2: Geriatrics 1

Question 1

What is a Posey sound amplifier?

Answer 1

Posey Hearing Enhancer improves your hearing discreetly. High sensitivity microphone amplifies sound so you can listen to music, watch TV, or just hear people better.

Question 2

Keep your mouth _____ when interacting with older patients.

Answer 2

visible

Question 3

True/ false: families are crucial when interacting with older patients.

Answer 3

True

Must corroborate history from elderly spouse or adult child = More than one “patient”. Social support is key.

Question 4

What are the items of the functional assesment?

Answer 4

Mnemonic = DEATH SHAFT

ADLs (activities of daily living):
D - Dressing
E - Eating
A - Ambulating (moving)
T - Toileting
H - Hygiene

IADLs (Instrumental activities of daily living ):
S - Shopping
H - Housekeeping
A - Accounting
F - Food preperation
T - Transportation

Question 5

What are the 2 components of the cognitive evaluation?

Answer 5

Cognitive Evaluation:

 Mental Status Testing

 Geriatric Depression Scale = list of questions asking deep questions

Question 6

What are 3 tasks in a mini cognitive assesment?

Answer 6

1. Repeat three unrelated words.
2. The patient is then asked to draw a clock.
3. The patient is then asked to recall the three words.

Scoring:

• Recall of 3 words = perfect = no dimentia
• Cannot recall (1 or 2) = maybe dimentia–if cannot draw clock then demented or impaired. If CAN draw, then NOT impaired
• Recall of 0 = impaired or demented

This is not a diagnostic test, it is used as an indication to proceed further.

Question 7

What are 3 tasks in a social assesment?

Answer 7

Social Assessment

Formal and Informal Supports
Financial Resources
Area Resources

Question 8

What are 3 tasks in an enviornmental assesment?

Answer 8

Environmental Assessment

Home Safety Check
Transportation issues
Living Arrangements

Question 9

For elderly vital signs, always check blood pressure in ______ positions. 20% of elderly have _______ hypotension. Pulse pressure _______ with aging.


Answer 9

For elderly vital signs, always check blood pressure in 2 positions. 20% of elderly have orthostatic hypotension. Pulse pressure increases with aging.

Orthostatic hypertension, or postural hypertension, is a medical condition consisting of a sudden increase in blood pressure when a person stands up.


Question 10

In the elderly, heart rate stays ______, max heart rate ______ with age @ _____, & there is an increase in ______ atrial and ventricular beats.

Answer 10

In the elderly heart rate stays the same, max heart rate decreases with age @ 220 - age, & there is an increase in premature atrial and ventricular beats.

Question 11

In the elderly, there is _____ change in respiratory rate, Pulse Oximetry may be _____ by a few percentage points, & Temp may be on the _____ end of normal and may not increase with infection/ illness.

Answer 11

In the elderly, there is no change in respiratory rate, Pulse Oximetry may be lower by a
few percentage points, & Temp may be on the lower end of normal and may not increase with infection/ illness.

Question 12

The elderly get Solar Letigines: AKA ______. They also get Actinic Keratosis, which is a _____ lesion.

Answer 12

The elderly get Solar Letigines: AKA “Sun Spots”. They also get Actinic Keratosis, which is a pre-cancerous lesion.

Question 13

For the elderly, what can we find in HEENT exam?

Answer 13

 Fat pads around the eyes can atrophy

 Eyelids skin can be loose …senile (aging) ptosis

 Arcus senilus. Arcus senilis (or arcus senilis corneae) is a white, gray, or blue opaque ring in the corneal margin (peripheral corneal opacity), or white ring in front of the periphery of the iris.

 Cataracts. A cataract is a clouding of the lens in the eye that affects vision.

 Entropions, Extropions. Entropion is a medical condition in which the eyelid (usually the lower lid) folds inward. Ectropion is a medical condition in which the lower eyelid turns outwards.

Question 14

The elderly can get ______ which are Cholesterol and fat deposits.


Answer 14

The elderly can get Xanthelasma which are Cholesterol and fat deposits.


Question 15

What do we check for in the cardiac exam for the elderly?

Answer 15

 Bruits over the carotids

 Systolic murmur right upper sternal
border

Aortic sclerosis vs. aortic stenosis

Question 16

 S3 may be heard in _________

 S4 may be heard in _________

Answer 16

 S3 may be heard in congestive heart failure

 S4 may be heard in stiffening of ventricles

Question 17

In the elderly, what are common findings in the Pulmonary and Thorax Exam?

Answer 17

Pulmonary and Thorax Exam

 Stiffer chest wall, decrease in strength of diaphragm…prolonged expiration and less forceful cough

 Kyphosis = Kyphosis (from Greek = a hump), also called roundback, is a condition of overcurvature of the thoracic vertebrae.


Question 18

What can we find in the older female exam?

Answer 18

 Breasts become atrophic

 Lithotomy position may be difficult for
pelvic exam = back on bed & legs propped up & spread out

 Ovaries are non-palpable

 Decrease in pubic hair, vaginal mucosa gets thinner and dry

 Uterine or bladder prolapse may be seen

Question 19

What can we find in the older male exam?

Answer 19

 Decrease in pubic hair

 Decrease in penis size, atrophy of
testicles

 Benign prostatic hypertrophy


Question 20

In the elderly, what are common findings in the abdominal exam?

Answer 20

 Listen for abdominal bruits

 Palpate for a widened aorta

 Potbelly in some

 Guarding and rebound may be less reliable indicators of an acute abdomen


Question 21

In the elderly, what are common findings in the musculoskeletal exam?

Answer 21

 Loss of height

 Decrease range in motion of joints

 Muscles less bulky

 Osteoarthritis changes. Osteoarthritis is a group of mechanical abnormalities involving degradation of joints, including articular cartilage and subchondral bone (hands of old ppl).

 Loss of interosseus muscles…hands look thin and bony