Geriatrics Study Harder

Multi infract dementia

acute stepwise decrease in neuro function, multiple focal deficits on exam, htn, and old infarcts in CT

Parkinson

· Know the Triad: tremor, dyskinesia, rigidity

· Which medications will improve their sx: carbidopa, levodopa

· Seborrheic dermatitis

Woman with vertebral crush fx secondary to osteoporosi

· calcitonin

RA-

symmetric inflammatory arthritis, worse in am mcp-boutineres pip- swan neck and ulnar deviation Thyroid disease DM

PTH

secreted in response to low serum calcium. Induces osteoclasts to resorb bone and increase plasma calcium. Induces kidneys to increase conversion of 25 oh to 1,25 oh vit d. decreases phosphate reabsorption. And increase distal tubule calcium reabsorption in net increase for plasma calcium.

Hyperparathyroidism

hypercalcemia and osteopenia. Low phosphate. Due to an adenoma, bones moan stones trx-surgical resection and put in the arm for production of pth

Hypoparathroidsm

mcc is due to surgerical removal. p/e- tingling in lips, dry skin, weakness, abd pain, tetany, dyspnea, seizures

Chvostek sign

tapping of facial nerve causes spasm

Trousseau sign

- blood pressure cuff causes spasm of carpal. Trx: ca and vit d supplements

) BPH Obstructive uropathies

Obstructive uropathy occurs when urine cannot drain through a ureter (a tube that carries urine from the kidneys to the bladder). Urine backs up into the kidney and causes it to become swolle

Know signs and symptoms of BPH (dribbling). All are signs of BPH except

relaxed urinary meatus

BPH affects

transistional zone/ prostate cancer affects peripheral zone

) Renal ca

clear casts

Digitals toxicity

yellow colored vision, svt with av block.

PVD peripheral vascular disease

intermittent claudication, rest pain, ulceration, gangrene, reduced pulses, wet gangrene with infection. Dry gangrene w/o infection.

Glaucoma

major cause of blindness in the elderly

Open angle glaucoma

gradual b/l increase of iop. Gradual loss of vision from peripheral to central. no pain or corneal edema., increase in size of optic cup. Tx: b-blockers and adrenergic agonist

Closed angle glaucoma

acute increase in iop, SEVERE eye pain, halos, eye is inflamed hard and non reactive pupil. Tx: acetazolamide and pilocarpine after pressure is lowered.

Acute glaucoma

· - red painful eye, dilated pupil and dilated conjunctiva vessel

Cataract

clouding of lens leading to progressive vision loss. Decreased red reflex.

) Retinopathy

vascular occlusion ischemia w or w.o neovascularization leading to visual changes ass. With micro aneurysms.

non proliferative diabetic retinopathy

Flame hemorrhages, microaneurysms, cotton wool spots on retina

Neovascularization

proliferative diabetic retinopathy

BPV

sudden episodic vertigo NO HEARING LOSS with head movement lasting for secs.... Tx: aply maneuver

Pt with lesion on lip that is crusting or in the sun exposed area

squamous cell carcinoma

Indication for mammography

50-74 every 2 years

Pt who sounds like classic hypothyroidism but lab values show (low t3/t4 and low TSH)

hypopituitarism not hypothyroid

Pt comes with back pain that radiates down his leg bilaterally which spinal roots involved?

· L5-S1

TIA

No thrombolystics for TIA give the pt aspirin or anticoagulants/antiplatelet

What won't do for delirious patient

· don't get confused by administering Haldol in the elderly ( it is safe in .251g dosage in the elderly)....answer was placing a demented pt in the room with another demented pt

) Pt comes with a 75% right carotid artery occlusion what you won't do?

· Refer to neurologist

A patient comes with syncope and bradycardia, which of the following is a cause?

Timolol

) microcytic anemic iron deficiency patient who has had constipation for 6months NEXT STEP?

colonoscopy

iron deficiency (microcytic anemia

colon cancer until proven otherwise in the elderly

B12 deficiency (macrocytic anemia) in the elderly What test?

· Schilling test tests for B12 def

) What is the MC preoperational modality used in the elderly

EKG

Pt stable post surgery with a new Xray that shows a tracheal shift

atelectasis

Pt has mild stable angina and goes in for elective turp procedure.....should you do any extra testing (stress test, TTE, Cath)

answer was None of the above

Vision loss that comes and goes over a month and pt present with permanent vision loss in last 4 hours that is described as Curtain coming down ?

central artery occlusion

MC brain bleed caused by head trauma in the elderly

Subdural hematoma

) Definitive dx of Alzheimer's pt

it is a diagnosis of exclusion but you need sx and plaques and tangles on biopsy (they're dead when you do this). Age is biggest RF

Pt presents with stroke SX and CT negative, what is the least invasive procedure (pt has repeated TIA)

carotid US

Pt has a stroke which drug would you give

(antiplatelet)aspirin , clopidogrel, within 3 hours of stroke give thrombolytic if no CI Alteplase

Orthostatic Hypotension

Pt with SBP going from 165 to 145 with standing

LHF

bibasilar crackles, S3 (systolic) S4 (diastolic) gallop

Carpal tunnel syndrome

median nerve

pyelonephritis

N/V, fever, flank pain, dysuria

UGI bleed

peptic ulcer

CP relieved by leaning forward or sitting up

pericarditis

MCC of stroke

HTN

) leading cause of liver cirrhosis

alcohol

Pain of lower back radiating to B/L buttocks and proximal leg. Pain worse with extension (walking, standing upright)

lumbar stenosis

) physiological signs of aging

ALL serum chemistries remain the same

Pt presents with urine dribbling during exercise

stress incontinence

Thickened plaque overlying the flexor tendon of the ring finger and possibly the little finger at the distal palmar crease

Duputyen's contracture

Woman who can make it to the bathroom but all labs are normal (she has urge incontinence

antimuscarinics/anticholinergics, tolterodine, OXYBUTYIN, mirabegron

Colon CA

CEA

Dementia pt keeps wandering

redirect them

benzos are associated with

cognitive decline

hyponatremia is caused b

diuretics

Pt comes to hospital with signs of shock (pale skin, lethargic

compromised circulation

Macular degeneration

deficits in central vision

Drusen bodies tx

dry- zinc , vit c &e

Wet macular degeneration

new abnormal vessels-intravitreal VEGF Bevacizumab

Pt with edema

will have decreased pulses

) What do you do for a terminal pt?

pain management

. Pt who is suicidal

......psych consult and hospitalization

. Pt who just had surgery and is AMS

vascular dementia

Side effect of long term psychotic

tardive dyskinesia

Side effect of fosamax (biphosphonate

esophageal strictures

What can cause false positive on occult blood

Turnips

. Turners sign/Cullens sign

Flank/umbilical

Most common type of stroke

Ischemic: thrombotic

BPH SX

TURP

. Risks factors for hip fractures

age, women, decreased bone density, osteoporosis, alcohol- obesity is not a RF for hip fracture

. Diagnosis of MS

Gad enhanced MRI

. Female with painless hematuria but normal exam

cystoscopy and biopsy

. Female with low bone density

give Fosamax bisphosphonate

Pt trouble sleeping

Trazadone

Know glaucoma....fixed and mid dilated are in the question

Glaucoma

. Know signs and symptoms of depression

SIGECAPS

what metabolic problem you see in a patient with anorexia nervosa/bullima nervosa

Metabolic alkalosis, hypokalemia , hypochloremic, inc BUN

Stroke effects

contralat side

. herpes simplex infxn is in inflammation of

dorsal root ganglia

pt on a couple of months of antipsychotic drug therapy, what would be the next appropriate therapy for the pt?

psychotherapy

Multiple Myeloma Protein

Bence Jones

68 y/o LLQ pain dx?

diverticulitis

. Diverticulitis presentation dx

CT

Tia presentation?

Amarosas fugax

.all are ssx of hypothyroidism except?

bowel changes

lady given ace and furosemide now complains of fatigue, muscle pain what you give

potassium

elderly pt with prostatis and epididymitis mc etiology

E. Coli

. When is power of attorney effective?

When pt cant say his wishes

conjugated bilirubin, alp x 3, normal AST/ALT next step ?

US - this is a biliary obstruction case, cholestasis - they get sono

. Elderly pt walking in backyard what's in differential

All of the above

. Glaucoma would have what

Peripheral vision loss

. Mc site of colon cancer

sigmoid

screening for prostate CA

PSA blood test

Guideline for colon cancer screening?

At 50 every 2 years

cognitive decline caused by?

benzos (alprazolam, lorzepam, diazepam, clonzepam)