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Finals > Ageing and Complex Health > Flashcards

Ageing and Complex Health Flashcards

1
Q

What tool can be used to estimate risk of fractures

A

FRAX tool - estimates 10 year fracture risk and guides whether or not to initiate treatment

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2
Q

Treatment for osteoporosis

A

Bisphosphonate - Alendronic acid 70mg once weekly

Calcium and Vitamin D supplements

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3
Q

Risk factors for osteoporosis

A 
Female
Small/thin
Menopause
Inactivity
Smoking
Alcohol
Steroids
Low Ca/VitD
White/Asian
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4
Q

What mneumonic can be used to categorise causes of falls

A 
DAME
D - drugs
A - ageing 
M - medical
E - environmental
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5
Q

Medications that can increase the risk of falls

A 
Polypharmacy
Anti-hypertensives
Sedatives
Opioids
Psychotropics
Anti-hyperglycaemics
Alcohol
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6
Q

What ageing-related changes can increase risk of falls

A 
Vision deterioration
Cognitive decline
Abnormal gait
OA
Decreased baroreceptor sensitivity
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7
Q

Which medical conditions can increase the risk of falls

A 
Hypotension
Postural hypotension
Arrhythmias
Parkinson's disease
Stroke
Neuropathy
Cataracts
Epilepsy
BPPV
UTI/infection
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8
Q

What environmental causes of falls could you ask patients about

A

Walking aids
Footwear
Home hazards

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9
Q

Elderly patients who get dizzy when looking up indicates what pathology

A

Vertebrobasilar insufficiency

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10
Q

Peripheral (ear) causes of vertigo

A

Benign paroxysmal positional vertigo (BPPV)
Menieres disease
Vestibular neuritis
Acoustic neuroma/vestibular schwannoma

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11
Q

Central (neuro) causes of vertigo

A

Migraine
Brainstem ischamia
Cerebellar stroke
Multiple sclerosis

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12
Q

What test is used to diagnose BPPV

A

Dix-hallpike manoeuvre

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13
Q

What is used to treat BPPV

A

Epley manoeuvre

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14
Q

Typical history of BPPV

A

Short spells of vertigo (5-30 seconds), settle spontaneously, happen with head movement and lying down

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15
Q

Typical history of menieres disease

A

Intermittent attacks of vertigo, fluctuating hearing loss, fluctuating tinnitus
Get symptoms before the attack and vomiting

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16
Q

What causes menieres disease

A

Increased pressure in the inner ear

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17
Q

Difference in symptoms between vestibular neuronitis and labyrinthitis

A

People with labyrinthitis also get hearing loss and tinnitus

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18
Q

Symptoms of both vestibular neuronitis and labyrinthitis

A

Usually following URTI/viral illness
Sudden severe vertigo
Nausea and vomiting
Balance and concentration difficulties

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19
Q

The labyrinth (inner ear) contains what two main structures

A 
Cochlea
Vestibular system (semicircular canals)
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20
Q

Acoustic neuroma symptoms

A

Unilateral hearing loss
Tinnitus
Vertigo
Headache

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21
Q

What is an acoustic neuroma

A

Benign tumour of the vestibulocochlear nerve

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22
Q

BP drop needed to diagnose postural hypotension

A 
Systolic drop of 20+
OR
Diastolic drop of 10+
OR 
Systolic drops to < 90
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23
Q

Bedside investigations for a fall

A 
Obs - HR, BP, RR, Sats, Temp
Lying + standing BP
Urine dip
ECG
Cognitive screening - e.g. AMT
BM
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24
Q

Differentials for confusion

A 
Delirium
Stroke
TIA
SOL
Cerebral bleed
Dementia
Constipation
Dehydration
Recent surgery
Environmental
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25
Q

Causes of delirium

A 
Dehydration
Electrolyte disturbances
Infection - UTI, pneumonia
Urinary retention
Constipation
Medication/drug toxicity or withdrawal
Lack of sleep
Hypoglycaemia
Stroke/subdural haemorrhage
Hypoxic states
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26
Q

Definition of delirium

A

Acute onset of disturbed consciousness/cognitive function/perception that has a fluctuating course

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27
Q

What are the 3 types of delirium

A

Hyperactive
Hypoactive
Mixed

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28
Q

Management of delirium

A 
Treat underlying cause
Reassurance
Reorientation to their environment
Calm
Establish normal sleeping pattern
Close monitoring
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29
Q

What questions are asked in the AMT 4 (abbreviated mental test 4)

A

Age
DOB
Current year
Current location

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30
Q

What are the 4 components of the 4 AT test

A

Alertness
AMT 4 - age, DOB, year, location
Attention - name the months backwards
Acute + fluctuating course

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31
Q

What are the 4 components of CAM (confusion assessment method)

A

Acute onset + fluctuating course
Inattention/counting backwards
Disorganised thinking/incoherent
Altered level of consciousness

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32
Q

Which lobe of the brain contains brocas area

A

Frontal lobe

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33
Q

What is brocas area responsible for

A

Language production

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34
Q

Which lobe of the brain contains Wernicke’s area

A

Temporal lobe

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35
Q

What is Wernicke’s area responsible for

A

Language comprehension

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36
Q

The ACA supplies which part of the brain

A

Frontal and parasaggital region

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37
Q

The MCA supplies which part of the brain

A

Lateral part of the frontal and parietal lobe, superior temporal lobe

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38
Q

The PCA supplies which part of the brain

A

Occipital lobe, inferior temporal lobe, thalamus

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39
Q

Signs of an MCA stroke in the dominant hemisphere (left in most people)

A

Brocas/Wernickes/conduction aphasia

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40
Q

Signs of an MCA stroke in the non-dominant hemisphere (right in most people)

A

Hemineglect to the contralateral side (left)

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41
Q

Is the leg or arm more affected in an ACA stroke

A

Leg

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42
Q

What visual defect is caused by a PCA stroke

A

Homonymous hemianopia with macula sparing

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43
Q

Which parts of the brain do the vertebrobasilar arteries supply

A

Brainstem

Cerebellum

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44
Q

Which parts of the brain do the lacunar arteries supply

A

Basal ganglia
Internal capsule
Thalamus
Pons

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45
Q

Risk factors for ischaemic stroke

A 
HTN
DM
IHD
Smoking
Carotid stenosis
AF
Polycythaemia
Sickle cell
Thrombophilia
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46
Q

Risk factors for haemorrhagic stroke

A 
HTN
Aneurysms
AV malformations
Vascular brain tumours
Anticoagulation
Alcohol
Smoking
Stress
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47
Q

What is the NIHSS

A

National Institute of Health Stroke Scale - scores stroke severity and monitors improvement

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48
Q

The Oxford Stroke Classification applies only to which type of stroke

A

Ischaemic

49
Q

Criteria for a TACS (total anterior circulation stroke)

A

ALL OF:
Unilateral weakness/decreased sensation of face, arm, leg
Homonymous hemianopia
Higher cerebral dysfunction - dysphasia, visuospatial disorder

50
Q

Criteria for a PACS (partial anterior circulation stroke)

A

TWO OF:
Unilateral weakness/decreased sensation of face, arm, leg
Homonymous hemianopia
Higher cerebral dysfunction - dysphasia, visuospatial disorder

51
Q

Criteria for a LACS (lacunar stroke)

A 
ONE OF:
Unilateral weakness +/- sensory deficit - arm/leg+arm/al 3
Pure sensory/motor/mixed
Ataxic hemiparesis
WITH NO HIGHER CEREBRAL DYSFUNCTION
52
Q

Criteria for a POCS (posterior circulation stroke)

A

ONE OF:
Cranial nerve palsy + contralateral decreased motor/sensation
Bilateral decreased motor/sensation
Conjugate eye movement - horizontal gaze palsy
Cerebellar dysfunction - vertigo, nystagmus, ataxia
Isolated homonymous hemianopia

53
Q

Name some stroke mimics

A 
Seizure
Sepsis
Hypoglycaemia
Bell's palsy
Migraine
MS
SOL
Transverse myelitis/cord disease
MND
Polyneuropathies
54
Q

What is the window for thrombolysis following an ischaemic stroke

A

Within 4.5 hours from symptom onset

55
Q

Which medication is used in post-stroke thrombolysis

A

Alteplase

56
Q

Which stroke patients do we start on anticoagulants

A

Those with AF

57
Q

What is dysarthria

A

Unclear articulation of speech

58
Q

What is expressive aphasia

A

They know what they want to say but they can’t say it

59
Q

What is receptive aphasia

A

Their words are incomprehensible but they are unaware of it

60
Q

Changes to speech in patients with MS

A

Slurred/scanning/staccato speech

61
Q

Changes to speech in patients with Parkinson’s disease

A

Dysrhythmic, monotonous

62
Q

Describe Wernicke’s aphasia

A

General comprehension deficits, word retrieval deficits, semantic paraphrasias, semantic content of language damaged but production in tact. Speech is fluent but lacks content. Patients lack awareness of their speech difficulties.

63
Q

Describe Broca’s aphasia

A

Deficits in speech production, rhythm + syntactic comprehension. Speech is slow and halting but with good semantic content. Comprehension usually good. Patients are aware of their language difficulties.

64
Q

Describe conduction aphasia

A

Normal speech production and comprehension but impaired ability to repeat words

65
Q

TIA definition

A

Acute onset of focal neuro dysfunction related to a vascular territory that leave no permanent damage, symptoms often improved before they even have time to present. <24 hours to complete recovery

66
Q

Definition of crescendo TIA

A

2 or more episodes in one week

67
Q

What does the ABCD2 score assess

A

Risk of stroke within 2 days following a TIA

68
Q

TIA differentials

A

Stroke
Migraine
Ophthal causes of vision loss - retinal haemorrhage, retinal detachment
Hypoglycaemia
Atypical seizures
Inner ear disorders can mimic posterior circulation TIA

69
Q

What does the CHADSVASc score assess

A

Risk of stroke in AF patients

70
Q

Causes of TIA

A

Embolus - carotids, heart
Vasculitis
Infective endocarditis

71
Q

Risk factors for TIA

A 
Carotid stenosis
HTN
DM
IHD
Smoking
AF
Polycythaemia
Thrombophilias
72
Q

What is the definition of malnutrition

A

A state of nutrition in which deficiency or excess of energy, protein and other nutrients causes measurable adverse effects on tissue or body form or function and clinical outcome

73
Q

Causes of oropharyngeal dysphagia

A

Neuro - stroke, MS, trauma, tumour
Infectious - mucositis from chemo, candida
Muscular - myasthenia gravis, dermatomyositis
Structural - cricopharyngeal stricture, pharyngeal pouches, oropharyngeal tumour

74
Q

Causes of oesophageal dysphagia

A 
Function
Achalasia
Motility disorders - stroke, muscular disease
Tumour
Oesophagitis
Stricture/rings/webs
Mediastinal mass
75
Q

Causes of malnutrition

A

Increased needs - surgery, illness
Increased loss - D+V, fever, wounds, burns
Decreased intake - appetite, dysphagia, practical issues

76
Q

What score can be used to assess for malnutrition

A

MUST score

77
Q

What 3 main things does the MUST score take into account

A

BMI
Unplanned weight loss
Acute illness/no intake for 5 days

78
Q

A MUST score of ? is managed by observation and encouragement

A

1

79
Q

A MUST score of ? is managed by treatment +/- dietician referral

A

2+

80
Q

TPN is given via which vessel

A

Central SVC line

81
Q

PPN (partial parenteral nutrition) is given via which vessel

A

A peripheral venous line

82
Q

5 main feeding tube options

A 
Nasogastric
Nasoduodenal
Nasojejunal
Gastrostomy
Jejunostomy
83
Q

Common indications for parenteral nutrition

A

Mechanical dysphagia
Neurological dysphagia
Global neurological deficits
Increased nutritional requirements - e.g. malabsorption states such as CF or Crohn’s disease

84
Q

How can you check the positioning of an NG tube

A

Aspirate stomach fluid and check pH with litmus

X-ray

85
Q

What are the 4 grades of pressure ulcers

A

1 - skin intact but erythematous
2 - partial thickness skin loss
3 - full thickness skin loss
4 - destruction of underlying muscle/bone/fascia

86
Q

Risk factors for pressure ulcers

A 
Decrease mobility
Decreased circulation
Poor nutrition
DM
Smokers
High or low BMI
Medical equipment in prolonged contact with skin
87
Q

Areas at high risk of pressure ulcers

A

Heels, hips, buttocks, elbows, back of head

88
Q

What is continuing health care

A

Arrangement for free care outside of the hospital - arranged and funded by the NHS

89
Q

What are the 3 main types of care home

A

Residential - personal care only
Nursing - personal and nursing care
Specialist care home for dementia - only if prominent behavioural/pscyh disorders associated with their dementia

90
Q

What are the 6 categories of elder abuse

A 
Physical
Financial
Psychological
Sexual
Discriminatory
Neglect/acts of omission
91
Q

What are the 4 categories of risk factors for abuse

A

The victim
The perpetrator
The relationship
Environmental

92
Q

What is pharmacodynamics

A

What the drug does to the body

93
Q

What is pharmacokinetics

A

What the body does to the drug

94
Q

What 4 main processes are involved in pharmacokinetics

A

Absorption
Distribution
Metabolism
Excretion

95
Q

What is the definition of polypharmacy

A

5+ drugs

96
Q

Examples of prescribing cascades

A

Codeine - constipation - senna
Amlodipine - oedema - diuretic
Statin - muscle pain - analgesia

97
Q

What tool can be used in medication reviews

A

STOPP/START toolkit

98
Q

Lewy bodies are made up of which protein

A

alpha-synuclein protein

99
Q

Patho of Parkinson’s disease

A

Lose of dopaminergic neurones in the substantia nigra and lewy body build up –> decreased dopamine delivery to the basal ganglia –> decreased excitatory input to cortical areas of motor control

100
Q

Symptoms in the Parkinsonism triad (+ pentad)

A
  1. Resting tremor
  2. Bradykinesia
  3. Rigidity
  4. Postural/gait instability
101
Q

Differentials for tremor

A 
Parkinsonism
Essential
Cerebellar
Hyperthyroidism
Medication induced
Flapping
Alcohol withdrawal
102
Q

Character of parkinson’s disease tremor

A

Fine, unilateral/asymmetrical, worse at rest

103
Q

Character of essential tremor

A

Coarse, worse on movement, improved by alcohol, often FH

104
Q

Character of cerebellar tremor

A

Intention tremor

105
Q

What causes a tremor that is worse on movement

A

Essential
Hyperthyroidism
Medication induced

106
Q

Causes of a flapping tremor

A

Liver disease

CO2 retention

107
Q

Differentials for Parkinonsim

A

Idiopathic PD
Vascular parkinsonism
Lewy body dementia
Medication induced - antipsychotics, metoclopramide
MSA - multisystem atrophy (early autonomic features)
PSP - progressive supranuclear palsy
Normal pressure hydrocephalus

108
Q

Motor features of Parkinson’s disease

A 
Bradykinesia
Akinesia (freezing)
Resting tremor
Pin rolling tremor
Micrographia
Low blink rate
Hypophonia
Parkinsonian gait
Rigidity
Normal reflexes
Difficulty turning in bed
Decreased facial expression
109
Q

Describe a Parkinsonian gait

A

Stooped posture
Shuffling
Reduced arm swing

110
Q

Non-motor features of Parkinson’s disease

A 
Constipation
Urinary urgency
Uncontrolled saliva production
Swallowing difficulties
Back pain
Poor sleep
Vivid dreams/nightmares
Short term memory and recall loss
Anxiety
Depression
111
Q

How can you elicit bradykinesia in a patient with PD

A

Ask them to repeatedly pinch their fingers together or tap their foot

112
Q

How can you elicit/exaggerate tremor in a patient with PD

A

Ask them to move their other arm up and down repeatedly

113
Q

Which two enzymes break down dopamine in the synapse

A

MAO (monoaminde oxidase)

COMT (catechol-o-methyltransferase)

114
Q

Which enzyme breaks down dopamine in the periphery

A

DOPA Decarboxylase

115
Q

Name of a DOPA decarboxylase inhibitor

A

Carbidopa

Benserazide

116
Q

Name of a COMT inhibitor

A

Entecapone

117
Q

Name of an MAO inhibitor

A

Rasagaline

118
Q

How do we treat essential tremor

A

Beta-blockers

119
Q

2 problems that can occur after having use levodopa/Parkinon’s meds for a long time

A

On-off phenomena

Peak dose dyskinesias

Finals (32 decks)

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