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HCOLL Flashcards

1
Q

What is the frail phenotype

A

Unintentional weight loss / sarcopenia
Weakness, exhaustion, slow walking
Low level physical activity
Falls, immobility, delirium, memory loss, incontinence

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2
Q

Epidemiology of dementia

A

7.1% of >65y
F>M
Age biggest RF

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3
Q

Aetiology of dementia

A

Neuronal loss: location in brain determines symptoms
Temporal lobe involvement = STM

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4
Q

Symptoms of dementia

A

Memory loss
Difficulty with higher cognitive processes: impaired executive function, apraxia, agnosia (difficulty recognising objects)
Impaired function
>6m

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5
Q

Types of dementia and their prevalence

A

Alzheimer’s : 50-75%
Vascular : 20%
LBD: 10-15%
FTD: 2%

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6
Q

Aetiology of Alzheimer’s disease

A

Characteristic beta amyloid plaques and neurofibrillary tangles

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7
Q

Symptoms of Alzheimer’s

A

Progressive memory loss that affects function
Forget names, people, places
Repeats self
Can’t remember new info
Misplace items
Confusion about time
Getting lost
Cant find words
Mood / behaviour problems

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8
Q

CT brain findings of alzheimers disease

A

Volume loss and enlarged ventricles

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9
Q

Pathogenesis of vascular dementia

A

Diseased blood vessels -> multiple small areas of ischaemia -> brain cell death

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10
Q

CT brain findings of vascular dementia

A

Small vessel ischaemic change

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11
Q

Aetiology of LBD

A

Lewy body protein deposits in the basal ganglia and thalamus

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12
Q

History of illness with LBD

A

Parkinsonism
Motor symptoms occur after or within 1 year of memory problems

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13
Q

Aetiology of FTD

A

Tau protein deposits in frontal and temporal lobes
Protein deposits cause brain cell death

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14
Q

History of illness with FTD

A

Earlier age onset (56-61) and 40% have family history
Slow onset
Progressive non fluent aphasia

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15
Q

DD of dementia

A
  • delirium
  • substance misuse
  • depression / psychosis
  • traumatic brain injury
  • metabolic (hypothyroid / B12)
  • meds (steroids / antidepressants)
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16
Q

Symptoms of vascular dementia

A

Problems with:
Memory, thinking, reasoning
Planning and organising
Decision making / problem solving
Concentrating
Following instructions
Slower thoughts

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17
Q

Early Symptoms of Lewy body dementia

A

Fluctuating memory loss
Hallucinations and delusions
Parkinsonism
REM sleep disorder
Falls

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18
Q

Later symptoms of LBD

A

Motor problems
Mood swings / short tempered
Speech and swallow problems

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19
Q

What does confusion screening bloods include

A

FBC
U&Es
LFT
TFT
Glucose
Calcium
B12
Folate

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20
Q

Medical management of dementia

A

Cholinesterase inhibitors (for mild / moderate alzheimers, LBD or Parkinson’s) -> donepezil, rivastigmine

NMDA receptor antagonists (for moderate alzheimers if intolerant to ACh or severe): Memantine

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21
Q

Psychological management of dementia

A

Interventions to promote cognition, independence and wellbeing
Group cognitive stimulation therapy
Group reminiscence
OT / cognitive rehab

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22
Q

What is hyperactive delirium

A

Agitation, confusion, hallucinations / delusions
Mood disturbance
Disturbed sleep

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23
Q

What is hypoactive delirium

A

Similar to depression
Withdrawn, not eating / drinking
Sleeping a lot
Hallucinations / delusions

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24
Q

Causes of delirium (DELIRIUM)

A

Drugs / dehydration
Electrolyte imbalance
Level of pain / lack of analgesia
Infection / inflammation
Respiratory failure
Impaction of faeces
Urinary retention
Metabolic / MI

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25
Management of delirium
Reduce medications Only use drugs if other interventions have failed and patient is a risk to themselves or others Haloperidol Lorazepam
26
Aetiology of Parkinson’s disease
Loss of dopamine producing cells in substantia nigra
27
Pre clinical signs of Parkinson’s
Symptoms dont manifest clinically until 80% of dopamine producing cells are lost Depression Anosmia Constipation REM sleep disorder Postural hypotension
28
4 main symptoms for Parkinson’s diagnosis
Rigidity + bradykinesia +/- postural instability +/- resting tremor
29
Motor symptoms of Parkinson’s
Bradykinesia Rigidity Postural instability Resting tremor
30
Non motor symptoms of Parkinson’s
Depression / anxiety Psychosis Cognitive impairment Autonomic dysfunction
31
Suggestive features of progressive supranuclear palsy
Vertical gaze palsy Frontal disinhibition Not responsive to dopaminergic treatment
32
Suggestive features of Multi system atrophy
Prominent, autonomic features (postural hypotension, incontinence, impotence) Cerebellar signs
33
Medical management of PD
1. L-dopa mono therapy : time and dose critical 2. Dopamine agonists patch eg rotigotine 3. L-dopa dual therapy 4. Treat non motor symptoms
34
Causes of acute urinary incontinence (DIAPERS)
Delirium Infection Atrophic urethritis and vaginitis Pharmaceuticals / psychiatric Excess urine output Restricted mobility Stool impaction
35
Medications causing urinary incontinence
CCBs, antidepressants, antipsychotics A blockers ACEis Opioids Sedatives Diuretics
36
Cause of urge incontinence
Overactivity of detrusor muscle Bladder over sensitivity Abnormal neuro stimulation
37
Risk factors for urge incontinence
Idiopathic Diuretics UTIs Caffeine / increased fluid intake Alcohol / smoking Constipation Neurogenic
38
Medical management of urge incontinence
Anticholinergics : avoid oxybutynin as increases risks of falls / confusion Botulinum toxin A Intravaginal oestrogens
39
Cause of stress incontinence
Increased IAP Weak pelvic floor and sphincter
40
Risk factors for stress incontinence
Urethral sphincter weakness (cannot withstand increased IAP) - pregnancy, obesity, age - previous vaginal delivery - prolapse / hysterectomy - muscular diseases
41
Medical management of stress incontinence
After pelvic floor training Duloxetine increases sphincter activity Injectable bulking agents
42
Surgical management of stress incontinence
Colposuspension
43
Cause of overflow incontinence
Chronic urinary retention Obstruction to outflow Detrusor muscle failure
44
Risk factors for obstruction to outflow
Constipation Pelvic surgery / strictures BPH / prostate tumour Bladder calculi
45
Risk factors for detrusor failure
Neurological / DM Medication
46
Key investigations for all falls patients
Hx and examination - Gait, heart sounds, neuro, visual ECG Lying and standing BP
47
Medical management of falls
Analgesia Cognitive screen Bone health assessment - FRAX score
48
Common osteoporosis fractures
Neck of femur Colles Vertebral crush
49
Aetiology of osteoporosis
Bone resorption (osteoclasts) > bone formation resulting in: - gradual bone weakening - increased risk of fracture - back pain / kyphosis / loss of height
50
Primary RF for osteoporosis
Age / female Genetics Low BMI Calcium / vit D deficiency Previous low trauma fracture
51
Medical management of osteoporosis
1. Bisphosphonates 2. Denosumab (inhibits osteoclasts) 3. Teriparatide (increase osteoblasts activity)
52
Bisphosphonates counselling
Tablets or injections once weekly Take with water Sit upright 30min after Empty stomach
53
Side effects of Bisphosphonates
GI upset Oesophageal ulcers Jaw necrosis
54
Features of a pressure ulcer
Base : if bone = osteomyelitis Floor: necrosis / pus suggests infection Edge: sloped = normal ulcer Undermined edges = TB Rolled up / everted = risk of malignancy
55
Complications of pressure ulcers
Skin and soft tissue infection (cellulitis) Bone infection (osteomyelitis) SCC : chronic inflammation Sinus tract formation : chronic inflammation Sepsis
56
Define ischaemic stroke
Blockage in the blood vessel stops blood flow
57
Define haemorrhagic stroke
Blood vessel bursts leading to reduction in blood flow
58
2 types of ischaemic stroke
Thrombotic : thrombosis from large vessel Embolic: usually a blood clot can be fat, air or clumps of bacteria - can be caused by AF
59
2 types of haemorrhagic stroke
Intracerebral haemorrhage Subarachnoid haemorrhage
60
Risk factors for ischaemic stroke
General CVD RF’s AF
61
RF’s for haemorrhagic stroke
Age HTN Arteriovenous malformation Anticoagulation therapy
62
RF for haemorrhagic stroke
Age HTN Arteriovenous malformation Anticoagulation therapy
63
Features of a stroke
Motor weakness Speech problems Swallowing problems Visual field defects Balance problems
64
Symptoms of cerebral hemisphere infarcts
Contralateral hemiplegia Contralateral sensory loss Homonymous hemianopia Dysphasia
65
Symptoms of brainstem infarction
Quadriplegia Lock in syndrome
66
Symptoms of lacunar infarcts
Ataxia Pure motor signs Pure sensory sings Mixed signs
67
What are the initial symptoms in the oxford stroke classification
1. Unilateral hemiparesis and / or hemisensory loss of face, arm, leg 2. Homonymous hemianopia 3. Higher cognitive dysfunction
68
Arteries involved in total anterior circulation infarcts
Middle and anterior cerebral arteries
69
Arteries involved in partial anterior circulation infarcts
Smaller arteries of anterior circulation eg upper or lower division of middle cerebral artery
70
Arteries involved in lacunar infarcts
Perforating arteries around internal capsule, thalamus and basal ganglia
71
Arteries involved in posterior circulation infarcts
Vertebrobasilar arteries
72
What symptoms are more common in haemorrhagic stroke over ischaemic
Decrease in consciousness level Headache N&V Seizures
73
What is the FAST campaign
Face - has face fallen on one side? Can they smile Arms - can they raise both arms and keep them there Speech - slurred Time - call 999 if any 1 of these signs
74
Criteria for thrombolysis in ischaemic strokes
Patients present within 4.5hrs of onset No prev intracranial haemorrhage, uncontrolled HTN, pregnancy Then give aspirin 300mg and antiplatelet therapy
75
Immediate management of TIA
Aspirin 300mg unless contraindicated
76
Management of haemorrhagic strokes
Stop anticoagulation and antithrombotics Lowered BP
77
Management of acute ischaemic stroke
Blood glucose, hydration, o2 sats and temp maintained BP should not be lowered unless being considered for thrombolysis Aspirin 300mg Anticoagulants after 14 days Statin if cholesterol >3.5
78
Absolute contraindications to thrombolysis
Previous intracranial haemorrhage Seizure at time of stroke Intracranial neoplasm Suspected subarachnoid haemorrhage Stroke / brain injury in prev 3 months Lumbar puncture prev 7 days GI bleeding prev 3w Active bleeding Oesophageal varices Uncontrolled HTN
79
Relative contraindications to thrombolysis
Pregnancy Concurrent anticoagulation (INR >1.7) Haemorrhagic diathesis Active diabetic haemorrhagic retinopathy Suspected intracardiac thrombus Major surgery in prev 2 weeks
80
When is thrombectomy indicated
Within 6h of onset Together with thrombolysis (if within 4.5hrs) In people who have confirmed occlusion of the proximal anterior circulation
81
Secondary prevention of strokes
Clopidogrel Aspirin
82
Secondary prevention of strokes
Clopidogrel Aspirin
83
What is the rosier score for assessing stroke
Loss of consciousness -1 Seizure activity -1 New acute: Asymmetrical facial weakness +1 Asymmetrical arm weakness +1 Asymmetric leg weakness +1 Speech disturbance +1 Visual field defect +1 Stroke likely if >0
84
Symptoms caused by stroke in anterior cerebral artery
Contralateral hemiparesis and sensory loss Lower extremity > upper
85
Symptoms caused by stroke in anterior cerebral artery
Contralateral hemiparesis and sensory loss Lower extremity > upper
86
Symptoms caused by stroke in middle cerebral artery
Contralateral hemiparesis and sensory loss Upper extremity > lower Contralateral homonymous hemianopia Aphasia
87
Symptoms caused by stroke in the posterior cerebral artery
Contralateral homonymous hemianopia with macular sparing Visual agnosia
88
Symptoms caused by stroke in the posterior cerebral artery
Contralateral homonymous hemianopia with macular sparing Visual agnosia
89
Symptoms of Webers syndrome (branches pf posterior cerebral artery)
Ipsilateral CNIII palsy Contralateral weakness of upper and lower extremity
90
Symptoms of a stroke in the posterior inferior cerebellar artery
Ipsilateral: facial pain and temp loss Contralateral: limb / torso pain and temp loss Ataxia Nystagmus
91
Symptoms of a stroke in the posterior inferior cerebellar artery
Ipsilateral: facial pain and temp loss Contralateral: limb / torso pain and temp loss Ataxia Nystagmus
92
Symptoms of a stroke in the anterior inferior cerebellar artery
Ipsilateral: facial paralysis and deafness
93
Symptoms of stroke in the basilar artery
Locked in sydnrome
94
Symptoms of stroke in the retinal / ophthalmic artery
Amaurosis fugax
95
Symptoms of lacunar strokes
Present with either isolated hemiparesis, hemisensory loss of hemiparesis with limb ataxia Associated with HTN Basal ganglia, thalamus and internal capsule
96
What is waterlow score used for
To identify patients at risk of pressure sores
97
What medications should be avoided in LBD
Neuroleptics Especially risperidone and typical antipsychotics such as haloperidol
98
CT findings in Alzheimer’s
Atrophy of the cortex and hippocampus
99
How to differentiate between dementia with Lewy bodies and Parkinson’s disease dementia
In PD dementia the tremor, bradykinesia and rigidity will develop before dementia In DLB the opposite
100
Presentation of frontotemporal dementia
Social disinhibition Family history
101
How to differentiate between mania and FTD
Mania causes reduced appetite FTD increases appetite
102
What conditions is haloperidol contraindicated in
PD LBD
103
Define frailty
A state of impaired homeostasis leading to increased vulnerability to minor stressor events
104
Most likely diagnosis for a middle aged adult with insidious onset dementia and personality changes
FTD
105
Most likely diagnosis for a middle aged adult with insidious onset dementia and personality changes
FTD
106
MOA of Memantine
NMDA receptor antagonism
107
MOA of Memantine
NMDA receptor antagonism

HCOLL (1 decks)

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