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3a follow up > Geris > Flashcards

Geris Flashcards

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1
Q

Manoeuvre to diagnose BPPV?

A

Dix-Hallpike manoeuvre

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2
Q

Manoeuvre to treat BPPV?

A

Epley manoeuvre

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3
Q

Causes of delirium?

A

PINCH ME
Pain
Infection
Nutrition
Constipation
Hydration
Medication
Electrolytes

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4
Q

Examples of drugs which can cause delirium?

A

Steroids, opioids, benzodiazepines, anticholingeric

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5
Q

Different types of delirium?

A

Hyperactive, hypoactive, mixed

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6
Q

Non-pharmacological management of delirium?

A

24 hour clock
Keep environment the same
Bring familiar objects and photos
Help them eat and drink regularly
Talk calmly in short sentences

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7
Q

First line treatment for mild-moderate Alzheimers?

A

Acetylcholinesterase inhibitors e.g. donepezil/galantamine/rivastigmine

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8
Q

Second line treatment for Alzheimers?

A

NMDA receptor antagonist e.g. memantine

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9
Q

Which risk score used for pressure sores?

A

Waterlow score

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10
Q

Delirium risk assessment tool?

A

4 AT test
Alertness, AMT4, attention, acute change

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11
Q

AMT4 questions?

A

Age, DOB, place, year

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12
Q

Genetic risk factors for Alzheimer’s disease?

A

Apolipoprotein E mutation
Mutations in the amyloid precursor protein

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13
Q

Which blood tests included in a confusion screen?

A

FBC
U+E
LFTs
Coagulation/INR
Calcium
B12/folate
Glucose
TFTs
Blood cultures

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14
Q

Non-blood tests for confusion screen?

A

Urine MC+S
Sputum culture
Chest xray
ECG

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15
Q

Antidote for dabigatran?

A

Idarucizumab

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16
Q

Antidote for NOACs?

A

Andexanet alfa

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17
Q

Antidote for warfarin?

A

Vitamin K

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18
Q

First line drugs for Parkinson’s?

A

Levodopa + decarboxylase inhibitor
e.g. carbidopa/benserazide

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19
Q

Drug classes used for Parkinson’s?

A

Levodopa
COMT inhibitors
Dopamine agonists
MAOBs

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20
Q

Antiemetic used in parkinsons and why?

A

Domperidone - doesn’t cross the BBB

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21
Q

Examples of COMT inhibitors and mechanism?

A

Entacapone, tolcapone
Stops breakdown of levodopa

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22
Q

Examples of dopamine receptor agonists?

A

Ropinirole, bromocriptine, cabergoline, rotigotine

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23
Q

Examples of MAOBs and mechanism?

A

Selegiline, rasagiline
Prevent breakdown, increases circulating dopamine

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24
Q

Which tool is used in deciding whether to start new medications?

A

START - screening tool to alert doctors to the right treatment

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25
What is the FRAX assessment?
Risk assessment for 10-year risk of developing osteoporosis-related fracture
26
Elements included in FRAX score?
Age, gender, BMI Prev fracture Parental hip fracture Smoking Corticosteroids Rheumatoid arhtritis Alcohol Femoral neck BMD (DEXA)
27
What is a DEXA T score?
Score of bone mass based on young reference population
28
DEXA T score classifications?
> -1.0 = normal -1.0 - -2.5 = osteopenia < -2.5 = osteoporosis
29
What is the tool for discontinuing medications?
STOPP - screening tool of older persons' prescriptions Identifies medications where risks outweigh benefits
30
What tool is used to assess frailty of a patient?
PRISMA-7
31
What is included in the PRISMA-7 questionnaire?
Age Gender Health problems Assistance required Walking aid use
32
Which medications associated with significant increase in mortality in dementia patients?
Antipsychotics
33
Difference between Lewy body dementia and Parkinson's disease dementia?
In Lewy body, dementia precedes motor symptoms In Parkinson's, motor symptoms precedes cognitive Usually within ~1 year of each other
34
How long should warfarin be given for in an uncomplicated DVT?
6 months
35
Symptoms of digoxin toxicity?
N+V+D Confusion Yellow-green vision Arrhythmias
36
Precipitating factors for digoxin toxicity?
Hypokalaemia Renal failure
37
Pressure ulcer grading?
1 - Erythema, intact skin 2 - Partial thickness skin loss 3 - Full thickness skin loss 4 - Extensive destruction, tissue necrosis, or damage to muscle, bone or supporting structures
38
Main risk factors for osteoporosis?
Female gender Age Corticosteroid use Smoking + alcohol Low BMI Fhx
39
Non-pharmacological management of osteoporosis?
Lifestyle - diet, smoking, alcohol Exercise - weight bearing/strength training
40
Medical management of osteoporosis?
1st line - Bisphosphonates 2nd line - denosumab Calcium and vitamin D supplementation
41
How long bisphosphonates taken for?
Oral - 5 yeas IV - 3 years
42
Mechanism of bisphosphonates?
Inhibit osteoclast-mediated bone resorption
43
Main risk factors of bisphosponates?
Increased risk of atypical stress fractures Otseonecrosis of the jaw Oesophageal reactions Acute phase response
44
Classic sign of hip fracture?
Shortened and externally rotated leg
45
Possible locations of hip fracture?
Intracapsular or extracapsular
46
Test for diagnosing heart failure?
NT-proBNP blood test BNP
47
What is BNP?
B-type natriuretic peptide Hormone produced by left ventricle in response to strain
48
Features of chronic heart failure?
Dyspnoea, Orthopnoea Paroxysmal nocturnal dyspnoea Wheeze, cough Weight loss (cardiac cachexia) Bibasal crackles Oedema Raised JVP, hepatomegaly
49
Chronic heart failure drug management?
1st line - ACEi and BB 2nd line - aldosterone agonist, SGLT2 inhibitors 3rd line - digoxin, ivabradine, sacubitril-valsartan
50
Which heart failure should SGLT2 inhibitors be used in?
HF with reduced ejection fraction
51
Which vaccines should heart failure patients be offered?
Annual influenza One-off pneumococcal
52
NYHA classification for chronic heart failure?
I - no symptoms, no limitation II - mild symptoms, slight limit to physical activity III - moderate symptoms, comfortable at rest but less than ordinary activity results in symptoms IV - severe symptoms, unable to carry out physical activity without discomfort, symptoms present even at rest
53
3 groups of LUTS in men?
Voiding, storage and post-micturition
54
Medical management for voiding symptoms in men?
Mod/severe - alpha-blocker (tamulosin/alfuzosin) Enlarged prostate - 5-alpha reductase inhibitor (finasteride) If both - dual therapy
55
U&Es in rhabdomyolysis?
Hyperkalaemia - breakdown of skeletal muscle = leakage of intracellular potassium
56
Postural hypotension definition?
Fall of blood pressure within 3 minutes of standing Systolic = 20mmHg Diastolic = 10mmHg
57
What are the 4 criteria a patient needs to meet to demonstrate capacity?
Understand the decision Retain the information long enough to make the decision Weigh up the pros and cons Communicate their decision
58
What is a best interest meeting?
Deciding treatment decisions for patients that lack capacity taken in their best interest, taking into account their individual wishes and values
59
What is lasting power of attorney (LPA)?
LPA = person legally nominates a person to make decisions on their behalf if they lack mental capacity - LPA only comes into effect if the patient lacks the capacity to decide for themselves
60
What are deprivation of liberty safeguards (DoLS)?
Application made by a hospital or care home for patients who lack capacity to allow them to provide care and treatment Whilst in hospital/CH the pt is under control and is not able to leave. “Deprived of their liberty”
61
Which score estimates stroke risk following TIA?
ABCD2
62
Factors in ABCD2?
Age BP Clinical features Duration Diabetes
63
Investigations for myeloma?
Bence-Jones proteins Serum electropheresis
64
X-ray findings in myeloma?
Lytic lesions
65
Complications of myeloma?
AKI Anaemia Neutropenia Thrombocytopenia Hyperviscosity
66
5-HT3 agonists?
Ondansetron Palonosetron
67
5-HT3 side effects?
QT prolongation

3a follow up (7 decks)

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