Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Ageing > Week 1 > Flashcards

Week 1 Flashcards

(76 cards)

Start Studying
1
Q

What is a stroke?

A

A vascular event causing loss of brain function with rapidly developing symptoms lasting more than 24 hours.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the difference between a stroke and TIA?

A

The only difference is timing. A stroke is said to last longer than 24 hours and a TIA less than 24 hours.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Types of stroke (short description)

A

Haemorrhagic- bleed somewhere causing ischaemia in the brain.
Infarct- blockage causing ischaemia in the brain.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

In which type of stroke would you use thrombolysis therapy? What timing should thrombolysis only be used in?

A

Infarct- when a clot is blocking the artery. Should only be used within 4 hours of symptom onset.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Most common name of thrombolysis treatment?

A

Tissue plasminogen activator (TPA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What factors should you consider when deciding when to thrombolyse a patient?

A 
Age
Time since onset!
Previous intracerebral haemorrhage or infarct
BP
Diabetes
Amount to be gained from thrombolysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Essential acute management steps of a stroke patient

A 
Thrombolysis/thromboectomy
Imaging- CT 
Swallow assessment
Nutrition and hydration
Antiplatelets
DVT prevention
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Why do you have to do a swallow assessment for stroke patients?

A

Stroke patients may not be able to swallow and therefore are at higher risk of aspiration which can lead to pneumonia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Give an example of anti platelets?

A

Aspirin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When is it appropriate to give anti platelets in a stroke?

A

Need to CT first to exclude a haemorrhagic stroke. Then give aspirin asap to prevent another infarct.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How does aspirin help in stroke patients?

A

Aspirin is an anti-thrombotic drug that will prevent white (arterial) thrombosis. It prevents new thrombosis from forming.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What precautions should you take to stop DVTs after a stroke?

A

TED compression stockings
Heparin
Intermittent pneumatic compression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What sorts of different ischaemic strokes can you get?

A

Cardioembolic- occlusion of the brains blood supply by a clot from the heart. Red clot. Fibrin dependent. This is basically a blood clot.
Atheroembolic- Blockage made of cholesterol- white in appearance.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What prevention methods would you put in place if a patient had a cardioembolic infarct stroke?

A

Anticoagulants
Stop smoking
Control bp
Diet and lifestyle advice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What prevention methods would you put in place if the patient had a atheroembolic stroke?

A 
Antiplatelet- clopidogrel
Stop smoking
Control bp
Diet and lifestyle
Statin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What medical condition can increase your risk of ischaemic stroke?

A

AF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Examples of anti-coagulants

A

Heparin, warfarin, low molecular weight heparin

They prevent red thrombosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is delirium?

A

Defined by 4 traits-
Inattention
Fluctuates and develops acutely
Change in cognition e.g. memory deficit, speech and language disturbances

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Why do people get delirium?

A

Its a direct physiological consequence of a general medical condition e.g. an infection, polypharmacy or a number of causes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How does delirium differ from depression and dementia?

A

Delirium is acute in onset and fluctuates over the course of the day whereas dementia doesn’t. Depression takes slightly longer to present and will be worse in the mornings.
Delirium also can cause patients to be agitated (hyperactive delirium) or sleepy and slow (hypoactive). Depression causes the person to be withdrawn and dementia can cause the person to become wandering.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Wandering patient- delirium, depression or dementia?

A

Likely dementia- patients tend to forget their surroundings and become confused.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Agitated patient- delirium, depression or dementia?

A

Could either be delirium or dementia. Hyperactive delirium can cause agitation but dementia can do the same.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Onset of confusion within 2 weeks- delirium, depression or dementia?

A

Likely depression because its not acute enough to be delirium however dementia sets in after a far longer period of time.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Distorted perception e.g. hallucinations and illusions- delirium, depression or dementia?

A

Likely to be delirium. However severe cases of dementia may have these.
Dementia’s perception is normal in early stages.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What particular aspect of speech do patients with dementia struggle with?
Word-finding difficulties.
26
What mood would you expect a patient with delirium, depression and dementia to have?
Delirium- fluctuating emotions Dementia- possible low mood. Depression- low mood. Lack of interest.
27
Short theory about what causes delirium?
Something to do with Ach effect on the brain. Also know its to do with direct toxic insults to the brain e.g. in infection or with drugs.
28
Name some factors that can predispose you to delirium?
``` Pre-existing dementia Advanced age Co-morbidity Post op period Terminal illness Sensory impairment Polypharmacy Depression Alcohol dependency Malnutrition ```
29
Name some precipitating (factors that trigger the onset of an illness) factors for delirium?
``` Drugs Alcohol UTI Hypoxia Hyperglycaemia Being in hospital (unfamiliar environment= loss of normal orientation queues) Infections ```
30
What hallmarks of delirium should you look for in a history?
Acute and fluctuating presentation Inattention Disorientated thinking Altered level of consciousness
31
Describe hyperactive delirium?
Agitated, aggressive and wandering | easy to diagnose
32
Describe hypoactive delirium?
Withdrawn, apathetic, sleepy, coma | Easily missed in diagnosis
33
Which two tools are used to diagnose delirium?
The CAM and the 4AT
34
What questions would be asked in a 4AT?
Attention- say the months of the year backwards AMT4- Where are we? Who are you? What year is it? Alertness- were they difficult to wake? were they agitated? Acute in course- evidence of change in mood over the last two weeks and in particular the last 24 hours.
35
Describe the CAM method?
Feature 1: Acute onset and fluctuating course- evidence? Feature 2: Inattention- did the patient have difficulty keeping track of the conversation? Feature 3: Disorganised thinking- did the patient show signs of this? Feature 4: Overall how would you rate the patients consciousness?
36
General management of delirium?
Identify that its delirium and reverse all possible underlying causes. This could be drug changes or eradicating an infection etc. Need to reassure relatives and control any symptoms.
37
What environmental factors can aid in a patient with deliriums recovery?
Allow them to walk around. Restraining them makes things worse. Orientate them- put clocks and newspapers around so they know when it is. Reduce noise- side room. Make sure the buzzer is within reach. Hearing aid switched on, glasses close by.
38
When would you use sedation in a patient with delirium?
Don't use unless completely necessary. This is when the patient is being a harm to themselves or others around them.
39
Which drugs would you consider using to calm someone with delirium who is a danger?
Haloperidol- low dose and given orally. | Quetiapine- for patients with parkinsons
40
What is the comprehensive geriatric assessment? Describe the process.
A way of assessing older people as they present in hospital. Create a problem list from the history. Agree objectives of care e.g. palliative, symptom controlling, treating Develop management plan Regular review
41
What key things should be included in a CGA?
Problem list Past medical history Functioning - Activities of daily living Exercise state Gait and balance Psychological Mental status and mood Social/environment -social circle care resource eligibility
42
What is sarcopenia?
Age related loss of muscle and function.
43
3 criteria for sarcopenia?
1) low muscle mass 2) low muscle strength 3) low physical performance
44
When does muscle mass start to decline and when does it accelerate?
Muscle mass starts to decline around age 30 and accelerates at age 60.
45
What is sarcopeinic obesity?
Slow infiltration of fat around the muscle tissue. | Technically- loss of muscle mass with increased fat.
46
What does sarcopeinic obesity lead too?
Increased risk of cardiometabolic issues e.g. cardiovascular disease, insulin resistance, metabolic syndromes.
47
What interventions can stop sarcopenia and its consequences?
Exercise- using progressive resistance training. Aerobic training will increase endurance Also decrease cardiac risk etc.
48
What is rehabilitation?
Enabling an individual to maximise their potential to live a full and active life within their family, social networks, education/training and workplace where appropriate.
49
What is reablement?
The active process of an individual regaining their skills, confidence and independence to enable them to do things for themselves, rather than having things done for them.
50
What is habilitation?
The process of assisting an individual with achieving developmental skills when impairments have caused a delay or blocking of initial acquisition of these skills.
51
What are the 10 key elements of care for a dying patient?
1) Recognition that the patient is dying 2) Communication between yourself and the patient and family and loved ones 3) Spiritual care 4) Anticipatory prescribing for relief of symptoms 5) Review of clinical interventions should be in the patients best interests 6) Hydration review 7) Nutritional review 8) Full discussion of the care plan with the patient and relatives 9) Regular reassessment of the patient 10) Dignified and respectful care after death
52
How would you diagnose dying?
Worsening weakness and performance status Worsening physiological status with no reversibility Struggling to manage oral meds Losing interest in food and fluid Sleeping more, eventual unconsciousness.
53
Describe each step in the cancer pain management ladder?
Step 1) Non-opioid +/- adjunct This could be paracetamol or NSAIDs plus an adjunct which could be amitryptilline, gabapentin Step 2) Add an opioid for mild to moderate pain E.g. codeine or tramadol Step 3) Opioid for severe pain plus the non-opioid and adjunct. This could be morphine, diamorphine
54
In the elderly when starting morphine you should..
Start low and go slow
55
Which types of morphine will you give to a patient?
You'd put them on a twice a day bolus of morphine like MST but then you'd also need to give them something for the 'breakthrough' pain. This could be oromorph QRS. The breakthrough tends to be about 1/6th of the total daily dose.
56
What are you likely to have to prescribe alongside morphine especially in the first week?
An antiemetic e.g. metaclopramide. | Also regularly a laxative- patient preference.
57
How would you management of morphine doses change if the patient could no longer take it orally?
Morphine is twice as potent subcutaneously so you'd have to take your oral dose and divide it by two.
58
Which drug are you likely to prescribe at the end of life for a distressed patient?
midazolam
59
Which drug are you likely to prescribe at the end of life for a nauseous or agitated patient?
levomapromazine
60
Which drug are you likely to prescribe at the end of life for respiratory secretions (makes a horrible choking noise that is not nice for the family to hear)?
Buscopan.
61
When looking for a cause of falls, when should you stop looking?
You shouldn't, there will be lots of factors involved and you need to minimise the effect of each one.
62
What physiological factors change as you get older?
``` Vision- smaller pupils and increased lens thickness Decreased reaction time Sarcopenia Decreased cardiorespiratory fitness Increased postural sway. ```
63
What medical conditions can cause syncope?
``` Arrhythmias Orthostatic hypotension (postural) Neurogenic Carotid sinus hypersensitivity Valvular heart disease (aortic stenosis) ```
64
Diagnosis of orthostatic hypotension
A reduction in systolic bp of 20 | or a reduction in diastolic bp of 10 after 3 mins of standing
65
Name some extrinsic factors that can cause older people to fall?
``` Medications Alcohol Environmental hazards Inappropriate clothing/shoes Inappropriate walking aids ```
66
Which drugs are likely to increase the risk of falls?
``` Neuroleptics are the big ones Benzodiazepines Anti-hypertensives Anti-depressants Anti-cholinergics Class 1 anti-arrhthymics ```
67
Key questions to ask in a fall history?
What happened before and after the fall? Has anything like this ever happened before? Was it from getting up too quickly? Did they feel nauseous beforehand? Impact/consequences of fall
68
How would you carry out a lying and standing bp
Patient has to be lying down for at least 5 mins- take his bp Ask them to stand up- take bp in the 1st minute and again at 3 minutes
69
What assessments can you use to look at their stability and gait?
Timed up and go test- patient sits and has to walk to a point 3m away then sit back down. Longer than 12 seconds is abnormal.
70
What test would you use to test for BPPV?
Dix-Hallpike manœuvre
71
Definition of ageing
Progressive, generalised impairment of function resulting in loss of adaptive response to disease.
72
What factors stop us from ageing to 1000?
``` Mutations in chromosones Mutations in mitochondria Intracellular aggregates Extracellular aggregates Cellular loss (loss of stem cells) Cell senescence Extracellular protein crosslinks ```
73
What is the Hayflick limit? (to do with telomeres)
Telomeres sit at the end of chromosomes and every time they replicate they shorten. The theory thinks these limit the amount of times the cell can divide.
74
Damage to cells causes 4 main responses which are:
Apoptosis- programmed cell death Repair Senescence- inactive cell that essentially just sits and takes up space Malignant transformation
75
What is the Soma hypothesis?
When you reach a certain age (after reproductive age) your body isn't interested in repair as much anymore.
76
How would you define frailty?
Loss of homeostasis and resilience Increased vulnerability to decompression after a stressor event Increased risk of falls, delirium, disability etc.

Ageing (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions