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Phase 2 > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

Define a fall

A

Unintentional loss of balance resulting in coming to rest on the floor or an object below knee level
Not as a consequence of force, sudden onset paralysis, seizure or XS alcohol

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2
Q

What is the biggest risk factor for falls?

A

Previous fall

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3
Q

What assessments help in falls risk assessment?

A

Timed up and go test

Turn 180 test

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4
Q

What are the causes of transient loss of consciousness?

A

Syncope

Epilepsy

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5
Q

What are the potential causes of unconsciousness?

A

Trauma
Metabolic
Infection
Neuro

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6
Q

What are the potential causes of apparent unconsciousness?

A

Dizziness
Vestibular
Mechanical
Pseudo

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7
Q

What extrinsic factors may contribute to falls risk?

A 
Drugs
Footwear
Obstacles
Inappropriate walking aids
Gravity
Lighting conditions
Furniture
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8
Q

What intrinsic factors contribute to falls risk?

A 
BP
HR
Neurology
Muscle strength
Joint integrity
Vision
Vestibular dysfunction
Reflexes
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9
Q

What are the components of a falls clinic appt?

A 
History of falls, syncope, neuro, msk, cardiac, vestibular
Focused examination
Bone health/osteoporosis review
Drug / polypharmacy review
Investigations: bloods, ECG, X-rays etc
Physio and ot assessment
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10
Q

Define syncope

A 
Transient loss of consciousness
Loss of voluntary muscle tone
Rapid onset with spontaneous prompt recovery on lying down
Full recovery (no focal deficit)
Transient global cerebral hypoperfusion
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11
Q

What are the causes of syncope?

A
  1. Neurally-mediated reflex: situational / vasovagal faint / carotid sinus syndrome
  2. Orthostatic hypotension
  3. Cardiac syncope
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12
Q

What questions should you ask a witness to a ?syncopal episode?

A 
Posture just before
Appearance / colour
Any abnormal movement
Tongue biting or incontinence
Duration
Post-event confusion
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13
Q

What factors make cardiac syncope the likely diagnosis?

A 
CHESS...
Congestive heart failure
Haematocrit <30%
ECG abnormality
Shortness of breath
Systolic BP <90 on triage
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14
Q

What investigations would you request for a patient with syncope related to a tachy or bradyarrhythmia?

A

24h tape or consider inpatient monitoring

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15
Q

How do you investigate suspected orthostatic hypotension?

A

Postural drop in BP: lying/standing BP

Accompanied by increase in HR

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16
Q

Define orthostatic hypotension

A

= postural hypotension
Systolic BP fall of more than 20 or diastolic fall more than 10
Within 10 minutes of standing

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17
Q

How do you measure lying/standing BPs?

A

Measure BP at 0, 3 and 5 minutes

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18
Q

What are the potential underlying causes of orthostatic hypotension?

A 
Hypovolaemia
Autonomic failure eg PD or DM
Prolonged bed rest
Drugs eg anti-hypertensives
Alcohol
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19
Q

How do you manage orthostatic hypotension?

A

Treat underlying cause, recognise precipitating factors
Conservative: education, bed tilt, increase salt
Medical: fludrocortisone
Averting action: recognise pre-syncope and sit/lie down

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20
Q

Describe tilt table testing

A

Moving from supine to upright causes shift of 300-800ml blood to venous capacitance system within 10 seconds
Reduced venous return and cardiac filling which decreases stroke volume
Compensatory increase in HR not enough
Sympathetic increase in TPR is key
Failure of compensatory mechanism is the cause of vasovagal

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21
Q

What are the contraindications to carotid sinus massage?

A

Heterogenous plaque disease

Stenosis

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22
Q

How do you manage carotid sinus sensitivity?

A

Dual chamber pacing if cardio-inhibitory

Vasodepressor: education, reassurance, drugs alteration

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23
Q

Define delirium

A

Global impairment of cognition and awareness / concentration

24
Q

What are the signs of delirium?

A 
Disordered thinking
Euphoric / depressed (labile mood)
Language impaired
Illusions, delusions, hallucinations
Reversal of sleep-awake cycle
Inattention
Unaware/disorientated
Memory deficits
25
Q

What are the criteria required for delirium diagnosis?

A

Disturbance of consciousness
Change in cognition
Disturbance develops over a short period of time

26
Q

What are the risk factors for delirium?

A 
Older age
Multiple comorbidities
Dementia
Physical frailty
Renal impairment
Sensory impairment
27
Q

What are the common causes of delirium?

A 
DIMES:
Drugs
Infection
Metabolic
Environmental
Structural
28
Q

What are the common investigations in a delirium screen?

A

FBC, U&E, LFT, BM, ABG
Septic screen
ECG
AMT

29
Q

What tests of cognition are commonly used for delirium?

A

AMTS: 10 Qs, if score less than 8 then proceed to
CAM: confusion assessment method

30
Q

How do you manage delirium?

A 
Identify and treat underlying cause
Reduce distress
Mod.lit, quiet room with same staff
Improve orientation: clock, daylight
Hearing aids and glasses
No physical restraints, catheters, IV lines etc
Music, massage, muscle relaxation
Minimise medication
Haloperidol 0.5mg if required, only as last resort
31
Q

What are the types of delirium?

A

Hypo active
Hyperactive
Mixed

32
Q

What are the features of hypo active delirium?

A

Lethargy and reduced motor activity

Can be mistaken for depression

33
Q

What are the features of hyperactive delirium?

A

Increased motor activity, agitation, hallucinations

More likely to be recognised

34
Q

What is mixed delirium?

A

Fluctuations between hypo and hyperactive, often fluctuates during the day

35
Q

What questions should you ask about in a history of incontinence?

A 
Ability to stop midstream
Soreness
Prolapse
LUTS: frequency, nocturia, urgency
Stress
Obstructive: hesitancy, stream, dribbling
Bowels
36
Q

What are obstructive urinary symptoms?

A

Hesitancy
Straining
Terminal dribbling
Complete bladder emptying

37
Q

Define overflow incontinence

A

Leakage of urine at greater than normal bladder capacity

38
Q

What is the underlying mechanism of overflow incontinence?

A

Either
incomplete bladder emptying
impaired detrusor contractility
bladder outlet obstruction

39
Q

What are the causes of overflow incontinence?

A

Prostatic hyper trophy
Faecal impaction
Urinary retention
Atonic bladder

40
Q

Why do women get incontinence post-menopause?

A 
Oestrogen deficiency leads to...
Atrophic urethritis
Decreased vascularity
Decreased sphincter resistance
Weakened skeletal muscle and pelvic floor
Sensory urgency
41
Q

At what ml do you get desire to void?

A

150-300

42
Q

What is the normal bladder capacity?

A

400-600ml

43
Q

What is the average void?

A

250-400ml

44
Q

Describe parasympathetic control of the bladder

A 
Pees
Detrusor muscle
S2-4
Pelvic splanchnic nerve
ACh muscarinic
45
Q

Describe sympathetic control of the bladder

A 
Stores
Bladder neck/upper urethra
T10-L2
Hypgastric nerve
Alpha receptors noradrenaline
46
Q

How do you manage stress incontinence?

A

Pelvic floor exercises
Duloxetine
Surgery

47
Q

How do you manage detrusor over activity?

A

Bladder retraining, regular toiletting regime

Anticholinergic drug: tolterodine, oxybutynin

48
Q

How do you manage overflow incontinence?

A

Remove the obstruction

Catheterisation: intermittent or permanent

49
Q

What are the different types of urodynamic studies?

A

Flow rate
Cystometry
Urethral pressure profile

50
Q

What are the risk factors for incontinence?

A 
Constipation
Childbirth
Surgery
Obesity
Pregnancy
Activity level
Post menopause
Dietary irritants: caffeine, alcohol
Meds: diuretics, Anticholinergics, antiDs, alpha blockers
51
Q

What are the underlying causes of faecal incontinence?

A 
Sphincter weakness
Ano-rectal pathology
Neurological disease
Acute or chronic confusion
Diarrhoea
Constipation
52
Q

What are the different categories of laxatives?

A

Bulking and softening
Stimulant
Faecal softeners
Osmotic

53
Q

Give an example of a bulking laxative

A

Ispaghula husk - fybogel

54
Q

Give an example of a stimulant laxative

A

Senna

Sodium picosulfate

55
Q

Give an example of a faecal softener

A

Arachis oil (enema)

56
Q

Give an example of an osmotic laxative

A

Lactulose
Movicol
Phosphate enema

57
Q

What lifestyle changes help with constipation?

A

Diet
Fluid
Exercise
Comfort, privacy, relaxation

Phase 2 (21 decks)

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