Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
33 Cards in this Set
- Front
- Back
Transient loss of consciousness and postural tone due to inadequate cerebral blood flow and O2 delivery
|
Syncope
|
|
Syncope is most common in what three types of patient?
|
More common in pts with heart dz, older men and young women
|
|
2/2 excessive vagal tone or impaired reflex control of peripheral circulation
|
Vasomotor syncope
|
|
What are two types of vasomotor syncope?
|
Enhanced vagal tone secondary to hypotension
-Syncope in carotid sinus hypersensitivity -Post micturation syncope Vasodepression -Often initiated by stressful, painful or claustrophobic experience -Often in young women |
|
Vasoconstritctive response is impaired
Common in elderly, diabetic, pt w/ hypovolemia Pt s taking vasodilators, diuretics, beta blockers Idiopathic orthostatic hypotension (elderly men) |
Orthostatic (postural) Syncope
|
|
No prodrome leading to injury is common
2/2 mechanical problem Aortic stenosis, pulm stenosis, hypertrophic obstructive cardiomyopathy, right –to-left shunting, LA myoma obstructing the mitral valve 2/2 automaticity problem Sick sinus syndrome, AV block, tachyarrhythmia |
Cardiogenic syncope
|
|
What is used to diagnose syncope, ie. what tests?
|
EKG, Tilt Table Testing, Electrophysiology studies, exercise testing
|
|
Used in pts with recurrent syncopal episodes, nondiagnostic ambulatory EKGs and negative autonomic testing
Check sinus node fct and AV conduction Try to repeat induction of supraventricular or ventricular tachycardia |
Electrophysiology studies
|
|
This is used in patients who experience syncope with exertion or stress.
|
Exercise testing
|
|
How do you TX Syncope?
|
Avoid predisposing situations
Stay hydrated Stand up slowly Maybe some serotonin reuptake inhibitors |
|
Acute fluctuating disturbance of consciousness associated w/ change in cognition or the development of perceptual disturbances
2/2 underlying medical condition such as infection, coronary ischemia, hypoxemia or metabolic derangement Present in 25% of pts |
Delirium
|
|
This is associated with the following:
↑ in hospital and post d/c mortality ↑ length of stay ↑ probability of NH placement |
Delirium
|
|
What are the symptoms of delirium?
|
Acute agitation (‘sun downing’)
Anxiety and irritability Perceptual disturbance (visual hallucinations) Psychomotor restlessness w/ insomnia Marked deficit of short-term memory Retrograde amnesia (can’t recall past memories) and anterograde (can’t recall events since onset of delirium) Hypoactivity Cognitive slowing Inattention |
|
All of these things are risk factors for what?
Cognitive slowing Male Severe illness, infection Fever Hip fracture Hypotension Respiratory d/o Malnutrition Polypharmacy Use of psychoactive medications Sensory impairment Use of restraints Use of IV lines, urinary catheters Metabolic d/o Depression Intoxication or withdrawal |
Delirum
|
|
What is extremely important in delirium assessment?
|
Current meds
Newly added meds Discontinued meds (withdrawal) |
|
How do you manage delirium?
|
Correct underlying cause
Eliminate unnecessary meds Avoid restraints Haldol 0.5-1 mg qhs or bid or Quetiapine 25mg qhs or bid In emergency: Haldol 0.5 mg po or IM q 30 min prn agitation Side effect: prolonged sedation |
|
If delirium doesn't clear up shortly after treating it, what should you consider?
|
Dementia
|
|
Acquired, persistent, progressive impairment in intellectual fct with compromise of memory and at least one other cognitive domain
Insidious onset over months to years Dx requires significant decline in fct that is severe enough to interfere with work or social life Often associated with depression in early dz |
Dementia
|
|
What are the risk factors of Alzheimer's
|
Older age
Fam Hx Lower education level Female gender |
|
What are the risk factors of vascular dementia?
|
Older age
HTN Tobacco Afib DM Hyperlipidemia |
|
What are the less common, potentially reversible causes of dementia?
|
Drug effect
Depression Thyroid dz Vitamin B12 deficiency Subdural hematoma HIV infection Normal-pressure hydrocephalus |
|
Dementia is characterized by Memory impairment + at least one of these
|
Language impairment (initially word finding difficulty leading to difficulty following conversation leading to mutism)
Apraxia ( inability to perform previously learned task e.g. cutting loaf of bread, in spite of intact motor fct) Agnosia ( inability to recognize objects) Impaired executive fct ( poor abstraction, mental flexibility, planning and judgment) |
|
Problems w/ memory & visiospacial abilities (becoming lost in familiar surroundings, inability to copy geometric design on paper)
Social ability intact Personality changes & behavioral difficulties (wandering, inappropriate sexual behavior, agitation) Hallucinations (in moderate to sever dz) End stage: near mutism, inability to sit up, hold up the head, track objects with eyes, difficulty with eating and swallowing, weight loss, bowel and bladder incontinence, recurrent urinary and respiratory infections |
Alzheimer's Disease
|
|
Fluctuating cognitive impairment (thus can be confused with delirium)
Rigidity Bradykinesia Rare tremor Poor response to dopaminergic agonists Early Sx: Hallucinations (of people or animals) |
Lewy Body Dementia
|
|
(group of dzs such as Pick’s dz. and others)
Personality change (euphoria, disinhibition, apathy) Compulsive behavior (peculiar eating habits or hyperorality) |
Fronto-temporal Dementias
|
|
This imaging in dementia is for younger pts w/ acute onset of focal neurologic symptoms, sz, gait abnormalities
|
MRI
|
|
This imaging in dementia is for older pts w/ classic presentation of Alzheimer’s
|
Non-Contrast CT
|
|
You use this to distinguish depression from dementia
In pts w/ very poor education or very high premorbid intellect In pts with very mild impairment |
Neuropsych evaluation
|
|
Plaques - deposits of the protein beta-amyloid accumulate between neurons
Tangles - deposits of the protein tau that accumulate inside of nerve cells |
Alzheimer's
|
|
Plaques and tangles
Neuronal loss especially in subtantia nigra |
Lewy Body Dementia
|
|
How do you TX mild to moderate dementia?
|
Mild to moderate dz: Acetylcholinesterase inhibitor (donezepil, galantamine, rivastagmine)
Modest improvement in cognitive fct, but no difference in NH placement Side effects: diarrhea, nausea, anorexia and weight loss |
|
How do you TX severe dementia?
|
Severe dz: N-methyl-D-aspartate antagonist (memandine) +/- Acetylcholinesterase inhibitor
Unknown long-term benefit |
|
It is important to rule out what with dementia?
|
R/o delirium 2/2 pain, urinary obstruction or fecal impaction
|