Geriatric Medicine&nbsp;&nbsp;&nbsp;

For elderly patients (i.e. older than 80) with only one documented episode of paroxysmal atrial fibrillation following a stress event (such as acute illness/steroid administration) and a CHADsVASc score greater than 1, how would you counsel them on the risks/benefits of anticoagulation and subsequent monitoring for afib recurrence?

How do you decide between anticoagulation and observation for an incidentally detected subsegmental pulmonary embolism in elderly patients with a history of gastrointestinal bleeding?

What suggestions for environmental modifications do you find most helpful to reduce the risk of falls in the geriatric population?

Are there certain modifications to the home or aid devices that you commonly recommend? Some that are more cost-effective?

How do you counsel patients who are concerned that discontinuation of certain chronic medications may actually perpetuate suffering at the end of life?

Do you ever continue medications such as rate-control agents for tachyarrhythmias, anticoagulation for blood clots, immunosuppression to prevent trans...

Is there any benefit in maintaining statin or aspirin therapy in patients >75 years old with stable, multivessel ischemic heart disease in light of challenges encountered with polypharmacy?

How do you recommend counseling patients on the prognosis of advanced cancer as a generalist who is not highly specialized in cancer literature or cancer-directed therapies?

For patients over 90 years old, is there any foreseeable benefit to undergoing left atrial appendage occlusion over permanent cessation of anticoagulation, particularly for those at high risk for major bleeding?

Is it necessary to prescribe a steroid taper after two weeks of high-dose prednisone (60 mg daily)?

When do you consider using aspirin 81 mg PO BID for VTE prophylaxis over other agents in patients with a fracture, considering recent trial data?

O'Toole et al., PMID 36652352

How do you counsel non-diabetic patients who wish to start metformin to reduce the risk of developing dementia?

What is your approach to a newly diagnosed LBBB in individuals >70 years old who are free of any signs or symptoms of heart disease and without other significant ASCVD risk factors besides age?

If the ECG was obtained prior to major orthopedic surgery (such as hip replacement) would that change your approach?

3 Answers available

Is a target TSH closer to the mid normal range justified in older individuals (age 70 or above) without any known cardiac ischemia or dysrhythmia or osteoporosis?

Is this recommended TSH target of 7 or higher based on the fact that globally iatrogenic hyperthyroidism is common in older individuals on levothyroxi...

How do you approach revascularization in patients over 75 years with NSTEMI, given recent evidence from the SENIOR-RITA trial that an invasive strategy does not significantly reduce cardiovascular events compared to a conservative strategy?

Kunadian, et al., PMID 39225274

Does aspirin dose (81 mg vs 325 mg) matter for secondary stroke prevention?

Should some patients get 325 mg instead of 81mg at least for a certain amount of time, such as patients in the acute phase of ischemic stroke or patie...

Is there any role for 25-OH Vitamin D testing in patients older than 75 years old in the general population?

Demay, et al., PMID 38828931

How do you approach selecting biologic therapy vs non-biologic DMARD (such as methotrexate) as initial therapy in patients with new RA diagnosis with significant erosive disease?

This question is part of a collaboration with RheumMadness and is specifically in reference to: NORD-STAR (Østergaard et al., PMID 3742364...

5 Answers available

How would you approach the work up of SLE in a patient over 80 years old?

How would you work up an elderly female with persistent anemia secondary to warm AIHA requiring almost monthly transfusion, with positive ANA,dsDNA (b...

3 Answers available

Do you typically screen every patient with headaches after the age of 60 with ESR?

What criteria are used to choose a specific dose of aspirin in ischemic stroke?

We have seen 81 vs 162 vs 325 mg up to 1300 mg.

3 Answers available

What duration of dual antiplatelet therapy do you use for secondary prevention of ischemic stroke due to intracranial atherosclerotic disease?

While some have the practice of 90 days per SAMMPRIS trial, the lower rates of ischemic stroke in the medical therapy group were driven by events with...

8 Answers available

Do you recommend performing cognitive testing in the clinic to determine the blood pressure target in patients 80 years or older?

Would you recommend AV fistula placement in a CKD Stage 5 patient who is over the age of 80?

Would you recommend PFO closure in patients >60 years old with presumed paradoxical embolism as their mechanism of stroke?

Do you recommend life long aspirin 81 mg daily for non-specific T2 white matter hyper-intensities on MRI brain?

7 Answers available

How do you manage myasthenia gravis in patients over the age of 90?

What is the best way to treat late onset myasthenia gravis (in this case, age >90)? Would the newer complement inhibitors be safe? Steroids in this...

How do you approach a mildly positive finding on an autoimmune encephalitis panel when there is no other evidence of encephalitis (such as elevated CSF protein, abnormal imaging, or EEG findings)?

For example, a GAD65 Ab of 0.07 when the cut-off is 0.02. Does this answer change if you consider adult vs pediatric populations?

Do you still plan to offer tofacitinib to RA patients over 65 if they have one or more additional CV risk factors?

Given the "LDL Paradox", in which RA patients with the highest levels of inflammation can have ultra-low levels of LDL (<70), how do you approach initiation of statin therapy in these patients?

Dr. Charles-Schoeman presented data at ACR 21 showing that, paradoxically, there is a U-shaped relationship between inflammation and LDL levels in pat...

In patients with thrombocytosis with negative MPN workup from peripheral blood and bone marrow, is there a role for daily 81mg aspirin or other treatment?

What is your approach to checking serum vWF antigen levels in adult patients with CNS vasculitis for monitoring disease activity?

Small study in pediatric PACNS have evaluated this as a potential marker (Cellucci et al., PMID 22740622)