Care Of Older Adults -1

Question 1

TIA in someone on Anticoagulants

Answer 1

Call for ambulance immediately.
Admission to stroke unit.
Needs Hemorrhagic stroke to be ruled out

Question 2

First line treatment for Fungal skin infections (extensive rash on body)

Answer 2

Terbinafine (250mg OD for 4weeks)

Itraconazole if terbenafine not tolerated
Itraconazole contraindicated in Heart failure

Question 3

History (gradual onset of back/thoracic pain, associated fatigue) and investigations (X-ray-vertebral fracture with lytic lesions, Microcytic anaemia, Leukopenia, Raised ESR)

Answer 3

Suspected Myeloma
Offer urgent protein electrophoresis and Bence Jones urine test (with in 48hours)

If Protein electrophoresis or urine suggest Myeloma-2WWR

Question 4

Persistent productive cough with mucopurulent sputum and dyspnea

Answer 4

Bronchiectasis

May also have finger clubbing, coarse crackles

Question 5

Short (3days) Hx of rash (chest,back &arms). Itchy. Blanching, maculopapular
No previous episodes. No change is household products. No travel Hx.
Recent use of antibiotics (Trimethoprim)

Answer 5

Drug eruptions- May occur up to a week after cessation.

Question 6

Hx of URTI. Followed by drop like pink pa papules with some scales

Answer 6

Guttate psoriasis

Question 7

Rash after exposure to sun and in spring/summer or after a period of holiday.
Legs tend to be affected

Answer 7

Polymorphic light eruptions

Question 8

Old lady, unable to walk due to hip pain. Getting worse. Constant pain worse on movement. Worsening tiredness, weight loss. PMH Breast cancer

Answer 8

Pathological fracture likely breast metastasis

Question 9

Threshold for diagnosis of osteoporosis or bisphosphonates treatment

Answer 9

T score >/=2.5

Question 10

Patient not tolerating oral bisphosphonates (Alendronate)

Answer 10

Treat with alternative oral bisphosphonates (Risedronate) 5mg OD or 35mg weekly

If Risedronate not tolerated- Referral to secondary care for specialist treatment

Question 11

Licensed treatment for osteoporosis in men

Answer 11

Alendronate 10mg OD

Or Risedronate 35mg weekly

Question 12

Ongoing prophylactic dose of iron

Answer 12

200mg Ferrous sulphate OD

Question 13

Bilateral/ Symmetrical hip and shoulder pain with morning stiffness and systemic upset (general feeling of being unwell)

Answer 13

Poly myalgia rheumatica (PMR)

Question 14

Hx of smoking. Difficulty in walking. Deep aching pain in calf.
O/E: Neuro muscular Normal

Answer 14

Chronic limb ischemia

Claudication upon a predictable distance, relief on rest

Question 15

DDs for constant calf pain

Answer 15

Gastrocnemius tear 
Ruptured Baker’s cyst 
DVT 
Osteoarthritis 
Morton’s neuroma

Question 16

Old man with Hx of claudication now presented with short Hx of constant pain in left lower leg.

Answer 16

Acute limb ischemia secondary to thrombosis

Question 17

Elderly man, unable to walk.

O/E: Foot pale with marbled appearance and icy cold. Unable to wiggle toes

Answer 17

Acute limb ischemia secondary to embolus
(Sudden loss of blood supply)
May be background of atrial fibrillation

Question 18

Laxatives not indicated for opioid induced constipation

Answer 18

Bulk forming like Ispagula husk, Bran powder or methyl cellulose
(They distend the colon and stimulates peristalsis)

Question 19

Laxatives for opioid induced constipation

Answer 19

Stimulants- Bisacodyl (10mg OD) /Senna (7.5mg OD)

Osmotic- Lactulose (15ml BD)

Question 20

Medicines that can cause delirium

Answer 20

Opioids 
Benzodiazepines (use and withdrawal) 
Dihydropyridine( such as amlodepine) 
Antihistamines 
AntiParkinsonian 
TCAs 
Antispasmodics
NSAIDs 
Corticosteroids 
Antipsychotics 
Anti hypertensives 
Anti arrhythmic 
Lithium 
Anticonvulsants

Question 21

Frailty assessment in someone having fear of fall

Answer 21

180• test (Ask her to stand up and step around until she is facing the opposite direction) - if patient takes more than 4 steps
Further assessment is required

Question 22

Timed up and go test

Answer 22

Ask patient to get up from chair without using arms and walk 3meters, turn and return to seated position in the chair.
A score of 12-15seconds or more indicates high risk of fall in older people

Question 23

Apixaban dose reduction is required

Answer 23

If two of following:
Age >80
Weight <60kg
Creatinine clearance 133 or more

Question 24

Target Ventricular rate control in AF

Answer 24

Between 60-80bpm

Question 25

Outcomes of 6-CIT

Answer 25

Normal
Probably significant-cut off 8
Significant -city off 10