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Phase 3A > Geriatrics Teaching > Flashcards

Geriatrics Teaching Flashcards

1
Q

What is frailty?

A

A state of increased vulnerability resulting from ageing associated decline in reserve and function across multiple systems, such that the ability to cope with stressors is reduced

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2
Q

What are the most common presentations to geriatric medicine?

A

Falls, confusion, incontinence, immobility, chest pain, SOB, urinary symptoms

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3
Q

What are some of the added complications that come with treating older patients?

A

Non-specific presentations, complex co-morbidities, reduced organ function, more prone to side-effects, polypharmacy

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4
Q

What is deconditioning?

A

Deterioration of function that happens due to an illness usually

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5
Q

What is the comprehensive geriatric assessment (CGA)?

A

A process focused on determining a frail older person’s medical, psychological, social and functional capacity

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6
Q

What is included in the CGA medical assessment?

A

Problem list, co-morbidities, medication review, nutritional status

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7
Q

What is included in the CGA functional assessment?

A

Activities of daily living, activity/exercise status, gait and balance

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8
Q

What factors increase the risk of dying from Covid-19?

A

Ethnicity, BMI, Co-morbidities, immunosuppression, age

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9
Q

What is the management for an elderly patient with Covid-19 infection?

A

Frailty assessment, DNAR form, antibiotics, fluids, oxygen, resp rate, escalation plan, physio

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10
Q

What is the management for palliative covid infection?

A

Oxygen, reduce unneccessary meds, pre-emptive prescribing of opiates, sedatives, hyoscine for secretions)

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11
Q

What is the most common cause of major trauma?

A

Elderly patient’s falling indoors

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12
Q

What is a fragility fracture?

A

A fracture from standing height or less

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13
Q

What are the six components of the best practice tariff for hip fractures?

A

Prompt surgery within 36 hours, prompt orthogeriatric assessment within 72 hours, pre-operative cognitive testing, delirium assessment post-operatively, prompt mobilisation after surgery, fracture prevention assessments, nutritional assessment

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14
Q

What lifestyle factors can prevent frailty?

A

Good nutrition, physical activity, avoid social isolation, reduce alcohol

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15
Q

How is frailty assessed?

A

Clinical frailty scale, walking speed, grip strength

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16
Q

How can you reduce post-operative delerium?

A

Oxygen, correcting anaemia, maintaining fluids and electrolytes, analgesia, ensuring regular bowel and bladder function, nutritional support, appropriate environmental stimuli

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17
Q

What analgesia are typically used in hip fractures?

A

Fascia iliaca nerve block, paracetamol, opioids (+laxative) - usually buprenorphine patch.

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18
Q

What tool can be used to assess risk of fractures?

A

FRAX score

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19
Q

What measures can be used to reduce risk of fractures?

A

Weight-bearing exercises, muscle strengthening, falls prevention, smoking cessation, avoid alcohol, calcium and Vit D supplements, Bisphosphonates (alendronic or zolendronic acid)

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20
Q

What is delerium?

A

An acute confusional state that fluctuates in severity and is usually reversible. Usually the result of another organic process.

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21
Q

What is BPSD?

A

Behavioural and psychological symptoms of dementia - agitation, irritability, depression, disinhibition, hallucinations

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22
Q

What tests are included in the confusion bloods screen?

A

Calcium levels, B12, folate, ferritin, TSH

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23
Q

What is the first line treatment of delirium?

A

Orientation, reassurance, continuity of care, provide hearing aids/glasses/quiet environment
Sedation (haloperidol, lorazepam) if risk to self/others

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24
Q

Can you have delirium and dementia?

A

Yes, they can occur simultaneously

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25
Q

How do you diagnose dementia?

A

Long-term history - decline in memory with impairment of at least one other cognitive function, such as skilled movements, language or executive function for > 6 months

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26
Q

What are the common causes of reversible dementia?

A

Depression, B12/folate, hypothyroid, NPH

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27
Q

What is the difference between hypo and hyperactive delirium?

A

Hypo - lethargy, slowness, sleepy, inattention
Hyper - aggressive, confused, agitated, hallucination

28
Q

What is a TIA?

A

Transient Ischaemic Attack - less than 24 hours neurological dysfunction caused by focal brain, spinal cord or retinal ischaemia without evidence of acute infarction

29
Q

What is the acute management of a TIA?

A

High dose (300mg) aspirin to prevent stroke, refer to specialist

30
Q

What is the ABCD2 score?

A

A score used to put someone into the category of a low or high risk TIA (age, BP, clinical features of TIA, how long it lasts, diabetes)

31
Q

What investigations are done for TIA and stroke?

A

Bloods, ECG, USS carotid, brain imagining, ?echo, 24hr tape

32
Q

What is the management for a TIA?

A

Antiplatelet therapy - aspirin/clopidogrel

33
Q

What are the three main causes of ischaemic stroke?

A

Atherosclerosis, cardio-embolic, dissection

34
Q

What are some common causes of carotid dissection?

A

Over-extending the neck - cycling, painting ceiling, hairdressers leaning back

35
Q

How fast should neuroimaging be done after stroke admission?

A

Within 1 hour

36
Q

What is the short term management of an ischaemic stroke?

A

Anti-platelets (aspirin 300mg OD for 2 weeks, then swap for clopidogrel), manage BP, thrombolysis, thrombectomy, endarterectomy

37
Q

What is the long-term management of ischaemic stroke?

A

Lifestyle - salt, exercise, smoking alcohol, lipids - reduce by 40%, keep BP under 130/80

38
Q

What is a carotid endarterectomy?

A

Removal of the plaque from the carotid artery

39
Q

Give an example of a drug used for thrombolysis?

A

Alteplase

40
Q

When can alteplase be used for thrombolysis?

A

If patients present within 4.5 hours of stroke

41
Q

What are the causes of haemorrhagic stroke?

A

CAA - amyloid beta peptide deposits in arteries, hypertension, aneurysms, AVMs, trauma, blood thinners

42
Q

What is the treatment for haemorrhagic stroke?

A

BP management < 140/80, reverse anticoagulation, neurosurgical referral, drain if hydrocephalus

43
Q

What is blood pressure like after a TIA?

A

Higher - due to body trying to re-perfuse the area

44
Q

How long do you not drive after a TIA?

A

one month

45
Q

What are the main general causes of malnutrition?

A

Impaired nutrient intake, increased nutrient requirements, malabsorption or inability to use ingested nutrients

46
Q

What are the consequences of malnutrition?

A

Decreased immunity, muscle wasting, impaired wound healing, poorer recovery outcomes

47
Q

What is the MUST score?

A

The malnutrition Universal Screening Tool - scores a patient based on their BMI, history of weight loss, acute disease effect

48
Q

How often are MUST scores completed?

A

Weekly/ every outpatient appointment

49
Q

What is the approach to treating malnutrition?

A

Food first, supplements, then enteral/parenteral nutrition

50
Q

What types of nutritional supplements are offered?

A

milkshake style (fortisip), juice style, high energy powders, soup style, semi-solid, high protein

51
Q

What is enteral nutrition?

A

Direct feeding into the gut - usually stomach or duodenum and jejunum

52
Q

What are the benefits of enteral nutrition?

A

Preserves gut mucosa and integrity, improves nutritional status, inexpensive compared to parenteral nutrition

53
Q

What are the typical routes of short term enteral nutrition?

A

Nasogastric tube (can be inserted at ward level, can be checked by pH), nasojejunal tube (needs radiological assistance, cant be checked using aspirate.

54
Q

What are the typical routes for long term enteral nutrition?

A

PEG (Percutaneous endoscopic gastrostomy), PEJ - jejunoscomy

55
Q

What are the indications for parenteral nutrition?

A

Inadequate absorption, GI fistula, bowel obstruction, severe malnutrition

56
Q

What is refeeding syndrome?

A

A group of clinical symptoms asssociated with the reintroduction of nutrition after starvation/malnourishment. Shift in use of fats to carbs as energy, initiates insulin increase and cellular uptake of potassium, phosphate and magnesium - can cause fluid retention, arrhythmias, resp insufficiency

57
Q

What is the management of refeeding syndrome?

A

IV pabrinex(B1 and B12) or thiamine + vitamin B prior to feeding and for first 10 days. Slow reintroduction of nutrition, daily blood monitoring

58
Q

What is the Fried criteria?

A

A criteria for frailty - unintentional weight loss, self reported exhaustion, weakness, slow walking sleep, low physical activity

59
Q

In which individuals can the clinical frailty scale be used?

A

Individuals over 65 and not with an acute illness

60
Q

What is the e-FI?

A

The electronic frailty index, based on retrospective cohort data and calculated on the presence or absence of individual deficits as a proportion of 36 - including social factors, comorbidities and self-reported symptoms

61
Q

When is end of life?

A

Within the last 12 months of life

62
Q

What is advance care planning?

A

A process of discussion about goals of care and means of setting on record preferences for care of patients who may lose capacity or communicating ability in the future

63
Q

What is sarcopenia?

A

Loss of muscle mass or function - usually measured by loss of grip strength and slow walking

64
Q

How are hospitals not good for you?

A

No exercise - deconditioning, poor nutrition, unusual environment

65
Q

How do we prevent frailty and sarcopenia?

A

Being treated for their conditions - balance, nutrition, exercise, home assessment, social needs, therapy assessments

66
Q
A

Phase 3A (14 decks)

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