Geriatrics Flashcards
What is the differential diagnosis for:
- worsening dyspnea on exertion
- fatigue
- dizziness
- palpitations
- conjunctival pallor
- guaiac positive stool
- Anemia secondary to GI bleeding
- Angina
- Congestive heart failure
- Atril fibrillation
What are the next diagnostic steps for a patient with anemia secondary to GI bleeding?
- CBC to evaluate anemia
- ECG
- Cardiac enzymes
- Pt and PTT for coagulation abnormalities
What are the next steps in treatment for a patient with anemia secondary to GI bleeding?
- Blood transfusion if needed
- 2 sets of cardiac enzymes + ECG
- Esophagogastroduodenoscopy and colonoscopy due to postive guaiac
Fatigue in the context of conjunctival pallor should warrant what type of work up?
- Anemia work up
When assessing for anemia, what type of CBC work up should be done?
- CBC with peripheral smear
- Reticulocyte count
- Iron study
- Vitamin B12
- Folic acid levels
What is a big concern for routine aspirin/NSAID use?
- GI ulcer (bleeding)
What physical exam signs may point to a GI bleed/ulcer?
- LUQ and epigastric pain
* GI bleeds could also occur from coagulopathy or liver disease
What are signs of B12 deficiency anemia?
- Glossitis
- Decreased vibratory and positional senses
- Ataxia
- Paresthesia
- Confusion/dementia
- Pearly gray hair at an early age
How is folate deficiency different from B12 deficiency?
All symptoms are similar except NO neurological deficits
Iron deficiency anemia is associated with what nail abnormality?
- Koilonychia => spoon nails
What is the significance of jaundice in the context of anemia?
- Jaundice can be a clue that hemolysis is a contributing factor to the anemia
What is the significance of splenomegaly in the context of anemia?
-Splenomegaly can indicate that a thalassemia or neoplasm may be present
What is the most common cause of microcytic anemia (low MCV)?
- Iron deficiency anemia
What tests should be done to verify iron deficiency anemia?
- Serum iron ( should be low)
- Ferritin ( should be low)
- Total iron binding capacity (TIBC- should be high)
What are the common causes of iron deficiency anemia in the elderly?
- GI blood loss (or GI malignancy)
- Poor nutritional intake
- Bleeding disorder
What are the most common causes of macrocytic anemias?
B12 or folate deficiency
What test can be done to confirm B12 deficiency macrocytic anemia?
- Methylmalonic acid (review biochem pathway in step 1)
What conditions predispose to B12 deficiency?
- Pernicious anemia
- History of gastrectomy/PPI use (chief cells secrete intrinsic factor needed to absorb B12 in the ileum)
- Malabsorption (bacterial infection, crohn disease, celiac disease)
- Strict vegans
What conditions predispose to folate deficiency?
- Alcohol abuse
- Severe nutritional deficiency (tea and toast diet)
What are two major causes of normocytic anemia?
1) Anemia of chronic disease/inflammation (decreased usage of iron stored in reticuloendothelial system)
2) Renal insufficiency => decreased erythropoietin production
What is presbycusis?
- Age-related sensorineural hearing loss typically associated with selective high frequency loss and difficulty with speech discrimination
What is the leading cause of severe vision loss in the elderly?
- Macular degeneration => atrophy of cells in the central macular region f the retinal pigment epithelium, resulting in the loss of central vision
Define glaucoma.
- a group of optic neuropathies that can occur in all ages; associated with elevated intraocular pressure
Define cataracts.
- Any opacification of the lens; 90% is age related
- Cataract disease is the most common cause of blindness in the world
Apart from macular degeneration, glaucoma, and cataracts, what other ocular condition should be considered in the geriatric vision exam?
- Diabetic retinopathy
What is the differential diagnosis for hearing loss in the geriatric population?
- Presbycusis
- Noise induced hearing loss
- Cerumen impaction
- Otosclerosis
- Central auditory processing disorder
What are the instrumental activities of daily living?
IADLs
- Transportation
- Shopping
- Cooking
- Using the telephone
- Managing money
- Taking medications
- Housecleaning
- Laundry
What are the activities of daily living?
- Bathing
- Dressing
- Eating
- Transferring from bed to chair
- Continence
- Toileting
What is the prevalence of dementia after age 60?
The prevalence of dementia doubles every 5 years after age 60. By the age of 85, approximately 30-50% of individuals have some degree of impairment
Why is routine screening for prostate cancer no longer recommended?
- Screening elderly men for prostate cancer is not routinely recommended as it has not been shown to prolong life and because of the risk of incontinence or ED caused by treatments
How often should an elderly women receive breast cancer screening?
- Elderly women should undergo biannual mammograpahy until life expectancy falls below 5-10 years
When can colon cancer screening be stopped?
- Colon cancer screening can be stopped when the patient’s life expectancy falls below 5-10 years
What are the recommended vaccinations for individuals 60+?
- Annual flu >65
- Pneumonia vaccine >65 (pneumovax 23 and 13)
- Booster of tetanus and diphtheria (tdap) >65
- Zoster vaccine >60
What percentage of patients who receive in hospital CPR survive to discharge?
15%
What labs should be taken in the case of suspected dementia?
- B12
- TSH
- RPR (syphilis screening)
- CT or MRI
- also rule out depression
What are normal cognitive changes with aging?
- decrease in nonverbal creative thinking and new problem solving strategies
- skills learned with experience and memory retention should remain intact
Which alzheimer drug has a side effect of hepatotoxicity in addition to arrhythmias/bradycardia, urinary obstruction, n/v, diarrhea, dizziness, and headaches?
- Tacrine/Cognex
Which alzheimer drug has a side effect profile comparable to placebo?
- Memantine/ Namenda => NMDA antagonist
What are the side effects of donepezil/aricept?
- nausea, vomiting, diarrhea, dizziness, headahces
What are the side effects of galantine/razadyne?
- arrhythmias, bradycardia, urinary obstruction
What is the second most common cause of dementia after alzheimer’s?
- vascular dementia => neuronal loss as a consequence of one or more stroke
- Often has a sudden onset and progresses in a stepwise fashion
- treatment is to prevent strokes/TIAs
