Geriatric Micro Flashcards
Immune senescence
Immune response declines with age
Mostly depressed T cell and depressed T cell/macrophage interaction
What are the most marked defects of immunity in the elderly
- Poor antibody production
- Drying and Thinning of the skin and mucous membranes
- Poor production of IL-2 and T cell
Global undernutrition is present in 30-60% of pts over 65
ok…lymphocytes are directly proportional to nutrition level
Fever may be absent in almost half of all old ppl with infection
ok
Fever in elderly =
2 over baseline
oral over 99
rectal over 99.5
Elderly pts with bacteremia are less likely to have have chills or sweating, and fever is commonly absent
ok
What is a more common source of bacteremia in older ppl than in young andults
GI and GU
Pts over 65 account for over half of pneumonia cases
ok
Huge shift in bacteria population in hospital to gram negative rods
ok…. these end up being major causes of pneumonia for old ppl
Annual flu vaccine recommended for all adults over
50
Lower tract UTI in women treated how
3 days with flouroquinolones
amoxicillin for enterococcus
Upper tract UTI in women treated how
7-21 days of therapy
Older men with UTIs are treated longer than women, why?
Usually treated for up to 14 days because of risk of prostatitis. If prostatitis is suspected the therapy is generally given for over 6 weeks
Prevalence of positive TB skin test in nursing homes is 30-50% because of high rates of early exposure.
Thus most active cases of TB in older adults is due to reactivation
Induration over 15mm 48-72 hours after placement of a PPD indicates a positive TB test always
ok
Induration over 10 is positive in nursing home residents, immigrants from high TB countries, underserved populations, and persons with risk factors
And Induration over 5 is positive in HIV pts, those with close contact to TB, and those with chest x rays consistent with TB
most likely septic arthritis pathogen
s. aureus
treatment of septic arthritis
do arthrocentesis to figure out what org is….give antibiotics.
Treat as soon as possible
Ostemyelitis organism
staph aureus
Are surface swab cultures of pressure ulcers useful in diagnosing osteomyelitis
NO WAY….just tells you what is in the wound, not what is in the bone. Bone biopsies are required
What is the problem with AIDS HAART therapy in older adults
Causes cv issues because of what it does to cholesterol levels
HIV is the most treatable infectious cause of dementia so treat the shit
ok
Meningitis treatment
ADD amoxicillin to protect aginst listeria
Treatment of choice for neurosyphillis
penicillin….if they are alergic try to de-sensitize them
