Miscellaneous inc Pressure ulcers

Question 1

How do you investigate anaemia in the elderly

Answer 1

FBC, reticulocyte, film, bone marrow? 
ESR
LFT, U+E
Vit B12 + folate levels 
CXR
Stool for occult blood
TFT
S. electrophoresis

Question 2

What is Dx of DM

Answer 2

Fasting> 7
RBS >11
OGTT >11.1

Question 3

What further investigation should you do in DM

Answer 3

Infection screen
Ketones in urine
Cholesterol / HbA1c >7 = microvascular complication
U+E / LFT
ACR
Fundoscopy
Feet - diabetic neuropathy / fungal / corn / calluses / bony deformity + pulses

Question 4

Patient with breathlessness

Answer 4

Bloods - FBC, U+E, LFT
Sputum culture 
ABG
Troponin 
BNP level - if low = HF unlikely 
CXR
ECG
ECHO
Drug toxicity
D dimer
V/Q

Question 5

What is differential for breathlessness

Answer 5

Malignancy
Lung - resp failure, pleural effusion, pneumonia, PE, asthma, COPD, sarcoidosis
Cardiac - CCF, pericardial effusion, MI, oedema
ANaemia
DKA
Metabolic / electrolyte
Salcilyic poisining

Question 6

How do you treat leg oedema

Answer 6

Raise legs
Compression stocking - TED 
Physio / OT input 
Rx condition
Possible DVT - doppler? 
Diuretics only for resistant - furosemide

Question 7

How do you treat insomnia

Answer 7

Benzo

Question 8

How do you Dx an treat depression

Answer 8

Geriatric depression score

SSRI

Question 9

How do you treat constipation

Answer 9

Stop drugs
Increase fluid + fibre
Bulk forming laxative - Senna 1st line (stimulant) then
Movicol / laxido = isotonic (1st in paeds)
Lactulose = osmotic

Question 10

Chest infection

Answer 10

Typical Sx
Coarse crackles (on inspiration) typical of infection / exudate / filled up alveoli
Fine crackles more suggestive of fibrosis / HF on expiration

Question 11

What do you do for chest infection

Answer 11

Culture sputum / blood - don’t have to do
Sputum culture more if CF / bronchiectasis
If pyrexia = start Ax
CURB 65
As per guidelines - Amoxicillin + doxycycline
CXR

Question 12

If typical history of holiday to Spain / cough / bilateral consolidation

Answer 12

Legionella - atypical

Start clarithromycin

Question 13

What are other typical

Answer 13

S.pneumonia
H.influenza
M.catarrhalis

Question 14

How long should you give for Ax to work

Answer 14

48-72 hours

Question 15

DO you treat UTI on dip alone

Answer 15

NO

Need systemic signs e.g. pyrexia or culture

Question 16

What do you do for urosepsis

Answer 16

Sepsis 6
Renal USS
CT

Question 17

What are most common abdominal infections

Answer 17

Diverticulitis
Gastroenteritis
Appendicitis
Cholangitis

Question 18

Do you treat cholangitis / chest before culture back

Answer 18

YES if pyrexia etc.

Question 19

CLL

Answer 19

Increased WCC
LDH - high cell turnover
Uric acid - kidney need to work to remove cells

Question 20

High urea

Answer 20

Dehydration

GI bleed

Question 21

If low Hb

Answer 21

Haematimic bloods

Possible transfusion if <70 ?

Question 22

When do pressure ulcers develop

Answer 22

Areas of unrelieved pressure 
Unable to change position
Illness
Paralysis
Age

Question 23

Where do ulcers develop

Answer 23

Over bony prominence

Question 24

Who is at risk of pressure ulcer

Answer 24

Malnourished
Incontinence
Lack of mobility
Pain - reduced perception

Question 25

What is used to screen for ulcer

Answer 25

``` Waterlow BMI Nutrition Skin Mobility Continence ```

Question 26

What is grade 1 ulcer

Answer 26

Erythema INtact skin Warm, hard, oedema

Question 27

What is grade 2

Answer 27

Partial skin loss | Epidermis or dermis

Question 28

What is stage 3

Answer 28

Full thickness | Damage / necrosis of subcutaneous tissue

Question 29

What is stage 4

Answer 29

Destruction to muscle or bone

Question 30

How do you treat ulcers

Answer 30

``` Pressure relief every 2 hours Moist wound environment to encourage healing Dressing Tissue viability nurse Surgical debridement if severe Analgesia Dietician ```

Question 31

When do you give Ax

Answer 31

``` CLINICAL SIGNS OF INFECTION Swab is likely to show organisms Fever Discharge Sepsis OM Spreading cellulitis ```

Question 32

Low Na in elderly

Answer 32

Take into context of fluid balance If low Na / high K could also be Addison More likely dehydration

Question 33

What do you want to know about creatinine

Answer 33

Baseline as older people don't have high muscle bulk

Question 34

Do you dip urine in >65

Answer 34

No harm but likely to have asymptomatic bacteria ONLY DIP IF SYMPTOMS Doesn't need to be treated unless symptom Can send for MSSU to see bacteria

Question 35

What can UTI in elderly cause

Answer 35

Very confused Sepsis More likely to fall

Question 36

DNACPR

Answer 36

``` Should be discussed with all admission Shared decision Will it be successful Will become a medial decision Counter sign with senior ```

Question 37

How do you treat steroid myopathy

Answer 37

PT / OT

Question 38

What is inappropriate in elderly

Answer 38

NSAID and zopiclone | Prescribe paracetamol and go up WHO