Geriatrics

Question 1

LOC

Answer 1

Causes: 
Vasovagal syncope
Postural hypotension 
Cardiac (Aortic stenosis, arrhythmias)
Epilepsy
Hypoglycaemia
Drugs (antihypertensives, antisympathetics, doxazosin (alpha 1-blocker)) 

Examination: 
Lying/standing BP (>20 systolic or >10 diastolic drop when standing)
Head injury
Dry mucous membranes (dehydration) 
Tongue (if bitten - epilepsy)
Murmurs (aortic stenosis) 

Ix:
Bloods: FBC (anaemia), U&Es (dehydration - urea much higher than creatinine), BM, ECG (cardiac cause - arrhythmia)

Question 2

Urinary incontinence

Answer 2

Stress
Triggered by cough, sneeze etc.
Tx: pelvic floor exercises, duloxetine (increases muscle tone)

Urge/overactivity
- Detrussor overactivity
- Sudden urge then bladder contracts when not supposed to
Tx: anti-muscarinics: oxybutynin, tolteridone (contra-ind: in acute -angle glucoma)
mirabegron

Overflow
- Bladder outlet obstruction e.g. enlarged prostate

Question 3

Delirium

Answer 3

Acute confusional state from previous baseline due to organic cause

Sx: develops over days, fluctating awareness, disturbance in cognition (memory, attention), disorganised thinking

Triggers: NEWS, BM, pain, sensory impairement
Investigate causes: Bloods, fluid balance, infection screen (CXR, urinalysis), AMT test
Management: document
Engage/explore - explain family, AWI (if lack of capacity)

Risk fx: age, underlying cognitive disorder, comorbidities

Causes: infection, dehydration, constipation, drugs (esp. anticholinergics e.g. oxybutinin, furosemide, amytriptyline)

Indications CT: signs increased ICP, focal neuro signs, confusion after head injury

Tx:
Treat cause
Haloperidol
Lorazepam (if have Parkinson’s, Lewy body dementia, prolonged QT)