Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Geri Midterm
Geriatrics: Midterm
| Term | Definition |
|---|---|
| What is a hallmark of normal aging? | Poorer adaption to external stress than they once had |
| T/F: Elderly have decreased sensitivity to narcotics | False, increased sensitivity |
| T/F: Elderly have a decreased GFR | True |
| T/F: Elderly have increased incidence of thyroid disease? | True |
| Central focus of Geriatric Assessment | Functional abilities |
| What age group is the fastest growing segment of the US population (yes, it is Geriatrics duh, give me a age in years and a subset). What percentage of all health care does this cost? | >65 fastest growing segment in US population and >85 yo fastest subset of population. 1/3 of all health expenditures |
| T/F: May not have pain w/ MIs and will have normal resting pulse and CO that does not increase w/ exercise | True |
| What happens to renal function as we age? | GFR and blood flow decrease, but creatinine may be normal since there is less production |
| What happens to blood sugars as we age? | Normal fasting blood sugar, but inability to handle glucose load |
| T/F: Systolic BP decreases as we age | False, one of the few things that increases (most everything else in the body decreases, atrophies or loses) |
| Other that SBP, what else increases with age (Hint: reproductive system)? | Prostate tissue! |
| 3 other things that increase in the elderly body | 1) lens size of the eye 2) cerumen in the ears 3) Fibrosis of thyroid |
| 4 things we want to look at for the Geriatric Primary Care role: | 1) Clinical assessment 2) Chronic illnesses 3) Geriatric syndromes 4) resources to optimize function and QoL (quality of life) |
| 4 elements of Comprehensive Geriatric Assessment | 1) Physical 2) Psychological 3) Socio-economic 4) Function |
| Why does cognitive impairment and depression go overlooked? | Providers mistake them for being normal signs of aging |
| 3 essential ways to assess function status of elderly? | 1) Ability to walk into exam room 2) Ability to get up and down from being seated 3) Dressing/undressing |
| ADL or IADL required to maintain independent living? What does the other measure? | IADL (Instrumental Activities of Daily Living. ADL measures basic self-care |
| What are a few specific things to enhance communication w/ elderly? (just name a few as there are 9) | Allow time. Avoid distractions. Sit face-to-face with patient. Maintain eye contact. Listen. Speak clearly; loud enough for patient to hear. Provide information systematically. Simplify instructions. Give the patient opportunity to ask questions. |
| T/F: Therapeutic window decreases as toxic response and age increase | True |
| T/F: WBCs will be even higher in an elderly patient with an infection | False, may not be elevated at all w/ infection. Conversely, patient may be septic and ASx. Crazy old people! |
| Abnormal presentation of diabetes in elderly | May not see the classic "polys" (polyuria, polydipsia, polyphagia) |
| Goal of chronic disease mamagement (2) | 1) Prevent catastrophes 2) Palliative care |
| Probably the most important preventable problem for Geriatrics: | Iatrogenesis |
| T/F: Leading causes of death mirror the actual causes of death, which are modifiable | True |
| Give an example of a leading cause of death and its modifiable actual cause of death: | Heart disease from Tobacco use (this is just ONE of many examples) |
| How often is diabetes screening recommended for those over 45 yo? | Every 3 years |
| T/F: Statin therapy is not recommended for those over 70 yo | False, Recommended for those INCLUDING over 70 yo |
| When is abdominal aortic aneurysm screening recommended and for who? | Men 65-75 yo who have EVER smoked |
| What lifestyle preventions are recommended for elderly? (6) | 1) Diet 2) Tobacco 3) Exercise 4) Cognitive Activity 5) Social Activity 6) Napping |
| Which screening test for elderly aren't necessary? BMI, BP, Lipids, Glucose, TSH, Cancer, Depression, Dementia, Cognition, Vision, Hearing | Dementia |
| How often should a high-functioning elderly women over 75 get a mammogram? Over 50? | Every 2 years |
| When do you stop PSAs for men? | >75 yo |
| When can you stop pap smears for women w/ history of normal pap smears and are at low risk? | >70 yo |
| What 3 tests are not routinely recommended for elderly? | 1) Asymptomatic bacteriuria 2) TSH 3) Hemochromatosis |
| When can elderly stop getting colonoscopys? | >85 yo |
| Confusion in an older adult? | Impaired cognitive function |
| Acute disorder associated w/ acute illness, drugs, environment | Delirium |
| Slowly progressive impairment of cognitive function | Dementia |
| Dementia or Delirium? Changing levels | Delirum |
| Dementia or Delirium? Hallucinations | Delirium |
| Dementia or Delirium? No acute illness | Dementia |
| Dementia or Delirium? No change in attention span | Dementia |
| Dementia, depression, renal insufficiency, Hx alcohol abuse, Hx of age, male | Predisposing factors of delirium |
| Medications, immobilization, restraints, dehydration, alcohol withdrawal, pain, emotional stress, sleep deprivation | Precipitating factors of delirium |
| T/F: Can have a high vulnerability with a less noxious insult or a low vulnerability with a noxious insult | True |
| Management process of delirium? | 1) Dx w/ H/P and labs 2) Evaluate potential causes especially life threatening 3) Manage Sx (socialization, reorientation, sleep protocol, haldol for psychosis, benzos for alcohol withdrawal) |
| What is the CAM? | Confusion Assessment Method |
| Gradual progressing course w/ no disturbance of consciousness | Dementia |
| Subjective memory or executive function complaint with objective deficit in one or more cognitive areas and NO functional impairment. Tx? | Mild Cognitive Impairment; No Tx |
| Dementia or Delirium? Difficulty learning/retaining, handling complex tasks, reasoning, spatial ability, language, behavior | Dementia |
| DSM-IV for Dementia | Memory impairment w/ 1 or more of the following Aphasia, Apraxia, Agnosia, Executive functiong |
| Most common cause of dementia, progressive cognitive/behavioral deficits. Sx: memory loss, confusion, impairment. Biggest risk factor? | Alzheimers; age |
| Neuropathology of Alzheimers | amyloid plaques and neurofibrillary tangles |
| Step-wise decline of dementia | Vascular/Multi-Infarct |
| Early decline in social interpersonal conduct and language skills, later to lose memory Sx, early impairment. | Frontotemporal Dementia |
| Fluctuating cognitive Sx, recurrrent hallucinations, syncope, visuospatial/construtional impairment on cognitive testing | Dementia w/ Lewy Bodys |
| Management of Dementia | Optimize function, ID/manage behavior, ongoing care, patient/family education. Therapy, regular appointments, avoid drugs that worsen cognitive function, treat comorbidities |
| Meds for Alzheimer's disease (one for mild to severe and the other for moderate to severe) | Donepezil (cholinesterase inhibitor) (mild to severe) and Memantine (NMDA receptor blocker for moderate to severe) |
| Family Hx, previous Hx, medical illness, memory loss, losses, social isolation, neurotransmission changes | Factors predisposing to depression |
| Depression accounts for 25% of what? What are risk factors for it? | suicides; male, white protestant, divorced/widowed, blue collar, alcoholism |
| SIG E CAPS? What is this for? | Sleep problems, Interest decreased, Guilt, Energy decreased, Concentration difficulties, Appetite disturbances, Psychomotor retardation, Suicidal thoughts; This helps Dx depression in YOUNGER people |
| What distinguishes presentation in older folks? | Somatic complaints (poor health, constipation etc), and impairment of memory/cognitive functions |
| CP, SOB, bowel/bladder issues, HA, memory disturbances, fatigue, weakness, anorexia, wt loss, anxiety, apathy | All physical Sx that can represent depression |
| Anti-hypertensives, narcotics, anti-parkinson meds, cardiac mdes, hypoglycemics, sedatives, anti-psychotics, alcohol, chemo | Meds that can all contribute to depression |
| Malignancy, COPD, CHF, MI, infections, incontinence, dehydration | all illnesses that can be associated with depressive Sx |
| Depressive syndrome w/in 2-3 months of a death? Some differences w/depression | Bereavement; preoccupation w/ worthlessness, prolonged functional impairment |
| CAGE questionnaire | Cut down? Annoy you? Guilty? Eye-opener? |
| SBIRT | Screening, Brief Intervention Referral to Treatment |
| Can cause and present as anxiety or depression | Insomnia |
| Chronic pain, GERD, nocturia, dyspnea | Conditions interfering w/ sleep |
| Best screening for depression? One that is more used? One most used for elders? | Beck Depression Inventory best, Zung Depression Scale shorter, Geriatric Depression Scale most used for elders |
| Management of Depression (4); potential side effects? | CBT or Cognitive Behavior Therapy, medications (SSRIs [hyponatremia, SIADH, HTN), exercise, ECT |
| What is a anti-depressant that helps with urinary incontinence and chronic pain? | Cymbalta (duloxetine) |
| What anti-depressant can cause wt gain? | Mirtazapine (Remeron is trade name) |
| Prevalence of urinary incontinence | 1/3 women and higher in nursing homes, 15% in men |
| coordinated balance between cortex and the spinal cord sympathetic and parasympathetic systems | Structural components of normal micturition |
| YTI/ atrophic vaginitis/urethritis, stool impaction, increased urine production, impaired mobility | All contribute to incontinence |
| DRIP. What is this used for? | Delirium, Restricted mobility, Infection, Polyuria; potentially reversible conditions leading to incontinence |
| Diuretics, TCAs, anti-cholinergics, anti-psychotics, narcotics, alpha blockers, alpha agonists | Meds contributing to incontinence |
| Pelvic floor laxity, associated w/ cough/obesity. Small amounts lost. | Stress incontinence |
| Detrusor hyperactivity=involuntary bladder contractions. Larger volumes | Urge incontinence |
| Anatomic or neurogenic obstruction (like BPH), small amounts of urine. Post-void residual. | Overflow incontinence |
| What is mixed incontinence | elements of urge and stress incontinence |
| Evaluation of incontinence | lab studies, renal ultrasound |
| How do you treat asymptomatic bacteriuria? | Usually don't because screening is not recommended! |
| Main management of incontinence | Modifcations of fluid, caffeine, meds, pelvic muscle exercises, scheduled toileting |
| Tx of stress incontinence | kegals, wt loss, alpha agonists (increase sphincter control) |
| Tx of urge incontinence | kegals, bladder training, bladder relaxants |
| Tx of overflow incontinence | surgical removal of obstruction |
| Meds for BPH | 5-alpha reductase inhibitor (finasteride/Proscar), alpha blockers (tamsulosin/Flomax) |
| Laxative overuse, dementia, stroke, spinal cord disease, colorectal disorders | causes of fecal incontinence |
| immobility, colorectal disorders/tumor, depression, drugs, diabetic autonomic neuropathy | causes of constipation |
| Management of constipation | ID cause, fluid and fiber, probiotics, improved mobility, timing (gastrocolic reflex), meds: milk of magnesia (osmotic cathartics), stool softners, bulk forming agents, enemas |
| Prolonged bed rest, hypovolemia, impaired venous return, post-prandial | causes of hypotension (orthostatic) |
| Throw rugs, frayed carpets, wires, pets | common environmental hazards that contribute to falls |
| 2 huge factors associated w/ falls at nursing home residents | 1) recent admission (new environment) 2) polypharmacy |
| Circumstances surrounding the fall, premonitory or associated Sx, LOC | Hx of falls |
| CATASTROPHE; what is this for? | Caregiver, Alcohol, Treatment, Affect, Syncope, Teetering, Recent illness, Ocular problems, Pain, Hearing, Environmental hazards; for a history after a fall |
| Key aspect of dizziness history | Distinguish between vertigo and lightheadedness |
| sensation of movement/spinning; usually vestibular origin; may be cervical origin | Vertigo |
| unsteadiness or imbalance primarily involving the lower extremities/ trunk; pt may feel that they are about to fall; disorders of proprioceptive system, musculoskeletal weakness, or cerebellar disease | Dysequilibrium |
| feeling of lightheadedness/faintness or the sensation that one is about to pass out; due to hypoperfusion of the brain; cardiovascular causes (including vasovagal disorders) | Presyncope |
| 2% to 8% of older patients with dizziness Triad of recurrent episodic vertigo, tinnitus, and fluctuating sensorineural hearing loss | Meniere's Disease |
| Sudden-onset, episodic vertigo, often associated with N/V, precipitated by changes in the position of the head. Causes: idiopathic, head injury, viral labyrinthitis. Assessment: Dix-Hallpike test Tx: Epley’s manuever. | Benign Paroxysmal Positional Vertigo |
| benign tumor of Cranial N 8; tinnitus, unilateral sensorineural hearing loss, feeling unsteady (CT scan shows) | Acoustic Neuroma |
| may cause dizziness along with diplopia, dysarthria, numbness, weakness (be especially suspicious in pt with DM/vascular risk factors with acute onset dizziness) | TIA/Stroke in vertebrobasilar distribution |
| I HATE FALLING; What is it used for? | Inflammation, Hypotension, Auditory/visual abnormalities, Tremor, Equilibrium, Foot problems, Arrhythmia, Leg length discrepancy, Lack of conditioning, Illness, Nutritional status, Gait disturbance, used to memorize PE for falls |
| Test for gait and falling | Get Up and Go Test |
| Management of elderly patients with instability or falls | Assess and treat injury, treat underlying conditions, prevent falls, provide PT and education, alter the environment |
| Management of dizziness; what should be avoided? | anti-histimines and benzodiazepines (avoid scopolamine, and anti-cholinergic, due to side effects in elderly), diuretics, PT |
| MSK disorders, neuro disorders, CV/Pulmonary disorders | Causes of Immobility |
| Pressure ulcers, MSK contractures, CV deconditioning, psychological | Some complications of immobility |
| Wt loss, PT, strength training, heat/ice, acupuncture, exercise, NSAIDs, joint replacement | management of arthritis |
| Management of bicipital tendonitis, olecranon and trochanteric bursitis | PT, steroid injection |
| T/F: 5-8x increased risk for mortality in first year after hip fracture | True :( |
| Management of Parkinson's Disease | Meds (increasing dopamine level), surgery, exercise/PT |
| Any lesion caused by unrelieved pressure that results in damage to underlying soft tissue when the tissue is compressed between a bony prominence and external surface over a prolonged period of time | Pressure Ulcer |
| Intrinsic (4) and extrinsic (3) RF for pressure sores | I: poor nutritional status, immobility, low body mass, moisture, poor circulation. E: direct pressure, shear force, friction |
| Persistent erythema of intact skin; often over bony prominence; may be red/blue/purple in dark skin (persistent, unblanchable redness | Stage 1 |
| Full-thickness skin ulcer extending through subcutaneous fat. This may extend down to but not through the underlying fascia. May have undermining | Stage 3 |
| Extension of ulcer through deep fascia, so that bone is visible at base of ulcer. Undermining and sinus tracts may be present as well as osteomyelitis. | Stage 4 |
| Partial-thickness skin loss involving epidermis, dermis, or both. Superficial ulcer that presents as an abrasion or blister | Stage 2 |
| ID those at risk, skin care (clean and dry), nutrition, decrease pressure and friction, avoid bedrest and sedation | Prevention of pressure ulcers |
| Tx of pressure ulcers (5) | Cleansing/warm NS or water, dressings, debridement of stage 3 or 4, IV ABX if stage 3 or 4 and infected, pain management |
| ____ in older persons is commonly underdiagnosed and undertreated despite the availability of many assessment tools and effective therapies | Pain |
| First line for pain in elderly | Acetaminophen |
| Neuropathic pain Tx; also how does it feel? | TCAs, anti-convulsants, opioids. Tingling, burning, shocklike pain |
| Chronic pain Tx (4) | TCAs, SSRIs/SNRIs, corticosteroids, anticonvulsants |
| Leading cause of death worldwide, most common cause for hospitalization | Cardiovascular disease |
| 4 physiologic changes that occur with aging with the heart | 1) decreased ability to raise HR 2) slight decrease in CO 3) hypertrophy 4) diastolic dysfunction (impaired filling) |
| T/F: 67% of people >60 yo hypertensive | True! |
| Eval of HTN | BP in both arms, wt, funduscopic exam, abdominal bruit, lab tests (U/A, electrolytes, Ca, TSH, ECG, GFR) |
| T/F: people over 85 should not be treated for HTN | False, Relatively healthy older persons at any age should be treated |
| What should you start with with stage 1 HTN? | Lifestyle modifications!!! |
| Firstline DOC in elderly for HTN? | Low-dose thiazide diuretic |
| Firstline DOC if you needed renal protection, have DM or CHF in HTN | ACEI |
| Choice of drug post-MI in HTN or w/ heart failure, CAD, tachyarrhythmias, or essential tremor. Avoid w/ bradycardia | BBs |
| Low cost, effective in systolic HTN | Thiazide diuretics |
| Angioedema and cough, less effective in AAs, but good for LV systolic dysfucntion and CHF. Can cause hyperkalemia. HTN | ACEI |
| Use if ACEI cough is too much, superior to BBs for HTN and LVH | ARBs |
| Good second line therapy, in addition to thiazide diuretic for HTN | CCBs (calcium channel blockers) |
| Useful in males w/ BPH, but can cause orthostatic/postural hypotension | Alpha blockers |
| Most common type of stroke? | Ischemic! |
| Most fatal type of stroke? | Hemorrhagic! |
| Tx for ischemic stroke, chronic? | tPA w/in 3- 4.5 hours of onset of ischemic. Chronic: control HTN, lipids, glucose, arrhythmias, platelets |
| Principles of Stroke Rehabilitation | Initiation of rehab early is advised. Most neurological return occurs during 1st month while little occurs beyond 3rd month. |
| Acute phase of stroke rehab | avoid complications like pressure sores, contractures, phlebitis, PE, fecal impaction by changing position every 2 hours |
| Later phase of stroke rehab | ADL training, ambulation training, muscle reeducation exercises |
| Coronary Artery Disease (CAD): RF, Tx | HTN major RF; Tx: nitroglycerin, ASA, BBs |
| What procedures associated w/ CAD carry higher risk in elderly? (3) | Interventional therapy, CABG, percutaneous procedures |
| What presenting Sx are different in the elderly w/ a MI? (4) | Confusion/delirium, rapid deterioration of health, dizziness/syncope, anxiety |
| Prevalence of valvular heart disease in elderly? | common, especially >75 yo; Degenerative changes and lipid deposition |
| Fatigue, syncope, CP, SOV, CHF, crescendo-decrescendo systolic murmur radiating to supraclavicular area. Dx? | Aortic stenosis; Dx: Echo |
| Arrhythmias especially blocks, AFib, stroke, CHF, endocarditis, apical holo-systolic murmur radiating to axilla. Dx? | Calcified mitral annulus with mitral regurgitation; Dx: Echo |
| Tx of AFib in elderly including prevention | Prevention: ACEI, ARB, BBs reduce risk. Tx: Cardioversion, anti-coagulation, rate control w/ CCBs or BBs, Digoxin if CHF. |
| Tx of Sick Sinus Syndrome | Medical therapy ineffective; Pacemaker may be required to alleviate Sx, especially if anti-arrythmics are ineffective or intolerable |
| Change in sleep pattern, confusion/delirium, anxiety, fatigue, decreased appetite. Cardiomegaly, S3, basilar crackles, JVD, hepatomegaly BNP > 400pg/mL; Dx? | Presentation of CHF in older adults; Dx: Echo to evaluate ejection fraction |
| Tx of systolic CHF (poor EF) (5) | Diuretics, ACEI/ARB, BBs, Aldosterone blockers, digoxin |
| Tx of diastolic CHF (preserved EF) | focuses on treating HTN and volume status; Diuretics for edema/congestion |
| Intermittent claudication, leg fatigue, difficulty walking, atypical leg pain, decreased pulses, hair loss, palor of color, ulcers; PE? | Peripheral Arterial Disease (PAD); PE: Ankle-Brachial Index (ABI) |
| Tx of PAD/PV(ascular)D | RF modification (smoking cessation, lowering lipids, controlling HTN and DM, exercise etc.), Foot care, Anti-platelet therapy, Revas |
Created by:
crward88
Popular Medical sets