Phase 3A > Geriatrics > Flashcards

Geriatrics Flashcards

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1
Q

Features of Parkinsons + Cognitive impairment

A

Lewy-body dementia

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2
Q

What system assess frailty in elderly patients?

A

PRISMA-7

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3
Q

What factors are considered in PRISMA-7?

A
  • Age
  • Sex
  • Health problems
  • Assistance required
  • Walking aid
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4
Q

What is first line for mild-moderate Alzheimers disease?

A

Acetylcholinesterase inhibitors e.g. donepezil

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5
Q

What is second line for Alzheimers disease?

A
  • Memantine
  • Used for moderate/severe
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6
Q

What screening tool is used to assess starting new medications in elderly patients?

A

START

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7
Q

What screening tool is used to assess which drugs can be discontinued in a patient with poly pharmacy?

A

STOPP

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8
Q

Which type of dementia is likely to present with visual hallucinations?

A

Lewy-body dementia

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9
Q

Management of acute confusional state?

A
  • Treat underlying cause
  • Change environment
  • Haloperidol e.g. oral/IM
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10
Q

Causes of delirium in the elderly?

A
  • UTI
  • New surroundings
  • Community-acquired pneumonia
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11
Q

New surroundings can cause what in elderly patients with cognitive impairment?

A

Delirium

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12
Q

What medication should be stopped in patients with dementia due to risk of further cognitive impairment?

A

TCAs such as Amitriptyline

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13
Q

What kind of drug is Haloperidol and what conditions is it C/I with?

A

Dopamine antagonist
Parkinson’s disease

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14
Q

What type of dementia presents with step-wise progression?

A

Vascular

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15
Q

Which medications should be avoided in the elderly due to the risk of adverse reactions/increased mortality?

A

Antipsychotics such as Haloperidol

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16
Q

Which type of dementia has social disinhibition and often a family history?

A

Frontotemporal dementia

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17
Q

What class of drug is Memantine?

A

NMDA Antagonist

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18
Q

Why is digoxin a dangerous drug in the elderly?

A

Narrow therapeutic index and toxicity can be triggered by illness/renal failure/hypokalaemia

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19
Q

What are symptoms of digoxin toxicity?

A
  • GI disturbances e.g. nausea, vomiting, abdominal pain
  • Arrhythmias
  • Blurred vision
  • Drowsiness
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20
Q

What type of drugs can cause gout?

A
  • Loop diuretics
  • Thiazide diuretics
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21
Q

Symptoms of hypoactive delirium?

A
  • Withdrawn
  • Lethargy
  • Slow to respond to questions
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22
Q

What type of dementia is associated with visual hallucinations?

A

Lewy-body dementia

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23
Q

What is the risk score for pressure sores?

A

Waterlow score

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24
Q

ICD-10 criteria for delirium

A

1.) Impairment of consciousness and attention
2.) Global disturbance in cognition
3.) Psychomotor disturbance
4.) Disturbance of sleep-wake cycle
5.) Emotional disturbances

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25
S/E of acetylcholinesterase inhibitors?
Cholinergic effects -> diarrhoea, incontinence, N+E, increased salivary production
26
Delirium
- Acute - Fluctuating course - Inattention - Altered level of consciousness - Reversible - Associated with underlying medical cause
27
Delirium causes?
Pain Infection Nutrition Constipation Hydration Medication (withdrawal/overdose) Environment
28
What domains are in comprehensive geriatric assessment?
- Physical Health - Mental health - Social aspects - Functional aspects - Environment
29
Complications of long lie down following a fall?
- Pressure ulcers - Dehydration - Rhadbomyolysis
30
Iv for pressure ulcers?
- Bloods - CRP, ESR, WCC - Swabs and blood cultures - X-ray for bone involvement
31
Tx for pressure ulcers?
- Abx - Wound dressing - Analgesia - Debridement
32
How often should you/patient move to prevent pressure ulcers?
Low risk - 6 hours High risk - 4 hours
33
Risk factors for osteoporosis?
Steroid use Hyperthyroid/parathryoid/calcaemia Alcohol/Tobacco Thin Testosterone decreased Early menopause Renal/Liver failure Erosive inflammatory bone disease (RA) Dietary reduced
34
Geriatric Giants
- Immobility - Instability - Incontinence - Interllectual impairment
35
Risk factors for Pressure Ulcers?
- Immobility - Malnutrition - Dehydration - Sensory impairment - Obesity - Urinary/Faecal incontinence - Reduced tissue perfusion
36
Causes of falls in elderly?
- Drugs - MSK - Syncope/Stroke/Tia - Vertigo - Pos HTN - Hypoglycaemia - Visual impairment - Dementia
37
Prevention of pressure ulcers?
- Barrier creams - Pressure redistribution (mattress, cushions, heel support) - Repositioning - Regular skin assessment
38
What is levodopa commonly combined with?
Decarboxylase inhibitor e.g carbidopa to prevent peripheral metabolism of levodopa to dopamine
39
Hypocalcaemia symptoms?
- Peripheral paraesthesia - Muscle cramps - Seizures - Prolonged QT
40
Hypercalcaemia symptoms?
- Bone pain - Fractures - Renal stones - Drowsiness/Delirium - N+V, Weight loss, shortened QT
41
What MMSE score supports dementia?
<25
42
What should be done after 5 years of bisphosphonate Tx?
- Repeat DEXA/FRAX and stop bisphosphonate is low risk and review in 2 years
43
How do bisphosphonates work?
- Pyrophosphate analogues -> inhibit osteoclasts
44
Bisphosphonate S/E?
- Dizziness - Electrolyte imbalance - GI disorders (oesophagitis for Alendronic) - Anaemia - Headache - Myalgia
45
Causes of malnutrition?
- Starvation - Increased nutrient requirement (sepsis/injury) - Malabsorption
46
Diagnosis malnutrition
- BMI < 18.5 - >10% weight loss in last 3-6 months - BMI < 20 and weight loss
47
Causes of malnutrition
Intake: mealtimes, feeding problems, appetite, pain, surgery, medication Increased requirement: trauma, surgery, malignancy Loss: diarrhoea, vomiting, IBD, surgery
48
Consequences of malnutrition
- Impaired immunity - Impaired wound healing - Muscle mass loss - Resp function loss - Longer recovery from illness - Lower quality of life
49
Mental Capacity Act Guidelines
- Assume capacity - Maximise decision-making capacity - Freedom to make unwise decisions - Best interests - Least restrictive option
50
Advanced directions Advanced refusal - legally binding Advanced requests - not legally binding but considered
- Allows people to state treatment wishes in advance to authorise certain procedures and refuse treatment - It must be an adult, fully competent at that time, applicable to current circumstances and no reason to believe they have changed their mind
51
DOLS
- Person does not consent to care/treatment
52
Lasting Power of Attorney
- Nominate someone else to make decisions on their behalf - Registered with Office of the Public Guardian
53
IMCA
- Support and represent people who lack capacity and do not have anyone else to represent them
54
What is frailty?
State of increased vulnerability resulting from ageing-associated decline in functional reserve
55
Assessment tool for delirum?
4-AT
56
What tool is used to assess nutritional status?
MUST tool
57
Complications of re-feeding syndrome?
- Cardiac arrhythmias - Coma - Convulsions - Cardiac failure
58
Blood tests to exclude treatable causes of dementia?
- Vitamin B12, thiamine, folate - Thyroid - FBC - Syphillis serology - LFTs
59
3 adverse effects of bisphosphonates?
- Oesophagitis - Osteonecrosis of the jaw - Increased risk of atypical stress fractures of the proximal fracture shafts
60
Role of vit D
Increase Ca2+ absorption in the gut Increased Ca2+ release from the bone
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