Geriatrics Flashcards
How do you treat agitation in Delirium ?
Haloperidol x 0.5mg
or
Olanzepine
How do you treat Delirium in someone with parkinsonsim features
Atypical Antispsychotics
( quetiapine / Clozapine )
What is the 1st Line Medical Mx of Alzheimers
Acetylcholinesterase Inhibitor
( Donepezil, Galantamine, Rivastigmine )
Used in Mild to Moderate Alzheimers
When do you use NMDA receptor antagonists in Alzheimers
> If 1st line is contraindicated / Intolerant
as mono therapy in severe Alzheimers
What are the 2 main things to know about Donepezil
Bradycardia > Relative contradiction
Insomnia > Most common side effect
What are the factors that make you think Delirium over Dementia
> Acute Onset
Impaired consciousness
Fluctuation of symptoms
( Worsening at night, with periods of normalcy )
Abnormal perception ( illusions. Hallucinations)
Agitation, Fear
Delusions
What are the 3 types of Fronto Temporal Lobar Degeneration ?
> Frontotemporal dementia ( Picks)
Progressive non Fluent Aphasia
( CPA - Chronic progressive aphasia )
Semantic dementia
What are the features of Fronto Temporal Dementia
> Onsent before 65
Insidious onset
Preserved Memory and visuospatial skills
Affected Personality and Social Conduct Problems
What are the macroscopic and microscopic changes you see In Picks Disease
Macroscopic :
personality changes
Atrophy of frontal lobe
Microscopic ;
Picks Bodies
Gliosis
Neurofibrillar tangles
Senile Plaques
What are the features of CPA (Chronic progressive aphasia)
Non Fluent speech
Utterances that are agrammatic
Compression is preserved
What are the features of Semantic Dementia
Fluent progressive aphasia
Speech is fluent, but no meaning
Memory is preserved
What are the key features of Lewy body Dementia
> Progressive cognitive impairment
Cognition is Fluctuating ( moments of normalcy )
Parkinsonism features
Visual Hallucinations
How do you Dx Lew Body Dementia
> Clinical Dx
SPECT ( Commercial known as DATscan)
Mx of Lewy body Dementia
Acetylcholinesetrase Inhibitors
(Donepezil)
What are the biggest side effects of Haloperidol
> Drug induced Parkinsonism
( Extra pyramidal side effects)
> Akathisia and Orofacial Dyskinisa
( This feature is seen mainly in drug induced Parkinsonism)
What is the feature in drug induced Parkinsonism that is different when compared to other causes of Parkinsonism
> Akathisia and Orofacial Dyskinisa
What is the most common organism causing HAP
Pseudomonas Arginosa
mx: Taz
What are the main features of Presbycusis
> Age related Hearing loss
Features: Tinnitus, Raising TV volume
Audiogram : Loss of High Frequency sounds
What are the Audioty test signs in Presbycusis
> progressive “ B/L Sensorineural hearing loss”
+ve Rinnes due to B/L SN hearing loss
What do you see in Acoustic Neuroma / Vestibular Schwanomma
Vertigo/ Tinnitus
Unilateral sensorineural Hearing loss
Ix : MRI
What do you see in Meniers Disease
Triad of
>Vertigo
>Tinitus
>Unilateral SN hearing loss
Fullness in ear +
What do you see In otosclerosis
Young Women
Autosomal Dominant
Increased Bone turnover
B/L Conductive hearing loss
What are the features of PICA stroke
Vertigo
Nystagmus
Impaired co-ordination
Ipsilateral pain/temp loss of face
Contraleral loss of pain and temp in trunk
What is PICA stroke also called as ?
Lateral Medullary Syndrome
Do we treat Asymptomatic Bacteriruia ?
Usually NO
In Whom do you see Asteatotic Eczema
> Common in dry areas of the world
Diamond shaped plates of skin; separated from each other by red bands ; hence forming a network
What is the triad of Felty Syndrome
> RA
Splenomegaly
Neutropenia/Leucopenia
What is the Mx of Felty Syndrome
> Pulsed corticosteroids
DMAARDS + NSAIDs
Severe cases, can have GCSF
Splenectomy in severe cases
How do you treat Urge Incontinence
( Leaking urine)
> Bladder training
Antimuscarinics ( Oxybutinin )
- NOT in elderly
Darifenacin
Solifenacin
How do you treat Stress Incontinence ( On cough/ laughter)
> Pelvic floor excercises
Duloxetine
Urogynecologist for Sx if above fails
What are the Key features of Multiple System Atrophy ( MSA)
> Parkinsonism + “Autonomic dysfunction )
Postural drops
What are the features of Vitamin C deficiency.
> Bleeding gums
Skin Changes
Hyperkeratosis of hair follicles
What are the features of zinc Deficiency
> Well demarcated psoriatic formant eczema plaues
in peri-oral and ano-genital areas
What is the 1st line of Mx of Pressure sores
Calcium Alginate –> Main Mx
followed by colloid
What are the features of chronic venous insufficiency
> ABPI >0.8
Ulcer in the medial malleolus
Pain on chronic standing/ walking
Which side is the neurological deficit in carotid artery Stenosis
> Contralateral Hemiparesis
What are the features of Vertebral Artery Stenosis
> Vertigo
Nausea/ Vomiting
Nystagmus
What are the normal heart Pressures
Left vent pressure :100-150mmhg
Right arterial pressure : 2-6 mmhg
Right Vent pressure : 15-30 mmhg
Pull Artery wedge pressure: 8-10
What do you see in High Lateral wall MI
St elevation in I and aVL
What do you see in Lateral transmural MI
St elevation in V5 and V6
What do you see in Inf. Transmural MI
St elevation in II, III, aVF
What do you see in Subendocardial MI
St depression in II, III, aVF
What do you see in ant Transmural MI
St elevation in V1-V4
What is the 1st line Tx for depression
SSRI - Setraline
When do you use ECT in depression
in Severe Refractive depression
Where do you normally see Carcinoid syndrome and when do the symptoms appear
> Appendix and Ileum (but can be seen elsewhere as well)
Only occurs when metastasis to liver
What are the key features of PSP
> Impaired Downward gaze
Backward falls +++
Dysphasia and Dysarthria
Is impaired upward gaze in elderly normal
Yes
What should you do when you’re unable to taper down red
> Start Tocilizumab along with the lowest tolerated dose of prednisone
once established, the taper down pred
What are some of the common interactions of clarithromycin
It is a CYP3A4 Inhbitor
> Warfarin, Statin, Amlodipine, Ciclosporin
Which vessel is affected in Locked in Syndrome
Proximal and Middle Basilar Artery
What are the features of Locked in Syndrome
> Multiple TIA ; Collapses
Bulbar palsy - But maintains airways
cannot move arms and legs, but can blink ++ and consciousness preserved
What is the difference in Proxima and middle vs distal basal artery involvement
> Distal : > it affects Consciousness
How do you Mx severe Agitation in Alzheimers disease
Olanzepine
Which is the 1st cardiac marker to rise in MI
Myglobin - (1-2 hrs)
Trop I/T - ( 3-12h)
Which organism affects Athroplasty joints years later
Propinobacterium Acnes
( Slow growing Gram -ve Bacterium )
What are the keys features in Mesentric Ischaemia
> Seen in AF, DM
Abdo pain, constipation,
raised WCC, Raised Lactate ; Fever
CT: Dilated loops ad thicken bowel wall
Mx: IV fluids + Urgent laparotomy
What is a serious side effect of tamsulosin
( Alfa adrenergic receptor antagonist )
> Severe postural hypotension
What skin rash is associated with Coeliac disease
Dermatitis Herpetifromis
What is the Major side effect for Ropinirole
Impulsive Behaviour
What is the Mx of Type A and type B dissection
type A- Sx
Type B ( distal to Subclavian Artery )- IV labetalol
What is Waterlow score used for
Risk of developing pressure sore
What is the mx of Aortic Regurgitation that is symptomatic
Surgery ; Valve replacement
( Regardless of EF)
Side effects of amitryptiline
> Long term use ; memory loss
Urine Retention
Common Abx causing C. diff
Ciproflox, Clindamycin , 3rd gen cephalosporins
What is the best long term Mx of stroke
Clopdiogrel
What is the Mx of stroke, in Pt. who have AF
Warfarin
What is the Mx of stroke long term, if pt is allergic/ intolerant to clopidogrel
Asprin + Dipyramidol
Best Ix for Lewy Body Dementia
PET with Dopamine Transporter Imaging
What are the features for ischaemic colitis
> Sudden abdominal pain
Bleeding PR
CT: Thumb printing sign
Mx: Conservative
