Elderly care Flashcards by Alex palmer

Deficiency In B12 Results in what type of anaemia

Macrocyctic

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Comment on this chest x-ray

Anterior posterior chest x-ray = hard to comment on any cardiomegaly
Multiple pleural plaques (calcified)
Sternotomy suture can be noted

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Especially if they involve the diaphragmatic pleura

Multiple Bilateral Calcified pleural Plaques Indicate What exposure.

Asbestos exposure

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Incidental findings of non-symptomatic pleural plaques require treatment?

Not really, no Follow-up needed unless the patient becomes symptomatic

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Not COPD

The spectrum of asbestos-related thoracic disease include:

Benign pleural effusion
Pleural plaques
Diffuse pleural thickening
Atelectasis
Asbestosis
Mesothelioma
Lung cancer

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In women presenting with frailty fractures what is the age cut-off between further testing needed versus presumed osteoporosis

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In a woman presenting with a Frailty fractureb Under the age of 75 What further investigations are indicated?

DEXA scan + calcium and vitamin D bloods

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What is the T score needed to diagnose osteoporosis

-2.5

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A patient post DEXA scanAs indicated to have mineral density suggestive of severe osteoporosis what additional investigations should be done

/Could be done

Calcium + vitamin D
Parathyroid hormone + thyroid
Bone turnover markers

A myeloma screen (urine and plasma electrophoresis), immunoglobulins and liver function tests would be additional tests to consider

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What are some important considerations when starting on alendronic acid

Only taken once a week
Contraindicated in peptic ulceration/significant swallowing difficulties

Taken 30 minutes before breakfast with a full glass of water and remaining upright/standing 30 minutes

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For patients who are unable to swallow alendronic acid what is NICEs recommended alternative

Denosumab

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What is the single best means of Distinguishing between delirium And pre-existing dimension

Collateral history from relatives

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The PINCH ME pneumonic is useful for identifying causes of delirium.What are these causes?

Everyone loves a pneumonic (This one is a bad one)

Pain
INfection
Constipation
DeHydration
Medication
Environment

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Is low lighting helpful in delirium

Not exactly, while it may seem soothing it can cause shadows which can be miss perceived

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What would be first-line Drug treatment in managing a patient with delirium

Low dose lorazepam (0.55 mg orally)

Drug treatment should Always be a last resort

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What would be first-line Drug treatment in managing a patient with delirium

Low dose lorazepam (0.55 mg orally)

Drug treatment should Always be a last resort

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Salbutamol can cause what electrolyte imbalance

Hypokalaemia

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Hyperparathyroidism does what you Serum calcium

Hypercalcaemia

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Aminobisphosphonate =

Alendronic acid

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What is the therapeutic concentration of Digoxin

1 to 2 Micrograms/mL

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What are some common symptoms of digoxin toxicity

Nausea and vomiting
Diarrhoea
Hallucinations
Visual disturbance
Drowsiness

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What is important to consider when prescribing erythromycinIn a patient on Digitoxin

Erythromycin is a very potent hepatic enzyme inhibitor and will inhibit the metabolism of many drugs, This can result digoxin toxicity

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Mechanism of action of warfarin?

It acts by antagonising the effects of Vitamin K

Prevention of DVT/PE and surgical patients is done how pharmacologically

Usually low molecular weight heparin e.g. Enoxaparin tinzaparin
At prophylactic dose

What Coagulation pathway does Warfarin effect

Extrinsic

What is the recommended INR range for prevention of strokeIn patients with AF patients who have already suffered a stroke?

2-3

Patients who have had prosthetic heart valve replacements are at higher risk of VTE; therefore, the recommended INR range in this population is usually?

3-4

As warfarin contraindicated In a patient who has a history of falls

Not exactly, nice recommends to use The HAS-BLED tool to identify those at high risk of bleeding

How does Cranberry juice affect warfarin

It has been found to enhance the effects therefore increasing INR

Delirium is the syndrome characterised by

an acute confusion state associated with marked fluctuations in orientation and conscious level, including periods of lucidity.

A Total Anterior Circulation Stroke syndrome requires all three of the following to be present:

1. Unilateral weakness (and/or sensory deficit) of face arm and leg 2. Homonymous hemianopia 3. Highest Cerebral dysfunction (Dysphasia, visuospatial disorder)

The most common site of occlusion for an TACI is the

Middle cerebral artery

Anterior Circulation Infarcts are much less common than either MCA or Posterior occlusions(True or false)

True

Advice for acute management of ischaemic strokes With acute hypertension is generally to avoid treating hypertension, what are the exceptions to this?

When there is: * Hypertensive encephalopathy * Hypertensive neuropathy * Hypertensive cardiac failure * Aortic dissection * Preeclampsia/Eclampsia

Polypharmacy is an important risk factor for falls and should be considered in all patients prescribed more than How may medications?

How can citalopram cause hyponatraemia

Citalopram is an SSRI, these can cause syndrome of inappropriate secretion of antidiuretic Hormone and Subsequently cause hyponatraemia

In a adult over the age of 55 the most appropriate first-line antihypertensive would be a calcium channel blocker (or thiazide diuretic) however is this still the case in a type II diabetic?

A ACE inhibitor would be preferred here

In a adult over the age of 55 the most appropriate first-line antihypertensive would be a calcium channel blocker (or thiazide diuretic) however is this still the case in a type II diabetic?

A ACE inhibitor would be preferred here

Recurrent laryngeal nerve palsy Can present with

A horse/weak voice

Superior vena cava obstruction Can present with

* Swollen plethoric face and neck * Distended neck veins + chest Veins * Elevated JVP (absent Pulsation) * Headaches

Horner's syndrome can present with

* Miosis (pupil constriction) * enophthalmos (Sunken eyes) * Ptosis * Ipsilateral anhydrousis

Primary lung tumours can metastasise to:

* Bone * Brain * Liver * Adrenals

Eton lambert syndrome typically occurs in association with

Small-cell lung cancer

Eton lambert syndrome affects

Muscle fatigability of the proximal limbs and trunk. Autonomic involvement is common = dry mouth, hyperreflexia. Repeated muscle contractions lead to increased strength and reflexes (unlike myasthenic syndrome It is associated with small-cell lung cancer | (Rarely eyes) ## Footnote It is the pre synaptic membrane that is affected (unlike myasthenia)

Describe a classic presentation of HHS | hyperosmolar hyperglycaemic state

* Elderly patientWith type II diabetes (possibly undiagnosed) * Unwell for about a week * Marked dehydration * glucose of >35mM | Acidosis is absent as there has been no switch to ketone metabolism.

What is the most important element of treating HHS | hyperosmolar hyperglycaemic state

Rehydration (probably intravenous) | Once hydration has begun may require only small doses of insulin ## Footnote atients may have lost 8-10 litre of fluid

A postitive postural BP test is said to occur when there is:

* A drop in systolic BP of 20mmHg or more (with or without symptoms). * A drop to below 90mmHg on standing even if the drop is less than 20mmHg(With or without symptoms) * A drop in diastolic BP of 10mmHg with symptoms

What other two agents (first-line and last line) used to treat postural hypertension

1. Fludrocortisone 2. Midodrine

Some investigations are always performed routinely in patients with confusion.In BSUH it is called Geriatric Admission Profile (GAPS) and includes:

* U&E, * FBC * LFT * glucose * CRP * calcium * B12 & folate * ferritin, iron and transferrin * TFT * vitamin D

Subdural haematomas appear How on CT?

concave medially, this means that they appear as a crescent shaped pool of blood between the skull and the brain tissue

What does this show

Right-sided mixed density subdural haematoma

Subdural bleeding and rebleeding is usually due to damage which structures

tearing of fragile, bridging subdural veins (not arteries).

‘Osborn’ or ‘J’ waves can occur in ?

Hypothermia

Why is it important to re-warm elderly patient slowly who have hypothermia?

rapid rewarming may cause vasodilatation → shock → death. | rate of re-warming is between 0.5-2 degrees per hour

alopecia areata, myxoedema and erythema ab igne are all associated with?

hypothyroidism

Vitiligo appears as?

hypopigmented patches, sometimes with hyperpigmented borders. It is associated with autoimmune disorders.