GeriQBank · Topic
Diabetes, thyroid, adrenal, metabolic and reproductive health.
Set 3 or more times
Hormone Replacement Therapy in the Geriatric Patient RECURRING TOPIC HRT / menopausal hormone therapy = oestrogen therapy, with a progestogen added in every woman who still has a uterus to prevent endometrial hyperplasia and carcinoma.…
Set twice
DKA is an acute metabolic emergency defined by the triad of hyperglycaemia, ketosis and metabolic acidosis, caused by absolute or relative insulin deficiency with excess counter-regulatory hormones. In older people DKA is less common…
Insulin analogues are recombinant insulins with altered amino-acid sequence or acylation that change absorption kinetics, producing either faster prandial action or flatter, longer basal profiles. The direction of insulin development…
After age 30, free testosterone falls by about 1% per year; in the European Male Ageing Study total testosterone fell 0.4% and free testosterone 1.3% per year between ages 40 and 79. The fall in free testosterone is steeper because SHBG…
Set once
Definitions. DKA = hyperglycaemia + ketonaemia + metabolic acidosis (classically glucose >250 mg/dL, pH <7.30, HCO₃ <18 mEq/L, ketones positive). HHS = marked hyperglycaemia (usually >600 mg/dL) with raised effective osmolality and…
Definition and causes. Overt hyperthyroidism is characterised by high levels of thyroid hormones with a low TSH. The most common causes in old age are Graves' disease in iodine-sufficient areas and nodular goitre (Plummer's disease or…
Hypothyroidism is deficient thyroid hormone action. In old age the commonest cause is autoimmune (Hashimoto's) thyroiditis, followed by earlier thyroid surgery or radioiodine given for thyrotoxicosis. The three aims of treatment are:…
Definition: an elevated serum TSH with a normal or low-normal free T4. It is a biochemical, not a clinical, diagnosis. Prevalence: 4–10% of the general population, rising to up to 20% in women over 60. Very common because of widespread…
Definition and significance: a discrete lesion within the thyroid, radiologically distinct from surrounding parenchyma. About 95% are benign, but every nodule deserves evaluation because a few harbour malignancy. Epidemiology: palpable…
Hypoglycaemia is a plasma glucose low enough to cause symptoms or harm; the conventional biochemical threshold is <70 mg/dL. Three levels: Level 1 (alert value) <70 mg/dL; Level 2 (clinically significant) <54 mg/dL; Level 3 (severe) —…
Agents: empagliflozin, dapagliflozin, canagliflozin, ertugliflozin, bexagliflozin; also marketed as fixed-dose combinations with metformin and with DPP4 inhibitors. Mechanism: inhibit the sodium–glucose co-transporter 2 in the proximal…
Definition: corrected serum calcium below 8.5 mg/dL (normal range 8.5–10.5 mg/dL). Always correct for albumin or measure ionised calcium — hypoalbuminaemia is very common in the frail elderly and causes pseudo-hypocalcaemia. Corrected…
Definition: benign proliferation of glandular breast tissue in a male, caused by an increased ratio of oestrogen to androgen action on the breast. Must be distinguished from lipomastia (pseudogynaecomastia), which is fat alone with no…
“Andropause” is a misnomer. Unlike the menopause there is no abrupt, universal, inevitable loss of gonadal function in men; testosterone declines gradually and continuously throughout adulthood. The preferred term is late-onset…
Erectile dysfunction (ED) is the persistent inability to attain and maintain an erection satisfactory for sexual intercourse, present for at least 3 months. Prevalence rises steeply with age: about 50% of non-diabetic men over 60, and…
Definitions: hirsutism is excessive growth of terminal (coarse, pigmented) hair in a male pattern in a woman — upper lip, chin, chest, upper abdomen, back and thighs. It must be distinguished from hypertrichosis, which is generalised…
Metformin remains first-line after lifestyle measures in older adults; it lowers glucose without hypoglycaemia, causes modest weight loss, reduces microvascular complications, and reduced cardiovascular events and mortality in obese…
Diabetic foot syndrome is the combination of infection, ulceration or destruction of tissues of the foot associated with neuropathy and/or peripheral artery disease in a person with diabetes. The majority of the elderly diabetic…
Strictly, “andropause” does not exist — unlike the female menopause there is no precipitous, universal loss of gonadal function in men. What occurs is a gradual, variable decline in testosterone with a continuously rising prevalence of…
Non-selective (α1 + α2): phenoxybenzamine (irreversible) and phentolamine (reversible) — used in phaeochromocytoma. Selective α1 (non-subtype-selective): prazosin (short-acting), terazosin, doxazosin (long-acting), alfuzosin…
Asymptomatic bacteriuria (ASB) is significant bacteriuria in the absence of signs or symptoms referable to the urinary tract. Microbiological criteria: in women, ≥10⁵ CFU/mL of the same organism in two consecutive clean-catch voided…
No university frequency data yet
Frame the problem before naming a drug. This man has obesity-driven type 2 diabetes with a very high HbA1c (10%), hypertension, dyslipidaemia and osteoarthritis — a cluster that is essentially the metabolic syndrome with a mechanical…
SGLT2 inhibitors — mechanism. They block the sodium–glucose cotransporter 2 in the proximal tubule, producing glycosuria and natriuresis. The natriuresis restores tubuloglomerular feedback, causing afferent arteriolar constriction and a…
Mechanism. Alpha-glucosidase inhibitors are competitive, reversible inhibitors of the α-glucosidase enzymes of the intestinal brush border — glucoamylase, sucrase, maltase and isomaltase — and acarbose additionally inhibits pancreatic…
Classification by pharmacokinetics. Rapid-acting analogues (lispro, aspart, glulisine) — onset 10–20 min, peak 1–2 h, duration 3–5 h. Ultra-rapid (faster aspart, lispro-aabc) — onset ~5 min. Short-acting regular human insulin — onset…
Definition and grading. Level 1 (alert value) — glucose <70 mg/dL; Level 2 (clinically significant) — <54 mg/dL; Level 3 (severe) — any level associated with cognitive impairment requiring external assistance, with no glucose threshold.…
Definition. Diabetic foot syndrome is ulceration, infection and/or destruction of deep tissues of the foot in a person with diabetes, arising from the interaction of peripheral neuropathy, peripheral arterial disease and repetitive…
Recurring question — asked ×2. Extra scaffolding provided below. Definition and prevalence. Subclinical hypothyroidism is an elevated serum TSH level in the face of normal or normal-low free thyroid hormone values. Overall prevalence is…
follow-up and specific instructions Establish the diagnosis and its cause before prescribing. This is overt primary hypothyroidism — a markedly elevated TSH with low free T4. The most frequent cause of hypothyroidism in old age is…
Definition and importance in old age. Hashimoto's thyroiditis is chronic autoimmune (lymphocytic) thyroiditis — the classic organ-specific autoimmune disease, in which lymphocytic infiltration and antibody-mediated destruction of…
Prevalence and baseline risk. Thyroid nodules occur with increasing frequency in older people and about 95% are benign. Palpable nodules are found in 3–7% of the population, but prevalence rises to about 50% on ultrasound or at autopsy.…
"Andropause" does not exist. Circulating testosterone declines with age, but unlike menopause, men do not suffer a rapid, inevitable loss of gonadal function. After age 30 free testosterone falls at about 1% per year; in the European…