Dr Brown GERIATRICS q9
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- What pre-renal cause causes acute renal failure?
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DehydrationàVolume depletion (#1 cause)
Hypotension
CHF
Renal artery stenosis (atherosclerotic D) - What renal cause causes acute renal failure?
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Glomerulonephritis
Tubular necrosis (nsaid,aBs)
Contrast media injections
Thrombo-embolic activity - What Post-renal cause causes acute renal failure?
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Enlarged prostate
Pelvic Tumor blocking ureters
Renal stone in ureter
Renal calculi in pelvis - UTI presents MC as what?
- UVeitis/cystitis>pylonephritis
- UTI presentation:
-
MC no symptoms
Frequency
Urgency
Dysuria (pain on voiding)
± Hematuria
fever, nausea, vomiting - common symptom of bladder cancer?
-
Gross hematuria (painless)
Clot can form due to Hematuria
This can lead to obstruction of Bladder
± Pyuria (may be painless) - Urinary incontinence in a female?
-
multiparous (multiple births) = weak pelvic floor
decrease in estrogen
G – B9PH
UTI
Dec. mobility
Drugs (> 40 YO) - Cause of fecal impaction?
-
Neuro
Dec motility/mobility
poor diet/nutrition
Dec Fluid intake - dental carries are more or less painful in the geriatric?
- Less painful
- cause an unpleasant taste in the mouth?
-
Oral mucosa DZ
Chronic Renal Failure(metallic taste) - Oral mucosa DZ causes:
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Candidiasis albicans
aka oral thrush
MC from ill fitting dentures - S/Sx Oral mucosa DZ:
-
asymptomatic
Bad taste in mouth as a side effect of drugs
Burning
Aphthous ulcers – white ulcerations w/red base (found on cheek, floor, lips)
Canker sore – stress, new toothbrush
toothbrush trauma
Herpetic ulcers (Type I) – painful
stress
too acidic - MC cause of xerostomia?
-
drying around the mouth
a side effect of medications - What dental treatments follow an MI?
- no proof that there should not be dental treatments following an MI
- most common cause of progressive dysphagia?
-
esophageal cancer MC
aortic aneurysm
stroke
myasthinia gravis - esophaqeal Ca Sites
-
M/c cause obstruction & prog dysphagia
site 1 phary-esoph jxn
site2 L-main bronchus
crosses the esophagus
3rd site distal end
60% occlusion before symptoms - hat are the causes of acute gastritis?
-
NSAID use - MC
Alcohol
Overwhelming stress - Where is the pain with peptic ulcer disease?
-
poorly localized
L-sided abd pain
lower chest (thoracic) - result of malabsorption in a case such as celiac’s disease?
-
Weight loss
Steatorrhea
Diarrhea
Anemia
Osteoporosis/Osteopenia/Osteopmalacia
Vitamin loss - Occult blood tests to detect colorectal cancer should be done how often?
-
sigmoidoscopy every 2-3 years
Guiac at least once a year
Vitamin C = false positive - periodic episodes of constipation
-
Lack of motility & mobility (movement essential)
Dietary (poor diet/nutrition)
Fluid intake (Dehydration) - fecal impaction – leading to megacolon
-
Anal sphincter muscle – loss of control (80% is the internal and 20% external sphincter)
Rectal wall compliance – can it be stretched
The Anorectal angle – the muscle that wraps around the anus and forms an angle
Anorectal sensations
diabetes M and stroke inc risk - 16. What kind of GI Tract indications is suggested by a patient with unexplained psychological complaints such as depression?
- pancreatic cancer
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RISK FACTORS
of pancreatic ca? -
Smoking
Fat diets for a long time
EtOH
Exposure to volatile hydrocarbons - SSX OF PANC CANCER
-
Unexplained psychiatric complaints – over 75% of elderly have unexplained anxiety or depression
Weight loss
Anorexia
Upper abdominal pains
Steatorrhea
Jaundice - Male feminization is due to?
-
Cirrhosis of the liver
estrogen is usually detoxified by the liver, anything that may cause severe liver damage (i.e. severe hepatitis) - Dryness from decreased sebaceous activity is found where?
-
Xerosis (dry skin from cebum)
Excessive washing, detergents
Location = lower legs, forearms, hands, ano-genital region
Fine scaling of skin, fissures
skin is mildly inflamed
Lower leg = varicose veins (stasis deramtitis) - danger of an actinic keratosis?
-
aka Solar Keratosis
developing into Squamous Cell Carcinoma
thickens hardens - 20. Where do decubitus ulcers present?
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Heels
Greater Trochanter
Sacrum
Scapulae
Kyphotic spine (T-spine if you weren’t sure) aka dorsal spine
Elbows - Predisposition to decubitus ulcers caused by:
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Immobility
Underlying fat
Sensory loss
Poor nutrition
atherosclerosis - findings of decubitus ulcers
-
Loss of sensory input
Dec Circulation (may be hypotensive as well)
Dec Nutritional status (¯ healing)
Deep ulcerations may form – possible DVT form - Psoriasis Vulgaris
-
has white scales with an erythematous base found on the anterior thorax
Redness that is well demarcated
Silvery white scales are superimposed on them
spreads with scratching - distrib of psoriasis vulgaris
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Scalp
Extensor surface of elbow & knee
Anterior trunk
Pre-sacral area into inter-gluteal fold
Palms & soles - #1 cause of uti
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Urinary Stasis
80% of Benign Prostate Hypertrophy - What do you do for benign prostatic hypertrophy?
- Proscar Drug, balloonoplasty, TURP
- proscar drug for prostatic hyertrophy
-
Blocks conversion of Testosterone to Dihydrotestosterone
1 year to reach max gland reduction
PRO – decreases size of Prostate by 30%
CON – 50% of the time, it reduces the PSA level - Stages of prostate CA
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A Carcinoma In Situ (Foci of Cancer) = feels normal
B (Foci Grows) islets get larger form bump on prostate, intracapsular
C (Tumor Enlarged) MC found here (extracapsular)pelvis film
D (Tumor has taken over the gland) - What causes a “pear shape†of the geriatric patient’s trunk?
-
Narrow shoulders
Pelvis widens
Inc. Chest AP diameter - progressive skeletal changes
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Females 43%, Males 27% bone loss by age 80
dec disc/vb ht, cart grows - bone absorption begins to exceed bone formation, about what age does that occur at?
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0-14 – osteoblastic
14-25 – =
25+ – osteoclastic - 28. Where does most muscle wasting occurs?
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Hands – interosseous spaces bc thin and bony
Arms / legs – thin & flabby
Optimal chng = seen in older Asian females - causes the restless leg syndrome?
-
MC to AVOID discomfort
Diabetic Hypoglycemia
Hypocalcemia
Diabetic Neuropathy
Hyperventilation/Respiratory Alkalosis - symptoms of a burning tongue?
-
Giant Cell Arteritis – burning tongue
albicans/oral thrush-whole moulth - pseudogout mc where?
-
knee
iv. Concurrent DZ
Gouty arthritis
Wilson’s DZ
Hyperthyroidism
Hemochromatosis (accumulated dietary Fe)Normal serum uric acid
Do not respond to colchisine therapy
Joint aspiration for crystals = (+) biofringent (under Polarizing microscope) - 35. Which can develop into a beta cell lymphoma?
- Sjögrenson’s Syndrome
- Nail incurvation?
-
onycho/crypt/osis (ingrwn nail
Dorsal Exostosis
Hooked nail corner - Sullivan’s sign?
-
X-ray shows splaying of proximal phalanges (if Neuroma is large enough)
mortons neuroma