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MD3 RAPP Flashcards

1
Q

What defines a mild cognitive impairment over dementia?

A

Mild cognitive impairment does not impact function

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2
Q

mx for mild cognitive impairment?

A
  • improve CVD risk factors as these are same as dementia
  • medicolegal - will + POA
  • retest 12 months
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3
Q

What are the two medications that may be used to slow dementia?

A

donepezil and rivastigmine commonly.

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4
Q

irritability and change in sleep pattern on top of prior cognitive impairment should ring alarm bells for?

A

delirium

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5
Q

Define delirium.

A

An acute and fluctuating change in cognition often featuring inattention.

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6
Q

Screening tool for delirium?

A

4AT

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7
Q

Ix for delirium screen?

A

SCRUBS mnemonic
Scan brain (sometimes)
CXR
Rationalise meds
Urine
Bloods - FBE, UEC, CMP, LFT, TFT, CRP
Scan bladder

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8
Q

Why do LFTs in suspected delirium?

A

to rule out hepatic encephalopathy

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9
Q

What is the molecular pattern responsible for alzheimers?

A

Amyloid beta plaques and neurofibrillary tangles

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10
Q

Is memory impacted in vascular dementia?

A

It can be or it can be spared. More typical is slow info processing and personality change.

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11
Q

Mx for vascular dementia?

A

CVD management to prevent further strokes.

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12
Q

Lew Body dementia is unique due to what defining feature?

A

Visual hallucinations

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13
Q

2 main types of fronto-temporal dementia and their classic signs.

A

fronto - behavioural change
temporal - primary progressive aphasia

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14
Q

Do cholinesterase inhibitors work for front-temporal dementia?

A

no

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15
Q

Brain imaging can be useful in declines in cognition to rule out?

A

space occupying lesions and brain bleeds (subdural in oldies)

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16
Q

Key finding on MRI in Alzheimers?

A

Hippocampi atrophy

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17
Q

Key MRI finding in vascular dementia?

A

Microhemarrohages

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18
Q

Triad for normal pressure hydrocephalus?

A

falls
ataxia
incontinence

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19
Q

Key to venous ulcer management?

A

compression (check for PVD first by ABI)

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20
Q

Most important mx for falls?

A

exercise

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21
Q

NOF mx principles

A
  • operate early
  • mobilise early
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22
Q

key for mx for neuropathic ulcers?

A
  • remove pressure eg. orthotics
  • beware osteomyelitis
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23
Q

Mild traumatic brain injury is also known as?

A

concussion

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24
Q

Name two unique features of traumatic brain injury compared to other ABIs?

A
  • diffuse axonal injury (sheared axons)
  • post-traumatic amnesia !!!
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25
Only sign you will see on initial CT of ischemic stroke?
hyperdense artery sign
26
All spinal patients should have what intervention?
IDC - risk of retention
27
All acute quadreplegics should have what intervention?
NGT - huge aspiration risk
28
Which Ix and medication are used in many spinal patients with bladder issues?
urodynamics and oxybutynin
29
Which bacteria causes bladder stones in spinal bladders?
proteus - need to treat always
30
Virtually every spinal patient should on which medicines for their constipation?
coloxyl - morning senna - night
31
First line treatment for spasticity?
Baclofen
32
Pain in spinal patients is typically treated with which agents?
= neuropathic pain - amytriptyline - pregabalin
33
First step in managing geriatric depression?
rule out organic causes
34
Safe anti-depressant option in geris?
Mirtazepine
35
One reason why tricyclics are poor options for geris?
orthostatic hypotension also QT elongation
36
SSRIs may cause _____ or _____ in conjunction with other medications.
SIADH or serotonin syndrome
37
Mx option for refractive geri depression?
ECT
38
Main ECT side effect?
memory loss (short term)
39
Pharm mx for serotonin syndrome?
benzos
40
Dementia risk factors?
- CVD risks - hearing/visual impairment - TBI
41
What is the anti-psychotic of choice for Lewy Body Dementia?
Quetiapine
42
'incongruent affect' is code for ?
psychotic disorders
43
Immediate pharm mx for mass compressing spine?
dexamethasone
44
Why are LFTs relevant to bone mets?
ALP up in bone mets
45
Scan for PE?
CTPA
46
Opioid breakthrough dose?
1/6th of regular.
47
max paracetamol dose in adults?
4g in 24hrs
48
Side effects of opioids?
constipation, confusion, sedation, nausea, dry mouth.
49
Best opioid for renal disease?
fentanyl
50
Cyclizine is great for N+V caused by?
vestibular n+v
51
Switch from metaclopramide to donperidone if....
noticing EPSE caused by metaclopramide (or pre-exisiting EPSE)
52
Convert oral morphine to subcut.
Subcut is 1/3 of dose of oral.
53
3 steps following pt death.
1. call death same day, get chosen funeral services involved. 2. Report to GP 3. Bereavement resources to family
54
What is a pancoast tumour?
Apical lung tumour causing shoulder pain, radiculopathy and Horner's syndrome.
55
Which stroke type is typically sensory only?
thalamic
56
The main risk of diuretics in geris?
dehydration
57
Right parietal stroke causes what type of presentation?
hemineglect
58
What is an antalgic gait?
weird gait due to pain
59
2 main falls rehab goals: 2 main falls risks:
strength and balance bleed and fracture
60
serum osmolality is the key ix in which geriatric presentation?
HHS (hyperosmolar hyperglycemic syndrome)
61
Which cognitive screen is best for non-english speakers?
RUDAS
62
2 key features of Wernicke's Korsakoff?
No new memory laying + ophthalmogplegia
63
Slow release K+ tablet?
Clorvescent
64
two med classes used for neuropathic pain?
Anti convulsants eg. pregabalin and gabapentin Anti-depressants - duloxetine and amitryptaline
65
post-void residual level that is classified as retention?
over 300ml
66

MD (18 decks)

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