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Year 3 Medicine > Older Person's Medicine > Flashcards

Older Person's Medicine Flashcards

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1
Q

What do the domains of a comprahensive geriatric assesment include?

A 
Problem list- current and past
Medication review
Nutritional status
Funcational capacity 
Social circumstances 
Environment
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2
Q

What is a CGA?

A

Multidimensional, interdisciplinary, diagnostic process to determine the medical, psychological, and functional capabilities of a frail older person in order to develop a coordinated and intergrated plan for treatment and follow-up.

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3
Q

What do the numerical values of the clinical frailty score indicate?

A

1 Very fit
2 Well
3 Managing well (not active beyond routine walking)
4 Vulnerable (not dependent on other but symptoms limit activities)
5 Mildly frail (need help in high order IADLs)
6 Moderately frail (requiring help with all outside activities, minimal assistance with ADLs)
7 Severely frail - dependent on others for personal care
8 Very severely frail - completely dependent on othersm approaching end of life)
9 Terminally Ill (<6 months life expectancy)

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4
Q

What is frailty?

A

Distinctive health state in which multiple body systems gradually lose their inbuilt reserves and this group of people are at higher risk of adverse health outcomes.

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5
Q

How many drugs prescribed at any one time constitutes ‘polypharmacy’?

A

6 or more

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6
Q

What tool can be utilised during a medication review, particularly when perforoming a CGA?

A

STOPP/START tool

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7
Q

What are the 4 criteria for capacity?

A
  1. able to understand the information
  2. able to retain the information given
  3. able to use this information to make their decision
  4. able to communicate this decision back
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8
Q

How can capacity be maxamised?

A

Discuss the options in a time and place that helps them to understand and remember what you say.
Ask whether having a friend or relative with them might help them to remember information, or otherwise help them make the decision.
Offer written or audio information if it will help.
Speak to the patient’s relatives, friends, and others in the healthcare team, about how best to communicate with the patient.

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9
Q

What are the signs that a patient is reaching the end of their life?

A

Bedbound
Unable to swallow medication
Unable to take sips of water
Semi-comatose state

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10
Q

What symptoms may a patient experience at the end of their life?

A 
Pain
Nausea and vomiting 
Dysponea
Adgitation
Confusion
Terminal Secretions
Constipation
Anorexia
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11
Q

What are common anticipatory end of life medications?

A

Medicine for pain – an appropriate opioid, for example, morphine, diamorphine, oxycodone or alfentanil.
Medicine for breathlessness – midazolam or an opioid.
Medicine for anxiety – midazolam.
Medicine for delirium or agitation – haloperidol, levomepromazine, midazolam or phenobarbital.
Medicine for nausea and vomiting – cyclizine, metoclopramide, haloperidol or levomepromazine.
Medicine for noisy chest secretions – hyoscine hydrobromide or glycopyrronium.

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12
Q

What is a ReSPECT form?

A

Recommended Summary Plan for Emergency Care and Treatment

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13
Q

What is delirium?

A

Acute confusional state, with a sudden onset and fluctuating course.
May be hypoactive or hyperactive - recognised change in conciousness
Onset of 1-2 days.
CHANGE FROM BASELINE

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14
Q

Causes of delirum

A 
Infection
Intoxication
Substance withdrawal
Constipation
Uncontrolled pain 
Hypoxia
Electrolyte imbalance
Urinary retention
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15
Q

What is dementia?

A

Progressive decline in cognitive function usually occuring over several months. It affects many different areas of function, including:
Retention of new information, managing complex tasks, language and word finding difficulty, behaviour, orientation, recognitiion, ability to self care, and reasoning

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16
Q

What are the most common types of dementia?

A 
Alzheimers
Vascular
Lewy Body
Parkinson's disease with dementia
Frontotemporal dementia
Mixed (Alzheimers and Vascular type)
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17
Q

How can Alzheimer’s be managed pharmacologically?

A

Cholinesterase inhibitors such as Donepezil
Antispychotic medications such as memantine or risperidone
Benzodiazapines such as lorazepam

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18
Q

Management of vascular dementia

A

Optimisation of vascular risk factors (stroke/tia)

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19
Q

What is the difference between Lewy Body dementia and Parkinson’s disease with dementia?

A

In Parkinson’s disease typical features of Parkinson’s will present and precede confusion by over a year
Lewy Body dementia Parkinsonism tends to be less severe
Both are progressive with prominent auditory or visual hallucinations, delusions are well formed and persistent

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20
Q

What are the main types of incontinence?

A

Stress
Urge
Overflow
Functional (cognitive impairment, behavioural problems)

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21
Q

What is required for a full continence examination?

A

Review of bladder and bowel diary
Abdominal examination
Urine dipstick and MSU
PR examination (including prostate in men)
External genitallia review (atrophic vaginitis in women)
A post micturation bladder scan

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22
Q

What is the firstline management for urinary incotincence?

A 
Switching to decafinated drinks
Good bowel habit
Improving oral intake
Regular toileting 
Pelvic floor exercises
Bladder retraining
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23
Q

Why are pharmacological measures for urinary incontinence often contraindicated in older patients?

A

Antichollenergics adversely affect their cognition

Many of the drugs used for bladder stabalization can also cause postural hypotension leading to increased falls

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24
Q

When might you be suspicious of feacal impaction in a patient who is opening their bowels?

A

Small amount of type 1 stool
Copious amount of type 6/7 stool
No sensation of defecation

This could be overflow constipation

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25
What type of faecal loading are enemas more effective for?
Soft stool loading
26
What is the risk with manual stool evactuation?
Bowel perforation Must be reserved for difficult cases where the risk is outweighed by the positive impact on patient symptoms and wellbeing
27
When should stimulants laxatives such as senna or laxido be used?
Soft stool constipation
28
What is are the life-threatening risks of chronic constipation?
Stercoral perforation and ischemic bowel
29
Pharmacological mangement of hard stool impaction?
Stool softeners such as Docusate sodium (Colace)
30
What are the 4 types of laxative and what are examples of them?
Osmotic (lactulose, movivcol (macragol)) Stimulant (senna, biasacodyl) Bulk forming (methylcellulose: fybogel) Stool softeners (docusate sodium, glycerin suppository)
31
What are common causes of constipation?
``` Urinary retention Dehydration Lack of dietary fibre Inactivity/immobility Medication e.g. opioids Stress ```
32
What questions should be asked when taking a falls history?
- What were they doing when they fell - How did the fall happen - How did they feel before the fall - Was there any dizziness or lightheadness - LOC? - Cardiac symptoms? Palpitations? - Any weakness - Any history of falls or near misses - Normal mobility, any aids? - Medication history: sedatives, cardiac medications, anticholinergics, hypoglycaemics, opiates - Head injury? - Seizure activity - Associated neurological symptoms
33
What treatment should be commenced if a large bone is fractured with minimal trauma in a patient over 75?
Osteoperosis treatment
34
What causes elderly patients to fall?
``` Delirium Vision loss Hypotension Balance problems Muscle weakness Poor fitting footwear Unsuitable home environment (too dim, insecure rugs or carpets, wet floors) Urinary/feacal urgency Pain TIA ```
35
What is syncope?
Temporary loss of conciousness due to diruption of blood flow to the brain Also known as vasovagal/faint
36
What is the pathophysiology behind a vasovagal episode?
Vagus nerve receives strong stimulus Stimulation of parasympathetic nervous system Parasympathetic activation counteracts the sympathetic nervous system Blood vessels delivering blood to the brain relax Blood pressure in cerebral circulation drops Hypoperfusion of the brain tissue
37
What are primary causes of syncope?
Dehydration Missed meals Extended standing in a warm environment Vasovagal response to a stimulie such as pain/suprise/blood
38
What are some secondary causes of syncope?
``` Hypoglycemia Dehydration Anaemia INfection Anaphylaxis Arrhythmias Valvular heart diease Hypertrophic obstructive cardiomyopathy ```
39
Syncope vs Seizure?
Syncope: Prolonged upright position before the event Lightheaded before the event Sweating before the event Burning/clouding vision before the event Reduced tone during the episode Return of conciousness shortly after falling ``` Seizure Aura (smells, tastes, deja vu) Head turning Abnomral limb positions Tonic clonic activity Tongue biting Cyanosis More than 5 mins Prolonged post-ictal period ```
40
Investigations following a fall?
ECG, particularly assessing for arrhythmia and the QT interval for long QT syndrome 24 hour ECG if paroxysmal arrhythmias are suspected Echocardiogram if structural heart disease is suspected Bloods, including a full blood count (anaemia), electrolytes (arrhythmias and seizures) and blood glucose (diabetes)
41
What patients are at risk of falls?
``` Lower limb muscle weakness Vision problems Balance/gait disturbances (diabetes, rheumatoid arthritis and parkinson's disease etc) Polypharmacy (4+ medications) Incontinence >65 Have a fear of falling Depression Postural hypotension Arthritis in lower limbs Psychoactive drugs Cognitive impairment ```
42
What common medications can cause falls secondary to postural hypotension?
``` Nitrates Diuretics Anticholinergic medications Anti depressants B blockers L dopa ACEi ```
43
What common medications are associated with falls, not related to postural hypotension?
``` Benzodiazepines Antipsychotics Opiates Anticonvulsants Codeine Digoxin Sedative agents ```
44
What is an important assessment to perform on an elderly patinet presenting with a pressure ulcer?
Nutritional assessment
45
Which type of dementia presents with fluctuating cognition in comparison to other types?
Lewy Body
46
How does frontolobal dementia usually present?
Social dishinibition | Family history
47
What blood tests form part of the 'confusion screen'
TSH B12 Folate Glucose
48
What type of drug is memantine?
NMDA receptor antagonist
49
What is Picks disease?
Frontotemporal dementia
50
In which patients should haloperidol be avoided and lorezapam instead be considered
Patients with Parkinsons disease
51
What does the STOPP tool indentify?
Where the risk of a medication outweighs the theraputic benifit in certain conditions
52
Why should TCAs be used with caution in the elderly?
Risk of increased cognative impairement
53
What questionaire should be used to assess frailty?
PRISMA-7
54
What are the grades of WHO performance status (0-5)
0 Fully active without restriction 1 Restricted in physically strenuous acitivty but ambulatory and able to carry out light work 2 Ambulatory and capable of all self care but unable to carry out any work activity, up and about more than 50% of working areas? 3 Capable of only limited self care, confined to bed or chair more than 50% or waking hours 4 COmpletely disabled, cannot self-care, totally confinded to chair or bed 5 Dead
55
What kind of investigation results indicate rhabdomyalysis?
CK Raised LDH (muscle damage) Hyperkalemia (liverated from damaged muscle) Hyperphosphatemia (liberated from damaged muscle) Hyperuricaemia (liberated from damaged muscle) Hypocalcemia (calcium is taken into damaged muscle)
56
In which patients is haloperidol contraindicated in?
Patient's with Parkinson's disease, it promotes dopamine blockade so it can result in psychosis and a deterioration in motor function Use lorazepam instead
57
Lewy body dementia is the presence of dementia alongside two of the three of which core features?
Fluctuating attention and concentration Recurrent well-formed visual hallucination Spontaneous Parkinsonism
58
What is Charles Bonnet syndrome?
Associated with visual loss, patients describe smaller versions of real life objects commonly or faces or cartoons They realise these hallucinations aren't real It is thought that this is due to damage of visual system itself - not a mental health disorder Main treatment is reassurance
59
Common conservative measure for managing postural hypotension?
Standing slowly, dorsiflexing the feet and crossing the legs on standing upright This prevents diuresis and fluid shifts that can cause a sudden drop in blood pressure
60
In what patients must tramadol be avoided?
Epileptic patients, as it lowers seizure threshold
61
What is DOLS (deprivation of liberty safeguard)
A means to protect the rights of patients who lack capacity and are detained in a hospital or care home
62
What is pseudo-dementia?
Depressive dementia Severe depression leading to psychomotor slowing, memory impairment and difficulties in concentration Often presents with significant self neglect and weight loss as a result

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