Older Persons Medicine Flashcards
(20 cards)
Describe how to take a postural BP measurement.
- Have the patient lie down for 5 minutes.
- Measure blood pressure and pulse rate.
- Have the patient stand.
- Repeat blood pressure and pulse rate measurements after standing 1 and 3 minutes.
What is a AMTS?
Abbreviated Mental Test Score (AMTS)
It is a useful tool for determining the presence of cognitive impairment in a patient. Initially developed to pick up the presence of dementia, now commonly used to identify any confusion (acute or chronic).
Name some of the questions asked during a AMTS.
- Age
- Current time (to the nearest hour)
- Recall: Ask the patient to remember an address (e.g. 42 West Register Street). Ensure they are able to say it back to you immediately, then check recall at the end of the test
- Current year
- Current location (e.g. name of hospital or town)
- Recognise two people (e.g. relatives, carers, or if none around, the likely profession of easily identified people such as doctor/nurse)
- Date of birth
- Years of the first (or second) world war
- Name of the current monarch (or prime minister)
- Count sequentially backwards from 20 to 1
Under what score does the AMTS imply the presence of cognitive impairment?
8
Describe some limitations of the AMTS.
- In a patient with reduced GCS (or language barrier) the test cannot be completed
- The test was validated during the 1970s in the elderly population i.e. some of the questions are outdated
What is a MMSE?
Mini-Mental State Examination
Describe some advantage of the MMSE.
- Relatively quick and easy to perform
- Requires no additional equipment
- Can provide a method of monitoring deterioration over time
Describe some disadvantages of the MMSE.
- Biased against people with poor education due to elements of language and mathematical testing
- Bias against visually impaired
- Limited examination of visuospatial cognitive ability
- Poor sensitivity at detected mild/early dementia
Explain when X-rays are used and why.
They are used as a first-line imaging investigation in most situations due to their low radiation dose and easy availability.
Explain when nuclear imaging is used and why.
Nuclear imaging measures the uptake of various labelled radioactive isotopes.
They are mainly used to show bone metastases (multiple myeloma is an exception which may not show).
Arthritis will also show as hot spots.
The renal collecting system (kidneys and bladder) show high uptake as they excrete tracer.
Explain when fluroscopy imaging is used and why.
Fluoroscopy is the use of X-rays to obtain live moving images. Common uses include barium studies, angiography, and interventional procedures.
Describe how CTs work.
CT (computed tomography) uses X-rays to obtain images. A heated cathode releases high-energy electrons, which in turn release their energy as X-ray radiation. X-rays pass through tissues and hit a detector on the other side.
The more dense a tissue, the more X-rays it absorbs.
Bone: X-rays absorbed = few X-rays reaching detector: White
Air: X-rays not absorbed = lots of X-rays reaching detector: Black
Describe how MRIs work.
The MRI (magnetic resonance imaging) machine generates an extremely strong magnetic field and pulses of radiofrequency energy, which align hydrogen nuclei in tissues and body water. The subsequent loss of alignment with time produces the MRI signal.
There are two main MRI sequences:
T1: Water is dark - better for anatomy (soft tissue structures)
T2: Water is bright - better for pathology (inflammation, oedema)
What is CDT?
Catheter-directed thrombolysis (CDT) is an emerging, minimally invasive alternative treatment for patients with massive and submassive PE.
Describe the pathophysiology behind osteoporosis.
Osteoporosis is a metabolic bone disease that, on a cellular level, results from osteoclastic bone resorption not compensated by osteoblastic bone formation. This causes bones to become weak and fragile, thus increasing the risk of fractures.
Describe how to manage osteoporosis.
Healthy lifestyle choices such as proper diet, exercise, and medications can help prevent further bone loss and reduce the risk of fractures. But, lifestyle changes may not be enough if you have lost a lot of bone density.
Medications include, bisphosphonates, selective oestrogen receptor modulators, parathyroid hormone, Calcium and vitamin D supplements.
Describe how to prevent osteoporosis.
Healthy lifestyle choices such as proper diet, exercise, and medications can help prevent further bone loss and reduce the risk of fractures.
Describe the pathophysiology behind pressure ulcers.
Pressure ulcers are areas of necrosis and ulceration where soft tissues are compressed between bony prominences and external hard surfaces. They are caused by unrelieved mechanical pressure in combination with friction, shearing forces, and moisture.
Describe how to manage pressure ulcers.
- Wash the area gently with mild soap and water. If needed, use a moisture barrier to protect the area from bodily fluids.
- Stage II pressure sores should be cleaned with a salt water (saline) rinse to remove loose, dead tissue.
- Keep the sore covered with a special dressing. This protects against infection and helps keep the sore moist so it can heal.
Describe how to prevent pressure ulcers.
Relieve the pressure on the area.
Use special pillows, foam cushions, booties, or mattress pads to reduce the pressure.
Change positions often. If you are in a wheelchair, try to change your position every 15 minutes. If you are in bed, you should be moved about every 2 hours.
