3a > Geriatrics > Flashcards

Geriatrics Flashcards

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1
Q

What is dementia ?

A

disorders characterised by loss of memory + other cognitive abilities affecting IADLs + ADLs
- group of disease (like cancer)

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2
Q

what acronym can be sued for overall presentation of dementias ?

A

DIRE
- Decline in cognition (language, attention)
- Impairment (not keeping up with IADL + ADLs)
- Rule out delirium (acute state of confusion)
- Exclude mental disorders (depression, schizophrenia)

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3
Q

what are IADLS ? acronym

A

SHAFT
- Shopping
- Houskeeping
- Accounting
- Food prep
- Transportation

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4
Q

what are ADLs ? acronym >

A

DEATH
- Dressing
- Eating
- AMbulating
- Toilet
- Hygiene

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5
Q

what are the different types of dementia ? (5) most common ?

A
  • Alzheimers disease (most common)
  • Vascular
  • Lewy body
  • Frontotemporal
  • Mixed (multiple types)
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6
Q

Describe the presenfiaotn of Alzheimers disease ? onset ? symptoms ?

A

gradual onset
- amnesia + neurocognitive deficits (amnesia, aphasia, apraxia, agnosia)
- Psychiatric symptoms: mood changes (depressed, anxious, irritability), psychotic symptoms (delusional misidentification
- activity; sundown activity
- lack of insight (don’t usually have knowledge of illness)

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7
Q

Alzheimers disease pathophysiology ?

A

caused by plaques made of beta amyloids
- tends to misgold => becomes sticky => clumping => large insoluble fibril s=> plaques => weaken communication + plasticity at synapses => neurodegeneration + neural death

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8
Q

How Is Alzheimers investigation ? diagnosed ?

A
  • diagnosis made clinically
  • bedside cognitive test
  • FBC (rule out delirium)
  • CSF testing (amyloid + tau biomarkers)
  • Structural MRI (atrophy => shrinkage)
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9
Q

what found in css in alzeihmers disease ?

A

amyloid plaques + neurofibirially tau tangles

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10
Q

alzheimers epi ?

A

less than 1%
(20% >80, 50% >90)
F>M

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11
Q

Alzheimers disease management ?

A

can’t halt or reverse progression (so symptom reduction and slow progression)
- cholinesterase inhibitors (=> increase Ach in brain)
- Antidepressants and antipsychotics

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12
Q

What is vascular dementia ? pathophys

A

infarction, haemorrhage + small vessel changes cause damage to white + grey matter (loss of brain parenchyma)
- multiple infarcts exhaust the brains compensatory mechanisms

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13
Q

vascular dementia présentation ?

A

due to the vascular pathology, doesn’t present with specific sign or symptoms but series of stepwise decreases in cognition

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14
Q

what will be seen on imaging in vascular dementia ?

A

imagine of brain will show multiple areas of ischaemic damage to varying ages

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15
Q

vascular dementia mangment ? (2)

A
  • Cholinesterase inhibitors
  • Reduce stroke RF: atiplatelt therapy, BP control, statins, control DM
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16
Q

what causes dementia with leeway bodies ?

A

accumulation of leeway bodies in CNS: protein alpha-synuclein accumulations that affects synaptic communication + plasciticy

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17
Q

dementia will Lewy bodies presentation ? age of onset ?

A

earlier onset (staring around 50) + worse decline than Alzheimers
- visual hallucinations (distinctive features - visual Hal-lewy-cinations, often have insight that not real)
- cognitive defects (memory not affected as much, more attention + concentration)
- neuroleptic sensitivity
- sleep
- Parkinsonism

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18
Q

describe how sleep is affected in dementia with Lewy bodies ?

A

REM sleep behaviour disorder => thrashing + flailing while asleep
(often one of the first signs)

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19
Q

why should you be careful prescribing antipsychotics to a px with Lewy body dementia ?

A

greater risk of neuroleptic malignant syndrome
- don’t give em (easily mistaken with psychosis)
- AP => extrapyramidal SE, confusion, catatonia, neuroleptic malignant syndrome)

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20
Q

Lewy body dementia epi ?prognosis ?

A

M=F
4 yrs life expectancy form diagnosis (alzheiemrs is 5-10)

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21
Q

Lewy body dementia management ? avoid what ?

A
  • cholonetsrase inhibitors
  • antiparkinsonsims (levodopa)
  • Avoid AP
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22
Q

what is frontotemporal dementia ? (2)

A

degeneration of the frontal + temporal lobes of brain => decline in cognition + inappropriate/impulseive behaviour

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23
Q

fronttemporal dementia pathophysiology ?

A

caused by focal neurodegeneration of the frontal or temporal lobes of the brain
- neuronal loss, gloss, microvascular changes

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24
Q

frontotemporal dementia presentation ?

A
  • obliviousness (saying hurtful things, not respecting pals personal space)
  • hyperorality (even inedible objects)
  • disinihibition (hypersexual)
  • apathy (indifference to self care)
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25
frontotemporal dementia epi ?
quite rare - earlier onset (45-65) - M=F - Familial link ?
26
frontotempora dementia mangmet ?
behavioural interventions, social wokr - SSRIs
27
What is delirium ?
fast developing type of confusion that affects ability to focus of attention
28
What are the consequences of delirium (3) ?
- Can increase mortality - Can increase number of patient that end up in care home - increase length of hospital stay and risk of acquired infections
29
What is delirium generally caused by ?
results form underlying organic illness
30
What is the triad of delirium ?
- Acute confusion - Disturbed consciousness - Altered behaviour (hyper/hypoactivity)
31
Causes of delirium ? pneumonic
DELIRIUM - Drugs (poly pharmacy, withdrawal from drugs) - Eyes or ears (sensory defects - hearing aid, glasses) - Low oxygen (MI, Stroke, PE) - Infection: most common is chest or urinary infection - Retention: urianry retention or constipation - Ictal states - Undernutrition: not eating or drinking properly - Metabolic causes: diabetes, post op state
32
How common is delirium on post op ward ?
10-15% develop delirium
33
In what groups of people is delirium most common (4) ?
- ICU - stroke - hip fracture - terminal illness
34
What investigations might you do for delirium ?
try to investigate for the cause - Bloods: FBC (inflam marksers, U+E (metabolic problems), CROP, Calcium, glucose - TFT - Urinalysis - Blood culture - Sputum culture
35
Delirium Mx ?
- Recognise and investigate cuases - Orientate the patient: hearing aids/glasses on, clock + calendar visible, display familiar personal items, encourage visits form family, consistent staffing - Medication review - If severe: medical sedation
36
name some potentially treatable causes of cognitive impairment ? (6)
- Depression - Delirium - Vitmin deficiecny - Stroke - Tumour - Intoxication
37
What is BPPV ? what Stan for ?
Peign paroxysmal positional vertigo - common cause of recurrent eps of vertigo, triggered by head movement - common in older adults
38
is BPPV peripheral or central cause of vertigo ?
peripheral cause of vertigo
39
BPPV presentation ? triggered by ?
20-60s eps => asymptomatic inbetween - triggered by turning head (running in bed) - no hearing loss or tints
40
BPPV pahtophsyiolgy ?
calcium carbonate crystals (otoconia) become displaced in to the semicircular canals => disrupt endolymph flow => confuse vestibular system
41
what could displace otoconia in BPPV ? (aetiology)
displaced due to viral infection, head trauma, aging (BPPV)
42
how is BPPH diagnosed ?
(Dix => Dx) - Dix Hallpike manœuvre
43
what is dix hall pike manoeuvre for ? what does it aim to do ?
do diagnose BPPV - move patients head to move endolymph through semi circular canal => trigger vertigo
44
How is BPPH treated ?
reply manoeuvre
45
what is employ manoeuvre for ? what does it aim to do ?
move crystals in semicircular canal to position that doesn't disrupt endolymph
46
Nam some RF for falls ? (7)
- fear of falling - vision changes (changing glasses) - medications (which act on CNS) - under/malnourishment: contributes to frailty + loss of muscle mass + strength) - Diabetes: peripheral neuropathy - Dementia: cognitive impairment - Incontinence: rushed movement to bathroom
47
Name some RF for poor bone health ? (6)
- Low dietary calcium => low BMD + early bone loss - Physical inactivity - Tobacco + alcohol use - Sex: female - Hormones: high thyroid hormone, menopause (low oestrogen) - Medications: steroids, SSRIs, PPIs
48
what is chronic Heart Failure ? specifically affects which bit fo the heart ?
clinical features of impaired heart function specifically function of LV
49
describe the pathophys of chronic HF and what this leads to ?
chronic back flow of blood to LA, pul veins, lungs => increase vol and pressure of blood => start to leak fluid => pulmonary oedema
50
what is normal ejection fraction ?
normal >50 %
51
what is heart failure with presence EF ?
clinical HF features with EF > 50% due to diastolic dysfunction
52
causes of chronic heart failure ?
- IHD - vascular heart disease (aortic stenosis) - hypertension - arrthymias (AF) - cardiomyopathy
53
HF presentation ?
- breathlessness 9worse on exertion) - cough (frothy white/pink sputum) - orthopnea - paroxysmal nocturnal dyspnoea - oedema - fatigue
54
what is paroxysmal nocturnal dyspnoea ? associated with what ? pathophsycioloyg (3)
waking up in the night with sever attack of Sob, cough + wheeze (associated with HF) - life flat => fluid settles - resp centre less responsive during sleep (reduced RR despite hypoxia) - low Ad during sleep so myocardium more relaxed
55
signs of HF ?
- tachycardia - tachypnoea - hypertension - murmur (valvular heart disease) - bilateral basal crackers - raised JVP - peripheral oedeem
56
what do bilateral basal crackles in person with HF indicate ?
pros pulmonary oedema
57
what investigations for HF ? (4)
- clinical assessment - NT-proBNP - ECG - Echo
58
HF mangement ? overall Mx ?
- refer to cardiology - medical - procedural
59
what determines how quick the referral to cardiology must be for patient presenting with HF ?
depend on the NT-proBNP result - 400-2000: within 6 weeks - >2000: within 2 weeks
60
Medical management of HF ? (4)
ABAL - ACEI - BB - Aldosterone antoagnosit - Loop dieretic
61
What changes would be seen on XR in HF ?
ABCDE - Alveolar oedema (bat wing opacification) - Kerley B lines (interstitial oedema) - Cardiomegaley - Dilated upper lobe vessels - Effusions (with blunted costophrenic angles)
62
Where and when is BNP produced ?
hormone produced mainly by the left ventricular myocardium in response to strain
63
What is reduced LVEF typically defined as ? what measures this ?
echocardiograph <35 to 40 % (this is around half of the patients with HF)
64
What classification system can classify the severity of heart failure ? how many categories ?
New York Heart Association (NYHA) classification class I - IV (worst)
65
what is is NYHA Class II ?
HF severity scale - mild symptoms - slight limitation of physical activity, comfortable at rest but ordinary activity results in fatigue, palpitations or dyspnoea
66
What is NYHA Class III ?
HF severity scale - moderate symptoms - marked limitation of physical activity: comfortable at rest but less than ordinary activity results in symptoms
67
What blood test is first line in HF diagnosis ?
N-terminal pro_b-type natriuretic peptide (NT-proBNP)
68
What are some clinical sings of right sided heart failure ? (3)
- raised JVP - Ankle oedema - Hepatomegaly
69
Patient is on second line therapy for chronic heart failure. what drug types are they on ? and what electrolyte do they need to be cautious about/ monitored ?
ACEI, BB, aldosterone antagnost - risk of hyperkalaemia (due to ACEI and AA)
70
What is osteoporosis ? osteopenia ?
condition here there is reduced density of bones ? osteopenia is a less reduced version - low BMD => less strain => more prone to fractures
71
osteoporosis RF ? (6) which drugs associated with increased risk? (5)
- increasing age - female (especially PM) - reduced mobility - low BMI - alcohol and smoking - low vit D and Ca diet - long termcorticosteroids - SSRI - PPI - Antiepileptics - Antioestrogens (used in breast cancer)
72
what tool is used related to osteoporosis ? what does this calculate risk of ?
FRAX tool - risk of fragility fracture in next 10 yrs
73
what assess BMD ? interpret the results ?
DEXA scan (reading at the hip) - Z score (compared to someone their age) - T Score (compared to healthy person): normal>-1, osteopenia -1 to -2.5, osteoporosis <-2.5
74
osteoporosis Mx ? first line ?
depend on FRAX score - lifestyle changes - calcium + vit D supplements - Bishphosiphoantes (first lien treatment) - HRT in PM women
75
modifiable RF for osteoporosis ? lifestyle changes ?
- increase activity - maintain healthy weight - increase dietary Ca and vit D - avoid falling - smoking cessation - reduce alcohol
76
How do bisphosphanates work ? SE (3) how must they be taken ?
interfere with osteoclasts - take on empty stomach + sit up for next 30 mins to prevent reflux - SE: reflux, oesophageal erosions, atypical fractures
77
What scale used to assess frailty ? how many categories ?
Rockwood frailty scale - 1 (very fit) - 9 (Terminally ill)
78
What is multimorbidity ?
presence of 2 or more long term health conditions
79
Underlying medical conditions causing constipation ? (3)
- hypothyroidism - multiple sclerosis - structural abnormalities (haemorrhoids, anal fissure)
80
Medications causing constipation ? (4)
(iatrogenic) - Opiods - iron supplements - tricyclic antidepressants - Antipsychotics
81
name the different types of laxatives (4)
- Bulk forming - osmotic - stimulant - stool softening
82
give example of bulk forming laxative ? how does it work ?
ispghula husk, methycellulose - bulks out the stool with soluble fibre => increase faecal mass and stimulate peristalsis (patients should increase fluid intake when taking this laxative type)
83
give example of somatic laxative ? how do they work ?
lactulose - draw water via osmosis into stool => softer and easier to pass
84
85
give an example of stimulant laxative ? how do they work ?
Senna, sodium picosulfate - stimulate the nerves of the digestive tract to cause peristalsis
86
where do pressure ulcers typically develop ?
bony prominences (sacrum or heel)
87
what scale is used to screen for patients at risk of developing pressure areas ?
Waterlow score
88
how many grades are there to pressure sores ? which is worse ? describe a bit
grades 1-4 (worse) - 1: non-blanch able erythema, discolouration of skin - 4: tissue encores, damage to muscle or bone
89
pressure sores management ? (3)
- moist wound environment encourage healing - wound swabs (as often colonised with bacteria) - surgical debridement
90
What is squamous cell carcinoma of the skin ?
common variant of skin cancer - metastases may occur in 2-5% of patients
91
SCC of skin RF ?
- excessive exposure to sunlight - immunosuppression - smoking
92
SCC of skin Mx ?
surgical excision
93
definition of malnutrition ?
- BMI < 18.5 - unintentional weight loss greater than 10% within last 3-6 months - BMI <20 plus unintentional weight loss greater than 5%
94
what screening tool is there for malnutrition ?
MUST (malnutrition universal screen tool) - categorises into low, medium and high risk
95
what temperature counts as hypothermia ?
milk: 32-35 moderate or severe: <32
96
why avoid rapid re-warming in hypothermic patient ?
can lead to peripheral vasodilation and shock
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