490.2 ๐ ๅ่็๏ผ้ซๅธซๅ่ / PGY OSCE๏ผ
490.2.0.1 ๐ Cram Sheet
490.2.0.1.1 ๐ฅ ้ซ yield 20
- 5Ms framework: Mind, Mobility, Medications, Multicomplexity, Matters most
- Mini-Cog: 3-item recall + clock drawing โ ็ฏฉ cognition
- CAM 4 criteria: acute onset + inattention + (disorganized thinking OR altered LOC)
- Delirium ่็: ๆพๅๅ + non-pharm๏ผ่ฅ็ฉ first-line haloperidol low-dose๏ผ้ฟ BZD๏ผ้ค้ withdrawal๏ผ
- Falls: ่ไบบ 1/3/yr๏ผTUG > 14 sec = risk๏ผmultifactorial ไปๅ ฅ
- Vit D ่ทๅ: 800 IU/d ๅฏ๏ผ้ซๅ้ 60,000 IU monthly ๅ่ โ falls
- Beers PIM ้้ป: 1st-gen antihistamineใanticholinergicใBZDใglyburideใlong-acting PPIใNSAID
- Old DM HbA1c target: < 7.5-8.5%๏ผๅไบบๅ๏ผ๏ผ้ฟ glyburide๏ผ้ฆ้ธ metformin + DPP4i
- Anti-amyloid mAb (lecanemab/donanemab): ARIA-E/H ๅฏไฝ็จ๏ผๆฅ apoE4๏ผbaseline MRI
- Dementia 4 ๅคง: ADใVaDใDLB (parkinsonism + visual hallucination + fluctuating)ใFTD
- PEG tube ไธๆพ in advanced dementia โ ๆน hand feeding
- BPSD ไธ้ฆ้ธ antipsychotic โ boxed warning โ stroke + ๆญปไบก็
- Fried frailty 5 criteria: weight lossใweaknessใexhaustionใslownessใlow activity๏ผโฅ 3 = frail๏ผ
- Sarcopenia ๆฒป็: resistance training + protein 1.2 g/kg + Vit D
- Pressure injury Braden โค 18 = at risk๏ผstaging 1-4 + unstageable + DTPI
- Refeeding syndrome: hypoP/K/Mg + thiamine๏ผslow refeed
- Incontinence DIAPPERS: Delirium, Infection, Atrophy, Pharma, Psych, Excess output, Restricted mobility, Stool
- 3IQ: distinguish urge vs stress
- Subclinical hypothyroid TSH < 10 + โฅ 80 + asymp โ ไธๆฒป็๏ผTRUST trial๏ผ
- Advance care planning: POLSTใDNR๏ผCPR survival < 20% in ่ไบบ hospitalized
490.2.0.1.2 ๐ข ๅฟ ่
ไธญๆๅฐ่ฎ๏ผไปฅไธๆธๅญ OSCE ่ท็ญ่ฉฆๅธธ่๏ผๅฟ ่ใ
| ้ ็ฎ | ๆธๅญ |
|---|---|
| ่ไบบ โฅ 80 ๆญฒ โฅ 3 ๆ ขๆง็ ๆฏไพ | ~ 50% |
| ็คพๅ่ไบบๆฏๅนด่ทๅ | 1/3 |
| LTC ่ไบบๆฏๅนด่ทๅ | 1/2 |
| Hip fx ๅพ 1 ๅนด mortality | 20-25% |
| ไฝ้ข่ไบบ delirium ๆฏไพ | 40% |
| โฅ 85 ๆญฒ dementia ๆฏไพ | 30-40% |
| MCI ่ไบบๆฏไพ๏ผโฅ 70๏ผ | 20% |
| MCI โ dementia ๆฏๅนดๆฏไพ | 15-20% |
| TUG normal | < 10 sec |
| TUG fall risk | > 14 sec |
| Vit D ๅฎๅ จๅ้ | 800 IU/d๏ผ้ฟ้ซๅ้ๅฎๆฌก๏ผ |
| PVR normal | < 100 mL |
| PVR abnormal | > 200 mL |
| Braden ้ซ้ขจ้ช | โค 18 |
| ่ไบบ protein ๅปบ่ญฐ | 1.0-1.2 g/kg/d |
| Frail ่ไบบ protein | 1.2-1.5 g/kg/d |
| Old DM HbA1c target | 7.5-8.5% |
| ่ไบบ polypharmacy threshold | โฅ 5 ็จฎ |
| Hospitalized old CPR survival | < 20% |
| Hospice life expectancy | โค 6 mo |
| Fried frailty diagnosis | โฅ 3/5 |
| โฅ 65 OAB ๆฏไพ | ~ 40% |
| Postpartum thyroiditis with elder n/a | - |
490.2.0.2 โญ ้ซ yield
490.2.0.2.1 5Ms Framework ่กจๆ ผ
| M | ๅ งๅฎน | ่ฉไผฐๅทฅๅ ท |
|---|---|---|
| Mind | Dementia, delirium, depression | Mini-Cog, MoCA, CAM, PHQ-9, GDS-15 |
| Mobility | Gait, balance, falls, sarcopenia | TUG, SPPB, grip strength |
| Medications | Polypharmacy, PIM, deprescribing | Beers criteria, STOPP, medication review |
| Multicomplexity | Multimorbidity, frailty, function | Fried, Frailty Index, CFS, ADL/IADL |
| Matters most | Goals of care, ACP | POLST, healthcare proxy |
490.2.0.2.2 CAM Algorithm
| Feature | Description |
|---|---|
| 1. Acute onset + fluctuating | ๅฟ ่ฆ |
| 2. Inattention | ๅฟ ่ฆ |
| 3. Disorganized thinking | (3) OR (4) |
| 4. Altered LOC | (3) OR (4) |
| CAM positive | (1) + (2) + [(3) or (4)] |
490.2.0.2.3 Delirium vs Dementia
| Delirium | Dementia | |
|---|---|---|
| Onset | Acute (hr-day) | Insidious (mo-yr) |
| Course | Fluctuating | Progressive |
| Attention | Impaired | Usually intact (early) |
| LOC | Altered | Normal |
| Reversibility | Usually | Usually no |
490.2.0.2.4 Beers PIM ้่จ่กจ
| ้กๅฅ | ็ฏไพ | ็บไฝ้ฟๅ |
|---|---|---|
| 1st-gen antihistamine | Diphenhydramine | Anticholinergic |
| BZD | Diazepam, alprazolam | Falls, cognition |
| Z-drugs | Zolpidem | Falls, parasomnia |
| Long-acting SU | Glyburide | Severe hypoglycemia |
| TCA | Amitriptyline | Anticholinergic |
| Anticholinergic OAB | Oxybutynin | Cognition |
| Long-term PPI | Omeprazole > 8 wk | Pneumonia, osteo, dementia |
| Chronic NSAID | Ibuprofen | GI bleed, CKD, HF |
| Skeletal muscle relaxant | Cyclobenzaprine | Anticholinergic |
| Antipsychotic in dementia | Haloperidol, risperidone | โ stroke, mortality |
| ฮฑ-blocker for HTN | Doxazosin | Postural hypotension |
490.2.0.2.5 Fall Multifactorial Causes
| Domain | Examples |
|---|---|
| CV | Arrhythmia, AS, postural hypotension, HTN over-tx |
| Neuro | Parkinsonโs, NPH, vision, vestibular |
| MSK | Foot disorder, sarcopenia, OA |
| Drug | Sedative, opioid, anticholinergic, antihypertensive |
| Metabolic | Vit D โ, hypoglycemia, hyponatremia |
| Environment | Loose rugs, poor light |
490.2.0.2.6 Fried Frailty 5 Criteria
| Criterion | Definition |
|---|---|
| Weight loss | โฅ 10 lb or 5% in 1 yr (unintentional) |
| Exhaustion | Self-report |
| Weakness | Grip strength โ (M < 26 kg, F < 18 kg) |
| Slowness | Gait speed < 0.8 m/s |
| Low activity | kcal/wk โ |
โฅ 3 = frail๏ผ1-2 = pre-frail๏ผ0 = robust
490.2.0.2.7 Pressure Injury Staging
| Stage | Description |
|---|---|
| 1 | Intact skin + non-blanchable erythema |
| 2 | Partial-thickness + dermis exposed |
| 3 | Full-thickness + SC fat visible |
| 4 | Full-thickness + muscle/bone/tendon |
| Unstageable | Slough/eschar covers |
| DTPI | Persistent non-blanchable deep red/purple |
490.2.0.2.8 Incontinence Types
| Type | Mechanism | Tx |
|---|---|---|
| Urge / OAB | Detrusor overactivity | Bladder training, ฮฒ3-agonist (mirabegron), antimuscarinic (ๆ ็จ elderly) |
| Stress | Sphincter weakness | Kegel, topical estrogen, sling |
| Overflow | Outlet obstruction / detrusor underactivity | ฮฑ-blocker, 5-ARI, cath |
| Functional | Cognition / mobility | Prompted voiding, environment |
| Mixed | ๅค็จฎ | ๆฒป็ไธปๅฐ็็ |
490.2.0.2.9 DIAPPERS๏ผreversible causes๏ผ
- Delirium
- Infection (symptomatic UTI)
- Atrophic vaginitis
- Pharmaceutical
- Psychological
- Excess output (hyperglycemia, hypercalcemia, CHF)
- Restricted mobility
- Stool impaction
490.2.0.2.10 ่ไบบ DM ๆฒป็ Quick
| Drug | Geriatric ๆณจๆ |
|---|---|
| Metformin | ้ฆ้ธ๏ผeGFR โฅ 30 ๅฎๅ จ |
| DPP4i | Low hypo๏ผ็ก CV harm๏ผ่ฒป็จ |
| SGLT2i | CV + renal benefit๏ผcaveat: volume depletionใGU infection |
| GLP-1 | Weight loss๏ผcachexia ๆ ๏ผ๏ผN/V๏ผinjection skills |
| SU | ้ฟ glyburide๏ผshorter-acting (glipizide) ๅฏ |
| Insulin | Once-daily basal ่ผไฝณ๏ผ้ฟ sliding-scale long-term |
| Pioglitazone | ่ไบบๆ ็จ๏ผHFใfallใ้ชจๆ๏ผ |
490.2.0.3 ๐ฏ ่ชๆๆชขๆธฌ
- 5Ms? โ Mind, Mobility, Medications, Multicomplexity, Matters most
- CAM 4 criteria? โ Acute onset + inattention + (disorganized thinking OR altered LOC)
- Delirium ไธ็จไป้บผ่ฅ? โ BZD๏ผ้ค withdrawal๏ผ
- ่ไบบ DM HbA1c target? โ 7.5-8.5% ๅไบบๅ
- ่ไบบๆ่ฉฒ้ฟๅชๅ SU? โ Glyburide
- TUG ็ฐๅธธ? โ > 14 sec
- Vit D ่ทๅ้ซๅ้็ตๆ? โ โ falls๏ผ60,000 IU monthly๏ผ
- Fried frailty 5 ้ ? โ Weight lossใweaknessใexhaustionใslownessใlow activity
- Frailty diagnosis? โ โฅ 3/5
- Mini-Cog ๅ งๅฎน? โ 3-item recall + clock drawing
- Dementia 4 ๅคง? โ ADใVaDใDLBใFTD
- DLB ็นๅพต 3? โ Early parkinsonism + visual hallucination + fluctuating cognition
- Anti-amyloid mAb ๅฏไฝ็จ? โ ARIA-E/H
- BPSD ไธ้ฆ้ธ? โ Antipsychotic๏ผboxed warning๏ผ
- PEG in advanced dementia? โ ไธๆพ๏ผๆน hand feeding
- Subclinical hypothyroid TSH 9 + 85 ๆญฒ + asymp? โ ไธๆฒป
- Beers ๅผท anticholinergic 3? โ DiphenhydramineใoxybutyninใTCA
- PVR abnormal? โ > 200 mL
- Braden ้ซ้ขจ้ช? โ โค 18
- CPR survival hospitalized ่ไบบ? โ < 20%
โ ๏ธ AI ่็จฟใ