Paediatrics and older patients

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Questions and Answers

Which of the following is typically the FIRST developmental skill observed in infants?

  • Posture and Movement (correct)
  • Hearing and Speech
  • Social Behaviour
  • Vision and Manipulation

At what age do infants typically begin to show a preference for watching faces?

  • 8 weeks
  • 6 months
  • 12 months
  • 2 months (correct)

At what age do children usually start to use a spoon and fork effectively?

  • 2 years
  • 9 months
  • 3 years (correct)
  • 12-15 months

What is the optimal age at which infants typically start localizing sounds?

<p>7 months (D)</p> Signup and view all the answers

At what age should you expect a child to start using single word labels?

<p>1 year (D)</p> Signup and view all the answers

Which factor is LEAST likely to be a primary cause for developmental concerns in toddlers?

<p>Delay in starting school (D)</p> Signup and view all the answers

What percentage of children in the UK are affected by asthma?

<p>15% (D)</p> Signup and view all the answers

Which statement accurately reflects the nature of Upper Respiratory Tract Infections (URTIs) in children?

<p>They are predominantly viral, though distinguishing the cause can be challenging. (B)</p> Signup and view all the answers

What is the MOST accurate definition of otitis media (OM)?

<p>Acute infection of the middle ear (D)</p> Signup and view all the answers

What is a common symptom of acute suppurative otitis media?

<p>Pyrexia (D)</p> Signup and view all the answers

All of these answers are TRUE of chronic otitis media with effusion ('Glue Ear'), EXCEPT:

<p>It only affects children over the age of 5. (C)</p> Signup and view all the answers

Which of the following is NOT associated with chronic otitis media with effusion?

<p>Improved school performance (D)</p> Signup and view all the answers

What is the MOST reliable indicator to differentiate between viral and bacterial tonsillitis?

<p>Patient age (B)</p> Signup and view all the answers

Which pathogen is MOST commonly associated with viral tonsillitis in preschool children?

<p>Adenovirus (B)</p> Signup and view all the answers

Which of the following is the leading cause of death in children under 5 years worldwide?

<p>Acute lower respiratory tract infections (A)</p> Signup and view all the answers

What is the MOST common viral cause of bronchiolitis?

<p>Respiratory Syncytial Virus (RSV) (C)</p> Signup and view all the answers

What age group is MOST commonly affected by bronchiolitis?

<p>Mainly children under 1 (D)</p> Signup and view all the answers

Which genetic characteristic is associated with Cystic Fibrosis?

<p>Autosomal recessive (D)</p> Signup and view all the answers

In developed countries, what is the primary cause of mortality associated with cystic fibrosis?

<p>Respiratory failure (B)</p> Signup and view all the answers

What specific physiological process is impaired in the exocrine organs of individuals with cystic fibrosis?

<p>Chloride transport (B)</p> Signup and view all the answers

Which sample collection method is used to perform initial diagnosis of Cystic Fibrosis?

<p>Dried blood spot sample (C)</p> Signup and view all the answers

What diagnostic test is used to assess chloride levels in patients suspected of having cystic fibrosis?

<p>Sweat Test (D)</p> Signup and view all the answers

An infant at 8 weeks observes a bright object about 30cm away from their face with a convergent gaze. Which developmental skill is being observed?

<p>Vision and Manipulation (D)</p> Signup and view all the answers

A 10-month-old infant consistently fails to transfer objects from one hand to the other and cannot sit unsupported for more than a few seconds. Which of the following is the MOST appropriate initial action?

<p>Conduct a comprehensive developmental assessment to identify specific areas of delay. (A)</p> Signup and view all the answers

A 3-year-old child consistently uses single-word utterances and struggles to follow simple two-step instructions. The parents report no known hearing or neurological issues. Which of the following underlying conditions should be MOST immediately investigated?

<p>Global Developmental Delay (A)</p> Signup and view all the answers

Which of the following is considered a key domain of developmental skills in children?

<p>Posture and Movement (B)</p> Signup and view all the answers

What is a typical characteristic of posture and movement development in infants?

<p>Body control develops from top down (C)</p> Signup and view all the answers

At what age range do infants typically start to smile in response to a parent's face?

<p>4-8 weeks (D)</p> Signup and view all the answers

A child is observed to join words together at 2 years old, which of the following developmental milestones is the child achieving?

<p>Hearing and Speech (C)</p> Signup and view all the answers

What is the implication of the statement 'great variation - talk of usual not normal' in the context of developmental skills?

<p>There is a wide range of ages at which children reach developmental milestones. (A)</p> Signup and view all the answers

According to the information provided, what percentage of children in the UK are affected by asthma?

<p>Up to 15% (A)</p> Signup and view all the answers

What is the MOST common causative agent of bronchiolitis?

<p>Respiratory Syncytial Virus (RSV) (A)</p> Signup and view all the answers

Which physiological process is directly compromised in the exocrine organs of patients with cystic fibrosis, leading to the disease's characteristic symptoms?

<p>Chloride transport (D)</p> Signup and view all the answers

A child with chronic otitis media with effusion ('Glue Ear') is MOST likely to exhibit which of the following symptoms?

<p>Conductive hearing loss (C)</p> Signup and view all the answers

How is Cystic Fibrosis typically initially diagnosed?

<p>Dried blood spot sample (C)</p> Signup and view all the answers

Which age group is MOST typically affected by bronchiolitis?

<p>Children under 1 (D)</p> Signup and view all the answers

What is the typical age at which a child can chew lumpy food?

<p>9 months (C)</p> Signup and view all the answers

At what age do children typically start using sentences?

<p>3 years (A)</p> Signup and view all the answers

What does the presence of white exudate on the tonsils indicate?

<p>Either a viral or bacterial infection (D)</p> Signup and view all the answers

Which of the following is a common symptom of acute suppurative otitis media?

<p>Pyrexia (B)</p> Signup and view all the answers

What is the MOST appropriate next step when any 'milestones' are delayed?

<p>Consider immunisations are up-to-date (D)</p> Signup and view all the answers

Which of the following is a key aspect of vision and manipulation skill development in infants?

<p>A baby observes a dangling toy with a convergent gaze at 8 weeks (A)</p> Signup and view all the answers

Which factor is MOST likely to contribute to chronic otitis media with effusion ('Glue Ear')?

<p>Eustachian insufficiency (C)</p> Signup and view all the answers

What is the primary reason acute lower respiratory tract infections are a major concern in children under 5 worldwide?

<p>They are the most common cause of death in this age group globally. (D)</p> Signup and view all the answers

What best describes the underlying mechanism by which cystic fibrosis affects the body’s exocrine glands?

<p>Failure of chloride transport, dehydrating mucus and impairing cilia action, leading to bacterial colonisation. (C)</p> Signup and view all the answers

A 6-month-old infant consistently exhibits 'head lag' when pulled from a supine to a sitting position. As a healthcare provider, which of the following actions is MOST appropriate?

<p>Document the finding, counsel the parents on expected developmental milestones, and reassess at the next scheduled visit. (D)</p> Signup and view all the answers

A 4-year-old child presents with recurrent tonsillitis. Viral cultures are positive for adenovirus. Which recommendation is MOST appropriate?

<p>Symptomatic treatment and supportive care. (D)</p> Signup and view all the answers

Imagine a study examining the incidence of respiratory syncytial virus (RSV) in infants in different regions with varying air quality. Which study design would BEST isolate the impact of air quality on RSV incidence, while controlling for socioeconomic factors?

<p>A longitudinal cohort study following a group of infants from birth, tracking RSV incidence and air quality exposure over time. (B)</p> Signup and view all the answers

A researcher is designing a study to evaluate the effectiveness of a new physiotherapy program designed to accelerate the achievement of posture and movement milestones in premature infants. To ensure the MOST rigorous and unbiased results, which study design element is MOST crucial?

<p>Employing a randomized controlled trial (RCT) with blinding of assessors to treatment assignment. (A)</p> Signup and view all the answers

An extremely astute neonatologist observes that, contrary to established norms, a small cohort of infants reliably vocalize differentiated cries—indicating hunger, discomfort, or social interaction—within the first week of life. Assuming meticulous methodology and rigorous exclusion of confounding factors, which of the following inferences, while speculative, is the MOST defensible, aligning with biological plausibility and evolutionary principles?

<p>A novel epigenetic modification, induced by a specific environmental trigger during gestation, has accelerated neural maturation in speech centers, uncoupling vocalization from typical developmental timelines (C)</p> Signup and view all the answers

What is the recommended frequency of physiotherapy for managing cystic fibrosis?

<p>Daily (A)</p> Signup and view all the answers

Which type of dietary supplement are commonly used in the management of Cystic Fibrosis?

<p>Vitamin supplements (A)</p> Signup and view all the answers

What late complication in the biliary system can occur in patients with cystic fibrosis?

<p>Biliary cirrhosis (D)</p> Signup and view all the answers

Older cystic fibrosis patients, who do not gain weight, are susceptible to which of the following conditions?

<p>Diabetes mellitus (B)</p> Signup and view all the answers

Foetal Alcohol Syndrome is an example of which of the following causes of learning disability?

<p>Prenatal (C)</p> Signup and view all the answers

Meningitis is an example of which of the following causes of learning disability?

<p>Peri-natal (C)</p> Signup and view all the answers

NAI (Non-Accidental Injury) is an example of which of the following causes of learning disability?

<p>Post-natal (D)</p> Signup and view all the answers

Which of the following statements BEST characterizes paediatric medical emergencies in a dental setting?

<p>They are exceedingly rare but require systematic management. (D)</p> Signup and view all the answers

In the context of paediatric medical emergencies, what does the 'ABCDE approach' refer to?

<p>A framework for assessing and treating critical functions. (C)</p> Signup and view all the answers

What is a key difference between cardio-pulmonary arrest in children compared to adults?

<p>Airway and breathing problems are more frequently the primary cause in children. (D)</p> Signup and view all the answers

Following basic life support guidelines, what is the immediate next best step after finding an unresponsive child?

<p>Check responsiveness. (D)</p> Signup and view all the answers

What is the correct definition of when a child becomes an infant, according to the provided content?

<p>Less than 1 year (B)</p> Signup and view all the answers

What is a normal upper limit for the respiratory rate of an 8-month-old infant?

<p>40 breaths/minute (C)</p> Signup and view all the answers

What is the lower limit for the normal pulse rate at rest in a 1-year-old child?

<p>100 bpm (D)</p> Signup and view all the answers

In the context of assessing a child's disability during a medical emergency, what is an important consideration?

<p>Give the parent's opinion strong consideration (C)</p> Signup and view all the answers

During the 'Exposure' phase of a paediatric medical assessment, what is the priority?

<p>Assessing temperature and minimising heat loss (B)</p> Signup and view all the answers

When should emergency services be contacted during paediatric basic life support?

<p>After initiating CPR for 1 minute if you are alone (D)</p> Signup and view all the answers

To what depth should the chest be compressed during CPR on a child?

<p>One third of its depth. (C)</p> Signup and view all the answers

During infant CPR, should you use one or two fingers to complete compressions?

<p>Use two fingers (B)</p> Signup and view all the answers

Following the use of paediatric pads on an Automated External Defibrillator (AED) on a child, what is an appropriate energy dose to administer? (J = Joules, Kg = Kilograms)

<p>2-4 J/Kg (B)</p> Signup and view all the answers

Which of the following statements is correct regarding the use of adult AED pads on children?

<p>Adult pads can be used on children under 8 years, ideally attenuated. (A)</p> Signup and view all the answers

When a child has an inhaled foreign body, which of the following is NOT recommended?

<p>Performing blind finger sweeps (C)</p> Signup and view all the answers

What modifications should be made to adult guidelines when managing choking in children older than 1 year?

<p>Chest thrusts should be used instead of abdominal thrusts for infants. (B)</p> Signup and view all the answers

During the management of an infant with an airway obstruction, how should the infant be positioned?

<p>Across the rescuer's lap with the head lower than the chest. (D)</p> Signup and view all the answers

An extremely prematurely born infant shows no signs of preference for human voices over environmental sounds, even after several weeks of exposure. Assuming all potential biases and confounding factors have been meticulously controlled, which of the following highly speculative hypotheses is MOST defensible, aligning with known neurological development and evolutionary constraints?

<p>The prolonged absence of typical in-utero rhythmic maternal phonations has triggered a cascade of neurodevelopmental events, culminating in a critical period-independent rewiring of auditory pathways towards indiscriminate acoustic processing. (A)</p> Signup and view all the answers

What is a critical aspect of the daily management of cystic fibrosis?

<p>Daily physiotherapy (A)</p> Signup and view all the answers

Which type of supplementation is essential in managing malabsorption in cystic fibrosis patients?

<p>Pancreatic enzyme supplements (C)</p> Signup and view all the answers

What is a potential consequence of biliary complications in cystic fibrosis?

<p>Biliary cirrhosis (A)</p> Signup and view all the answers

Older cystic fibrosis patients who struggle to maintain their weight are at risk of developing which metabolic condition?

<p>Diabetes mellitus (D)</p> Signup and view all the answers

Which of the following conditions is categorized as a pre-natal cause of learning disability?

<p>Foetal Alcohol Syndrome (C)</p> Signup and view all the answers

Which of the following is classified as a peri-natal factor contributing to learning disabilities?

<p>Meningitis (B)</p> Signup and view all the answers

Which of the following exemplifies a post-natal cause of learning disability?

<p>Non-accidental injury (B)</p> Signup and view all the answers

Why are paediatric medical emergencies in a dental setting considered particularly critical?

<p>Children deteriorate rapidly. (A)</p> Signup and view all the answers

In paediatric medical emergencies, what is the primary focus of the 'ABCDE approach'?

<p>Airway, Breathing, Circulation, Disability, Exposure (C)</p> Signup and view all the answers

What is a key distinction in cardio-pulmonary arrest between children and adults?

<p>Children are more likely to suffer arrest due to breathing problems. (B)</p> Signup and view all the answers

What is the FIRST critical step after confirming an unresponsive child?

<p>Check for breathing (B)</p> Signup and view all the answers

According to the material, at which age does a child transition from infancy to childhood?

<p>1 year (B)</p> Signup and view all the answers

What is considered the upper limit of the normal respiratory rate for a 9-month-old infant?

<p>40 breaths/minute (A)</p> Signup and view all the answers

What is the lower limit of the typical resting pulse rate for a 1-year-old child?

<p>100 bpm (A)</p> Signup and view all the answers

During the 'Disability' assessment in a paediatric emergency, what is a key consideration?

<p>Asking the parent's opinion about the child's usual state (A)</p> Signup and view all the answers

During the 'Exposure' phase of a paediatric medical assessment, what is the primary goal?

<p>Minimising heat loss (A)</p> Signup and view all the answers

During paediatric basic life support, when is it MOST appropriate to contact emergency services?

<p>After administering initial ventilations and still no normal breathing (C)</p> Signup and view all the answers

Which method is recommended for chest compressions during infant CPR?

<p>Using one or two fingers on the lower half of the sternum (C)</p> Signup and view all the answers

Following the use of paediatric pads on an Automated External Defibrillator (AED) on a child, what is the recommended initial energy dose to administer?

<p>2-4 J/Kg (C)</p> Signup and view all the answers

What is the correct protocol when using adult AED pads on a child under 8 years old?

<p>Ensure pads are attenuated to reduce the energy delivered (D)</p> Signup and view all the answers

Which intervention is CONTRAINDICATED when managing a child suspected of having an inhaled foreign body?

<p>Blind finger sweeps (B)</p> Signup and view all the answers

What adaptation from adult guidelines is necessary when managing choking in children older than 1 year?

<p>Use adult guidelines without modification (B)</p> Signup and view all the answers

How should an infant with an airway obstruction be positioned to perform back blows?

<p>Across your lap with the head lower than the chest (B)</p> Signup and view all the answers

A clinical trial is conducted on a new physiotherapy regimen to improve lung function in CF patients. Despite rigorous adherence to the protocol, a subgroup of patients shows no improvement. Further investigation finds that these patients consistently skip their pancreatic enzyme supplements. Which of the following statistical methods could BEST isolate the true effect of the physiotherapy, accounting for the confounding effect of enzyme non-adherence?

<p>Stratified analysis or ANCOVA, grouping or adjusting based on enzyme adherence (C)</p> Signup and view all the answers

What is the recommended first action for an infant experiencing Foreign Body Airway Obstruction (FBAO)?

<p>Deliver 5 sharp inter-scapular blows. (A)</p> Signup and view all the answers

If back blows fail to dislodge a foreign body in an infant, what is the next recommended step?

<p>Perform 5 chest thrusts in quick succession whilst keeping the patients head lower than their chest. (A)</p> Signup and view all the answers

In what position should an infant be placed when administering back blows for a foreign body airway obstruction?

<p>Across the lap with the head lower than the chest (C)</p> Signup and view all the answers

When managing a case of infant FBAO, at what point should emergency services be contacted?

<p>As early as possible during the management of FBAO. (A)</p> Signup and view all the answers

If an infant with FBAO becomes unconscious, what is the immediate next step?

<p>Initiate CPR. (D)</p> Signup and view all the answers

What is the correct dose of adrenaline (epinephrine 1 in 1000 solution) for a child over 12 years of age during resuscitation?

<p>500 micrograms (D)</p> Signup and view all the answers

What is the appropriate dose of buccal midazolam for a 7-year-old child experiencing a seizure?

<p>7.5mg (C)</p> Signup and view all the answers

What is the recommended dose of adrenaline (epinephrine 1 in 1000 solution) for a 4-year-old child in anaphylaxis?

<p>150 micrograms (B)</p> Signup and view all the answers

What is the correct dose of buccal midazolam for a 15-month-old infant experiencing a prolonged seizure?

<p>2.5 mg (C)</p> Signup and view all the answers

Why is it important to 'look after' relatives during a paediatric medical emergency?

<p>To support them emotionally as they are under significant stress. (B)</p> Signup and view all the answers

What is a key consideration when relatives are present during paediatric emergencies?

<p>They can be both beneficial and require support themselves. (B)</p> Signup and view all the answers

In the context of paediatric medical emergencies, why is it important to have modified drug doses readily available?

<p>Drug dosages vary significantly based on a child's age and weight. (B)</p> Signup and view all the answers

Which statement best reflects the principles of managing paediatric medical emergencies compared to adult emergencies?

<p>The underlying principles are the same, but drug doses need to be adjusted. (B)</p> Signup and view all the answers

Which of the following is a potential sign of ADHD in children?

<p>Difficulty getting ready for school on time (B)</p> Signup and view all the answers

Which of the following is a potential sign of ADHD in adults?

<p>Impulsiveness and risk-taking behaviour (A)</p> Signup and view all the answers

ADHD is sometimes associated with which of the following disorders?

<p>Anxiety and Depression (C)</p> Signup and view all the answers

What type of medication is often the first-line treatment for ADHD?

<p>Stimulant-based medications (C)</p> Signup and view all the answers

Which of the following is a non-stimulant medication used in the management of ADHD?

<p>Atomoxetine (C)</p> Signup and view all the answers

According to the summary information provided, what is a trend observed in the population?

<p>Life expectancy Increasing. (C)</p> Signup and view all the answers

Which factor is MOST closely associated with the changes in bodily structure and function during aging?

<p>Decreased functional capacity (D)</p> Signup and view all the answers

Which of the following best describes dementia?

<p>Global cognitive impairment without impaired consciousness (B)</p> Signup and view all the answers

What is the Mini-Mental State Examination (MMSE) used for?

<p>Assessing cognitive function and suggesting dementia. (D)</p> Signup and view all the answers

What does a Mini-Mental State Examination (MMSE) score of less than 25 suggest?

<p>Possible dementia (C)</p> Signup and view all the answers

What is the significance of slow, repetitive speech in the context of dementia?

<p>Slow, repetitive speech can be a symptom associated with dementia. (B)</p> Signup and view all the answers

During the management of foreign body airway obstruction (FBAO) in an infant, where should the healthcare provider position the infant?

<p>Across the rescuer's lap with the head lower than the chest. (C)</p> Signup and view all the answers

If an infant is experiencing foreign body airway obstruction (FBAO), what is the correct sequence of actions?

<p>Give 5 back blows followed by 5 chest thrusts. (D)</p> Signup and view all the answers

What should you do if an infant with foreign body airway obstruction (FBAO) becomes unresponsive during your attempts to clear the airway?

<p>Initiate CPR, starting with chest compressions. (D)</p> Signup and view all the answers

When should emergency services be contacted during the management of an infant with foreign body airway obstruction (FBAO)?

<p>As early as possible in the process, while initiating first aid measures. (C)</p> Signup and view all the answers

What is the correct dose of adrenaline (epinephrine 1 in 1000 solution) for a 5-year-old child during resuscitation?

<p>150 micrograms (C)</p> Signup and view all the answers

What is the appropriate dose of buccal midazolam for a toddler, approximately 2 years old, experiencing a prolonged seizure?

<p>5 mg (B)</p> Signup and view all the answers

During a resuscitation, what is the recommended dose of adrenaline (epinephrine 1 in 1000 solution) for a 9-year-old child?

<p>300 micrograms (B)</p> Signup and view all the answers

What dose of buccal midazolam should be administered to an 8-month-old infant experiencing a seizure?

<p>2.5 mg (C)</p> Signup and view all the answers

Why is it important to address the needs and concerns of relatives during a paediatric medical emergency?

<p>Because their emotional state can impact the child's wellbeing and the relatives themselves need support. (B)</p> Signup and view all the answers

In the context of paediatric medical emergencies, why is it essential to have modified drug doses readily available?

<p>To ensure medications are administered quickly due to differences in pediatric physiology and weight. (D)</p> Signup and view all the answers

What is the MOST important distinction in managing paediatric medical emergencies compared to adult emergencies?

<p>Paediatric emergencies require modified drug dosages and specialized equipment due to differences in physiology and developmental stage. (B)</p> Signup and view all the answers

Which of the following behavioural patterns might suggest ADHD in a child?

<p>Difficulty listening to and following instructions (A)</p> Signup and view all the answers

Which presentation is more commonly associated with ADHD in adults?

<p>Restlessness and impatience (A)</p> Signup and view all the answers

Attention deficit hyperactivity disorder (ADHD) can often be seen alongside what other condition?

<p>Anxiety and Depression (B)</p> Signup and view all the answers

What class of medications is typically considered first-line treatment for managing ADHD?

<p>Stimulants (C)</p> Signup and view all the answers

Which of the following medications is classified as a non-stimulant and used in the treatment of ADHD?

<p>Atomoxetine (Strattera) (A)</p> Signup and view all the answers

What demographic trend is currently being observed in many developed countries?

<p>An increasing number of diagnoses made in adults. (C)</p> Signup and view all the answers

During aging, changes in bodily structure and function are most closely tied to:

<p>A gradual development of alterations not directly caused by preventable disease or trauma. (B)</p> Signup and view all the answers

Which of the following statements BEST describes dementia?

<p>A syndrome of global cognitive impairment without impaired consciousness. (C)</p> Signup and view all the answers

What is the primary purpose of administering the Mini-Mental State Examination (MMSE)?

<p>To evaluate cognitive functions like memory and orientation. (D)</p> Signup and view all the answers

In the context of assessing a patient for dementia using the Mini-Mental State Examination (MMSE), what does a score of less than 25 typically suggest?

<p>A high likelihood of dementia. (A)</p> Signup and view all the answers

In the context of dementia, what is the significance of observing slow, repetitive speech in a patient?

<p>It may indicate cognitive decline or aphasia associated with dementia. (A)</p> Signup and view all the answers

A 10-year-old child in anaphylaxis requires adrenaline (epinephrine). What dosage of a 1 in 1000 solution should be administered?

<p>300 micrograms (B)</p> Signup and view all the answers

During bag-mask ventilation, an astute and experienced paramedic notices an unusual degree of chest wall rigidity in a 7-year-old child who is otherwise exhibiting signs congruent with severe bronchospasm. Auscultation reveals markedly diminished bilateral breath sounds, and SpO2 remains critically low despite optimized ventilation. What rare—yet potentially catastrophic—etiology should the paramedic MOST urgently consider, given the totality of these atypical findings, and irrespective of prior medical history?

<p>Critical airway compromise due to hitherto undiagnosed laryngeal dystonia with paradoxical vocal cord adduction. (B)</p> Signup and view all the answers

An eminent researcher, investigating the cognitive trajectories of centenarians, discovers a statistically significant association between persistent engagement in complex Sudoku puzzles after age 95 and a markedly reduced incidence of late-onset vascular dementia. Which of the following statements, while inherently speculative and requiring extensive validation, represents the MOST defensible interpretation of this preliminary finding, grounded in established neurobiological principles and gerontological theory?

<p>Regular Sudoku engagement selectively strengthens pre-existing, less utilized neural networks, effectively augmenting cognitive reserve and imparting resilience against the functional consequences of age-related cerebral microinfarcts. (D)</p> Signup and view all the answers

What is the typical effect of treatments for Alzheimer's Dementia?

<p>They slow down progression rather than provide a complete cure. (D)</p> Signup and view all the answers

Which of the following symptoms is commonly associated with Alzheimer's dementia?

<p>Spatial disorientation (A)</p> Signup and view all the answers

Lewy Body Dementia is characterised by the presence of Lewy bodies in which areas?

<p>Neo-cortex and brainstem (A)</p> Signup and view all the answers

Which of these is a distinctive symptom of Fronto-temporal Dementia, that is NOT typically seen in Alzheimer's Disease?

<p>Personality changes and disinhibition (D)</p> Signup and view all the answers

Which of the following is linked to dementia?

<p>Alcohol abuse (D)</p> Signup and view all the answers

What score on the Mini-Mental State Examination (MMSE) strongly suggests dementia?

<p>Less than 25 (A)</p> Signup and view all the answers

Beyond memory loss, what other cognitive deficit is associated with dementia?

<p>Spatial disorientation (B)</p> Signup and view all the answers

In older adults, what could indicate frailty?

<p>A minor insult leading to a severe deterioration in health (D)</p> Signup and view all the answers

What physiological change is typically associated with decreased functional capacity in older adults?

<p>Decreased cardio-respiratory reserve (A)</p> Signup and view all the answers

What is a common feature associated with reduced homeostatic reserve in older adults?

<p>Increased risk of hypothermia (D)</p> Signup and view all the answers

An elderly patient who experiences a sudden drop in blood pressure upon standing is MOST likely experiencing:

<p>Postural hypotension (D)</p> Signup and view all the answers

What is a typical characteristic of disease presentation in older adults?

<p>Non-specific presentation (B)</p> Signup and view all the answers

Which of the following is a key feature that describes the 'Giants of Geriatrics'?

<p>Multiple causes that coexist and interact (B)</p> Signup and view all the answers

Which of the following is a dental consideration when treating older adults?

<p>Increased tissue fragility (D)</p> Signup and view all the answers

A dental practitioner is reviewing an elderly patient's medications and notices a prescription for warfarin. This raises concern for:

<p>Increased bleeding risk during dental procedures (D)</p> Signup and view all the answers

Which area is NOT a key part of the National Service Framework 2001?

<p>Respect for discrimination (C)</p> Signup and view all the answers

Which of the following is a form of elder abuse?

<p>Financial (C)</p> Signup and view all the answers

What is the appropriate action if you suspect elder abuse?

<p>Report concerns to social services or GP (A)</p> Signup and view all the answers

What is a potential problem with medication in older adults?

<p>Compliance may be affected (D)</p> Signup and view all the answers

Why might lower doses of medication be needed for older adults , compared to younger adults?

<p>They are often more sensitive (C)</p> Signup and view all the answers

An elderly patient consistently forgets to take their prescribed medication. What is an appropriate action?

<p>Use of dosing boxes (B)</p> Signup and view all the answers

What should you do to avoid adverse drug interactions?

<p>Consider current medications and other disorders. (D)</p> Signup and view all the answers

What is a common adverse effect of sedatives in older adults?

<p>Confusion and fall risk (A)</p> Signup and view all the answers

Which factor is MOST crucial to consider when prescribing medications for geriatric patients to mitigate potential risks and ensure optimal therapeutic outcomes?

<p>Known underlying medical conditions and concomitant medication use (D)</p> Signup and view all the answers

Which of the following can result from disability in old age?

<p>Isolation and difficulty in care (B)</p> Signup and view all the answers

What pathological process is associated with Alzheimer's dementia?

<p>Deposition of amyloid in the cortex (A)</p> Signup and view all the answers

Treatments for Alzheimer's dementia typically aim to:

<p>Slow the progression of the disease (A)</p> Signup and view all the answers

Which of these is a common symptom of Alzheimer's Dementia?

<p>Spatial disorientation (D)</p> Signup and view all the answers

Lewy Body Dementia is characterised by Lewy bodies, which can be found in which areas?

<p>Neo-cortex and brainstem (D)</p> Signup and view all the answers

Which of the following is a distinctive symptom of Fronto-temporal Dementia, and not typically seen in Alzheimer's Disease?

<p>Disinhibition (B)</p> Signup and view all the answers

Which condition is NOT typically associated with causing dementia?

<p>Multiple sclerosis (C)</p> Signup and view all the answers

On the Mini-Mental State Examination (MMSE), what score presents a strong indication of dementia?

<p>Less than 25 (C)</p> Signup and view all the answers

In addition to memory loss, what other key cognitive deficit is associated with dementia?

<p>Impaired judgement (D)</p> Signup and view all the answers

Which of the following is associated with frailty?

<p>Loss of in-built reserves (D)</p> Signup and view all the answers

Reduced cardio-respiratory reserve would lead to:

<p>Decreased functional capacity (A)</p> Signup and view all the answers

Which of the following is a characteristic feature associated with reduced homeostatic reserve in older adults?

<p>Hyponatraemia (B)</p> Signup and view all the answers

Postural hypotension is MOST associated with:

<p>Blood pressure control problems (C)</p> Signup and view all the answers

Which of the following BEST describes disease presentation in older people?

<p>Non-specific presentation (B)</p> Signup and view all the answers

What is a key 'Giant of Geriatrics' that describes multifactorial conditions?

<p>Instability (D)</p> Signup and view all the answers

Why is it important to conduct medication reviews in elderly patients, particularly when they are on medication such as Warfarin?

<p>Increased bleeding risk/tissue fragility (B)</p> Signup and view all the answers

Which key principle was included in the National Service Framework 2001?

<p>Respect for the individual (D)</p> Signup and view all the answers

Which of the following constitutes elder abuse?

<p>Emotional abuse (B)</p> Signup and view all the answers

If there's a suspicion of elder abuse, what action is legally appropriate?

<p>Address concerns to social services or GP (B)</p> Signup and view all the answers

Which of the following is a frequently encountered problem with medication in older adults?

<p>Adverse effects (D)</p> Signup and view all the answers

Why are lower doses needed for older adults?

<p>Often more sensitive (A)</p> Signup and view all the answers

An elderly patient displays poor compliance despite taking medication. What is an appropriate consideration?

<p>Side effects (C)</p> Signup and view all the answers

What should be considered when prescribing medication to an elderly patient to avoid adverse drug interactions?

<p>Only prescribe if sure of medications (A)</p> Signup and view all the answers

Which parameter needs to be considered when prescribing medications for older adults?

<p>Renal impairment (A)</p> Signup and view all the answers

By what age would a child typically be expected to walk?

<p>12-15 months (A)</p> Signup and view all the answers

What is the optimal age for an infant to localize sounds and turn to hear them?

<p>7 months (D)</p> Signup and view all the answers

At what age do infants generally begin to use single-word labels?

<p>1 year (C)</p> Signup and view all the answers

What percentage of children in the UK are estimated to have asthma?

<p>15% (A)</p> Signup and view all the answers

What is the MOST common cause of death in children under the age of 5 on a worldwide scale?

<p>Acute lower respiratory tract infections (C)</p> Signup and view all the answers

What is the genetic pattern associated with Cystic Fibrosis?

<p>Autosomal recessive (B)</p> Signup and view all the answers

What is the primary physiological defect in cystic fibrosis?

<p>Failure of chloride transport into the lumen of affected exocrine organs (A)</p> Signup and view all the answers

Which sample, collected at 5 days old, is initially used for Cystic Fibrosis diagnosis?

<p>Dried blood spot sample on the 'Guthrie card' (B)</p> Signup and view all the answers

According to the information provided, at what age do children typically start using sentences?

<p>3 years (A)</p> Signup and view all the answers

What is the MOST likely causative agent of viral tonsillitis in preschool children?

<p>Adenovirus (D)</p> Signup and view all the answers

According to the content, what is the typical age at which a child can chew lumpy food?

<p>9 months (B)</p> Signup and view all the answers

What is the frequency of physiotherapy in the daily management of cystic fibrosis?

<p>Daily (B)</p> Signup and view all the answers

Which supplementation is commonly used in the management of cystic fibrosis patients?

<p>Pancreatic enzyme supplements (C)</p> Signup and view all the answers

What is the immediate next step, following basic life support guidelines, after finding an unresponsive child?

<p>Check for breathing (A)</p> Signup and view all the answers

During infant CPR, how compressions are completed?

<p>Two fingers (A)</p> Signup and view all the answers

How should an infant with an airway obstruction be positioned when administering back blows for a foreign body airway obstruction?

<p>Across your lap with the head lower than the chest (A)</p> Signup and view all the answers

According to source NICE 2024, the dose of buccal midazolam should be administered to an 8-month-old infant experiencing a seizure?

<p>2.5 mg (C)</p> Signup and view all the answers

Which of the following potential signs may indicate that an adult has ADHD?

<p>Impulsiveness and risk taking (D)</p> Signup and view all the answers

On the Mini-Mental State Examination (MMSE), a maximum score of 30 can be achieved, what do the results suggest if a patient only scores less than 25.

<p>Suggests dementia (A)</p> Signup and view all the answers

According to doses of Adrenaline (Epinephrine 1 in 1000 solution) in child resuscitation, what does would you administer to someone over 12 years old?

<p>500 micrograms (A)</p> Signup and view all the answers

Which statement is absolutely correct regarding the effects of treatments for Alzheimer's Dementia?

<p>Specific treatments - tend to slow progression rather than provide a cure (D)</p> Signup and view all the answers

Lewy Body Dementia is characterised by the presence of Lewy bodies, where can these be found?

<p>Neo-cortex and brainstem (B)</p> Signup and view all the answers

A unique sign of Fronto-temporal Dementia, distinctive and not typically seen in Alzheimer's Disease, is:

<p>Personality changes, disinhibition (A)</p> Signup and view all the answers

Apart from memory loss, what other deficiency is closely associated with dementia?

<p>Cognitive (B)</p> Signup and view all the answers

A minor insult can lead to the risk of a severe deterioration in health is closely associated with:

<p>Frailty (C)</p> Signup and view all the answers

In older adults, reduced cardio-respiratory reserves can lead to:

<p>Reduced functional capacity (B)</p> Signup and view all the answers

Which area is NOT a key element of National Service Framework 2001?

<p>Cosmetic surgery/dentistry (A)</p> Signup and view all the answers

What should you do to avoid dangerous drug interactions in a patient aged 75?

<p>Do not prescribe unless sure of current medications and the possible effect known disorders (C)</p> Signup and view all the answers

Which of the following BEST describes the pattern of body control development in infants?

<p>From the head downwards (D)</p> Signup and view all the answers

A child who is 18 months old cannot yet walk. What is the MOST appropriate course of action?

<p>Undertake further investigation to identify any underlying causes (A)</p> Signup and view all the answers

At what age do infants USUALLY develop a mature grasp?

<p>12 months (A)</p> Signup and view all the answers

When assessing tonsillitis in children, what should you know about white exudate on the tonsils?

<p>It does not reliably differentiate between viral and bacterial infections (C)</p> Signup and view all the answers

Which is the MOST common causative organism in bronchiolitis?

<p>Respiratory Syncytial Virus (RSV) (B)</p> Signup and view all the answers

Which of the following is TRUE regarding the incidence of cystic fibrosis?

<p>1 in 2,500 live births (B)</p> Signup and view all the answers

What is the underlying cause of the various complications seen in cystic fibrosis?

<p>Excessive mucus production leading to obstruction and infection (D)</p> Signup and view all the answers

What is the MOST likely cause of death in countries with developed healthcare systems with patients who have cystic fibrosis?

<p>Respiratory failure due to progressive lung disease (B)</p> Signup and view all the answers

What test is PRIMARILY used as an initial diagnostic tool for cystic fibrosis?

<p>Dried blood spot sample on the 'Guthrie card' (D)</p> Signup and view all the answers

What is the standard treatment approach for managing cystic fibrosis?

<p>Physiotherapy, pancreatic enzyme supplements and dietary supplementation (A)</p> Signup and view all the answers

What pulmonary complication is MOST likely to occur in the later stages of cystic fibrosis?

<p>Bronchiectasis (C)</p> Signup and view all the answers

Adult patients with Cystic Fibrosis who are failing to gain weight are most at risk of developing:

<p>Diabetes mellitus (D)</p> Signup and view all the answers

Which of these conditions would be categorised an a pre-natal cause of learning disability?

<p>Foetal Alcohol Syndrome (C)</p> Signup and view all the answers

Which of the following conditions happening at the time of birth would be classified as a peri-natal cause of learning disability?

<p>Severe asphyxia (C)</p> Signup and view all the answers

Which of the following is an example of a post-natal cause of learning disability?

<p>Infection of CNS (A)</p> Signup and view all the answers

Why is the immediate management of a paediatric medical emergency in a dental setting particularly crucial?

<p>Paediatric patients can deteriorate rapidly (C)</p> Signup and view all the answers

What is the PRIME focus of the 'ABCDE approach' in paediatric medical emergencies?

<p>Airway, Breathing, Circulation, Disability, Exposure (A)</p> Signup and view all the answers

How does cardio-pulmonary arrest in children DIFFER from that in adults?

<p>Children are more likely to have a cardio-pulmonary arrest due to airway/breathing problems (D)</p> Signup and view all the answers

What is the MOST appropriate action after finding a child unresponsive?

<p>Open the airway and check for breathing (B)</p> Signup and view all the answers

According to the standard age definitions used in paediatrics, when does 'infancy' end?

<p>At 1 year old (B)</p> Signup and view all the answers

What upper limit is considered normal for the respiratory rate of a 6-month-old infant at rest?

<p>40 breaths/minute (D)</p> Signup and view all the answers

What is the LOWER limit considered normal for the pulse rate at rest in a 6-month-old infant?

<p>100 bpm (A)</p> Signup and view all the answers

During the 'Disability' stage of a paediatric medical emergency assessment, what is a KEY consideration?

<p>Asking the parent's opinion about the child's usual state (B)</p> Signup and view all the answers

During the 'Exposure' phase of a paediatric medical assessment, what is the MOST important factor?

<p>Minimising heat loss (A)</p> Signup and view all the answers

When should you call emergency services during paediatric basic life support?

<p>As soon as you recognise the child is not breathing normally (A)</p> Signup and view all the answers

During CPR for an infant, to what depth should the chest be compressed?

<p>One third of the chest depth (A)</p> Signup and view all the answers

How many fingers should be used to perform chest compressions during CPR on an infant?

<p>Two fingers (A)</p> Signup and view all the answers

Following the use of paediatric pads on an Automated External Defibrillator (AED), what is an appropriate initial energy dose to administer?

<p>2-4 J/Kg (A)</p> Signup and view all the answers

When can adult AED pads be used on a child?

<p>Adult pads can be used on a child ideally attenuated or failing that as standard (B)</p> Signup and view all the answers

Which of the following is CONTRAINDICATED when managing a child suspected of having an inhaled foreign body?

<p>Blind finger sweeps (D)</p> Signup and view all the answers

How should an infant with an airway obstruction be positioned to perform back blows effectively?

<p>Across the rescuer's lap with the head lower than the chest (C)</p> Signup and view all the answers

What dose of adrenaline (epinephrine 1 in 1000 solution) is appropriate for a child aged 7 during an anaphylactic reaction?

<p>150 micrograms (A)</p> Signup and view all the answers

What is the appropriate dose of buccal midazolam for a 6-month-old infant experiencing a prolonged seizure?

<p>2.5mg (B)</p> Signup and view all the answers

In paediatric medical emergencies, why is providing support and information to relatives considered beneficial?

<p>Relatives may be distressed and can benefit from support and clear information (A)</p> Signup and view all the answers

During a paediatric medical emergency, why is it especially important to have drug doses modified for children readily on hand?

<p>Paediatric patients require different drug doses compared to adults (C)</p> Signup and view all the answers

Which of the following behavioural features is MOST commonly associated with ADHD in children?

<p>Difficulty listening to and carrying out instructions (D)</p> Signup and view all the answers

Which other disorder is ADHD sometimes associated with?

<p>Anxiety and Depression (D)</p> Signup and view all the answers

Which medication is often used as a first-line treatment for ADHD?

<p>Stimulants (D)</p> Signup and view all the answers

What is a significant demographic trend observed in many developed countries?

<p>Life expectancy is increasing (A)</p> Signup and view all the answers

Which statement BEST describes dementia?

<p>A syndrome of global cognitive impairment without impaired consciousness (A)</p> Signup and view all the answers

In the context of assessing a patient for dementia, what does a Mini-Mental State Examination (MMSE) score of less than 25 typically mean?

<p>Suggests dementia (D)</p> Signup and view all the answers

In the context of dementia, what might slow, repetitive speech indicate?

<p>Cognitive impairment (D)</p> Signup and view all the answers

What is the primary goal of treatments for Alzheimer's dementia?

<p>To slow the progression of the disease (C)</p> Signup and view all the answers

Which of the following is a characteristic symptom commonly associated with Alzheimer's dementia?

<p>Failing memory (A)</p> Signup and view all the answers

Where are Lewy bodies typically found in Lewy Body Dementia?

<p>Neo-cortex and brainstem (B)</p> Signup and view all the answers

Which symptom is MOST characteristic of Fronto-temporal Dementia, yet NOT typically observed in Alzheimer's Disease?

<p>Personality changes, disinhibition (B)</p> Signup and view all the answers

Which factor could be linked to causing dementia?

<p>Alcohol abuse (D)</p> Signup and view all the answers

What score would STRONGLY indicate dementia on the Mini-Mental State Examination (MMSE)?

<p>A score of less than 25/30 (A)</p> Signup and view all the answers

Beyond memory loss, what other cognitive deficit is notably associated with dementia?

<p>Reduced cognitive ability (B)</p> Signup and view all the answers

Which of the following could MOST accurately describe or suggest frailty?

<p>Loss of in-built reserves and is related to ageing (D)</p> Signup and view all the answers

What is a common characteristic associated with reduced homeostatic reserve in older adults?

<p>Increased risk of hypothermia (D)</p> Signup and view all the answers

Reduced blood pressure control would lead to:

<p>Postural hypotension (B)</p> Signup and view all the answers

How does disease present itself in older people?

<p>Can affect function and independence (D)</p> Signup and view all the answers

Which key considerations, referred to as the 'Giants of Geriatrics', are essential for a comprehensive, multidisciplinary approach to care for the elderly?

<p>The 'Giants of Geriatrics' refer to a Multidisciplinary Approach is Needed instability, immobility, incontinence, intellectual impairment, isolation and latrogenesis (C)</p> Signup and view all the answers

What is the MOST common aetiology in cases of cardio-pulmonary arrest in children?

<p>Airway and breathing issues (D)</p> Signup and view all the answers

Assuming no prior intervention, what is the correct compression-to-ventilation ratio during one-person CPR for a child?

<p>15:2 (B)</p> Signup and view all the answers

What is a key consideration during the 'Exposure' phase of a paediatric medical assessment following the ABCDE approach?

<p>Detailed examination of the skin for rashes, whilst minimising heat loss (B)</p> Signup and view all the answers

A 6-year-old child requires adrenaline (epinephrine) during resuscitation. What is the appropriate dose of a 1 in 1000 solution (1mg/mL) to administer?

<p>0.15 mL (D)</p> Signup and view all the answers

A 3-year-old child is having a prolonged seizure. What dose of buccal midazolam should be administered?

<p>5mg (C)</p> Signup and view all the answers

When managing a case of infant FBAO, after delivering five back blows and noting continued obstruction, what is the MOST appropriate next step?

<p>Administer five chest thrusts with the infant supine, head positioned lower than the chest. (C)</p> Signup and view all the answers

A child presents with symptoms suggestive of ADHD; history taking reveals potential issues with organisation, time management and struggles with focusing and completing tasks as well as relationship struggles. What form of management would be MOST appropriate in such cases?

<p>CBT, DBT &amp; Counselling (A)</p> Signup and view all the answers

An elderly patient presents with a non-specific presentation and complex array of symptoms. Considering the 'Giants of Geriatrics', which of the following is LEAST likely to be relevant in this patient's care?

<p>Hypermobility (D)</p> Signup and view all the answers

An 80-year-old patient is prescribed a new medication. Which altered pharmacokinetic parameter could MOST significantly affect drug levels in such a patient?

<p>Decreased renal excretion (C)</p> Signup and view all the answers

Which of the following describes the typical pattern of body control development in infants?

<p>From top down. (B)</p> Signup and view all the answers

At what age is it MOST appropriate to start using chest thrusts instead of abdominal thrusts for infants?

<p>Under 1 year. (C)</p> Signup and view all the answers

What is the correct method for opening the airway of a child during bag-mask ventilation?

<p>Head tilt, chin lift. (A)</p> Signup and view all the answers

Which of the following is the appropriate chest compression depth during CPR on a child?

<p>Compress chest to one third of its depth. (C)</p> Signup and view all the answers

What is the appropriate rate of chest compressions for infants?

<p>100-120 compressions per minute (D)</p> Signup and view all the answers

Which is the appropriate first step to managing unresponsiveness/lack of normal breathing in pediatric BLS?

<p>Assess responsiveness (B)</p> Signup and view all the answers

What is the MOST common cause of cardio-pulmonary arrest in children?

<p>Airway and breathing problems. (D)</p> Signup and view all the answers

What is the MOST appropriate action when a child is known to have an inhaled foreign body?

<p>Encourage the child to cough forcefully. (D)</p> Signup and view all the answers

What should be done first if an infant has a foreign body airway obstruction?

<p>Administer 5 back blows. (B)</p> Signup and view all the answers

An infant is being given back blows to clear a foreign body airway obstruction. How should they be positioned?

<p>Prone across the rescuer's lap with the head lower than the chest (A)</p> Signup and view all the answers

At what point is it most important to call emergency services when managing a child with a foreign body airway obstruction?

<p>If initial attempts to dislodge the object are unsuccessful. (D)</p> Signup and view all the answers

What is the correct first action if you find an infant with FBAO unconscious?

<p>Begin CPR. (A)</p> Signup and view all the answers

For a child over 12, what is the amount of adrenaline (epinephrine 1 in 1000 solution) to be given during resuscitation?

<p>500 micrograms (C)</p> Signup and view all the answers

A 7-year-old child is experiencing a prolonged seizure. Which of the following dosages of buccal midazolam is MOST appropriate?

<p>7.5 mg (A)</p> Signup and view all the answers

What dosage of adrenaline (epinephrine 1 in 1000 solution) should be administered to a 4-year-old child experiencing anaphylaxis?

<p>150 micrograms. (D)</p> Signup and view all the answers

What dose of buccal midazolam should be given to a 15-month-old infant who's having a prolonged seizure?

<p>5 mg (C)</p> Signup and view all the answers

Why is it important to provide support to family members during paediatric emergencies?

<p>Their emotional state can affect the child and the treatment process. (D)</p> Signup and view all the answers

Why is important to have modified drug doses readily available during paediatric emergencies?

<p>Paediatric drug dosages are weight-dependent and require quick calculations. (B)</p> Signup and view all the answers

Pediatric medical emergencies differ from those in adults because:

<p>They share the same principles, but are more rare. (C)</p> Signup and view all the answers

Which of the following social difficulties may indicate ADHD in children?

<p>Difficulties following instructions. (D)</p> Signup and view all the answers

What characterizes the presentation of ADHD in adults?

<p>Difficulties with organization and time management. (C)</p> Signup and view all the answers

Which co-existing mental health condition is commonly associated with ADHD?

<p>Anxiety and depression. (C)</p> Signup and view all the answers

Methylphenidate (Ritalin) falls into what class of medications?

<p>Stimulants. (B)</p> Signup and view all the answers

What type of medication is considered a non-stimulant when managing ADHD?

<p>Atomoxetine. (C)</p> Signup and view all the answers

What demographic shift is being observed in many developed nations?

<p>A larger proportion of older individuals. (C)</p> Signup and view all the answers

Changes in the structure and function of the body during aging are MOST closely linked to?

<p>A gradual development of changes that are not due to preventable disease or trauma. (B)</p> Signup and view all the answers

The Mini-Mental State Examination (MMSE) is PRIMARILY used for what purpose?

<p>To assess cognitive impairment. (D)</p> Signup and view all the answers

During cognitive assessment using the Mini-Mental State Examination (MMSE), a score less than 25 typically suggests:

<p>Possible dementia. (B)</p> Signup and view all the answers

During assessment, what indicates that the patient may have demential?

<p>Patient has slow, reptitive speech. (A)</p> Signup and view all the answers

During management of a child with foreign body airway obstruction (FBAO), where should the healthcare provider be positioned?

<p>In front of the child. (D)</p> Signup and view all the answers

What sequence of management steps should be performed for a child displaying foreign body airway obstruction (FBAO)?

<p>Back blows -&gt; Chest thrusts (B)</p> Signup and view all the answers

What action should be taken if you are attempting to clear an infant with foreign body airway obstruction (FBAO) but they become unresponsive?

<p>Start CPR. (B)</p> Signup and view all the answers

What is the appropriate action to take if elder abuse is suspected?

<p>Report the concerns to social services. (C)</p> Signup and view all the answers

Why are lower medication doses a common consideration for older adults compared to younger adults?

<p>Reduced kidney and liver function impairs drug metabolism and excretion. (D)</p> Signup and view all the answers

What is a possible solution to improve poor patient compliance with medications?

<p>Write things down - beware of impaired vision. (C)</p> Signup and view all the answers

In order to avoid adverse drug interactions, what principle should be considered when prescribing medication to an elderly patient?

<p>Do not prescribe unless you're sure of current medications and the possible effects on the elderly patient. (A)</p> Signup and view all the answers

What is of MOST importance when prescribing medications for older adults?

<p>Renal function. (B)</p> Signup and view all the answers

Which is a direct consequence of disability in old age?

<p>Isolation and difficulty accessing care. (A)</p> Signup and view all the answers

Treatments for Alzheimer's dementia primarily aim to:

<p>Slow the progression of the disease. (B)</p> Signup and view all the answers

Which symptom is frequently observed in patients with Alzheimer's Dementia?

<p>Spatial disorientation. (A)</p> Signup and view all the answers

Lewy Body Dementia is distinguished by the presence of Lewy bodies in what regions of the brain?

<p>Neo-cortex and brainstem. (D)</p> Signup and view all the answers

What distinctive symptom differentiates Fronto-temporal Dementia from Alzheimer's Disease?

<p>Significant personality changes and disinhibition. (B)</p> Signup and view all the answers

Slow, progressive memory loss, aphasia, apraxia, and visuospatial deficits are MOST characteristic of which stage of Alzheimer's disease?

<p>Dementia due to Alzheimer's disease (C)</p> Signup and view all the answers

What is the significance of Incontinence, Immobility, Instability and Intellectual Impairment?

<p>The 'Giants of Geriatrics' (A)</p> Signup and view all the answers

In elderly adults, what physiological factor leads to decreased funtional capacity?

<p>Reduced cardio-respiratory reserve. (A)</p> Signup and view all the answers

What is a key characteristic of reduced homeostatic reserve in older people?

<p>Reduced cognitive reserve potentially leading to delirium. (A)</p> Signup and view all the answers

What is postural hypotension MOST associated with?

<p>Blood pressure control. (C)</p> Signup and view all the answers

What is a key principle to keep in mind when considering developmental skills in children?

<p>There is significant variation in when children acquire skills; focus on 'usual' rather than 'normal'. (A)</p> Signup and view all the answers

From which direction does body control typically develop in infants?

<p>From the top down (A)</p> Signup and view all the answers

What feature characterises vision and manipulation skill development in infants?

<p>Observing objects with a convergent gaze (B)</p> Signup and view all the answers

At what age do children typically start using a spoon and fork effectively?

<p>3 years (A)</p> Signup and view all the answers

Which of the following is a common 'main cause' for developmental concerns in toddlers?

<p>Social/behaviour problems (B)</p> Signup and view all the answers

What should you check regarding immunisations during a consultation with a child?

<p>If they are up-to-date (B)</p> Signup and view all the answers

Upper Respiratory Tract Infections (URTIs) account for approximately what portion of children's visits to general practitioners?

<p>Almost half (D)</p> Signup and view all the answers

Which statement is most accurate regarding tonsillitis?

<p>Viral tonsillitis is more common in preschool children. (C)</p> Signup and view all the answers

Which of the following is correct in the treatment of Cystic Fibrosis?

<p>Physiotherapy, daily, should be completed. (B)</p> Signup and view all the answers

What is the implication of biliary complications in Cystic Fibrosis?

<p>Biliary cirrhosis (A)</p> Signup and view all the answers

Older cystic fibrosis patients not gaining weight may need what?

<p>Regular insulin (D)</p> Signup and view all the answers

Which of the following statements best describes the typical course of paediatric medical emergencies, particularly in a dental setting?

<p>They are rare, but can deteriorate rapidly. (C)</p> Signup and view all the answers

In the 'ABCDE approach' to paediatric medical emergencies, what does 'A' stand for?

<p>Airway (D)</p> Signup and view all the answers

Cardio-pulmonary arrest in children is generally attributed to:

<p>Airway/breathing problems (B)</p> Signup and view all the answers

After finding an unresponsive child during basic life support, what should you do next?

<p>Check for a response. (D)</p> Signup and view all the answers

According to age definitions, what is the age range for infants?

<p>Less than 1 year (B)</p> Signup and view all the answers

What is the upper limit of the normal respiratory rate for a child under 1 year of age?

<p>40 breaths/minute (B)</p> Signup and view all the answers

What might be a normal pulse rate for a 9-month old infant?

<p>100-180bpm (B)</p> Signup and view all the answers

Which statement is correct during the 'Exposure' phase of a paediatric medical assessment?

<p>Minimise heat loss. (C)</p> Signup and view all the answers

During paediatric basic life support, when should emergency services be contacted?

<p>Immediately, if the child is not breathing normally. (B)</p> Signup and view all the answers

To what depth should the chest be compressed during CPR administrations on a child?

<p>One third of the chest depth. (D)</p> Signup and view all the answers

How many fingers should be used to administer chest compressions to an infant?

<p>Two fingers (C)</p> Signup and view all the answers

What is the recommended method for removing a foreign body from a child, older than 1 year, who is choking?

<p>Chest thrusts (A)</p> Signup and view all the answers

If initial back blows are unsuccessful in dislodging a foreign body in an infant with airway obstruction, what is the IMMEDIATE next step?

<p>Administer 5 chest thrusts (C)</p> Signup and view all the answers

If an infant experiencing foreign body airway obstruction (FBAO) becomes unresponsive during attempts to clear the airway, what should be the immediate next step?

<p>Initiate CPR (D)</p> Signup and view all the answers

What is the correct dose of adrenaline (epinephrine 1 in 1000 solution) for a child aged between 6 months and 6 years during resuscitation?

<p>150 micrograms (D)</p> Signup and view all the answers

Following a prolonged seizure, what is the appropriate dose of buccal midazolam for a child aged 5-9 years?

<p>7.5 mg (C)</p> Signup and view all the answers

Why is it essential to look after relatives during a paediatric medical emergency?

<p>Relatives can be beneficial (C)</p> Signup and view all the answers

Why is it important to have modified drug doses readily available during paediatric medical emergencies?

<p>Paediatric patients require different doses than adults (A)</p> Signup and view all the answers

According to the summary information provided, what is observed in the population?

<p>Life expectancy increasing (B)</p> Signup and view all the answers

At what age would a baby typically begin to show a social smile in response to interaction?

<p>4-8 weeks (C)</p> Signup and view all the answers

A child who is 14 months old is NOT yet walking. What should be considered?

<p>Walking varies considerably, it is 'usual' rather than 'normal' so this is not necessarily a cause for concern. (C)</p> Signup and view all the answers

Which of the following is the MOST common causative agent of acute suppurative otitis media?

<p>Streptococcus pneumoniae (A)</p> Signup and view all the answers

Adenovirus is commonly associated with which of the following?

<p>Viral Tonsillitis in preschool children (C)</p> Signup and view all the answers

What is the underlying cause of the physiological changes seen in Cystic Fibrosis?

<p>Failure of chloride transport across exocrine cell membranes. (C)</p> Signup and view all the answers

The 'Guthrie card' test, used in the diagnosis of Cystic Fibrosis, is performed by collecting what type of sample?

<p>Dried blood spot (C)</p> Signup and view all the answers

A 7-year-old child is brought into a clinic. Their parent reports that they seem to be unable to focus for long periods of time, are badly disorganised and have trouble listening to instructions. What might this suggest?

<p>ADHD (C)</p> Signup and view all the answers

Which of the following medication types is likely to be used as first line treatment for ADHD?

<p>Stimulants (A)</p> Signup and view all the answers

In the ABCDE approach to paediatric medical emergencies, what is the PRIMARY concern during the 'Breathing' assessment?

<p>Ensuring adequate chest expansion and ventilation. (D)</p> Signup and view all the answers

What is the BEST course of action when faced with a case of suspected elder abuse?

<p>Report your concerns to Social Services or the patient's GP in line with safeguarding policies. (A)</p> Signup and view all the answers

Flashcards

Developmental Skills

Skills such as posture, movement, vision, manipulation, hearing, speech and social behaviour.

Top-Down Control

Body control develops from the head down, demonstrated by 'head lag' in newborns.

Walking Age

Typically, infants begin to walk between 12 to 15 months of age.

Infant Vision

Around 8 weeks old, infants can observe dangling toys with a focused gaze.

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Facial Preference

Infants generally prefer looking at faces starting from 2 months old.

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Grasping Development

The ability to grasp objects typically develops by 12 months.

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Sound Localization

The ability to turn towards a sound source, optimally developed around 7 months.

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Single Word Usage

Children typically start using single words around one year of age.

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Two-Word Sentences

By age 2, children begin to combine words to express ideas.

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Sentence Formation

Children can typically form sentences by the age of 3 years.

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Social Smiling

Infants smile in response to a parent's face usually between 4-8 weeks.

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Chewing Lumpy Food

Around 9 months, infants start to chew lumpy food.

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Utensil Use

By 3 years old, children can use a spoon and fork.

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Otitis Media (OM)

A condition involving acute infection of the middle ear.

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Acute Suppurative Otitis Media

Infection characterized by irritability, pain, fever, hearing loss, discharge, and systemic illness.

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Chronic Otitis Media with Effusion

A multifactorial condition involving Eustachian insufficiency and environmental factors.

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Conductive Hearing Loss

Hearing loss due to issues conducting sound, seen in glue ear.

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Viral Tonsillitis

Viral tonsillitis often caused by adenovirus is most common in preschool children.

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Bronchiolitis

Mainly children under 1

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Respiratory Syncytial Virus (RSV)

Acute viral infection of airways < 1 mm in diameter, most commonly caused by RSV

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Cystic Fibrosis

Autosomal recessive

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Cystic Fibrosis

A multi system disorder affecting lung, sweat glands, GIT, pancreas, reproductive system

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Sweat test - chloride level

Dried blood spot sample collected on the 'Guthrie card' at 5 days

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Developmental Variation

Variations in developmental skills; consider 'usual' milestones rather than strict 'normal' expectations.

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Global Developmental Delay

Delay in reaching multiple developmental milestones.

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Immunization Status

Checking if a child's vaccinations are current and complete.

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Upper Respiratory Infections (URTIs)

Infections of the nose, throat, and upper airways; very common in children.

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Otitis Media

An infection of the middle ear.

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Streptococcal Tonsillitis

More common in school-aged children.

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Lower Respiratory Infections

Infections of the lungs and lower airways.

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Chloride transport in CF

Defect in chloride transport.

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Guthrie Card Test

Collection of a dried blood sample on special paper to screen newborns.

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Physiotherapy for CF

Daily physiotherapy is used in the treatment of Cystic Fibrosis.

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Enzyme Supplements

Pancreatic enzyme supplements are used in the management of Cystic Fibrosis.

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CF Dietary Supplements

Vitamin and dietary supplements are used in the management of Cystic Fibrosis

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NG or Gastrostomy feeding

In severe cases of Malnutrition with Cystic Fibrosis Nasogastric or gastrostomy feeding may be required

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Biliary complications/ CF

Biliary complications may lead to biliary cirrhosis, portal hypertension and oesophageal varices

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CF and Diabetes

Older CF patients who do not gain weight may have diabetes mellitus and need regular insulin.

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Pre-natal Learning Disability

In-utero Infections, Foetal Alcohol Syndrome, Chromosomal disorders or Single gene defects.

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Peri-natal Learning Disability

Complications of extreme prematurity, Birth trauma/Severe asphyxia, Bilirubin induced neurological damage, Hypoglycaemia, Meningitis or Hydrocephalus

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Post-natal Learning Disability

NAI/Accidental trauma, Prolonged convulsion, Infection of CNS or Environmental (malnutrition)

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Paediatric dental emergencies

Paediatric Medical Emergencies in dentistry are rare, can deteriorate rapidly if they happen and are best approached using ABCDE

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Children Cardio-Pulmonary Arrest

In children Cardio-Pulmonary Arrest is more likely to be due to airway/breathing problems

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Paediatric CPR

Initial oxygenation/ventilation is important

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Infant age

Less than 1 year

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Child Age

1 year to puberty

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Infant Respiratory Rate

Expect higher respiratory rates up to 40 breaths/minute

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3 months - 2 years Pulse Rate

Normal pulse rates at rest 100-180 bpm

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2-10 years Pulse Rate

Pulse rate 60-140 bpm

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Paediatric assessment

Check for a 'Floppy' child or ask parent's opinion

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Paediatric patient Exposure

Minimise heat loss, check for rashes or measure axillary temperature

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Call 999 Paediatric

Call CPR 999 if child is not breathing normally

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CPR ventilations

Give 5 initial ventilations before chest compressions.

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CPR Alone

If alone, CPR for 1 minute before 999 (but should not be!)

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Chest compressions

Compress chest to one third of depth using 2 fingers in an infant and one or two hands in a child

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Paediatric AED Usage

Rare, usually airway/ventilation problems and most supply paediatric pads

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Foreign Body Removal

Blind 'finger sweeps' not recommended

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Choking guidelines for children

Adult guidelines suitable for children over 1 year of age during choking scenarios

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Infant choking response

Use chest thrusts instead of abdominal thrusts for infants

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Infant positioning

Position the infant across your lap with their head lower than their chest.

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FBAO

Foreign Body Airway Obstruction. Blockage of the airway by a foreign object

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Infant Back Blows

Placing an infant face down along your forearm, delivering 5 back blows between the shoulder blades.

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Infant Chest Thrusts

After back blows, if the object not dislodged, deliver 5 chest thrusts with two fingers in the center of the chest.

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CPR

Emergency procedure to manually preserve brain function until further measures to restore spontaneous circulation and breathing

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Infant Positioning for FBAO

For infants with FBAO, position them head-downward to use gravity during back blows and chest thrusts.

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Adrenaline (Epinephrine)

Medication used to treat severe allergic reactions.

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Buccal Administration

For seizures, administer medication via the cheek.

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Epilepsy

A brain disorder characterized by recurrent, unprovoked seizures.

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ADHD Stimulant Medications

Stimulant-based medications like methylphenidate, such as Ritalin, used as a first-line treatment

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Atomoxetine

Atomoxetine, a non-stimulant medication, works by modulating norepinephrine.

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Management - Children ADHD

Support for parents and families, educational support and sometimes medication

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Management - Adults ADHD

Counselling and CBT (Cognitive Behaviour Therapy) and often medication are used to manage ADHD

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ADHD Diagnosis

An increasing number of adults are being diagnosed , many case diagnosed under 12 years of age

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Dementia

A syndrome of global cognitive impairment without impaired consciousness that affects memory and cognition.

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Mini-Mental State Examination Score

A score of less than 25 suggests dementia

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Dementia - Assessment

Mini-Mental State Examination, a series of questions used to assess mental abilities, with the aim of checking for dementia.

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Infant Inter-scapular Blows

In infants experiencing Foreign Body Airway Obstruction, this involves delivering five sharp blows to the back between the shoulder blades.

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Infant Chest Thrust Procedure

After inter-scapular blows, this technique involves administering five chest compressions with the infant positioned supine and head lower than chest.

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Adrenaline (Epinephrine) doses

Doses are: Over 12 years 500 micrograms, 6-12 years-300 micrograms, 6 months – 6 years 150 micrograms, Less than 6 months – 100 micrograms

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Epilepsy Buccal dose

Dosage: 1-2 months - 300 μg/kg, 3 -11 months - 2.5 mg, 1 - 4 Years – 5 mg, 5 - 9 years – 7.5 mg, >10 years - 10 mg

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A(D)HD

Affects behaviour; cause not really known. May have a familial element. Characterised by 'Micro-focusing'. May be restless and have trouble concentrating

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ADHD Management

Children: Educational support, support for parents/families, sometimes medication. Adults: Often medication, Counselling, CBT, DBT.

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Ageing definition

A gradual process involving structural and functional changes, with decreased functional capacity and potential increase of death.

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Dementia Indicators

May include personality change, slow repetitive speech and unusual if happens < 55 years

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Alzheimer's Dementia

Dementia caused by Alzheimer's disease, the most common form of dementia.

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Early-Onset Dementia

Dementia that may start as early as 40 years old.

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Dementia Risk Factors

Factors that increase the likelihood of developing dementia, such as genetic defects.

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Amyloid Deposition

The accumulation of amyloid plaques in the brain cortex, a characteristic of Alzheimer's disease.

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Dementia Treatments

Treatments that aim to slow down the progression of dementia symptoms rather than curing the disease.

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Vascular Dementia

Type of dementia caused by multiple small strokes in the brain.

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Sudden-Onset Dementia

Dementia with sudden onset, often associated with vascular dementia.

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Lewy Body Dementia

Hallucinations, cognitive impairment, and movement problems are characteristic of this type of dementia

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Fronto-temporal Dementia

Dementia marked by atrophy of the frontal and temporal lobes of the brain.

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Frailty

A syndrome common in old age that leads to an increased risk of severe deterioration in health from minor issues.

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Functional Decline

The decline of physical abilities, such as muscle strength, cardio-respiratory reserve, and cognitive capacity.

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Reduced Homeostatic Reserve

Decline in physical and cognitive function, making older adults more vulnerable to health issues.

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Atypical Presentation

Atypical, nonspecific, or subtle ways diseases present in older adults.

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Multiple pathologies and interactions

Simultaneous conditions, that can affect the health and function of older adults.

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Giants of Geriatrics

Instability, Immobility, Incontinence, Intellectual Impairment, Isolation and Iatrogenesis

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Dental Relevance (Geriatrics)

Increased bleeding risk, flat lying difficulty and increased risk with sedatives because of frailty

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National Service Framework 2001

Guideline promoting respect, intermediate primary care, specialist care, and active lifestyles.

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Elder Abuse

Abuse of elderly people, could be neglect, physical, emotional, financial or sexual

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Safeguarding Elder Adults

Report concerns to Social Services or GP if you suspect someone is at harm.

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Problems With Medication

Compliance, pharmacokinetics and adverse effects make this difficult.

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Pharmacokinetics

Reduced absorption in the GI tract, Reduced excretion in the kidneys and liver and Altered protein binding

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Possible Poor Compliance

Poor explanation of the condition and side effects of medication

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Drug Prescriptions in Older People

Multiple prescriptions between drugs can cause adverse effects on another disease.

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Increased Risk of Adverse effects

Antibiotics, sedatives. NSAIDs, Opioids and anticholinergic effects.

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Vascular Dementia (Prevalence)

The percentage of dementia cases attributed to vascular issues, from multiple small strokes.

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Fronto-temporal Dementia Characteristics

Dementia due to atrophy of the frontal and temporal lobes, characterized by personality changes and not affecting spatial orientation.

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Frailty Risks

A common condition in older adults leaving them vulnerable to deterioration in health from little ailments

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Decreased Functional Capacity

A common symptom of dementia resulting in a decrease in strength, cardio-respiratory capacity and cognitive function

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Reduced Homeostatic Reserve risks

A physiological state in the elderly, marked by impairment in blood pressure and increased risk of infection

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Atypical Disease Presentation

Non-specific, subtle ways diseases present in older adults.

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Elder Abuse Forms

Encompasses neglect, physical, emotional, financial, and sexual abuse against older adults

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Pharmacokinetics in Frailty

Reduced stomach absorption, excretion and altered protein binding

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Reasons for Poor Compliance

Lack of patient understanding, side effect complications and vision impairment

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Adverse effects

Increased Sensitivity to side effects from multiple prescriptions

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Mini-Mental State Examination

Several questions with a certain maximum score for detecting dementia signs.

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Alzheimer's Symptoms

Failing memory, spatial disorientation, behavioral changes, delusions and eventual loss of interest

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Lewy Body Dementia - Characteristics

A dementia characterized by lewy bodies in the neo-cortex that show cognitive impairment, hallucinations, and parkinsonism

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Dementia - other causes

Can be caused by alcohol abuse, huntingdons and parkinson's disease

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Decreased functional capacity

Muscle strength, cardio-respiratory reserve, cognitive capacity and bladder capacity all reduced

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Multiple pathology

Multiple pathologies and interactions are often present

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Dental relevance

Increased bleeding risk/tissue fragility, difficulty lying flat and difficulty tolerating long procedures

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Safeguarding

Everyone's business

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Drug prescriptions

Do not prescribe unless you are sure if their current medications.

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Summary

Disability is common is increased in older patients

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Dementia - Alzheimer's

Alzheimer's Dementia often presents with failing memory, spatial disorientation, changed behaviour, hallucinations and delusions.

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Drug Prescriptions and Interactions

Do not prescribe unless sure of current medications and the possible effect known disorders or between drugs/adverse effect on another disease.

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Characteristics of Disease in Older People

Characterized by non specific/occult presentation, impairment in homeostasis, resistance and recovery.

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Paediatric inter-scapular blows

Call for educational support in schools.

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Paediatric chest thrust procedure

Delivering chest compressions below the nipple line towards head

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Increase in diagnoses in adults

ADHD can be associated with other disorders, such as anxiety and depression

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Posture and Movement

Body control progresses from the head downwards.

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Acute Lower Respiratory Tract Infections

Most common cause of death in children under 5 worldwide

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Paediatric Basic Life Support

Call 999, 5 initial breaths, then compressions.

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Potential ADHD Signs - Adult

Problems following organisation and time management

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Life Expectancy

Increases in old age

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Geriatric Syndromes

Multiple, coexisting problems affecting older adults.

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Forms of Elder Abuse

Neglect, physical, emotional, financial, and sexual abuse

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Problems with Medication - Geriatrics

Compliance, pharmacokinetics/drug action/interactions, adverse effects

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Possible Poor Compliance (Geriatrics)

Poor explanation, side effects, difficulty due to mental physical impairment

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Possible Solutions

Careful explanation and aids such as alarms and special dispensing units can improve compliance

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Reduced Homeostatic Reserve (Geriatrics)

reduced postural stability and thermo-regulation, increased risk of hypothermia,

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Problems in the lungs

Lung disease in childhood

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Study Notes

Developmental Skills

  • Developmental skills include posture and movement.
  • Vision and manipulation, specifically hand-eye coordination, contributes to developmental skills.
  • Hearing and speech are considered developmental skills.
  • Social behavior is also a developmental skill to consider.
  • There is great variation in development, so it's better to talk of "usual" not "normal".

Posture and Movement

  • Body control develops from top down.
  • Newborn babies exhibit 'head lag'.
  • Walking is usually achieved by 12-15 months.

Vision and Manipulation

  • At 8 weeks, a baby observes a dangling toy or bright object 30 cm from the face with a convergent gaze.
  • From 2 months, a baby prefers watching a face.
  • Grasping is developed by 12 months.

Hearing and Speech

  • Localization of sound occurs; turning to hear it is optimal at 7 months.
  • Single word labels begin from one year.
  • Speech develops around two years, where words are joined to convey ideas.
  • By 3 years, sentences are formed.

Social Behaviour

  • At 4-8 weeks, babies smile in response to a parent's face.
  • By 9 months, babies will chew lumpy food, though some may start earlier.
  • The use of a spoon and fork begins around 3 years.
  • Toilet training is a key aspect of social behavior.

Main Causes for Developmental Concern

  • Delays in all 'milestones' can be cause for concern.
  • Delay in walking can be cause for concern.
  • Delays in speech can be cause for concern.
  • Social or behavioral problems can be cause for concern.

Immunisations

  • Checking if immunizations are up-to-date is important.

Respiratory infection in Childhood

  • URTIs account for almost half of children's visits to GPs.
  • Up to 15% in the UK have asthma, with incidence increasing.

Upper Respiratory Tract Infections

  • Most URTIs are viral, but it is difficult to tell.

Otitis Media (OM)

  • Otitis media characterized as an acute infection of the middle ear.

Acute Suppurative Otitis Media

  • Acute Suppurative Otitis Media is characterized by Irritability.
  • Acute Suppurative Otitis Media is characterized by Pain.
  • Acute Suppurative Otitis Media is characterized by Pyrexia.
  • Acute Suppurative Otitis Media is characterized by Hearing loss.
  • Acute Suppurative Otitis Media is characterized by Discharge.
  • Systemic illness

Chronic Otitis Media with Effusion ('Glue Ear')

  • Chronic Otitis Media with Effusion is multifactorial.
  • Chronic Otitis Media with Effusion can be caused by Eustachian insufficiency.
  • Environmental factors are a cause Chronic Otitis Media with Effusion.
  • Chronic Otitis Media with Effusion can be caused by immunity.
  • Social class is a factor on whether you develop Chronic Otitis Media with Effusion.
  • Allergy plays a role in causing Chronic Otitis Media with Effusion.
  • Childhood screening is helpful to identify cases of 'Glue Ear'.
  • Pure tone audiometry helps detect Chronic Otitis Media with Effusion.
  • It is Endemic in children under 5.
  • Conductive hearing loss is associated with with Chronic Otitis Media with Effusion.
  • A Language delay is associated with Chronic Otitis Media with Effusion.
  • Behavioural issues are associated with Chronic Otitis Media with Effusion.
  • Recurrent infections may present with Chronic Otitis Media with Effusion.
  • There is a risk of Poor school performance with Chronic Otitis Media with Effusion.

Tonsillitis

  • white exudate on the tonsil cannot distinguish viral from bacterial infection
  • Viral tonsillitis (often caused by adenovirus) is more common in pre-school children.
  • Streptococcal tonsillitis is more common in school-age children.
  • There are NICE Guidelines available.

Acute Lower Respiratory Tract Infections

  • Acute lower Respiratory Tract infections are the most common cause of death in children under 5 years worldwide.
  • Mortality is low in the UK.
  • Largely confined to those in with pre-existing cardio-respiratory disease.

Bronchiolitis

  • Bronchiolitis is an acute viral infection of airways under 1 mm in diameter.
  • It mainly affects children under 1.
  • Respiratory Syncytial Virus (RSV) is most common in cases of Bronchiolitis.
  • Bronchiolitis usually occurs in winter epidemics and is often mild and self-limiting.

Cystic Fibrosis

  • Cystic Fibrosis is Responsible for the majority of deaths in 'developed' countries from lung disease in childhood.
  • Incidence of Cystic Fibrosis is around 1 in 2500 live births.
  • Cystic Fibrosis is Autosomal recessive.
  • Most deaths are from respiratory failure.

Diagnosis Of Cystic Fibrosis

  • Diagnosis is with a Dried blood spot sample collected on the 'Guthrie card' at 5 days old.Tests are performed at the same time a tests for phenylketonuria and hypothyroidism.
  • Later tests 'Sweat Test' (chloride level) are performed.

Management Of Cystic Fibrosis

  • Daily there is Physiotherapy.
  • Pancreatic enzyme supplements.
  • There are Vitamin, dietary supplements and dietary supplementation and, in some cases a [Nasogastric or gastrostomy feeding].

Cystic Fibrosis con't

  • Multi-system disorder affecting lung, sweat glands, GIT, pancreas reproductive system.
  • Failure of chloride transport into the lumen of affected exocrine organs.
  • Water is drawn from lumen into cells, dehydrating mucus and impairing action of cilia promoting bacterial colonisation.

Later Developments Of Cystic Fibrosis

  • Complications in the biliary system may lead to biliary cirrhosis, portal hypertension and oesophageal varices.
  • Older CF patients who do not gain weight may have diabetes mellitus and need regular insulin.

Causes of Learning Disability

  • Prenatal.
  • Peri-natal.
  • Post- natal.

Pre-Natal causes of Learning Difficulties

  • In-Utero Infections
  • Fetal Alcohol Syndrome
  • Chromosomal disorders e.g Down Syndrome, Turner's Syndrome.
  • Single gene defects e.g Neurofibromatosis, Metabolic disorders.

Peri-natal causes of Learning Difficulties

  • Complications of extreme prematurity .
  • Birth trauma, Severe asphyxia.
  • Bilirubin induced neurological damage (Kernicterus).
  • Hypoglycaemia
  • Meningitis.
  • Hydrocephalus.

Post Natal causes of Learning Difficulties

  • NAI/Accidental trauma.
  • Prolonged convulsion .
  • Infection of CNS .
  • Environmental (malnutrition).

Paediatric Medical Emergencies

  • Medical Emergencies are rare in dentistry.
  • Medical Emergencies in this patient group can deteriorate rapidly.
  • Always use the ABCDE approach in Medical Emergencies.
  • They often Get well early.

Cardio-Pulmonary Arrest

  • Cardio-Pulmonary Arrest is more likely to be due to airway/breathing problems.
  • Initial oxygenation/ventilation important.

Age Definitions

  • In Paediatrics INFANTS are defined as less than 1 year.
  • In Paediatrics CHILD is 1 year to puberty.

Breathing

  • Expect higher respiratory rates
  • Under 1 year the infant must be up to 40 breaths/minute

Circulation

  • Normal Pulse rates for 3 months - 2 years is 100-180 bpm.
  • Normal Pulse rates or 2-10 years olds is 60-140 bpm.

Disability

  • They may be a 'Floppy' child.
  • Ask the parent's opinion.

Exposure

  • Minimise heat loss.
  • Check for rashes.
  • Take the axillary temperature.

Infant First Aid

  • Call CPR 999 if child not breathing normally.
  • Give 5 initial ventilations before chest compressions.
  • If alone, CPR for 1 minute before 999, but never be!

Chest Compression

  • Compress chest to one third of depth.
  • Use 2 fingers on infants.
  • Use one or two hands on a child.

Use of AED

  • Using an AED in paediatrics is rare.
  • Usually airway/ventilation problems resolve issues.
  • Most supply paediatric pads.
  • 50-75 J (2-4 J/Kg) may be delivered.
  • Adult pads can be used if attenuated for children under 8 years old.

Inhaled Foreign Body

  • Avoid blind 'finger sweeps'

Choking In Infant

  • Adult guidelines suitable for children over 1 year of age.
  • Chest thrusts instead of abdominal thrusts for infants.

Infant with airway obstruction with foreign body

  • Place infant across lap with head lower than chest.

Infant with FBAO

  • Place infant across lap with head lower than chest.
  • Give 5 sharp inter-scapular blows.
  • If this fails, try 5 chest thrusts with the patient supine, but with their head lower than their chest, one every 3 seconds.
  • You must repeat the above process.
  • Call 999/Emergency Services early.
  • If unconscious, start CPR.

Adrenaline Dosing

  • The dose for Over 12s is 500 micrograms.
  • The dose for a 6-12 year old is 300 micrograms.
  • The dose for 6 month - 6 year olds is 150 micrograms.
  • The dose for Under 6 month olds is 100 micrograms.

Epilepsy Dosing

  • Via Buccal administration.
  • The dose for 1-2 month old babies = 300 μg/kg.
  • The dose for a 3 -11 month old baby is 2.5mg.
  • The dose for a 1 - 4 year old child 5mg.
  • The dose for a 5 - 9 year old child is 7.5mg.
  • The for Over 10 year olds dose is 10mg.
  • Source: NICE 2024

Relatives

  • The Presence of Relatives is Beneficial.
  • However They Need to be 'looked after'.

Summary of Paediatric Medical Emergencies:

  • Follow the Same resuscitation principles.
  • Paediatric medical emergencies are Even more rare than adult medical emergencies!
  • Have modified drug doses to hand.

A(D)HD

  • Affects behaviour but some cases are more noticeable than others.
  • Cause is not really known and May have a familial element.
  • Patients with A(D)HD have a 'Micro-focusing' capability.
  • Patients May be restless and have trouble concentrating.

ADHD

  • Many ADHD cases are diagnosed under 12 years of age.
  • There has been an Increasing number of diagnoses made in adults.
  • A(D)HD symptoms can Sometimes improve with age.
  • A(D)DH Can be associated with other disorders, such as anxiety and depresion.

Potential Signs – Children with ADHD:

  • Difficulty Getting your child to sleep at night.
  • Difficulty Getting ready for school on time without assistance.
  • Difficulty Listening to and carrying out instructions.
  • Being (dis)organised.
  • Finding Social occasions difficult.
  • Finding Shopping difficult.

Potential Signs - Adult ADHD:

  • Difficulty with Organisation and time management.
  • Difficulty Following instructions.
  • Difficulty Focusing and completing tasks.
  • Difficulty Coping with stress.
  • Feeling restless or impatient.
  • Feeling Impulsiveness and risk taking. Some adults may also have issues with relationships or social interaction.

Management - Children with ADHD:

  • Provide Educational support.
  • Provide Support for parents (families).
  • Take Medication.

Management - Adults with ADHD:

  • Offer Medication.
  • Counselling.
  • CBT is Useful.
  • DBT is Useful.

Medication for ADHD:

  • First line is a stimulant based drug eg methylphenidate (trade name ‘Ritalin') and amphetamine.
  • These Medications Work faster than non-stimulant medications.
  • Non - stimulant Medications includes Atomoxetine (norepinephrine modulator).
  • Other non - stimulant Medications include alpha agonists.

Older Patients

  • Life expectancy is increasing.
  • There are Proportionately more older people.

Ageing

  • Ageing is the gradual development of changes in structure and function that are not due to preventable disease or trauma, and is associated with decreased functional capacity and an increased probability of death.
  • The incidence of many diseases increases with age.

Dementia - Different Types

  • Ensure that treatable factors have been dealt
  • There is A syndrome of global cognitive impairment without impaired consciousness
  • Affects memory and cognition
  • There will have often been signs several months (or years) before

Dementia

_ Dementia is Sometimes associated with personality change

  • Presenting it can be expressed by Slow, repetitive speech
  • Onset is Unusual under 55 years

Dementia - Assessment

  • Using Mini-Mental State Examination
  • There are Several questions with a maximum score of 30
  • Score of <25 suggests dementia

Dementia Cont'd

  • You may see Alzheimer’s Dementia.
  • Onset may be from 40 years of age.
  • Risk factors are gene defects.
  • There is Deposition of amyloid in cortex.
  • You may see Specific treatments - tend to slow progression rather than cure.

Dementia - Alzheimer’s

  • Can cause Failing memory
  • Spatial disorientation
  • Changed behaviour
  • Hallucinations, delusions of persecution
  • Eventually lose interest

Dementia -Vascular Dementia

  • (around 25% of cases)
  • Multiple small strokes
  • Showing a Sometime sudden onset

Dementia - Lewy Body Dementia- common form

  • Is from Lewy Bodies in neo-cortex and brainstem

  • Results in Cognitive impairment, hallucinations, Parkinsonism

Dementia - Fronto-temporal Dementia

  • From Atrophy of frontal and temporal Lobes without the pathological findings seen inAlzheimer’s Disease
  • This leads to Personality changes, disinhibition
  • And Does not affect spatial orientation

Dementia - Other Causes

  • Alcohol abuse
  • Huntingdon’s
  • Parkinson’s Disease

Frailty

  • Frailty is Related to ageing

  • And From A minor insult can lead to the risk of severe a deterioration in health

  • Because Of a Loss of in-built reserves

  • Meaning it Affects multiple systems

Diseases caused by Decreased Functional Capacity

  • Muscle strength
  • Cardio-respiratory reserve reduced
  • Cognitive capacity decreased
  • Bladder capacity/sphincter strength impaired

Diseases caused by Reduced Homeostatic Reserve

  • This means postural stability reduced

  • And Thermo-regulation – increased risk of hypothermia

  • Plus Cognitive reserve reduced – delirium

  • All leading to Metabolic homeostasis – hypercapnia, hyponatraemia, hyperglycaemia

Reduced Homeostatic Reserve

  • This also means Blood pressure control – risk of postural hypotension

  • Increased risk of infection

  • Along side Renal reserve – AKI/CKI

Characteristics of Disease in Older

People

  • These might have a Non-specific (and be occult) presentation

  • They Show Multiple pathology and interactions

  • They Can affect function and independence

  • And They Impaired homeostasis, resistance and

  • This Means there is a poor recovery

Giants of Geriatrics.’ Needed: Multidisciplinary Approach

  • Instability
  • Immobility
  • Incontinence
  • Intellectual impairment
  • Isolation
  • Iatrogenesis These are happening because of Multiple causes, that Coexist and interact, making them Embarrassing that Leads to limiting, isolating

Impact on Dental services

  • You may get Increased bleeding risk, due to tissue fragility

  • The patient may Have Possible difficulty lying flat

  • The patient may Find it hard Tolerating long procedures

  • As well as Difficulty complying with medication, and other instructions

  • They may have an Increased risk with sedatives and anaesthetics

National Service Framework 2001

  • There is a Respect for the individual: by rooting out discrimination and person-centred care

  • Focus is to Make provision for Intermediate care between primary and hospital care services

  • This means there is a Provision of evidence-based specialist care

  • In order to allow for Promotion of an active and healthy lifestyle for older people

Problems

  • Neglect
  • Physical abuse
  • Emotional
  • and Financial
  • As well as Sexual

Safeguarding needed

  • Safeguarding is Everybody’s business

  • But there is Less often publicised compared to child abuse

  • This means you need toReport concerns to Social Services or to the patients GP

Problems with Medication

  • There may be Issues complying with the prescribed Medication

  • Plus There may be Different pharmacokinetics, leading to drug action/interactions

  • Including Adverse effects

Impact on Pharmacokinetics and Drug action

  • As Patients often more sensitive, we should Consider lower doses

  • This may causes Gi tract- Causing Reduced absorption

  • Or the Kidneys, and liver to function with Reduced excretion

  • Not to forgot that the Altered protein binding leads to changes to albumin e.g. LA, and the drug Warfarin

How you can identify and improve compliance.

  • Possible Causes of Poor Compliance are: poor explanation, Side effects, Running out of prescriptions.
  • Additionally There may be No noticeable benefit, the Patient Scared by package leaflet, or if There is Impaired mental physical function
  • By Using Careful explanation you can Improve solutions, using things like Writing things down, taking note of Beware of impaired vision. As well Use of dosing boxes and Speak to relative/carer/GP and Keep an eye on the patient.
  • and if all fails you can offer Aids

Considerations for Drug Prescriptions and

Interactions

  • So Do not prescribe unless sure of current medications but also the possible effect with known disorders
  • Therefore check for the effect of Between Drug combinations

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