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WVSOM -- Geriatrics

Quiz yourself by thinking what should be in each of the black spaces below before clicking on it to display the answer.
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Question
Answer
show age 55 and up even though literature and medicare says it is 65 and up  
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show age 62 for reduced benefits; 65 for full benefits  
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show loss of physical endurance, memory, earn income, care for themselves, independence, support group, and the need to find a new source of support  
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show team approach  
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What are the four types of social agencies able to assist the elderly?   show
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What is Medicare Part a?   show
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show outpatient care and all physicisan charges (80%)  
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show portion of outpatient medication costs  
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show loss of independence  
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What are the 5 ADLs?   show
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What happens with the individual cannot financially support themselves?   show
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who is responsible for the 20% medicare part B doesn't cover?   show
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show clincal studies of mature adults and aging.  
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What is senescence   show
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What are the three senescence variations?   show
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What is gradual senescence ?   show
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What is cellular senescence   show
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show p53 transcriptace  
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What is the price we pay for protection against tumors?   show
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show preventative measures  
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What is the goal of proper prevention?   show
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show accumulation of random damage (random error). free radical damage; lack of dna repairs; somatic mutations from radiation; glycosylation of protiens  
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show holds that degeneration of the hypothalamic-pituitar-endocrine axis is central to aging as evidenced by hormonal control.  
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what is immunologic theory of aging?   show
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show progeria of childhood. median age 12. AMI/CHF major cause of death. due to single base change in DNA sequence of LMNA gene on chromosome 1.  
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show progeria of adulthood; median age mid-forties; autosomal recessive trait; gene on chromosome 8 affecting DNA unwinding  
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show cornea;angerior chamber; iris forming the pupil; lens; vitreous gel; retina  
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show caused by lipid depositis in teh deep layer of the peripheral cornea. NO clincial significatnce with vision  
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show opacification of the lens of the eye  
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show cataract  
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show cataracts  
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What symptoms are seen with cataracts?   show
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show will appear as a cloudy lens; usually bilateral; difficult to viualize the retinal structures  
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show far-sighted  
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what is myopic   show
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show increasing stiffness of lens with age  
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what is the result of presbyopia?   show
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What are some eye problems that are non-aging associated?   show
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what is presbycusis?   show
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What is meniere's disease?   show
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What do teleomeres have to do with aging?   show
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Why do elderly loose height?   show
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show decreases  
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show involves the subcutaneous tissue  
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What happens with skeletal senescence?   show
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show decreaed cartilage hydration; reduced condrocytes and proteoglycan get smaller in size  
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show decrease muscle mass and strength;  
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show exercise  
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show nonblanchable eyrhtema of intact skin  
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show superficial ulcer, abrasion, blister or shallow crater  
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what is stage III pressure sore?   show
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Waht is stage IV pressure sore   show
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show thinking of epidermis and dermis; atrophy of subcutaneous adipose tissue; decreased fascularity; decreaed oil and sweat production  
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What does aging of the skin result in?   show
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show NO  
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show limited ability to climb stairs, rise form chair; increase risk of falling; heat and cold intolerance  
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show decreased brain weight, cortical cell count; neuronal loss; declinging neurotransmitter prodction; loss of synaptic receptors  
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What happens in autonomic aging?   show
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What happens in central, motoar and senesory nervous system aging?   show
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show myocytes decrease and remaining myocytes hypertrophy. sclerosis and calcifications of the heart valves  
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How many myocytes has a 70 y/o male lost?   show
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show irregularities in size and shape of endothelial cells; fragmetnaion of elastin; increased lumen diamater, length adn wall thickness; collegen increase; decreased basal and stimulated NO production; increase in pulse pressure  
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show resting HTN; orthostatic hypotension; blunted heart rate response to stress; S4; sclerotic murmurs  
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what are aortic stenosis?   show
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What does calcific aoritc stenosis result in ?   show
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What happens with lung aging?   show
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show less exercise capacity; higher susceptibility to pulmonary diseases; higher incidence of respiratory tract infections; use of cough reflex due to decrease ciliary action  
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show reduction of post-prandial unger; decreased saliva; delinging dental health; decreased chewing str; decreased olfaction;  
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What GI physiology does not change?   show
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What declines in the absorption secretion functions of the GI?   show
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What absorption stays stable in teh GI?   show
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show result of pathological changes secondary to disease  
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What changes in renal function?   show
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How does tubular function decline impact geriatric patients?   show
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Progressive renal decline results in ?   show
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What are the 7 steps to pharmacology therapy selection?   show
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What is the plan for medication (6)   show
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What happens in the follow up meeting for medicine?   show
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show personal knowledge; reference; avoid allergies, contraindications, adverse outcomes; review previous therapy success; consider cost/compliance  
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What are abosprtion considerations when perscribing a medication?   show
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What are some acidic drugs that may be absorbed slower?   show
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show [(140-age)(kg)(.85 IF FEMALE)] / [72 x serum Cr]  
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show increased concentrations if no dose adjustement; ex: EtOH and digoxin  
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What will distribution of lipohilic drugs be like in geriatrics?   show
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What is distribution like for protein bound drugs?   show
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How does metabolism in geriatrics affect pharmachology?   show
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What are 2 drugs unaffected by metabolism adn age   show
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How is excretion measured?   show
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What are risk factors for adverse drug reactions?   show
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show benzos, barbituates, analgesics, muscle releaxants, antiemetics, anithistamines, antidepressents, antispasmotics, cardiovascular  
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What benzo should be avoided?   show
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show phenobarbital  
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what analgesics should be avoided?   show
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what muscle relaxants should be avoided?   show
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show metoclopramide (reglan)  
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show first generation like diphenhydramine  
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show amitriptyline (eleavil)  
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what antispasmotics shoudl be avoided?   show
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What cardiovascular drugs should be avoided?   show
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show beta blockers  
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what drugs should be avoided in COPD patients?   show
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show beta blockers  
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show NSAID, ASA, corticosteroids  
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what drugs should be avoided with clotting disorders?   show
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show anticholinergics, muscle relaxants  
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What drugs should be avoided with constipation?   show
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show TCA  
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What drugs should be avoided with insomnia?   show
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show anticholinergics, antihistamines, TCA  
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What should be avoided with osteoporosis?   show
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show needs to be decreased  
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the average patietn over 65 will fil how many prescriptions per year?   show
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what is optimal pharmocotherapy?   show
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What are some major cardiovascualr diseases seen in elderly?   show
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What diseases occur with coronary atherosclerosis?   show
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What diseases occur with cerebral atherosclerosis?   show
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What deficits are seen with cerebral atherosclerosis?   show
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What are the diseases that occur with peripheral vascular disease?   show
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show exertional ischemic pain; reduced endurance; sudden death  
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show brown discoloration; leathery skin; cellulitis; dependant edema; DVT  
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show A-Fib; complete heart block; PVC; tachy brady syndrome (sick sinus); sinus bradycardia  
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what is treatment of bradycardia?   show
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show influenza and pneumonia  
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show systolic HTN  
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What does impaired ventricular filling result in?   show
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What does impaired cardiac output with stress result in?   show
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show predisposes to arrhythmias  
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show prostate, lung and colon  
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show breast, lung, uterine  
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show 400,000  
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show 100,000  
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show thromobit and embolic  
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show blood clot; cerebral arteries  
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show fatty deposit; found in common carotid  
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what is hemorrhagic stroke?   show
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what is most common DM in geriatrics?   show
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show rare due to prsence of at least a small amount of insulin  
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show happens do to dehydraion in Type II diabetics with a chornic BS of 500-100.  
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show control BP; control lipids; keep HgbA1c < 7.0; smoking cessation  
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show PVD; nuropathy; retinopahty, macrualr degenration, cataracts; nephropathy  
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How is a patient treated when focusing on quality of life?   show
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What usually precedes end-of-life?   show
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show heart disease; cancer; stroke  
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show impairment of memory plus one of the following: aphasia; apraxia; agnosia  
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What is the differential diagnosis for Alzheimer's?   show
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What physiological impairments contribute to AD?   show
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What is used in Alzheimer treatment?   show
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show tacrine; donepezil  
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show memantine  
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What are the features of vascular dementia?   show
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how do you treat vascular dementia?   show
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show dementia with lewy bodies first then parkinsonian tremors second  
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How is demential with lewy body treated?   show
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show dementia criteria PLUS at least tow of the following: cognitive fluctuations; fvisual hallucinations; parkinsonism  
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show cholinsteratse inhibitors; treat motor parkinsonism symptoms same as for conventinal parkinsons disease  
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What are the clincal features of frontotemporal dementia?   show
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show delirium  
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How is delirium diagnosed?   show
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show mini mental status exam? series of questions, writings and a diagram drawing which can be easily scored with a maximum of 30 points  
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show 26-30  
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what is mild deficit in mini mental exam?   show
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show 10-19  
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What is severe deficit in mini mental exam?   show
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show an unintentional positional change that results in a person coming to rest on the ground, floor or other lower level  
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show functional decline  
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show vestibular function; tatile sensation; proprioception; visual acuity (light adaptation  
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What are intrinsic reasons for falls?   show
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What are environmental reasons for falls?   show
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show CATASTROPHE  
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show caregive/housing; alcohol; treatements; affect (depression); syncopy; teetering; recetn illness; ocular problems; pain with mobility; hearing; environment  
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show benzos; antidepressants; antiemetics; anticholinergics; antiHTN; NSAID; hypoglycemic agents; antipsychotics  
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show IHATEFALLING  
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show Inflammation of joints; hypotension; auditory/visual exam; tremor; equilibriumand balance; foot problems; arrhythmia/valvular disease; leg length; lack of conditioning; illness; nutritional status; gait disturbance  
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what lab work is done with fallign?   show
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show ecg; holor monitor; bone density imaging; brain imaging  
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show exercise; environment change; medication adjustment; gait training; physical therapy; nutritional status; hip protector; bed alamr; wander alarm; timed toileting  
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show actual loss of consciousness  
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what is presyncope?   show
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what can cause syncope?   show
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what is dysequilibrium?   show
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show specific dizziness which has a major symptom of balance disorder; acute labryinthitis; cerbral vascular disease; otitis media  
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what is orthostatic hypotension   show
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show prevention  
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What is primary prevention?   show
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show screen to detect disease while treatable  
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show primary + secondary prevention  
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show slowing teh disease process  
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show may misudnerstand aging from disease adn not make informed decision; may be put off by cost of tests; may be put off by fear of test;  
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what is competence?   show
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in the elderly patient secondary and tertiary screen take on more importance than primary screening. TRUE OR FALSE   show
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what is physician role in screening   show
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show a specific document tested in law tha defines the patient wishes in the event of a terminal illness or persistant vegatative state that has no reasonalbe hope of a recovery  
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show patient can define what care they want if they become incompetent  
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show require hydration adn nutrition intervention to maintain life; may show reflexes; often exhibit sleep/wake cycles  
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show legal document which designates another individual to make health care decision if the patient is not competent or able to make teh decisions  
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what is a DNR?   show
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Waht are DNR variations?   show
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show maintain their dignity; to feel prepared to die; have physical touch; presence of family; have financial affairs in order  
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what is the stages of grief?   show
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What is the common course of death?   show
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show restless; confused; tremulous; hallucinations; delirium; myoclonic jerks; seizures; semicomatose; comatose; death  
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What are 3 types of pain?   show
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show muscle; localized but dull, aching, throbbing  
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what is visceral pain?   show
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show severe, burning, stabbing; nerve compression, ischemia or infection  
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what is the therapy of pain?   show
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how do you treat SOB?   show
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what is comfort management?   show
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what finanical assistance programs are available at the end of life?   show
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show presence at time of death; pronouncing death; support the family;visitation/wake; answer questions; complete death certificate  
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show patietn may stay in the place of their choosing assuming support is available; nursing visists to monitor and deliver care; can visits to maintain hygiene and provide equipment  
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