Phase 3a - Arun&Erin > COTE > Flashcards

COTE Flashcards

(124 cards)

Study These Flashcards
1
Q

Name the 2 types of cerebrovascular accidents

A
  • Ischaemic stroke
  • Haemorrhagic stroke
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Name 4 things that can disrupt the blood supply to the brain

A
  • Thrombus/embolus
  • Atherosclerosis
  • Shock
  • Vasculitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is a TIA?

A

Temporary (< 24hrs) neurological dysfunction caused by ischaemia without infarction

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

Name 6 symptoms of stroke

A
  • Limb weakness
  • Facial weakness
  • Dysphasia
  • Visual field defects
  • Sensory loss
  • Ataxia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Name 5 risk factors for stroke

A
  • Previous stroke or TIA
  • Atrial Fibrillation
  • Carotid artery stenosis
  • Hypertension
  • Diabetes
  • Raised cholesterol
  • Family Hx
  • Smoking
  • Obesity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the FAST tool for stroke?

A

Face
Arm
Speech
Time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Tx: What is the management of a TIA?

A
  • Aspirin 300mg daily
  • Referral for specialist assessment
  • Diffusion-weighted MRI scan
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Tx: What is the immediate management of a stroke?

A
  • Immediate CT brain (to exclude haemorrhage)
  • Aspirin 300mg daily for 2 weeks + clopidogrel 300mg
  • Admission to a specialist stroke centre

For 21 days - clopidogrel

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

Tx: What management is considered once haemorrhage is excluded?

A

Thrombolysis with alteplase

  • Alteplase is a tissue plasminogen activator that rapidly breaks down clots
  • It may be given within 4.5hrs of symptom onset

Thrombectomy
* Considered in patients with a confirmed blockage of the proximal anterior/posterior circulation
* It may be considered within 24hrs of symptom onset and alongside IV thrombolysis

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

Ix: Name 2 things that are always investigated for in patients who have had a TIA or stroke

A
  • Carotid artery stenosis: carotid imaging
  • Atrial fibrillation: ECG

Anticoagulation is initiated for AF (after excluding haemorrhage and finishing 2 weeks of aspirin)
Surgical interventions are considered for significant CAS (carotid endarterectomy or angioplasty and stenting)

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

Tx: What is the secondary prevention of a stroke?

A
  • Clopidogrel 75mg once daily
  • Atorvastatin 20-80mg (not started immediately, usually delayed by at least 48hrs)
  • Blood pressure and diabetes control
  • Addressing modifiable risk factors (smoking, obesity, exercise)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Name 5 members involved in the MTD for stroke patients’ rehabilitation?

A
  • Stroke physicians
  • Nurses
  • Speech and Language therapists
  • Physiotherapy
  • Dieticians
  • Occupational therapy
  • Social services
  • Optometry and ophthalmology
  • Psychology
  • Orthotics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Definition: Parkinson’s disease

A

Condition where there is a progressive reduction in dopamine in the basal ganglia leading to disorders of movement

Sx are asymmetrical

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

What is the classic triad of Parkinson’s disease features?

A
  • Resting tremor: worse at rest
  • Rigidity: resisting passive movement
  • Bradykinesia: slow movement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Name 5 clinical features of Parkinson’s disease (8)

A
  • Pin-rolling tremor
  • Cogwheel rigidity
  • Bradykinesia: shuffling gait, micrographia, festinating gait, difficulty initiating movement, difficulty turning around, reduced facial movements/expressions
  • Depression
  • Insomnia
  • Anosmia
  • Postural instability
  • Cognitive impairment/ memory problems
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Tx: What are the 4 medical treatment options for Parkinson’s disease?

A
  • Levodopa + peripheral decarboxylase inhibitor (e.g. carbidopa, benserazide)
  • COMT inhibitors
  • Dopamine agonists
  • Monoamine oxidase-B inhibitors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is Levodopa?

A
  • Synthetic dopamine
  • Combined with a peripheral decarboxylase inhibitor which stops it from being metabolised before it reaches the brain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Name 2 combination drugs to treat Parkinson’s

A
  • Co-beneldopa (levodopa + benserazide)
  • Co-careldopa (levodopa + carbidopa)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the main SE of Levodopa and it’s Tx?

A

SE: Dyskinesia
Tx: Amantadine (glutamate antagonist)

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

Definition: Dyskinesia

A

Abnormal movements associated with excessive motor activity:

  • Dystonia: excessive muscle contraction leads to abnormal postures/exaggerated movements
  • Chorea: abnormal involuntary movements, jerking
  • Athetosis: involuntary twisting/writhing movements, usually in fingers/hands/feet
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are COMT inhibitors?

A

e.g. entacapone

  • Inhibits catechol-o-methyltransferase which metabolises levodopa
  • Taken with Levodopa to slow breakdown in the brain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are dopamine agonists?

A
  • Mimic action of dopamine in the basal ganglia, stimulating dopamine receptors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Name 3 dopamine agonists

A
  • Bromocriptine
  • Cabergoline
  • Pergolide
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the main SE of prolonged dopamine agonist use?

A

Pulmonary fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What are **monoamine oxidase-B inhibitors**?
* **Block** the action of **monoamine oxidase-B enzymes** which break down the neurotransmitter **dopamine** ## Footnote Monoamine oxidase enzymes break down other neurotransmitters such as serotonin and adrenaline, but monoamine oxidase-B is specific to dopamine
26
Name 2 examples of monoamine oxidase-B inhibitors
* **Selegiline** * **Rasagiline**
27
What information should be gathered in a **fall** history?
* Who? * When? * Where? * What happened before/after fall? * Why do they think they fell? * How many times have they fallen in the last 6 months?
28
What are 7 things you would ask in a **systems enquiry** in a fall Hx
* **General**: wt loss, fatigue * **Cardio**: chest pain, palpitations * **Resp**: SOB, cough * **Neuro**: loss of consciousness, seizures, motor/sensory disturbance * **GU**: incontinence, urgency, dysuria * **GI**: abdo pain, diarrhoea, constipation * **MSK**: joint pain, muscle weakness
29
What 7 things would you ask in **PMH** for a fall?
* **General**: visual/hearing impairment, diabetes, anaemia * **Cardio**: CVD, arrhythmias * **Resp**: COPD * **Neuro**: parkinson's, peripheral neuropathy, stroke, dementia * **GU**: recurrent UTI, incontinence * **GI**: diverticulitis, chronic diarrhoea, alcoholic LD * **MSK**: arthritis, chronic pain, fractures
30
Name 5 medications which can cause falls
* **Beta-blockers** (bradycardia) * **anti epileptics** (sedative) * **Antihypertensives** (hypotension) * **Benzodiazepines** (sedation) * **Antibiotics** (intercurrent infection) * **diabetic medication** (hypoglycaemia)
31
Name 4 investigations for falls
* **Bedside**: vital signs, lying/standing BP, urine dipstick, ECG, blood glucose * **Bloods**: FBC, U&E, LFT, bone profile * **Imaging**: chest x-ray, CT head, ECHO * **Specialist**: tilt table test, Dix-Hallpike test, 48hr tape cardiac monitoring
32
Name 6 differentials for a fall
* **Mechanical**: poor footwear, visual impairment * **Polypharmacy** * **Stroke** * **Peripheral neuropathy** * **Hypoglycaemia** * **BPPV**
33
Tx: Name 5 possible interventions to stop a fall? (10)
* Gait = **physiotherapy** * Visual/ hearing problems = **eye/hearing test** * **Reduce unneccessary meds** * **Alcohol cessation** * Cognitive impairment = refer to **psychiatric team** * Postural hypotension = review meds, imrove **hydration** * Treat/rule out **infections** * Ensure good fitting **footwear** * Environmental hazards = turn on lights, take up rugs
34
Definition: Urinary incontinence
**Loss of control of urination** Two types: * Urge (**overactivity** of **detrusor muscle**) * Stress (**weak pelvic floor** and **sphincter muscles** - leakage)
35
Name 5 risk factors for urinary incontinence (8)
* Increased age * Postmenopause * Increased BMI * previous pregnancy * Pelvic organ prolapse * Pelvic floor surgery * Neuro conditions e.g. MS * Cognitive impairment & dementia
36
Name 4 investigations for urinary incontinence
* **Bladder diary** * **Urine dipstick** * **Post-void residual bladder volume** * **Urodynamic testing**
37
Tx: What is the management of stress incontinence?
* Avoid caffeine, diuretics, excessive fluid intake * Weight loss * Pelvic floor exercises * Surgery * Duloxetine - 2nd line
38
Tx: What is the management of urge incontinence?
* **Bladder training** for at least 6 weeks * **Anticholinergic** meds (oxybutynin, tolterodine, solifenacin) * **Mirabegron** (alternative to anticholinergic) * **Invasive procedures** when medical Tx fails e.g sacral nerve stimulation/ Botox
39
Definition: Osteoporosis
* Significant reduction in **bone density** * T-score of **< -2.5**
40
What is a DEXA scan?
* Dual-energy x-ray absorptiometry * Measures how much **raditaion** is absorbed by the bones * Used to measure **bone mineral density** (BMD)
41
Name 5 risk factors for osteoporosis (10)
* Older * Post-menopausal * Reduced mobility/activity * Low BMI * Low calcium/vit D * Alcohol & smoking * Personal/Family Hx of fractures * Chronic diseases - e.g coeliac, diabetes * Long-term corticosteroids * Certain meds (SSRI, PPI, anti-epileptics, anti-oestrogens)
42
What are QFracture tool and FRAX tool used for?
Calculating the **10 year risk** of a **major osteoporotic fracture** and a **hip fracture**
43
Tx: What is the management of osteoporosis?
* Address **reversible risk factors** - e.g excercise, weight, stop smoking * Address **insufficient intake of calcium & vit D** e.g supplements * **Bisphosphonates**
44
Name 4 side effects of **bisphosphonates**
* **Reflux** / oesophageal erosions * **Atypical fractures** * **Osteonecrosis** of the **jaw** * **Osteonecrosis** of the **external auditory canal**
45
How should oral bisphosphonates be taken?
* On an **empty stomach** with a full glass of water * Afterwards pt should **sit upright** for **30 mins** before moving/eating
46
Name 3 examples of bisphosphonates
* **Alendronate** * **Risedronate** * **Zoledronic acid**
47
What is the Waterlow Score used for?
Risk assessment tool for estimating a pt's risk of developing a **pressure ulcer**
48
Definition: Pressure ulcer
Areas of skin **necrosis** due to **pressure-induced ischaemia**
49
Name 5 risk factors for developing a pressure ulcer (9)
* Age * Immobility * Low/high body weight * Malnutrition * Dehydration * Incontinence * Neurological damage * Sedative drugs * Vascular impairment
50
Name the 4 mechanisms of pressure ulcers
* **Pressure** * **Shear**: where skin is pulled away from skeleton small blood vessels can be kinked/torn * **Friction**: rubbing the skin decreases its integrity * **Moisture**: sweat, urine, faeces cause maceration adn decrease integrity
51
Tx: What is the management of pressure ulcers?
* **Prevention** * **Turning & handling** * **Pressure-relieving devices** * **Debridement**: dead tissue should be removed * Manage **nutrition**, **incontinence**, **glycaemic control**, **correct anaemia** * **Dressings** * **Antibiotics**
52
Name 4 administration challenges when prescribing for the elderly
* Labels too small to read / packaging hard to access / easy to muddle up tablets * **Distribution**: low lean body mass means dose should be adjusted if drug has a narrow therapeutic index * **Hepatic metabolism** * **Renal excretion** declines with age
53
Definition: Deprivation of Liberty Safeguards
DoLS protect people in **care homes/hospitals** from being **inappropriately deprived of their liberty** if they cannot consent to their care arrangements.
54
Definition: Power of Attorney
A legal document that allows an adult to **nominate another person** to conduct **financial affairs**/ health and welfare on their behalf
55
Definition: Advance directive
A **patient-led** medical decision made when the pt is **competent**, which comes into force if the pt becomes **incompetent**
56
Drugs that can cause postural HTN
Nitrates Diuretics Anticholinergic medications Antidepressants Beta-blockers L-Dopa Angiotensin-converting enzyme inhibitors - (ACE) inhibitors
57
Medications that can cause falls other than due to postural hypotension
Codeine Benzodiazepines Digoxin Antipsychotics
58
FRIED phenotype for frailty
Fatigue Low physical activity Exhaustion Weakness Unintentional weight loss Slowness in walking speed
59
Risk factors for a fall
- +65 years old - arthritis in lower limbs - postural hypotension - polypharmacy - peripheral neuropathy - vision problems - incontinence - constantly needing to get up - MS/GBS -hazardous environment e.g not clean -delirium and dementia
60
Tests for falls
Turn 180 test Timed up and go test more than 12 seconds
61
What is breakthrough pain?
Transient increase in pain intensity over and above background pain - rapid, severe ## Footnote i.e a flare up in a chronic condition
62
What are the 2 main subtypes o fpain
* Nociceptive - somatic, visceral (organs) * Neuropathic - nerves
63
What is nociceptive pain
Pain which is transmitted by damaged non-neural tissue
64
What is neuropathic pain?
Pain which is transmitted by a damaged nervous system
65
What are the features of neuropathic pain?
* burning * tingling * shotting * electric-shock * 'vice-like' (tight, like a corset)
66
What is the mechanism of paracetamol?
Inhibits production of CNS prostaglandins
67
What is the mechanism of NSAIDs?
* **Inhibit COX** (main enzyme in synthesis of prostaglandins from arachidonic acid) * Can be selective (celecoxib) or non-selective (ibuprofen)
68
What should you consider before prescribing paracetamol?
* Liver impairment * Severe cachexia
69
What should you check before prescribing NSAIDs?
Renal and platelet count
70
What are the contraindications to NSAIDs?
* GI bleeding/ulcer Hx * Asthma
71
What medications interact with NSAIDs? ## Footnote increase risk of bleeding
* Warfarin * Digoxin * Steroids
72
What should you consider when commencing opioids? ## Footnote 11 things (think pharmaceutical and social Hx)
* Route * Timing * Renal function * Previous opiod use * Allergies * Acceptability of SE * Polypharmacy * Previous addiction * Safety of medicine in the home * Patient concerns * Driving/ occupation
73
Side effects of opioids? ## Footnote common (4), less frequent (3), rare (3)
Common * consipation * nausea * sedation * dry mouth Less frequent * psychomimetic effects * confusion * myoclonus Rare * allergy * respiratory depression * pruritus
74
What are the indications of patches? (fentanyl/buprenorphine)
* Intolerable SE * Oral route difficulties: compliance or dysphagia * Renal impairment
75
Why wouldn't you use a patch in acute or unstable pain?
Takes minimum 3 days to reach analgesic concentrations when increased
76
What are the long term harms of opioids?
* Falls/fractures * Sensitivity * Immune system * Endocrine * Hyperalgesia * Dependence
77
What are antidepressants useful in? Give 2 examples ## Footnote (in terms of pain Mx)
**Neuropathic pain** * amitriptyline * duloxetine
78
What are antiepileptics useful in? Give 2 examples ## Footnote (in terms of pain Mx)
**Neuropathic pain** * pregabalin * gabapentin
79
What are antispasmodics useful in? Give 2 examples ## Footnote (in terms of pain Mx)
**Muscle spasms** * baclofen * tizinidine
80
What are steroids useful in? Give an example ## Footnote (in terms of pain Mx)
**Compression Sx** * dexamethasone
81
What are benzodiazepines useful in? Give 2 examples ## Footnote (in terms of pain Mx)
**Spasms**, **?neuropathic pain** * clonazepam * diazepam
82
What are local anaesthetics useful in? Give an example ## Footnote (in terms of pain Mx)
**Focal areas of pain** * topical lidocaine plasters
83
What are bisphosphonates useful in? Give an example ## Footnote (in terms of pain Mx)
**Bone pain** * zolendronic acid
84
What are some common palliative emergencies?
* Febrile neutropenia * SVCO (superior vena cava obstruction) * Stridor * Hypercalcaemia * Spinal cord compression
85
What is neutropenic sepsis/febrile neutropenia?
Life-threatening complication of **neutropenia** following chemotherapy
86
What are the signs of neutropenic sepsis?
* Clinical sepsis - **temp >38 degrees** * Clinical infection - **chest**, **urine**, skin, GI
87
How is neutropenic sepsis diagnosed?
* **Clinical sepsis** and/or **pyrexia >38C** * Neutrophil count **< 0.5**
88
What is the management of neutropenic sepsis?
* **IV access** * **Broad spec ABx** * **Fluid resus** * close observation & Ix (FBC, U&E, LFT, CRP, lactate, cultures)
89
What signs would make you think of superior vena cava obstruction?
Lung cancer/tumour involving the R upper lobe or mediastinum
90
What are the symptoms of SVCO?
* Facial swelling, redness * Periorbital oedema * Arm swelling * Breathlessness * Distended veins on chest
91
How is SVCO diagnosed?
**CT chest**
92
How is SVCO managed?
* ABCs * High dose steroids - **dexamethasone** * consider anticoagulation * stenting * radiotherapy (or chemo)
93
What are the signs of stridor?
* Noisy breathing - **on inspiration** * Harsh breath sounds * Breathlessness (can be a late sign of decompensation)
94
How is stridor diagnosed?
* Clinically * Upper airway visualisation * Upper airway imaging (CT)
95
How is stridor managed?
* ABC: oxygen/heliox * High dose steroids: dexamethasone * Urgent ENT/oncology review * Tracheostomy (new airway) * Stenting (open airway) * Radiotherapy
96
What signs make you think of malignant hypercalcaemia?
Cancers which has spread to bone: * breast * lung * kidney * thyroid * prostate
97
What are some acute and chronic symptoms of malignant hypercalcaemia?
Acute: * thirst * confusion * constipation * global deterioration Chronic: * Depression * Abdo pain * Constipation * Calculi
98
How is malignant hypercalcaemia diagnosed?
**Blood test** * corrected calcium > 2.6 = abnormal * corrected calcium >2.8 = usually symptomatic
99
How is malignant hypercalcaemia managed?
* **IV fluids** - immediate priority (lowers serum calcium) * **IV bisphosphonate** (returns calcium to bone) * If resistant to bisphosphonate --> **denosumab**
100
What signs make you think of malignant spinal cord compression?
* Cancer which has spread to bone - breast, lung, kidney, thyroid, prostate * Primary lesions affecting spine (much less common)
101
What are some signs of malignant spinal cord compression? ## Footnote depends on level, but generally...
* Parasthesia/sensory loss * Weakness/functional loss * Cauda equina syndrome * Loss of bladder/bowel function * Back pain * can be non-specific
102
How is malignant spinal cord compression diagnosed?
**MRI spine** - GS * if can't have MRI, then CT +/- myelography
103
What is the management of malignant spinal cord compression?
* High dose steroids - **dexamethasone** * Radiotherapy * Surgery
104
How should a massive haemorrhage be managed in a palliative patient?
* Stop anticoagulation * Dark towels * Remain with patient * Midazolam 10mg stat
105
What are the signs of opioid overdose in a palliative patient?
Toxicity: * reduced level of consciousness * reduced resp rate/SpO2 * Myoclonic jerks * Pinpoint pupils SE: * confusion * hallucinations * N+V * constipation
106
How is opioid overdose managed in a palliative patient?
* **Naloxone** - dilute 400mcg in 10ml N saline and give 20mcg every 2 mins until resp function/conscious level improves * Close observation
107
Why wouldn't you give naloxone to a dying patient?
Can precipitate sudden increase in pain
108
When is 'end of life' care?
Last 12 months of life
109
What is benign paroxysmal positional vertigo (BPPV)?
Common cause of vertigo chacterised by sudden onset dizziness & vertigo triggered by changes in head position * Average age of onset is 55 years
110
What are the features of BPPV?
* **Vertigo** triggered by change in head position * May be **nausea** * Typically lasts **10-20 secs** * **Positive Dix-Hallpike manoeuvre** - see seperate flashcard
111
What is the Dix-Hallpike manoeuvre?
* Rapidly lower patient to supine position (on back) with an extended neck * A positive test recreates the Sx of BPPV * Rotatory nystagmus
112
What is the management of BPPV?
* Usually resolves spontaneously after few weeks-months * **Eply manoeuvre** - see separate flashcard * Giving pts exercises to do at home e.g. **Brandt-Daroff exercises** * Can give **betahistine** but limited value * ~50% pts with BPPV have recurrence of Sx 3-5 years after diagnosis
113
What is the antibiotic treatment for neutropenic sepsis
IV piperacillin and tazocin - aka tazocin *can add vancomycin if locally indicated *if still febrile after 48hrs switch to **merepenem + vancomycin**
114
What is drug induced Parkinson’s
Form of secondary Parkinsonism caused by medication that deplete dopamine e.g metoclopramide or haloperidol
115
How to differentiate between drug induced Parkinson and normal Parkinson’s
**motor symptoms are generally rapid onset and bilateral** normal Parkinson’s is asymmetrical *rigidity and rest tremor are uncommon
116
Which parkisnon medications will improve motor sx
Leva dopa
117
In Parkinson’s what do you give for orthostatic HTN
**midodrine**
118
Which medication can cause impulse control in Parkinson’s
Dopamine agonists e.g gambling, binge eating
119
Which Parkinson’s medication causes dopamine dysregulation syndrome
Levadopa
120
What is dopamine dysregulation syndrome
Behavioural disorder characterised by overuse of dopaminergic mediation causing *mood swings *poor impulse control *mania *hypersexuality *social dysfunction
121
Adverse effects of leva dopa
nausea and vomiting (very common) dyskinesias palpitations postural hypotension psychosis dry mouth anorexia
122
Adverse effects of leva dopa due to not achieving a steady dose
*end of dose wearing off *on off phenomenon - variations in motor performance *dyskinesias at peak dose
123
What are the first line dopamine agonist used for parksinons
**non ergot derived** Ropinerole Prampexole Rotigotine
124
What is apomorphine
rescue therapy for advanced PD with severe off periods
Phase 3a - Arun&Erin
flashcards
Decks in class (18)
# Cards
Brainscape helps you reach your goals faster, through stronger study habits.
© 2026 Bold Learning Solutions. Terms and Conditions