Geriatrics Flashcards
Venous vs arterial vs neuropathic ulcers
Venous
-Shallow, painless
-Associated skin changes Eg haemosidderin desposits / eczema
Arterial
-‘Punched out’, usually deep and painful occurring at pressure points
- May have signs of chronic limb ischemia
Neuropathic
- Painless with surrounding paraesthesia
- Normal pulses present
-Usually have an underlying cause Eg diabetes
Poor prognostic factors in ulcers are
lasting >1yr
previous requirement for surgical Rx of ulcers
ABPI <0.8
Poor compliance with treatment / lifestyle advice
Generalised erythema, systemic symptoms and atypical t-cell invasion on skin biopsy
Cutaneous T-cell lymphoma
TTP Rx
Plasma exchange [+ ffp]
Rx of actinic keratosis - if they want gone
Topical 5-fluorouriacil cream
Which Abx is strongest P450 inhibitor
Erythromycin
Then Calri / azithro
Parkinson’s’ Sx is well controlled but having issues with dyskinesia from medication side effects. What can you prescribe?
Amantadine (NMDA receptor inhibitor)
What class of drug is entacapone? What is it good for?
COMT inhibitor.
Good for patients getting ‘off’ symptoms as inhibits the breakdown of dopamine and so prolongs its action
Allopurinol class? What does this do
Xanthine oxidase inhibitor
->Recudes urate production
Anaemia. confusion. Hepatosplenomegaly. Increased viscosity. Raised IgM =?Rx?
Walldenstrom macroglobulinaemia
[low grade lymphoma]
Plasmapheresis - to reduce plasma viscosity
[Will then likely need chemo]
Most important thing to work out if someone with AS needs replacement
Symptoms
Pontine bleed comes from which artery
Basilar
Parkinsonism, variable levels of arousal, forgetful, hallucinations, with some autonomic Sx? Rx?
Lew body disease
Cholinesterase inhibitors Eg Rivastigmine
Bipolar started on lithium but no response what next?
Add in valproate
MRSA but vanc allergic options
Teicoplanin or linezolid
Amiodarone mechanism
K channel blocker
lidocaine mechanism
Na channel blocker
Sensory supply to anterior groin
L1/2
An ulcerated nodular lesion with surrounding keratosis and paraesthesia on face
SCC
Bullous impetigo + pyrexia Rx
IV co-amox
[rather than fluclox]
Speckled appearance of LV on echo likely =
Amyloid
Left hemiparesis, right horners, left nystagmus, tongue deviates right. Where is lesion
R brainstem
Why does trimethoprim lead to raised Cr
COMPETITIVE inhibition of creatinine secretion
1st line Rx HTN in > 80
MR Nifedipine
Flat pigmented 2cm lesion on the face with an irregular border
Lentigo Melanoma
Older male presenting with symptoms of bony mets probably has
Prostate Ca
When would you prescribe Cef met AND amox for suspected meningitis
> 60 or immunocompromised to cover for listeria
Why ongoing UTI in someone whos catheter isn’t changed but is given Abx
Biofilm formation
Torsades in COPD on lots of diuretics what 2 classes Abx might he have been prescribed
Macrolide Eg clari
Quinolone Eg Cirpo
Rx of hallucinations / agitation in parkinsons.
Low dose atypical antipsychotics Eg Quetiapine
Aspergillus down a microscope
Septate hyphae
[If sinus infection and Septate hyphae it is aspergillus. They will likely be immunocompromised to some degree]
Nasal stuffiness, facial pain and oedema with necrotic black nasal turbinates. Hypae [not septate] on microscopy
Mucor ssp.
Hallucinations in Dementia with lewy bodies
Detailed and well-formed
Why do old people get a lower dose of digoxin
Reduced renal clearnace
What is the mechanism for developing a tolerance to nitrates
Generation of reactive oxygen species
[Chronic nitrate therapy -> vascular oxidative stress -> enhanced degradation of NO]
Choreform movements = lesion where?
Caudate nucleus
Issues with arm swing and upper limb motor control = lesion where
Red nucleus
saccade eye movement, sleep wake issues = lesion where
Thalamus
Symtomatic CLL in old person. Option for single agent Rx?
What is the choice for actually trying to treat it?
Chlorambucil
[Can add in rituximab if needed]
FCR combination chemo
[fludarabine, cyclophosphamide, rituximab]
Digoxin why does it take a while to have an effect if you don’t load ?
High degree of protein binding
->Widely distributed around body tissues
Bone pain, mildly low Ca, Raised ALP / PTH =
Osteomalacia
Rx of stroke if >4.5hrs
Aspirin 300mg only
Do you get neutropenia in CML
NO - you get a leukocytosis. But they are dysfunctional
Which haem onc has the high assoc with autoimmune haemolytic anaemia
CLL
NH resident found to be asymptomatic but MRSA positive on skin swab. Rx?
Needs topical decolonisation
-Usually mupirocin + chlorhexidine
Pins and needles in hands and feet
-> Weak legs, Reduced sensation and proprioception, reduced reflexes =
B12 deficiency -> subacute degeneration of the spinal cord
Left CN3 palsy + right hemiparesis where is lesion
Left paramedian arteries (supplying midbrain)
Which CN pass through the jugular foramen? Symptoms of compression here?
IX, X, XI
Weak neck, hoarse voice, absent gaga reflex
DVT -> treated with heparin then develops an ischemic foot. What has happened?
Arterial thrombus secondary to HIT
Multiple strokes with carotid stenosis when would you perform endarterectomy? What would be the Rx otherwise?
> 50% stenosis with thought strokes were coming from there
Clopidogrel for long term
AF with pauses what type of pacemaker
DDDR
Artery if amaurosis fugax
Internal carotid
Digoxin mechanism
Inhibiton of sodium-potassium ATPase
On aspirin with slighly prolonged PT and platelets of 140. Cause of extensive bruising?
Aspirin related
[Platelets slightly low and slightly high PT - not enough for big bruising]
What is most raised in a pathological fracture in prostate mets?
Key drug for Rx ?
ALP
[Ca often normal]
Denosumab
[Old denos with his dodgy prostate]
Old person on antihypertensives. Which one causing hypoNa and HypoK
Indapamide
Which arteries supply occiptal lobe? What is affected if bilateral cortical blindness ?
Posterior cerebral arteries
Basilar - if bilat
What would make you think fronto temporal dementia on exam
Failure to draw interlocking shapes
Barthol index post-stroke when are you 60% more likely to die
<50 = low ability to perform ADLs
Which -stigmine in alzheimers
Rivastigmine
When no ach inhibitor in dementia?
MMSE <10
Early falls with parkinsonism 2 key DDs?
PSP
NPH
