Elderly care Flashcards
How should someone on warfarin be treated with excessive bleeding?
INR > 8.0 (minor bleeding) - stop warfarin, give intravenous vitamin K 1-3mg, repeat dose of vitamin K if INR high after 24 hours, restart when INR < 5.0
What is the threshold for T2DM?
Diabetes mellitus - HbA1c of 48 mmol/mol (6.5%) or greater is now diagnostic (WHO 2011)
What are the features of MULTI SYSTEM ATROPHY?
There are 2 predominant types of multiple system atrophy
1) MSA-P - Predominant Parkinsonian features
2) MSA-C - Predominant Cerebellar features
Shy-Drager syndrome is a type of multiple system atrophy.
Features
parkinsonism
autonomic disturbance
erectile dysfunction: often an early feature
postural hypotension
atonic bladder
cerebellar signs
What are the features of acute intermittent porphyria?
Acute intermittent porphyria typically presents with abdominal, neurological and psychiatric symptoms
What are the features of multiple myeloma?
Multiple myeloma is a neoplasm of the bone marrow plasma cells. The peak incidence is patients aged 60-70 years.
Clinical features
bone disease
bone pain
osteoporosis + pathological fractures (typically vertebral)
osteolytic lesions
lethargy
infection
hypercalcaemia
primary factor: due primarily to increased osteoclastic bone resorption caused by local cytokines (e.g. IL-1, tumour necrosis factor) released by the myeloma cells
much less common contributing factors: impaired renal function, increased renal tubular calcium reabsorption and elevated PTH-rP levels
renal failure
other features: amyloidosis e.g. Macroglossia, carpal tunnel syndrome; neuropathy; hyperviscosity
What are the features of HUS?
Haemolytic uraemic syndrome is generally seen in young children and produces a triad of:
acute kidney injury
microangiopathic haemolytic anaemia
thrombocytopenia
Most cases are secondary (termed ‘typical HUS’):
classically Shiga toxin-producing Escherichia coli (STEC) 0157:H7 (‘verotoxigenic’, ‘enterohaemorrhagic’). This is the most common cause in children, accounting for over 90% of cases
pneumococcal infection
HIV
rare: systemic lupus erythematosus, drugs, cancer
What is an infection that can cause foul smelling diarrohea when people go abroad?
Giardiasis
What are the features of Giardiasis?
Giardiasis is caused by the flagellate protozoan Giardia lamblia. It is spread by the faeco-oral route.
Risk factors
foreign travel
swimming/drinking water from a river or lake
male-male sexual contact
Features
often asymptomatic
lethargy, bloating, abdominal pain
flatulence
non-bloody diarrhoea
steatorrhoea
chronic diarrhoea, malabsorption and lactose intolerance can occur
What is the qSOFA score?
qSOFA score
Respiratory rate > 22/min
Altered mentation
Systolic blood pressure < 100 mm Hg
What is a drug for myasthesia gravis?
Pyridostigmine
What are treatments for idiopathic intracranial hypertension?
Management
weight loss
diuretics e.g. acetazolamide
topiramate is also used, and has the added benefit of causing weight loss in most patients
repeated lumbar puncture
surgery: optic nerve sheath decompression and fenestration may be needed to prevent damage to the optic nerve. A lumboperitoneal or ventriculoperitoneal shunt may also be performed to reduce intracranial pressur
How is the PR interval defined?
Start of P-wave to the start of the QRS complex
A patient presents with NSTEMI, what medications should they have? This patient has gastric ulcers
Aspirin 300mg, Clopidogrel 300mg and Glyceryl Trinitrate spray.
Do not give foandparinox
What are the guidelines for HTN?
What are some features of cardiac pacing?
Pacing spikes preceding the QRS complexes. Broad QRS complexes with an RSR pattern in V5-6.
What are some features of wolf parkinson white?
Patients may present with:
No symptoms - WPW is often asymptomatic
Palpitations
Dizziness
Syncope
What medications can cause complete heart block?
Verapamil is a negative inotrope as it blocks calcium channels mainly in the SAN and AVN. Bisoprolol has a similar mechanism but the site of action is the adrenergic receptors and when used in conjunction can cause AV block
What are the features of aortic dissection?
Stanford classification of aortic dissections
Stanford Type A: Involves the ascending aorta, arch of the aorta
Stanford Type B: Involves the descending aorta.
Clinical features
Usually presents in men over the age of 50
Sudden onset ‘tearing’ chest pain or interscapular pain radiating to the back.
It can also present with (depending on how far the dissection extends):
Bowel/limb ischaemia
Renal failure
Syncope
Clinical signs on examination
Radio-radial delay
Radio-femoral delay
Blood pressure differential between arms
What won’t be seen in atrial fibrillilation in regards to the JVP?
The A-wave signifies atrial contraction. As a result of uncoordinated atrial activity, the A-wave will not be seen.
What is a sign of digoxin?
downsloping ST segments characteristic of digoxin. It indicates that a patient is taking the drug and not a sign of digoxin toxicity.
How should someone be treated with an ejection fraction of <35% on enalapril?
Sacubitril-valsartan is considered in heart failure patients with a LVEF < 35% who are still symptomatic on ACE-inhibitors & beta-blockers
What infection has a short incubation period for gastroenteritis?
Staphylococcus aureus gastroenteritis is characterised by a short incubation period and severe vomiting
How is COPD treated?
SABA required
LAMA or LABA regularly
OR
SAMA or SABA
LABA + ICS
How do you manage pneumothorax of less than 2cm and no problems breathing?
Management in primary pneumothorax without shortness of breath, and <2cm in size, is discharge and review
What is a problem with the following drugs:
Bisoprolol
Nicorandil
Isosorbide mononitrate
Bisoprolol - sexual dysfunction, libido
Nicorandil -Ulceration and perforation
Isosorbide mononitrate - tolerance
What are the signs of pericarditis?
PR innterval depressed
Widespread ST elevation - saddle
What time of STI causes painful ulcers?
Herpes is painful (her pain), painless is syphyllis
How should steroids be given for patients with Addisons?
Patients with Addison’s disease require steroid replacement therapy to manage their condition. This usually takes the form of standard-release hydrocortisone for glucocorticoid replacement and fludrocortisone for mineralocorticoid replacement. Standard-release hydrocortisone is usually given as two doses, with the larger dose being given in the morning as this more closely resembles the natural daily variation in cortisol secretion from the adrenal glands. A smaller dose is given in the evening. Some patients take hydrocortisone three times a day in which case a lunchtime dose may be added.
What are the different categories of AKI?
StageCreatinineUrine production
1Increase 1.5-1.9x baseline< 0.5ml/kg/h for >6 consecutive hours
2Increase 2.0-2.9x baseline< 0.5ml/kg/h for >12 consecutive hours
3Increase > 3x baseline or >354 µmol/L< 0.3ml/kg/h for > 24h or anuric for 12h
