specific plan 2. 1st line is pelvic floor exercises and bladder training 3. 2nd line oxybutynin (antimuscarinic) 4. solifenacin if not tolerated
43
how do you specifically treat overflow incontinence?
1. treating obstruction | 2. intermittent self-catheterisation
44
how do you specifically treat incontinence caused by neurological disease?
1. 1st line artificial sphincter 2. antimuscarinic (also in overactive bladder disease) 3. botox injection is sometimes used
45
what are 4 situations where an indwelling catheter is recommended?
1. chronic urinary retention 2. patient cannot self catheterise 3. skin wounds are present that could be contaminated by urine 4. there is distress caused to the patient by changing clothes
46
what are 9 risk factors for falls?
1. age over 80 2. female 3. low weight 4. history of falls 5. dependency 6. orthostatic hypertension 7. polypharmacy 8. vision impairment 9. balance issues
47
what are four risk factors for proximal femur fractures?
1. osteoporosis 2. osteomalacia 3. paget's disease 4. bone mets
48
what should the examination of a patient who has sustained a fall include?
1. mental state 2. visual impairment 3. cardio/ neuro exam 4. timed up and go test
49
how can you prevent falls?
1. mobility equipment 2. occupational therapy 3. active lifestyle and exercise
50
what are 4 neurological causes of falls?
1. myopathy 2. parkinson's disease 3. dementia 4. neuropathy
51
what blood results would you look for in a patient you suspect has sustained a fall due to alcohol abuse?
1. abnormal LFT's | 2. macrocytosis
52
what is a drop attack
a fall where the cause is unknown
53
what are 4 common causes of drop attacks after investigation?
1. cerebrovascular disease 2. carotid sinus hypersensitivity 3. transient ischaemic attack 4. orthostatic hypotension
54
what are 4 primary techniques to prevent falls?
1. increasing exercise 2. reviewing medications 3. changing environmental factors 4. improved management of medical conditions
55
what factors should multifactorial assessment of falls include?
1. cognitive impairment 2. continence problems 3. history of falls 4. unsuitable footwear 5. other health conditions 6. medication 7. postural instability 8. syncope syndrome 9. visual impairment
56
what is the clinical presentation of a pressure ulcer and where do they usually occur?
1. usually occurs as persistently red, blistered, broken or necrotic skin 2. usually occur over bony prominence 3. may extend to muscle and bone
57
what are 5 risk factors for pressure ulcers?
1. cardiovascular disease 2. continence 3. diabetes mellitus 4. hip fracture 5. limb paralysis
58
what risk assessment scales are used for pressure ulcers?
1. norton 2. braden 3. waterlow
59
what is the braden risk assessment for pressure ulcers made up of?
1. sensory perception 2. moisture 3. activity 4. mobility 5. nutrition 6. friction graded 1-4 and lower score is higher risk
60
what 10 things should an ulcer assessment include?
1. cause 2. site 3. dimensions 4. grade 5. exudate amount and type 6. infection 7. pain 8. appearance 9. surrounding skin 10. odour
61
what is a grade 1 ulcer?
discolouration of the skin with oedema
62
what is a grade 2 ulcer?
partial thickness skin loss, superficial presentation as a blister
63
what is a grade 3 ulcer?
full thickness skin loss with subcutaneous necrosis
64
what is a grade 4 ulcer?
extensive destruction, tissue necrosis and damage to underlying structures
65
what grades of ulcer should be referred to specialist services?
grade 3 and 4 ulcers that are deteriorating
66
how do you treat ulcers?
1. pressure management 2. nutrition 3. wound management 4. treating conditions that delay healing 5. infection control 6. pain management
67
what are 4 common sites for pressure ulcers?
1. sacrum 2. heels 3. back of head 4. shoulder
68
which areas are at the most risk of forming pressure ulcers in someone with spinal injury?
sacral and ischial areas
69
what is an advanced directive?
a persons wishes about their future medical or social care
70
what is a lasting power of attorney?
a persons nomination of another person to make health and social care related decisions after they lose capacity to do so
71
what court makes decisions and appoints deputies to act on behalf of people without capacity?
the court of protection
72
if someone did not appoint a LPA and has nobody willing to represent them, who represents them?
an independent mental capacity advocate
73
what is enteral feeding?
feeding that is delivered by a tube via the gastrointestinal tract
74
what are 4 methods of enteral feeding?
1. gastrostomy 2. nasogastric tube 3. jejunostomy 4. oesophagostomy
75
what is parenteral feeding?
intravenous feeding
76
what are 5 conditions where a person would require parenteral feeding?
1. inadequate absorption 2. GI fistula 3. bowel obstruction 4. prolonged bowel rest 5. severe malnutrition
77
what are 4 risks of parenteral feeding?
1. infection 2. venous thrombus 3. hypoglycaemia 4. hyperglycaemia
78
who should be the main point of contact for end of life care of a patient?
a key worker
79
if there is a problem out of hours with end of life care who should be contacted?
local provider of unscheduled care
80
what are 10 common end of life symptoms?
1. anorexia 2. insomnia 3. constipation 4. sweating 5. nausea 6. dyspnoea 7. dysphagia 8. neuropsychiatric symptoms 9. vomiting 10. dyspepsia
81
what method of taking medications should ideally be kept to in end of life care?
medications taken by mouth
82
how many medications is described as polypharmacy?
>5 medications
83
what are 3 interventions in patients with polypharmacy to prevent inappropriate prescribing?
1. MDT case conferences 2. computerised support systems 3. pharmacists
84
what 2 things related to geriatrics should trigger a medication review for a patient?
1. functional decline | 2. development of geriatric symptoms
85
what conditions should be screened for if non-adherence is suspected?
1. dementia | 2. depression
86
what are 4 risks of prescribing in older adults?
1. frailty 2. lack of communication 3. polypharmacy 4. changes in pharmacokinetics and pharmacodynamics
87
what are 4 criteria for a drug that is inappropriately prescribed?
1. contraindicated drugs 2. inappropriate dose or duration 3. adversely affects prognosis 4. makes no difference to patient outcome

Phase 3A Flashcards (6 decks)

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