GERIATRICS

Question 1

Rheumatic disorder that occurs in elderly pts, often female, characterized by stiffness and aching of proximal mms and joints of the neck, shoulders, torso, and hips. This dx normally lacks joint erosions and doesn’t involve interphalangeal joints. More prominent in the morning. Pts shows signs of systemic inflammation.

Answer 1

Polymyalgia rheumatica (PMR)

note that these pts are at increased risk of GCA
These pts are treated w/prednisone, not methotrexate

Question 2

77 yo female w/ abdominal discomfort, nausea, decreased appetite. Last bowel movement was 5 days ago and was characterized by loose stool. Hx of hysterectomy and has hx of urinary incontinence and is on oxybutinin. Abdomen is diffusely tender and rectal examination shows firm stool in the rectal vault. What is the most likely diagnosis?

Answer 2

Fecal impaction w/overflow diarrhea. You can see this in pts w/ decreased mobility, opiate use, or anticholinergis like oxybutinin which suppress bowel peristalsis

Note that adhesions would not be a bad idea to consider in this patient, no abdominal distention and presence of firm stool in rectal vault is more consistent w/fecal impaction

Question 3

Oxybutinin is what kind of drug?

Answer 3

antimuscarinic, it acts as a competitive antagonist of acetylcholine at post ganglionic muscarinic receptors resulting in relaxation of bladder smooth muscle deminishing the frequency of unihibited contractions of the detrusor mm, decreasing urinary URGENCY and frequency