Care Of Older Adults -1 Flashcards
TIA in someone on Anticoagulants
Call for ambulance immediately.
Admission to stroke unit.
Needs Hemorrhagic stroke to be ruled out
First line treatment for Fungal skin infections (extensive rash on body)
Terbinafine (250mg OD for 4weeks)
Itraconazole if terbenafine not tolerated
Itraconazole contraindicated in Heart failure
History (gradual onset of back/thoracic pain, associated fatigue) and investigations (X-ray-vertebral fracture with lytic lesions, Microcytic anaemia, Leukopenia, Raised ESR)
Suspected Myeloma
Offer urgent protein electrophoresis and Bence Jones urine test (with in 48hours)
If Protein electrophoresis or urine suggest Myeloma-2WWR
Persistent productive cough with mucopurulent sputum and dyspnea
Bronchiectasis
May also have finger clubbing, coarse crackles
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)
Drug eruptions- May occur up to a week after cessation.
Hx of URTI. Followed by drop like pink pa papules with some scales
Guttate psoriasis
Rash after exposure to sun and in spring/summer or after a period of holiday.
Legs tend to be affected
Polymorphic light eruptions
Old lady, unable to walk due to hip pain. Getting worse. Constant pain worse on movement. Worsening tiredness, weight loss. PMH Breast cancer
Pathological fracture likely breast metastasis
Threshold for diagnosis of osteoporosis or bisphosphonates treatment
T score >/=2.5
Patient not tolerating oral bisphosphonates (Alendronate)
Treat with alternative oral bisphosphonates (Risedronate) 5mg OD or 35mg weekly
If Risedronate not tolerated- Referral to secondary care for specialist treatment
Licensed treatment for osteoporosis in men
Alendronate 10mg OD
Or Risedronate 35mg weekly
Ongoing prophylactic dose of iron
200mg Ferrous sulphate OD
Bilateral/ Symmetrical hip and shoulder pain with morning stiffness and systemic upset (general feeling of being unwell)
Poly myalgia rheumatica (PMR)
Hx of smoking. Difficulty in walking. Deep aching pain in calf.
O/E: Neuro muscular Normal
Chronic limb ischemia
Claudication upon a predictable distance, relief on rest
DDs for constant calf pain
Gastrocnemius tear Ruptured Baker’s cyst DVT Osteoarthritis Morton’s neuroma
Old man with Hx of claudication now presented with short Hx of constant pain in left lower leg.
Acute limb ischemia secondary to thrombosis
Elderly man, unable to walk.
O/E: Foot pale with marbled appearance and icy cold. Unable to wiggle toes
Acute limb ischemia secondary to embolus
(Sudden loss of blood supply)
May be background of atrial fibrillation
Laxatives not indicated for opioid induced constipation
Bulk forming like Ispagula husk, Bran powder or methyl cellulose
(They distend the colon and stimulates peristalsis)
Laxatives for opioid induced constipation
Stimulants- Bisacodyl (10mg OD) /Senna (7.5mg OD)
Osmotic- Lactulose (15ml BD)
Medicines that can cause delirium
Opioids Benzodiazepines (use and withdrawal) Dihydropyridine( such as amlodepine) Antihistamines AntiParkinsonian TCAs Antispasmodics NSAIDs Corticosteroids Antipsychotics Anti hypertensives Anti arrhythmic Lithium Anticonvulsants
Frailty assessment in someone having fear of fall
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
Timed up and go test
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
Apixaban dose reduction is required
If two of following:
Age >80
Weight <60kg
Creatinine clearance 133 or more
Target Ventricular rate control in AF
Between 60-80bpm
