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3a neuro/geriatrics > gerries new > Flashcards

gerries new Flashcards

1
Q

What is Benign paroxysmal positional vertigo

A

MC cause of vertigo

sudden onset of dizziness and vertigo triggered by changes in head position

inner ear problem

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2
Q

What are features of Benign paroxysmal positional vertigo

A

vertigo triggered by change in head position (e.g. rolling over in bed or gazing upwards)
may be associated with nausea
Symptoms settle after around 20 – 60 seconds

positive Dix-Hallpike manoeuvre

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3
Q

What is Dix-Hallpike manoeuvre

A

rapidly lower the patient to the supine position with an extended neck

a positive test recreates the symptoms of benign paroxysmal positional vertigo

rotatory nystagmus towards the affected ear

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4
Q

How is Symptomatic relief given for Benign paroxysmal positional vertigo

A

Epley manoeuvre (successful in around 80% of cases)
teaching the patient exercises they can do themselves at home, termed vestibular rehabilitation, for example Brandt-Daroff exercises

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5
Q

what causes BPPV

A

caused by crystals of calcium carbonate called otoconia that become displaced into the semicircular canals

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6
Q

What is MC location of BPPV

A

posterior semicircular canal.

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7
Q

What can displace crystals of calcium carbonate in ear

A

viral infection, head trauma, ageing or without a clear cause.

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8
Q

what does peripheral cause of veritgo mean

A

the problem is located in the inner ear rather than the brain.

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9
Q

What is the Epley manoeuvr

A

move the crystals in the semicircular canal into a position that does not disrupt endolymph flow.

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10
Q

What is recurrence rate of BBPV

A

half will have recurrence 3-5 years after their diagnosis

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11
Q

WHat age group has highest risk of falls

A

over the age of 65 have the highest risk of falling with 30% of those over 65 and 50% of those over 80 falling at least once a year

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12
Q

What medical conditions could contribute to fall

A

Stroke
MS
Parkinson’s disease
Infection
Vasovagal syncope
Arrhythmias
Diabetes
Anaemia
pneumonia
Chronic pain

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13
Q

What medication can cause fall

A

Beta-blockers (bradycardia)
Diabetic medications (hypoglycaemia)
Antihypertensives (hypotension)
Benzodiazepines (sedation)
Antibiotics (intercurrent infection)

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14
Q

WHat can falls lead to

A

fractures, particularly hip fractures, which have high rates of disability and death

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15
Q

How can fall be investigated

A
  • orthostatic blood pressure measurements to detect postural hypotension
  • ECG for cardiac arrhythmias
  • Imaging studies if fracture or intracranial injury is suspected
  • Cranial nerve examination
  • Medication Review
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16
Q

What are types of Non-Accidental Falls

A

Syncope-related Falls:
Gait/Balance-related Falls:
Muscle Weakness-related Falls:

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17
Q

How is Functional Ability Assessed

A

Timed Up and Go test (TUG) or Berg Balance Scale (BBS)

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18
Q

What is included in a full falls risk assessment.

A

Gait
Visual problems
Hearing difficulties
Medications review
Alcohol intake
Cognitive impairment
Postural hypotension
Continence
Footwear
Environmental hazards

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19
Q

WHat is Frailty

A

multidimensional syndrome, is characterised by diminished strength, endurance and physiological function

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20
Q

What are two types of Frailty

A

physical frailty and frailty phenotype

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21
Q

What si physical frailty

A

weight loss, exhaustion, low physical activity, slowness and weakness

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22
Q

what is frailty phenotype

A

includes cognitive and social aspects

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23
Q

What are clinical implications of frailty

A

higher risk of adverse health outcomes such as falls, delirium, disability and hospitalisation

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24
Q

What is the significant implications of Frailty on treatment

A

altered pharmacokinetics and pharmacodynamics

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25
Q

How is frailty assessed

A

Fried Frailty Index or Groningen Frailty Indicator

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26
Q

How is frailty managed

A

multi-component interventions including exercise, nutrition optimisation and medication review

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27
Q

What is Osteoporosis

A

severe reduction in bone mineral density and defects in bone tissue micro-architecture.

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28
Q

What is the T Score at the Hip of Osteopenia

A

-1 to -2.5

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29
Q

what can cause secondary Osteoporosis

A

Hyperthyroidism
Hyperparathyroidism
Alcohol abuse
Immobilisation

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30
Q

How is Tscore measured

A

femoral neck, measured on a DEXA scan

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31
Q

What are two type of primary Osteoporosis

A
  • Postmenopausal osteoporosis (type I)
  • age-related osteoporosis (type II)
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32
Q

what is Osteopenia

A

less severe decrease in bone density

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33
Q

why do post-menopausal women experience increased degradation of bone tissue

A

decreased levels of oestrogen

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34
Q

What is the T Score at the Hip of Osteoporosis

A

Less than -2.5

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35
Q

What is the T Score at the Hip of severe Osteoporosis

A

Less than -2.5 plus a fracture

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36
Q

What is Z-score

A

the number of standard deviations the patient is from the average for their age, sex and ethnicity

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37
Q

What are RF for Osteoporosis

A

Older age
Post-menopausal women
Reduced mobility and activity
Low BMI (under 19 kg/m2)
Low calcium or vitamin D intake
Alcohol and smoking
Personal or family history of fractures

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38
Q

What is T-score

A

number of standard deviations the patient is from an average healthy young adult.

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39
Q

Is T score or Z score used to make diagnosis of Osteoporosis

A

T score

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40
Q

What chronic diseases are RF for osteoprosis

A

Chronic diseases (e.g., chronic kidney disease, hyperthyroidism and rheumatoid arthritis)

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41
Q

Where does Tamoxifen block oestrogen receptors

A

blocks oestrogen receptors in breast tissue but stimulates oestrogen receptors in the uterus and bones

helps prevent osteoporosis

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42
Q

What medications are RF for osteoporosis

A

Long-term Glucocorticoids (e.g., 7.5mg or more of prednisolone daily for longer than 3 months)
Certain medications (e.g., SSRIs, PPIs, anti-epileptics and anti-oestrogens)

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43
Q

What are the most common pathological fractures seen in osteoporosis

A

Vertebral compression fractures
Neck of femur
Colles fractures (fall on an outstretched arm)

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44
Q

What investigations ca exclude any secondary causes of osteoporosis

A

Quantitative CT and US of the heel
History and physical examination
FBC
U&Es (serum calcium, creatinine, phosphate)
LFTs (ALP, transaminases)
TFTs
25-OH vit D & 1,25-OH vit D
Serum testosterone & prolactin
Lateral radiographs of lumbar and thoracic spine
Protein immunoelectrophoresis and urinary Bence-Jones protein

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45
Q

What selective oestrogen receptor modulator (SERM) is used to treat osteoporosis

A

Raloxifene

stimulates oestrogen receptors in the bone but not in the uterus or breast.

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46
Q

How is 10-year risk of a major osteoporotic fracture and a hip fracture calculated

A

FRAX tool

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47
Q

What clinical risk factors are in FRAX

A

Age (between 40 and 90 years)
Gender
Previous fracture
Parent fractured hip
Smoking
Glucocorticoids (more than 3 months at a dose of prednisolone 5mg daily)
Rheumatoid arthritis
Secondary osteoporosis
Alcohol consumption
BMD

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48
Q

What are DDx for osteoporosis

A

Osteomalacia
Paget disease of bone
myeloma, primary and metastatic bone tumours, lymphoma

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49
Q

What is the initial management for osteoporosis

A

Lifestyle modification for the prevention of osteoporotic fractures

  • Falls risk assessment
  • Weight-bearing and muscle strengthening exercises
  • Calcium (at least 1000mg)
  • Vitamin D (400-800 IU)
  • Calculation of 10-year probability of osteoporotic fragility fracture
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50
Q

What is the first-line pharmacological treatment for osteoporosis

A

Bisphosphonates

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51
Q

What is insufficient intake of calcium

A

less than 700mg per day

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52
Q

How do Bisphosphonates work

A

inhibit osteoclast-mediated bone resorption

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53
Q

What are SE of Bisphosphonates

A

Reflux and oesophageal erosions
Atypical fractures (e.g., atypical femoral fractures)
Osteonecrosis of the jaw (regular dental checkups are recommended before and during treatment)
Osteonecrosis of the external auditory canal

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54
Q

How is oral Bisphosphonates taken

A

empty stomach with a full glass of water
patient should sit upright for 30 minutes before moving or eating

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55
Q

WHat are examples of Bisphosphonates

A

Alendronate 70 mg once weekly (oral)
Risedronate 35 mg once weekly (oral)
Zoledronic acid 5 mg once yearly (intravenous)

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56
Q

What is an alternative treatment option is bisphosphonates are not suitable

A
  • Denosumab (a monoclonal antibody that targets osteoclasts)
  • Romosozumab (a monoclonal antibody that targets sclerostin – a protein in osteocytes that inhibits bone formation)
  • Teriparatide (acts as parathyroid hormone)
  • Hormone replacement therapy (particularly in women with early menopause)
  • Raloxifene (a selective oestrogen receptor modulator)
  • Strontium ranelate (a similar element to calcium that stimulates osteoblasts and blocks osteoclasts)
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57
Q

What does Raloxifene increase risk of

A

venous thromboembolism.

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58
Q

What is a pathological fracture

A

when a bone breaks due to an abnormality within the bone

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59
Q

what are ways to describe how a bone breaks

A
  • Transverse
  • Oblique
  • Spiral
  • Segmental
  • Comminuted (breaking into multiple fragments)
  • Compression fractures (affecting the vertebrae in the spine)
  • Greenstick
  • Buckle (torus)
  • Salter-Harris (growth plate fracture)
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60
Q

What classification can be used to describe fractures of the lateral malleolus (distal fibula).

A

Weber classification

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61
Q

What is Weber classification

A

Type A – below the ankle joint – will leave the syndesmosis intact
Type B – at the level of the ankle joint – the syndesmosis will be intact or partially torn
Type C – above the ankle joint – the syndesmosis will be disrupted

62
Q

What cancers metastasise to the bone

A

Po – Prostate
R – Renal
Ta – Thyroid
B – Breast
Le – Lung

PoRTaBLe

63
Q

How are fractures imaged

A

X-rays - 1st line

CT scans -> if xray inconclusive

64
Q

How is mechanical alignment of the fracture achieved

A

Closed reduction via manipulation of the limb
Open reduction via surgery

65
Q

How is relative stability provided to fracture

A

External casts (e.g., plaster cast)
K wires
Intramedullary wires
Intramedullary nails
Screws
Plate and screws

66
Q

What are possible early complications of fracture

A

Damage to local structures (e.g., tendons, muscles, arteries, nerves, skin and lung)
Haemorrhage leading to shock and potentially death
Compartment syndrome
Fat embolism (see below)
Venous thromboembolism (DVTs and PEs) due to immobility

67
Q

What are possible long term complications of fracture

A

Delayed union (slow healing)
Malunion (misaligned healing)
Non-union (failure to heal)
Avascular necrosis (death of the bone)
Infection (osteomyelitis)
Joint instability
Joint stiffness
Contractures (tightening of the soft tissues)
Arthritis
Chronic pain
Complex regional pain syndrome

68
Q

How does fat embolisation present

A

respiratory distress, altered mental status, and petechial rash

69
Q

What is Cardiac failure

A

clinical syndrome that results from structural or functional cardiac disorders impairing the ability of the ventricle to fill with or eject blood

70
Q

How is Cardiac failure categorized

A

systolic and diastolic failure

71
Q

What is Systolic failure

A

reduced ejection fraction, results from the heart’s diminished capacity to pump blood effectively.

72
Q

WHat is diastolic failure

A

impaired filling of the heart chambers due to increased stiffness.

73
Q

WHat are common causes of heart failure

A

Ischaemic heart disease
Valvular heart disease (commonly aortic stenosis)
Hypertension
Arrhythmias (commonly atrial fibrillation)
Cardiomyopathy

74
Q

What are the symptoms of cardiac failure

A

Breathlessness
Cough
Orthopnoea
Paroxysmal nocturnal dyspnoea
Peripheral oedema
Fatigue

triad of symptoms: dyspnoea, fatigue, and fluid retention

75
Q

What are the signs of cardiac failure

A
  • Tachycardia (raised heart rate)
  • Tachypnoea (raised respiratory rate)
  • Hypertension
  • Murmurs on auscultation indicating valvular heart disease
  • 3rd heart sound on auscultation
  • Bilateral basal crackles (sounding “wet”) on auscultation of the lungs, indicating pulmonary oedema
  • Raised jugular venous pressure (JVP)
  • Peripheral oedema of the ankles, legs and sacrum
76
Q

How is cardiac failure diagnosed

A

Clinical assessment (history and examination)
N-terminal pro-B-type natriuretic peptide (NT‑proBNP) blood test
ECG
Echocardiogram

Bloods for anaemia, renal function, thyroid function, liver function, lipids and diabetes
Chest x-ray and lung function tests to exclude lung pathology

77
Q

What classification system grades the severity of symptoms related to heart failure

A

New York Heart Association (NYHA)

78
Q

What is the New York Heart Association (NYHA) classification system

A

Class I: No limitation on activity
Class II: Comfortable at rest but symptomatic with ordinary activities
Class III: Comfortable at rest but symptomatic with less than ordinary activity
Class IV: Symptomatic at rest

79
Q

What are the five principles of cardiac failure management

A

R – Refer to cardiology
A – Advise them about the condition
M – Medical treatment
P – Procedural or surgical interventions
S – Specialist heart failure MDT input, such as the heart failure specialist nurses, for advice and support

RAMPS

80
Q

What does the urgency of the referral and specialist assessment for cardiac failure depend on

A

NT-proBNP

81
Q

If a patient has a NT-proBNP of 1000ng/litre how soon should they be seen and have echocardiogram

A

From 400 – 2000 ng/litre should be seen and have an echocardiogram within 6 weeks

Above 2000 ng/litre should be seen and have an echocardiogram within 2 weeks

82
Q

What is the first-line medical treatment for chronic heart failure

A

A – ACE inhibitor (e.g., ramipril) titrated as high as tolerated
B – Beta blocker (e.g., bisoprolol) titrated as high as tolerated
A – Aldosterone antagonist when symptoms are not controlled with A and B (e.g., spironolactone or eplerenone)
L – Loop diuretics (e.g., furosemide or bumetanide)

83
Q

WHen should ACE inhibitors be avoided and what is alternative

A

patients with valvular heart disease

alt = angiotensin receptor blocker (ARB) (e.g., candesartan)

84
Q

What should be closely monitored whilst taking diuretics, ACE inhibitors and aldosterone antagonists.

A

U&Es & Renal fucntion

can cause electrolyte disturbances.
can cause hyperkalaemia

85
Q

When is Aldosterone antagonists used in cardiac failure

A

second-line treatment
when there is a reduced ejection fraction and symptoms are not controlled with an ACEi and beta blocker.

86
Q

What Surgical procedures can be used in cardiac failure

A

Implantable cardioverter defibrillators
Cardiac resynchronisation therapy (CRT)
heart transplant

87
Q

What is B-type natriuretic peptide

A

hormone produced mainly by the left ventricular myocardium in response to strain

88
Q

What are causes of Constipation

A

Functional constipation
Medication-induced constipation
Irritable bowel syndrome with constipation (IBS-C)
Colorectal cancer
Hypothyroidism

89
Q

What is functional constipation

A

MC form

infrequent bowel movements, hard stools, and difficulty passing stool

lack of fibre in the diet, inadequate fluid intake, or a sedentary lifestyle.

90
Q

What are complications of constipation

A

overflow diarrhoea
acute urinary retention
haemorrhoids

91
Q

What symptoms are associated with constipation

A

Infrequent bowel movements (fewer than three per week)
Hard or lumpy stools
Difficulty in passing stools (straining)
Sensation of incomplete evacuation after a bowel movement
Bloating and abdominal discomfort

92
Q

What complications are related to chronic constipation

A

haemorrhoids, anal fissures, rectal prolapse or faecal impaction.

93
Q

what is Encopresis

A

faecal incontinence
sign of chronic constipation
rectum stretched and looses sensation
Large hard stools remain in the rectum and only loose stools are able to bypass the blockage and leak out, causing soiling.

94
Q

What lifestyle factors can contribute to the development and continuation of constipation:

A

Habitually not opening the bowels
Low fibre diet
Poor fluid intake and dehydration
Sedentary lifestyle
Psychosocial problems such as a difficult home or school environment (always keep safeguarding in mind)

95
Q

What is the management for constipation

A
  • exclude any faecal impaction
  • advice on lifestyle measures
  • first-line laxative: bulk-forming laxative first-line, such as ispaghula
  • second-line: osmotic laxative, such as a macrogol
96
Q

What are ‘alarm’ symptoms for constipation

A

sudden onset constipation in older adults, blood in stools, unexplained weight loss, abdominal pain and change in stool calibre.

97
Q

Name two medications that can cause constipation

A

Opioids
CCB

98
Q

What are Risk factors for Urinary incontinence

A

advancing age
previous pregnancy and childbirth
high body mass index
hysterectomy
family history

99
Q

What are Classification of urinary incontinence

A

overactive bladder (OAB)/urge incontinence
stress incontinence:
mixed incontinence:
overflow incontinence:

100
Q

What is overactive bladder (OAB)/urge incontinence

A

due to detrusor overactivity

101
Q

What is stress incontinence

A

leaking small amounts when coughing or laughing

102
Q

what is mixed incontinence

A

both urge and stress

103
Q

what is overflow incontinence

A

due to bladder outlet obstruction, e.g. due to prostate enlargement

104
Q

What are initial investigation for Urinary incontinence

A
  • bladder diaries should be completed for a minimum of 3 days
  • vaginal examination to exclude pelvic organ prolapse and ability to initiate voluntary contraction of pelvic floor muscles (‘Kegel’ exercises)
  • urine dipstick and culture
  • urodynamic studies
105
Q

How is urge predominant incontinence managed

A
  • bladder retraining - gradually increase the intervals between voiding)
  • bladder stabilising drugs: Anticholinergic (antimuscrinic) medication, for example, oxybutynin, tolterodine and solifenacin
  • mirabegron (a beta-3 agonist) may be useful if there is concern about anticholinergic side-effects in frail elderly patients
106
Q

How is stress predominant incontinence managed

A
  • pelvic floor muscle training: NICE recommend at least 8 contractions performed 3 times per day for a minimum of 3 months
  • duloxetine
  • surgical procedures: e.g. retropubic mid-urethral tape procedures
107
Q

What can cause Overflow Incontinence

A

anticholinergic medications
fibroids
pelvic tumours

and neurological conditions such as multiple sclerosis, diabetic neuropathy and spinal cord injuries.

108
Q

WHat is Undernutrition

A

manifests as stunting, wasting, and deficiencies of micro- and macronutrients

109
Q

WHat is Overnutrition

A

results in overweight or obesity due to excessive nutrient intakes

110
Q

what is Protein-energy malnutrition

A

severe form of undernutrition characterised by insufficient intake of protein and energy.

111
Q

what can Protein-energy malnutrition lead to

A

marasmus, presenting as significant weight loss or kwashiorkor with oedema and skin changes.

112
Q

What can Overnutrition increase risk of

A

type 2 diabetes mellitus, cardiovascular disease, hypertension and certain cancers

113
Q

WHat biochemical abnormalities can Malnourished patients have

A

anaemia, hypoalbuminaemia or electrolyte imbalances.

114
Q

what causes malnutrition

A

Inadequate amounts of nutrients (e.g. poor variety in diet)
Difficulty absorbing nutrients (e.g. gastrointestinal dysfunction such as coeliac disease)
Increased nutritional demands (e.g. post-surgery for healing)

115
Q

what is Malnutrition

A

sudden or chronic decrease in the intake of sufficient nutrition to support the body’s requirements for growth, healing, and maintenance of life.

116
Q

Name a standardised screening tool for Malnutrition

A

Malnutrition Universal Screening Tool (MUST), the Malnutrition Screening Tool (MST) and Mini-Nutrition Assessment (MNA)

117
Q

What are RF for Malnutrition

A

Being hospitalised for extended periods of time
Problems with dentition, taste or smell
Polypharmacy
Social isolation and loneliness
Mental health issues including grief, anxiety and depression
Cognitive issues including confusion

118
Q

What are clinical features of malnutrition include

A

High susceptibility or long durations of infections
Slow or poor wound healing
Altered vital signs including bradycardia, hypotension, and hypothermia
Depleted subcutaneous fat stores
Low skeletal muscle mass

119
Q

what are complications of malnutrition

A

Impaired immunity (increased risk of infections)
Poor wound healing
Growth restriction in children
Unintentional weight loss, specifically the loss of muscle mass
Multi-organ failure
Death

120
Q

WHat is Hyperthermia

A

elevated core body temperature exceeding the body’s thermoregulatory set-point due to failed thermoregulation, is often induced by heat stroke or adverse drug reactions

121
Q

What can untreated Hyperthermia lead to

A

multi-organ dysfunction

122
Q

What is Hypothermia

A

when the body loses heat faster than it can produce, causing a dangerously low body temperature.

123
Q

What usually causes Hypothermia

A

prolonged exposure to cold weather or immersion in cold water.

124
Q

What can untreated Hypothermia lead to

A

esult in arrhythmias, impaired consciousness and potentially fatal complications like hypotensive shock.

125
Q

What are four criteria a patient needs to meet to demonstrate capacity to make a decision

A

Understand the decision
Retain the information long enough to make the decision
Weigh up the pros and cons
Communicate their decision

126
Q

WHat is Lasting power of attorney (LPA)

A

a person legally nominates a person of their choice to make decisions on their behalf if they lose capacity in the future

property and financial and health

127
Q

what is Deprivation of liberty safeguards (DoLS)

A

an application made by a hospital or care home for patients who lack capacity to allow them to provide care and treatment.

128
Q

What are 4 types of consent form

A

Consent Form 1: Patient consenting to a procedure
Consent Form 2: Parental consent on behalf of a child
Consent Form 3: Where the patient won’t have their consciousness impaired (e.g., a breast biopsy)
Consent Form 4: Where the patient lacks capacity

129
Q

What is Mental Capacity Act:

A

used in patients who require treatment for physical disorders that affect brain function. Remember this may be delirium secondary to sepsis or a primary brain disorder such as dementia

130
Q

What are 3 types of consent

A
  1. Informed
  2. Expressed
  3. Implied
131
Q

What is a Do Not Attempt Cardiopulmonary Resuscitation order (DNACPR)

A

document that formalises decision-making about whether an individual should be treated with CPR, in the event of a cardiac arrest.

advance directive

132
Q

Where do Pressure sores commonly occur

A

typically occur over bony prominences such as sacrum, coccyx, heels or hips

133
Q

What are Pressure sores

A

localised injuries to the skin and underlying tissue due to prolonged pressure

134
Q

What is the pathophysiology of pressure sores

A

ischaemic damage due to compression of capillaries leading to cell death and ulceration

135
Q

What is stage 1 pressure sores

A

characterised by non-blanchable erythema without skin loss

136
Q

What is stage 4 pressure sores

A

full thickness skin loss with extensive destruction involving muscle, bone or supporting structures

137
Q

What is stage 3 pressure sores

A

full thickness skin loss extending into subcutaneous tissue but not through underlying fascia

138
Q

What is stage 2 pressure sores

A

partial thickness skin loss affecting epidermis or dermis

139
Q

WHat are RF for pressure sores

A

immobility, malnutrition, incontinence and sensory impairment

140
Q

What is risk assessment tool for estimating an individual patient’s risk of developing a pressure ulcer

A

Waterlow Score

141
Q

What are Complications of Pressure Sores

A

Infection
Sepsis
Necrotising fasciitis

142
Q

How can pressure ulcers be prevented

A

individual risk assessments, regular repositioning, special inflating mattresses, regular skin checks and protective dressings and creams

143
Q

What is the management of Squamous cell carcinoma of the skin

A
  • Surgical excision with 4mm margins if lesion <20mm in diameter.
  • If tumour >20mm then margins should be 6mm.
  • Mohs micrographic surgery may be used in high-risk patients and in cosmetically important sites.
144
Q

What are complications of Squamous cell carcinoma of the skin

A

Local recurrence
Metastasis
Nerve involvement
Morbidity from surgical treatment - deficits

145
Q

What are Rf for Squamous cell carcinoma of the skin

A
  • excessive exposure to sunlight / psoralen UVA therapy
  • actinic keratoses and Bowen’s disease
  • immunosuppression e.g. following renal transplant, HIV
  • smoking
  • long-standing leg ulcers (Marjolin’s ulcer)
  • genetic conditions e.g. xeroderma pigmentosum, oculocutaneous albinism
146
Q

What is the Stage-specific 5-year survival rate of Localised SCC

A

99%

147
Q

What is the Stage-specific 5-year survival rate of Regional SCC

A

63%

148
Q

What is the Stage-specific 5-year survival rate of Distant metastasis SCC

A

16%

149
Q

What are indicators of a good prognosis for SSC

A

Well differentiated tumours
<20mm diameter
<2mm deep
No associated diseases

150
Q

What are indicators of a poor prognosis for SSC

A

Poorly differentiated tumours
>20mm in diameter
>4mm deep
Immunosupression for whatever reason
Perineural invasion

3a neuro/geriatrics (3 decks)

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