Geriatrics Flashcards
What are the key criteria for delirium?
1) acute onset with waxing and waning, 2) inattention; AND one of 3) disorganized thinking vs 4) altered level of consciousness
In what kind of dementia can there be dementia followed by parkinsonism symptoms?
Lewy Body Dementia
What is the most common kind of dementia after AD?
Likely vascular dementia, or mix of vascular-AD
Lab work up for reversible causes of dementia?
cbc, b12, tsh; optional: expanded opioid panel, serum tox, rpr
What is the thinking on imaging in dementia diagnosis?
CT or MRI are reasonable, but diagnosis primarily clinical
What are the three anti-Ach treatments?
donezpil (aricept), rivastigmine, galantamine
What are the main side effects of these anti-Ach treatments?
GI side effects
What is the criteria for Major Neurocognitive Disorder?
Reduction from baseline in one of the following domains: Learning and memory; Language; Executive function; Complex attention; Perceptual-motor function; Social cognition.
Interferes with activities of daily living
Doesn’t have a different diagnosis
What are two anti-psychotics with less EPS?
clozapine and quetapine
What are criteria for PD diagnosis?
bradykinesia plus RESTING tremor or rigidity; supportive criteria includes response to dopamine receptor agonist treatment
What does sinemet (carbidopa-levodopa) do?
Does not prevent progression, but can improve movement - and thereby help with ADLs
What are clinical signs of polymyalgia rheumatica? What three areas does it typically involve?
1) Bilateral aching/morning stiffness > 30 minutes, for atleast 1 month
2) and involving at least 2 of the following 3 areas - neck or torso; shoulders or proximal regions of the arms, hips or proximal aspects of thighs
What is an associated condition with PMR?
temporal arteritis
What should you check in patients with report of restless leg syndrome?
ferritin! Can treat Fe deficiency and see improvement. No sleep study is needed. it’s a clinical dx.
What are some risk factors for osteoporosis?
age, W > M, glucocorticoid steroids, post-menopausal women, prior fragility fractures, family hx of fragitlity fractures, smoking, RA or type 1 diabetes, celiac disease/Crohn’s disease, PPIs/SSRIs
What are our treatments for osteoporosis?
bisphosphonates, denosumab, raloxifene
What is a serious adverse outcome and what are side effects of bisphophonates?
jaw necrosis; GI upset in about 7% (esophagitis < 1%)
What is the deal with calcium supplementation?
Mild benefits if at all; risks of renal calculi and cardiac problems —– some benefit in nursing home frail population.
What would you encourage for Ca in diet on a daily basis?
Encourage atleast 1 serving of dairy or equivalent serving per day – half cup of yogurt, cup of milk per day.
Who gets screened and when for osteoporosis?
Women> 65. Not men (according to USPTSF)
Women > 50 with 2+ risk factors: fragility fracture (fracture without trauma, standing height at walking speed), glucocorticoids, history of parental hip fracture, smoking, heavy alcohol use, very low body weight, DM1, rheumatoid arthritis
What is a FRAX score?
fracture risk assessment tool
What is a measurement that is highly predictive of future vertebral fracture risk?
If there’s a >6cm height loss (between what you measure and what the patient says) or if >2cm prospective loss, it is highly predictive of someone who has had a vertebral compression fracture
How do bisphosphonates work?
they inhibit osteoclasts – controlled apoptosis of these cells
How do you counsel patients to take bisphosphonates?
Give on empty stomach with full glass of water - don’t eat for 30 minutes
What is a harmful fracture risk from bisphosphonates and other osteoporosis treatments?
atypical femoral neck fractures (not limited to bisphosphonates). - refer to orthopedics
What is the duration of treatment (depending on risk) of bisphosonates?
IF high risk, keep them on it; If patient is at moderate risk, has been on the bisphosphonate for at least 5 years, or IV bisphosphonate for at least 3 years, hasn’t had any new fractures and bone density is stable but still not > -2.5, consider holding the bisphosphonate; if low risk, can stop it after 3 years and repeat Dexa after 3 years.
What are some secondary causes of osteoporosis?
endocrine disorders, malabsoprtion/GI issues, nutritional disorders
What labs might you check for 2ndary causes of osteoporosis?
serum 25-hydroxyvitamin D, calcium, creatinine, and thyroid-stimulating hormone levels
How does memantine work? and who is it used in?
NMDA antagonist; used in moderate-to-severe dementia
Is memantine mono therapy or can it be used in combination with donezepil?
Can be mono therapy, but also used in combo with donezpeil, can stabilize decline for about 1 year
Which tachyarrythemia is most associated with syncope
AVNRT
When to consider implantable loop recorder for syncope?
if syncope is recurrent, rare, and work up including event monitor has not been diagnostic; simple brief surgical procedure; long term monitoring, patient non-compliance eliminated; gold standard in recurrent unexplained syncope
Neuroimaging in syncope
Not very valuable! EM study of over 1000 patients saw no clinically significant findings with neuro imaging
UNLESS focal neuro symptoms
Key ddx for syncope
1) Cardiogenic - structural (valvular) OR obstructive (PE/effusion)
2) Hypovolemic/orthostatic
3) Vasovagal
4) Reduced sympathetic tone - meds?
Main syncope work-up
EKG, telemetry, orthostatics, d-dimer/troponin PRN, TTE prn
What is a first line tx for refractory orthostatic hypotension
fludrocortisone or midodrine (need TID tx for midodrine)
lower compression stockings / abd binders
