Eggs 3a > COTE > Flashcards

COTE Flashcards

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1
Q

What are risk factors for falls?

A
  • Motor problems: gait/balance
  • Sensory impairment
  • Cognitive/mood impairment: dementia, delirium
  • Orthostatic hypotension
  • Polypharmacy
  • Drugs (sedatives, alcohol))
  • Environmental hazards: poor lighting
  • Incontinence
  • Fear of falling
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2
Q

Causes of falling in the elderly

A
  1. Drugs (sedative, alcohol)
  2. MSK eg OA of the hip
  3. Syncope (vasovagal, cardiogenic, arrhythmias)
  4. Stroke/TIA
  5. Hypoglycaemia
  6. Visual impairment
  7. Dementia
  8. Poor environment
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3
Q

What is hyperactive delirium?

A

Characterised by being highly alert and uncooperative

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4
Q

What is hypoactive delirium?

A

More common, you sleep more and become inattentive and disorganised with daily task you might miss meals or appointments

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5
Q

Clinical features of delirium

A
  • Globally impaired cognition, perception and consciousness which develops over hours/days
  • Marked memory deficit
  • Disordered or disorientated thinking
  • Reversal of the sleep-wake cycle
  • Tactile or visual hallucinations
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6
Q

Risk factors of delirium

A

> 65

  • Dementia/previous cognitive
  • Impairment
  • Hip fracture
  • Acute illness
  • Psychological agitation (eg pain)
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7
Q

Causes of delirium

A 
PINCH ME
Pain
Infection (systemic or intracranial) 
Nutrition (thiamine, nicotinic acid or B12 def) 
Constipation> Retention
Hydration
Metabolism/medication (uraemia, liver failure, Na, glucose) (withdrawal)
Environment
Surgery/post GA
Vascular (stroke, MI) 
Hypoxia (resp or cardiac failure)
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8
Q

What tests do you do with someone you suspect to be delirius?

A

Look for cause (eg UTI, pneumonia, MI)

  • FBC, U&E, LFT, glucose, ABG, septic screen (urine dipstick, CXR, blood cultures), malaria film, ECg, CT, EEG
  • Look for increased calcium
  • Haemantics (B12 and folate)
  • INR
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9
Q

Management of delirium

A
  • Treat underlying cause
  • Reorientate patient
  • Encourage visits from family and friends
  • Try no tot move around wards much
  • Monitor fluid
  • Mobilise and encourage activity
  • Practice sleep regime
  • Avoid or remove catheteres, IV cannula
  • Watch out for infection
  • Review medication
  • Avoid medication if possible, IM haloperidol, BDZ if needed
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10
Q

What are the 3 main features of Parkinson’s?

A
  • Resting tremor
  • Bradykinesia
  • Rigidity (cog-wheel)
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11
Q

What is the tremor like in Parkinson’s?

A
  • Pill rolling (slow)
  • Worse at rest
  • Asymmetrical
  • Reduced on distraction
  • Reduced on movement
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12
Q

Underlying pathophysiology of Parkinson’s

A

Loss of dopaminergic neurones in substantia nigra

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13
Q

What class of drugs is normally combined with L-Dopa to prevent peripheral side effects?

A
  • L-dopa carboxylase inhibitor (carbidopa or benzeraide)
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14
Q

Complications of L-dopa therapy

A
  • Postural hypotension on starting treatment
  • Confusion
  • hallucinations
  • L-dopa induced dyskinesias
  • On-off effect: fluctuations in motor performance between normal function (on) and restricted mobility (off)
  • Shortening duration of action of each dose (ie end dose deterioration, where dyskinesias become more prominent at the end of the duration of action
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15
Q

Define dementia

A

A chronic progressive illness, which is irreversible. There is preserved attention and consciousness with no underlying medical cause.

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16
Q

Describe delirium

A

Acute onset, fluctuating course, inattention, altered level of consciousness, usually reversible, associated with underlying medi al condition

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17
Q

Vascular Dementia

A
  • Step wise progression

- Caused by problems with the blood supply to the brain

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18
Q

Alzheimer’s Dementia

A
  • Most common type, progressive
  • Loss of ability to learn, process and retain new information
  • Looks atrophic on CT/MRI
  • 5 ‘a’s- amnesia
    aphasia, apraxia, agnosia, apathy
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19
Q

Pathophysiology of Alzheimer’s Dementia

A
  • Neurofibrillary tangle
  • Loss of neurones
  • Aggregation of beta-amyloid plaques
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20
Q

Management of Alzheimer’s

A
  • CT/MRI- atrophic
  • Supportive
  • AChE inhibitors (Donepezil, Rivastigmine, Galatine)
  • Memantine
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21
Q

What is a ‘Comprehensive Geriatric Assessment’ designed to do?

A
  • Identify health problems and establish a management plan in older patient with frailty
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22
Q

What domains are taken into account in the CGA?

A
  • Physical health
  • Mental health
  • Social aspects
  • Functional aspects
  • Environment
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23
Q

Who are involved in the CGA?

A
  • Geriatrician
  • Nurses
  • Pharmacist
  • OT
  • Physio
  • SALT
  • Dietician
  • Social worker
    etc
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24
Q

Complications of a long lie following a fall?

A
  • Pressure ulcers
  • Dehydration
  • Rhabdomyolysis - results from death of muscle fibres and release contents into blood stream- leads to kidney failure
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25
Investigations to do if you see a pressure ulcer
- Risk score to assess risk of developing = Waterlow score - CRP, ESR - WCC - Swabs - Blood cultures - Xray for bone involvement
26
Management of pressure ulcer
- Antibiotics - Wound dressing - Pain relief - Debridement if grade 3/4
27
Define 'osteoporosis'
Decreased bone mineral density due to imbalance between remodelling and resorption T score less than -2.5
28
Risk factors for osteoporosis
- Smoking - Early menopause - Steroid use - Underweight - Inactivity - Alcohol - ALL ELDERLY PEOPLE
29
Most common fractures in those with osteoporosis
- Hip - Spinal - NOF
30
How is osteoporosis diagnosed?
DEXA scan
31
What does the FRAX score assess
The risk of a 10 yr fragility fracture
32
How is osteoporosis managed?
Bisphosphonates
33
Presentation of Vit C deficiency
- Bleeding from gums | - Extensive bruising on legs (unrelated to falls)
34
Management of Vit C
- Correct the def > MDT approach to malnourishment
35
How is Nutritional Status assessed?
- Using the 'MUST' screening tool > Malnutrition Universal Screening Tool
36
What is Refeeding Syndrome?
- Metabolic disturbances as a result of reinstating nutrition to patients who are starved/severely malnourished
37
Biochemical features of refeeding syndrome
- Hypophosphataemia - Hypokalaemia - Thiamine deficiency - Abnormal glucose metabolism
38
Complications of Refeeding syndrome
- Cardiac arrhythmias - Convulsions - Cardiac failure
39
How should you manage Refeeding Syndrome
- Monitor blood biochemistry | - Commence re-feeding with guidelines
40
What are the four 'I's of Geriatrics Giants
- Immobility - Incontinence - Incompetence - Impaired homeostasis
41
What is receptive aphasia
Difficulty comprehending | - Wernicke's area
42
Expressive Aphasia
- Difficulty producing language | - Broca's area
43
Lewy body dementia
- Day-to-day fluctuating cognition - Visual hallucinations - Sleep disturbance - Recurrent falls - Parkinsons DON'T PRESCRIBE NEUROEPILEPTIC DRUG AS MAKES PATIENT WORSE
44
Vascular dementia
- No atherosclerotic risk factors; multiple cerebral infarcts - Step wise deterioration in cognition - Can get focal neurology - Fits - Nocturnal confusion
45
What is Pick's disease and what are the symptoms
- A type of front-temporal dementia - Disinhibition - Antisocial behaviour - Personality changes - Knife-blade atrophy
46
Symptoms of Normal Pressure Hydrocephalus
- Wet, whacky, wobbly - Urinary incontinence - Dementia - Gait disturbance - Due to increased CSF, b ut ventricles dilate
47
Name some cognitive assessment tools
- MMSE - Addenbrooke's cognitive examination tool III (ACE-III) - Montreal cognitive assessment (MOCA) - Abbreviated mental test score (AMT) - 6-item cognitive impairment test (6-CIT) - General practitioner assessment of cognition (GP COG)
48
What is involved in a septic screen
- Urine dipstick - CXR - Blood cultures - ABG- lactate - Bloods- infection? - Lumbar puncture - ECG
49
What is involved in a CGA for discharge planning
Medical assessment: diagnosis and treatment, co-morbid conditions and disease severity review- doctor/consultant Functional assessment: ADL, gait, balance- OT, physio Physiological assessment: cognition, mood- nurse, psychiatrist Social assessment: care resources, finances- social workers Environmental assessment:- home safety team
50
What is the bone profile in osteoporosis
- Normal - Calcium, phosphate, and alk phos are all normal - Bloods can help identify cause/risk factors for osteoporosis
51
Define osteopenia
- Precursor to osteoporosis | - T score -1 to -2.5
52
What is osteomalacia
- Softening of bones due to impaired bone metabolism from inadequate levels of calcium, phosphate and vit D
53
What does parathyroid hormone do?
- Increases osteoclast activity- release calcium and phosphate from bones - Increases calcium reabsorption but decreases phosphate reabsorption from the kidneys - Active vit D production is increased- increases calcium absorption from the gut and decreases phosphate
54
What is the role of vit D
- increases calcium absorption from the gut
55
Metabolite changes in muscle breakdown cause what?
Increased: potassium, phosphate, myoglobin, creatinine kinase Myoglobin is harmful to kidneys as it causes acute tubular necrosis Increased potassium- increased risk of arrhythmias- do an ECG
56
What is Rhabdomyolysis
Skeletal muscle breaks down due to traumatic, chemical or metabolic injury
57
What causes Rhabdomyolysis
- Crush injuries - Prolonged immobilisation following a fall - Prolonged seizure activity - Hyperthermia - Neuroepileptic malignancy syndrome
58
Management of Rhabdomyolysis
- Supportive - IV fluids - Correction of electrolytes - Renal replacement therapy
59
What does hyperkalaemia look like on an ECG
- Peaked T waves - Prolonged PR segment - Loss of P waves - ST elevation - Broad QRS - ST elevation - Sine wave pattern - Ventricular fibrillation
60
Management of hyperkalaemia
- Calcium glutinate (cardioprotective) - Bicarbonates - Insulin - Glucose (drives potassium into cells) - Kalayexalate ( bind K+ in the GI tract) - Diuretics- dialysis if kidneys are not okay
61
Depression in the elderly
- Some physical illness can give similar symptoms - Depression can make you think your long term illnesses are worsening even if they aren't - Depression can affect your memory - Antidepressants in older people can lower amount of salt in blood- can make feel weak and unsteady
62
What is the biggest cause of hypercalcaemia in older people
Hyperparathyroidism
63
How do diuretics work in heart failure
- In heart failure there is an increased preload and therefore decreased flow to kidneys - If you start on diuretics it will start looking like its damaging the kidneys as its dehydrating them - But really it is reducing the preload which then will increase the output and therefore in the long run increases the flow to the kidneys (Stalin model)
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