Geriatrics and Haematology Flashcards
What is vascular dementia?
Dementia arising after minor strokes
symptoms:
-Several months/years of sudden or stepwise deterioration of cognitive function
-Focal neurological abnormalities e.g. visual disturbance, sensory or motor symptoms
-difficulty with attention and concentration
-Seizures
-Memory disturbance
-Gait disturbance
-Speech disturbance
-Emotional disturbance
reduce chance of further strokes
How do you treat pressure ulcers?
-moist wound = Hydrocolloid dressings and hydrogels
-The use of soap should be discouraged to avoid drying the wound
-wound swabs should not be done routinely as the vast majority of pressure ulcers are colonised with bacteria. The decision to use systemic antibiotics should be taken on a clinical basis (e.g. Evidence of surrounding cellulitis)
-consider referral to the tissue viability nurse
-surgical debridement may be beneficial for selected wounds
What would be the treatment for hypochromatic microcytic anaemia and macrocytic Hyperchromatic anaemia?
Hypochromatic microcytic anaemia = iron
Hyperchromatic macrocytic anaemia = B12/folate
As Hodgkin’s lymphoma and non-Hodgkin’s lymphoma present similarly, how would you differentiate them?
Hodgkin’s lymphoma = Reed-Sternberg cells, pain with alcohol and B symptoms are earlier
Non-Hodgkin’s = B symptoms later
What scoring system is used for patients at risk of pressure ulcers?
Waterlow score
What are the symptomatic differences between B12 and folate deficiency?
B12 = pale, glossitis, mouth ulcers, pins and needles (paraesthesia), dementia
Folate = reduced sense of taste, diarrhoea, numbness and tingling in the feet and hands, muscle weakness
What would left lower quadrant pain and low-grade fever in an elderly patient suggest?
diverticulitis
How do you treat a DVT?
Wells score can be calculated
2 or more = high risk of DVT
high risk = ultrasound and then DOACs (apixaban for at least 3 months) unless ultrasound is negative then do a D-dimer—> use low weight heparin instead of DOACs if renal impairment or antiphospholipid syndrome
low risk = D-dimer and if this is positive do a ultrasound
What can taking ‘poppers’ cause and how do you treat it?
can cause Methaemoglobinaemia
Features:
-‘chocolate’ cyanosis
-a typical brownish blue coloration of the skin and mucous membranes and the brown coloured blood
-dyspnoea, anxiety, headache
-severe: acidosis, arrhythmias, seizures, coma
-normal pO2 but decreased oxygen saturation
Management:
-ascorbic acid
-IV methylene blue if acquired
What is myelofibrosis?
Features:
e.g. elderly person with symptoms of anaemia e.g. fatigue (the most common presenting symptom)
massive splenomegaly
hypermetabolic symptoms: weight loss, night sweats etc
Laboratory findings: anaemia
high WBC and PLATELET count early in the disease
‘tear-drop’ poikilocytes on blood film
unobtainable bone marrow biopsy - ‘dry tap’ therefore trephine biopsy needed
high urate and LDH (reflect increased cell turnover)
What level do you offer a platelet transfusion?
platelet count of <30 x 10 9 AND ARE SIGNIFICANTLY BLEEDING
platelet transfusions have the highest risk of bacterial contamination compared to other types of blood product
What is adult immune thrombocytopenia (ITP)?
immune related reduction in platelet
spetechiae
bleeding (epistaxis or gum bleeding)
isolated thrombocytopenia
full blood count
blood film
–> oral prednisolone but no treatment in children
How can you understand iron studies?
causes of macrocytic anaemia = B12 and folate deficiency, alcohol excess
microcytic anaemia = iron deficiency (ID) and anaemia of chronic disease (ACD)
iron studies shows the difference between these two ^
ID = transferrin and TIBC increases
ACD = transferrin and TIBC decreases
What scoring tool is used to assess frailty in the elderly?
PRISMA-7
What is haemochromatosis?
autosomal recessive of iron accumulation (HFE gene)
fatigue
erectile dysfunction
arthralgia (hands mostly)
bronze skin
diabetes
management:
1st line - venesection (monitor transferrin and serum ferritin)
2nd line - desferrioxamine
What is pernicious anaemia?
B12 deficiency
-fatigue
-dyspnoea
-pins and needles
-confusion, memory loss, poor concentration
-mild jaundice: combined with pallor results in a ‘lemon tinge’
‘test for anti intrinsic factor antibodies
** increased risk of gastric cancer**
3 injections per week for 2 weeks followed by 3 monthly treatment of vitamin B12 injections
What are the symptoms of sickle cell and differentials?
What are the investigations and management for sickle-cell anaemia?
Anaemia
Growth restriction
Splenomegaly
Recurrent infections
Jaundice
Rule out: thalassaemia, sepsis, autoimmune haemolytic anaemia
Blood film AND haemoglobin electrophoresis
acute:
pain relief
rehydrate
oxygen
blood transfusion
potential abx
chronic:
hydroxyurea
pneumococcal polysaccharide vaccine every 5 years
What is frontotemporal dementia also known as and expalin it.
A= frontotemporal dementia
B= normal
“Pick’s disease”
-onset usually before 65
-change in personality
-impaired social conduct
atrophy on frontal and temporal lobes
tau protein (silver staining)
no treatment but can use antipsychotics (quetiapine) and antidepressants
**antipsychotics can increase mortality in dementia patients”
What type of cells are seen on blood films of hyposplenism, iron deficiency and myelofibrosis?
Hyposplenism: target cells, Howell-Jolly bodies
Iron deficiency: target cells, ‘pencil’ poikilocytes
Myelofibrosis: ‘tear-drop’ poikilocytes
