Geriatrics Flashcards
Presentation of Dementia with Lewy Bodies
2 of 3 core features:
–> Fluctuating cognition, parkinsonism and visual hallucinations
Diagnosis of Postural hypertension
A fall of >=20mmHg in systolic BP or a fall of >=10mmHg in diastolic BP
Management of Postural Hypertension
Adequate hydration
Fall alarms, soft flooring
Rise from sitting slowly
Compression stockings
Pharma: Fludrocortisone, Midodrine
Management of Delirium
Treat underlying cause
Maintain environment w/ good lighting and frequent reassurance
In extremely agitated patients –> small doses of haloperidol or olanzapine
Causes of Delirium
D - drugs and alcohol
E - Eyes, ears and emotional
L - Low output state (MI, ARDS, PE, CHF, COPD)
I - Infection
R - Retention
I - Ictal
U - Under-hydration/Under-nutrition
M - Metabolic
S - Subdural, Sleep deprivation
Causes of iron deficiency anaemia
Increased loss: Menorrhagia, GI bleeding, hookworm
Reduced intake: Poor diet
Malabsorption: e.g. Coeliac disease and IBD
Features of iron deficiency anaemia
Lethargy, tiredness, weakness, jaundice, heavy periods, change in bowel habit
Iron deficiency treatment
Ferrous sulphate
How to convert oral morphine to subcutaneous morphine?
Oral morphine:Subcutaneous morphine
2:1
Half oral morphine to find subcutaneous
Treatment for erectile dysfunction
Sildenafil (viagra)
Mechanism of sildenafil (viagra)
Phosphodiesterase 5 (PDE5) inhibitor which enhances the effect of nitric oxide causing smooth muscle relaxation and subsequent penile erection due to inflow of blood
Side effects of sildenafil (viagra)
Flushing, headache, dyspepsia, nasal congestion, dizziness, diarrhoea, rashes, and UTIs
Contra-indications for sildenafil (viagra)
Patients taking organic nitrates due to risk of hypertension
What is Charles Bonnet syndrome?
Associated with visual loss, these patients often describe smaller versions of real life objects commonly people, animals, etc.
They realise these hallucinations are not real.
Features of pseudodementia
–> primarily associated w/ cognitive deficits in older patients with depression
Short duration of dementia
Equal effect on long and short term memory
Amnesia concerning specific events (often events that are emotionally charged)
Loss of social skills early in the illness
Patient’s will often answer ‘don’t know’ to closed questions rather than guessing the answer
Make little effort in performing tasks
4 As of Alzheimer’s
Amnesia
Aphasia (word-finding problems, speech muddles & disjointed)
Agnosia (recognition problems)
Apraxia (inability to carry out skilled tasks despite normal motor function)
Rome IV criteria constipation
Fewer than three bowel movements per week
Hard stool in >25% of bowel movements
Tenesmus (sense of incomplete evacuation) in >25% of bowel movements
Excessive straining in >25% of bowel movements
A need for digital evacuation of bowel movements
Primary constipation: no organic cause, thought to be due to dysregulation of the function of the colon or anorectal muscles
Secondary constipation: due to e.g diet, drugs, metabolic, endocrine or neurological disorder or obstruction
Alarm features of constipation
–> may indicate GI malignancy
Weight loss
Loss of appetite
Abdo mass
Dark stool
Subdural haemorrhage definition
Collection of venous blood accumulating in the potential space between the dura mater and arachnoid mater
Risk factors for subdural haemorrhage
Advancing age (>65)
Bleeding disorders or anticoag therapy
Chronic alcohol use
Recent trauma
Presentation of subdural haemorrhage
headache, N&V, confusion and diminished GCS
May be focal neurological signs indicative of haematoma site
Episodes of being alert and well
May present a few days after injury
CT scan appearance of subdural haemorrhage
Crescent-shaped
Presentation of vascular dementia
Progressive stepwise deterioration in cognition
Hx of cerebrovascular disease
