Geriatrics Flashcards
What is the criteria for diagnosing postural hypotension?
A systolic drop of >20mmHg or diastolic drop >10 mmHg within 3 minutes of standing from a sitting position
What are the results on imaging of vascular dementia?
MRI- infarcts and white matter hyperintensities
What is the characteristics of Alzheimer’s Disease histologically?
Characterised by beta amyloid depositions and neurofibrillary tangles composed of TAU proteins
What class of medications is contraindicated when prescribing sildenafil for erectile dysfunction?
Nitrates
Can cause severe hypotension
What medication can be prescribed in postural hypotension although not regularly done?
Fludrocortisone or Midodrine (alpha 1 agonist)
List the 4 cardinal Sx of Parkinson’s disease?
Lead pipe rigidity
Bradykinesia
Pill rolling tremor (resting)
Postural instability
What factors should be assessed in frailty and what questionnaire can be utilised to help make a diagnosis?
Gait speed
self reported health
PRISMA-7 Questionnaire
What are the side effects of L dopa?
Postural hypotension
Nausea and vomiting
Side effect of MAO-B inhibitors?
Serotonin syndrome
What medications are used in the treatment of Parkinson’s disease?
L-dopa
Dopamine agonists (ropinorole, bromocriptine)
MAO-B inhibitors (seligline)
COMT inhibitors (talcapone)
What clinical score can be used to determine severity of frailty?
Rockwood
- Level of independence
- Physical activity
- Cognitive status
- Functional status
1–3: Not frail (fit, well, or managing well)
4: Vulnerable (pre-frail)
5–9: Various degrees of frailty, with 9 indicating terminal illness.
List the different types of laxative giving an example for each?
Stimulant - senna, basocodyl
Bulk forming - isphagula husk
Osmotic - macrogrol, lactulose
Stool softener - docusate sodium
List 4 causes of postural hypotension
Medications
Dehydration - hypovolemia
Autonomic dysfunction
Adrenal insufficiency
Sepsis
Alcohol
What is osteoporosis
A systemic skeletal disease characterised by low bone mass and microarchitectural deterioration therefore increase in bone fragility and susceptibility to fractures
List three endocrine disease that contribute to osteoporosis
Cushings
Hyperthyroidism
Hyperparathyroidism
Male hypogonadism
Rf for osteoporosis
‘SHATTERED FAMILY’
Steroid use
Hyperthyroidism/Hyperparathyroidism
Alcohol and smoking
Thin (BMI <22)
Testosterone deficiency
Early menopause
Renal/liver failure
Erosive/inflammatory bone disease
Diabetes
Family Hx
What abnormal finding can be found in cross section of bone in osteoporosis
Fewer trabecular in spongy bone
Thinning of cortical bone
Widening Haversian canals
Gs Ix for osteoporosis and results
Dexa scan- t score of -2.5 or less
What 2 areas are commonly affected in osteoporosis that the dexa scan focuses on
Lumbar spine
hip
Hip
What is a t score
Standard deviation that is compared to gender matched young adult mean
What criteria are listed in the FRAX assessment tool
Sex Weight Height Previous fracture Corticosteroid use Current smoking Parent fractured hip Alcohol
Other than dexa scan what other Ix can be done in osteoporosis
X-ray of wrist, spine, hip- of fracture suspected MRI spine Bone profile- calcium, phosphate, alp Vit d levels TFTs
Tx for osteoporosis
Rx- lifestyle advise (stop smoking, diet, regular exercise)
1st line Rx- bisphosphoneates + vit d and calcium
2nd line- Desonumab, HRT, Teriparatide
What advice should be given for bisphosphonates
Take whole (swallow) with plenty water while standing or sitting on empty stomach at least 30 minutes beofre breakfast and stay upright after taking ~30 mins
What are the adverse effects of bisphosphonates?
oesophagitis
oesophageal ulcers
osteonecrosis of the jaw
What t score is indicative of osteopaenia
t score of -1 to -2.5
What t score is indicative of osteoporosis
t score of less than -2.5
What factors is the Z score adjusted for?
Gender, ethnicity and age
What is OA
Is a non inflammatory degenerative joint pain characterised by the deterioration of articulate cartilage and new bone formation
List 5 symptoms of OA
Joint stiffness
Joint pain - associated w/ activity
Bone enlargements
Crepitus
Restricted range of motion
What joints are affected in OA
PIP
DIP
Carpometacarpal joint
What signs of OA
Heberdens nodes- DIP
Bouchard nodes- Pip
squaring of carpometacarpal Joint
Signs on X-ray in OA
Loss of joint space
Osteophytes
Subarticular sclerosis
Subchondral cysts
Tx for OA
Cx- lose weight, exercise, braces, physio/occupational therapy
Rx- oral paracetamol/topical NSAIDs, NSAIDS
Sx- osteotomy, arthroplasty, arthroscopy, fusion of joints
Rf for OA
Female
Increasing age
Trauma bone
Early menopause
FHx
Obesity
What sign is seen in patients with NOF?
Shortening and external rotion of the affected hip
List 3 rf for falls
Postural hypotension
Polypharmacy
Vsion problems
>65
Balance/gait problems
What physical tests may you perform in a person presenting with falls?
Turn 180 test or
timed up and go test
List 5 medications that can cause postural hypotension?
Nitrates
Diuretics
Anticholinergic medications
Antidepressants
Beta Blockers
L-Dopa
ACEI
List 3 drugs that could be associated with falls?
Benzodiazepines
Antipsychotics
Opiates
Codeine
Digoxin
What other condition is polymyalgia rheumatica associated with?
GCA
List 5 features of polymyalgia rheumatica?
Shoulder/hip girdle stiffness (usaully in morning)
Reduced appetite
WL
Malaise
Low grade fever
What is BPPV?
characterised by sudden episodic attacks of vertigo by changes in head position
What is the cause of BPPV?
Detachement of otholiths from the utricle in the inner ear
What is the diagnostic test for BPPV?
Dip-Hllpike manoeuvre
What is the mx of BPPV?
Epley Manouevre
What would be the murmur associated with AS
Ejection Systolic
What would be the murmur associated with AR
Early diastolic murmur
What would be the murmur associated with MS
Rumbling mid diastolic
What would be the murmur associated with MR
Pansystolic
What non-pharmacological stratergies should be trialled in managing a patient with delerium?
Provide a quiet environement with good lighting
Maintaing a regular sleep-wake cycle
Regular orientation and reassurance
Ensuring patient glasses and hearing aids are used if needed
List 3 RF for pressure sores?
Immobility
Sensory impairment
Malnourishment
Older age
Surgery-
Incontinence
What clinical score is used to screen patinets who at risk of developing pressure sores?
Waterlow score
How can pressure sores be avoided?
Barrier creams
Pressure redistribution
Repositioning
Regular skin assessment
What is the management of pressure sores?
Moinst wound environement- Hydrocoloid dresssings
Surgical debridement
Antibiotics if signs of infection
WHat is the START tool
Suggests medications that may provide additional benefits
WHat is the STOPP tool
Used to assess which drugs can be potentially discontinued in elderly patients undergoing polypharmacy
WHat metabolic disturbances can be seen in refeeding syndrome?
Hypophosphataemia
Hypokalaemia
Hypomagnesia
Thiamine deficiency
Abnormal glucose metabolism
WHta are the potential complications of refeeding syndrome?
Cardiac arrythmias
Coma
Convulsions
Cardiac Failure
List primary prevention for strokeS?
Smoking cessation
COntrol HTN
Control Hypercholestraemia
Control diabetes
Encourage actuve lifestyle
List secondary prevention for strokes?
72 Hour ECG to look for paroxsyml AF
CAROTID DOPPLER
bp
eCHO
List the initial mx of ischaemic stroke>
Aspirin 300mg
Thrombolysis w/ alteplase if less than 4.5 hours
Control BP
List 3 RF for ischaemic stroke
Hypertension
Hypercholestraemia
Diabetes
Smoking
AFIB
Carotid stenosis
List 3 RF for haemorrhagic strokes?
AVM
Aneursyms
Anticoagulants
Which abx should be avoided in old patients w/ epilepsy as it could lower seizure threshold?
Ciprofloxacin
list a short term and long term se of levodopa?
short- abnormal dreams
long- on and off states
List 2 sx of pseudodemnetia?
repsonds to answers with ‘i dont know’
symtopms of depression
MOA of bisphosphonates?
Inhibit osteoclastic bone resorption
What are the common sites for pathological fractures in OP?
distal radius
proximal humerus
proximal femur (NOF fracture)
Pelvis
Vertebrae
What is the tool used to screen patients for malnutrition?
The Malnutrition Universal Screening Tool (MUST)
What is hyperthermia?
Defined as a core temperature over 40 degrees with CNS dysfunction
Name some risk factors for hyperthermia.
Older age, impaired cognition, pre-existing dehydration, obesity
What is hypothermia defined as?
Core body temperature <35 degrees Celsius
Mild hypothermia: 32-35°C
Moderate or severe hypothermia: < 32°C
What can rapid re-warming on an individual in hypothermia cause>
Distributive shock and Peripheral Vasodilation
What blood results are most consistent with Osteoporosis?
Normal calcium
Normal phosphate
Normal alkaline phosphatase
Normal PTH
What laxative is generally given first line?
Bulk forming laxative - ispaghula
What laxative is generally given second line?
Osmotic laxative such as macrogol
What to do if a patient with Osteoporosis taking Alendronate has significant upper GI side effects?
Switch to Risedronate or Etidronate
What is malignant hyperthermia?
Inherited autosomal dominant condition seen after administration of anaesthetic agents characterised by hyperpyrexia and muscle rigidity
Excess calcium ion release from skeletal muscle
What is Benign Paroxysmal Positional Vertigo (BPPV)?
A medical condition characterized by sudden, episodic attacks of vertigo induced by changes in head position.
What is the gold standard investigation for BPPV?
Dix-Hallpike Manoeuvre, where the patient is rapidly lowered to the supine position with an extended neck. A positive test recreates the symptoms of BPPV.
What is the first-line management for BPPV?
Epley manoeuvre, successful in around 80% of cases. It aims to move the detached otoliths out of the semi-circular canal and back to the utricle. Patients are also taught exercises to do at home, such as Brandt-Daroff exercises.
What is Mx for a post-menopausal woman who has an osteoporotic fracture?
Bisphosphonates
Dont wait for DEXA
