Adult I Final Flashcards
Visual Changes
A 75 y/o woman is concerned she may have to stop driving b/c of difficulty seeing on bright sunny days, and esp. at night with headlights. You recomm she see her optho and suggest most likely source of visual impairment is:
a) age related macular degeneration
b) cataract
c) glaucoma
d) uncorrected refractive error
b) cataract
Which of the following changes is NOT associated with aging?
a) miosis
b) lens yellowing
c) alterations in color vision
d) increased glare sensitivity and recovery
e) increased Intraocular pressure
e) increased intraocular pressure
What has been shown to NOT improve wet age-related macular degeneration?
a) laser photocoagulation
b) a hand magnifier
c) antioxidant vitamins
d) wearing a hat on bright sunny days
c) antioxidant vitamins
Most likely way older adults become blind?
a) Age Related Macular Degeneration (ARMD)
b) Glaucoma
c) Diabetic retinopathy
a) ARMD
Wet ARMD is called neovascular macular degeneration and accounts for 10% of ARMD cases and dry (non-neovascular) ARMD accounts for 90% T or F
T
Second-most leading cause of blindness?
POAG=primary open angle glaucoma
Risk of cataract development include:
a) low educational level
b) more hours in the sunlight
c) smoking
d) ETOH
e) All of the above
e) all of the above
Do vitamins or nutrition help cataracts?
No
Primary sx of cataracts?
Increased Glare
Macular degeneration causes a decrease in________________
central vision acuity
POAG causes degeneration in _____________and the leading cause of blindness in _____________
peripheral vision acuity, african-americans
Most common risk factors for occular disease
smoking and HTN
Most common visual loss associated with age?
Cataracts
Hallmarks of bacterial conjunctivitis include:
a) purulent discharge
b) conjunctive hyperemia and gluing of eyelids
c) a and b
d) a only
c) a and b
Viral conjunctivitis produces:
a) watery discharge
b) foreign body sensation
c) pre-auricular adenopathy
d) conjunctival follicles
e) pruritis
f) a,b,c,d
f) a,b,c,d
Etiology of bacterial conjunctivitis:
a) NG
b) haemophilus influenzae
c) streptococcus pneumoniae
d) moraxella catarrhalis
e) pseudomanas
f) a,b,c,d
f) a,b,c,d
Bacterial conjunctivitis will resolve with or without tx in 2-5 days 60% of the time T or F
true
Allergic Rhinitis is an ________mediated response
IgE
Best choice of OCP for breakthrough bleeding?
add estrogen
Best choice OCP for acne?
______________
What decreases the effectiveness of OCP?
a) HTN
b) smoking
c) weight gain
d) weight loss
c) weight gain
Important lab test prior to OCP start if FMhx cardiovascular disease?
Lipid panel
Prehypertension:
a) 122/79
b) 140/82
c) 134/90
d) 120/80
d) 120/80
prehypertension= 120-139/80-89
Stage I HTN: a) 159/92 b) 160/90 c) 140/88 d 144/90
d) 144/90
stage I= 140-159/90-99
Stage II HTN >______/________
Stage II >160/100
If a patient starts to have acute decline in renal function after starting an ACE, this may suggest:
a) primary HTN
b) secondary HTN
c) renal failure
b) secondary HTN
A change expected in an older patient with HTN:
a) increased peripheral vascular resistance
b) Decreased peripheral vascular resistance
c) Increased beta response
d) increased RAS response
a) increased peripheral vascular resistance w/ HTN
First line Rx for Stg I HTN:
a) BB
b) Ca+ Channel Blockers
c) ACE
d) Thiazide diuretics
d) thiazide diuretics
First line Rx for Stg II HTN:
a) 2 drug combo (thizaide + diuretic)
b) ARB
c) CCB
d) all of the above, starting with a
a) 2 drug combo (thiazide + diuretic)
Pt's with COPD should not be prescribed: a) ACE inhibs b) BB c) CRB d) ARB
b) BB
CRBs can cause all except
a) peripheral edema
b) gingival hyperplasia
c) shouldn’t be used with impaired EF
d) diarrhea
d) CRBs cause constipation
72 y/o black woman with HTN for many years and CHF. Best tx:
a) Thiazide diuretic
b) ARBs
c) ACE
d) CCB
c) ACE
70 y/o man with DMII and HTN. Best Rx:
a) BB
b) ARB
c) BB
d) ACE
d) ACE
fecal incontinence tx options:
a) biofeedback
b) Immodium
c) bentyl/dicyclomine
d) diapers
c) bentyl/dicyclomine
constipation- most common type in the USa) DM
b) laxative abuse
c) Rx Meds
d) normal transit
d) normal transit (or functional constipation)
Normal aging of the lower urinary tract includes:
a) bladder capacity decreases
b) residual urine volume increases
c) 10-20% of adults will have involuntary contractions of the bladder
d) 75% of elderly patients will have involuntary bladder contractions
e) all of the above
e) all of the above
Drug therapy for urge incontinence is directed at:
relaxing smooth muscle at the base (trigone) of the bladder or by blocking the involuntary bladder contractions at the base
True
Functional incontinence treatment:
a) diapers
b) Rx
c) BSC
c) BSC
functional (situational) incontinence is a manifestation of physical limitations or environmental barriers
(ie: diuretic adm- get BSC)
Acute or transient incontinence can be temporary and D/T:
a) fecal impaction
b) hospitalization
c) delirium
d) anxiolytics
d) bed rails
e) all of the above
e) all of the above
Unrelieved or new-onset constipation should be managed with:
a) laxatives
b) sigmoidoscopy/ba+ enema/or colonoscopy
c) EGD
d) FIT testing
b) sigmoidoscopy, ba+ enema or colonoscopy
Constipation that is refractory and is accompanied by nausea, vomiting and abd pain should
a) be considered IBS
b) could signal intestinal obstruction
b) intestinal obstruction
Which of the following does not contribute to constipation in adults?
a) PPI
b) CRB
c) Opioids
d) Calcium, FeSo4
a) PPIs
Lab values to assess incontinence:
a) UA, UAC, CBC
b) UA, UAC, LFT’s
c) UA, UAC, BMP
d) UA, UAC, BMP, Ca+
d) UA, UAC, BMP, Ca+
Best clinical tools for evaluating urinary incontinence: _________ & _____________
Comprehensive Hx and Physical Exam
Incontinence that doesn’t resolve in _________ is considered chronic:
a) 4 weeks
b) 2 months
c) 6 months
d) 6 weeks
d) 6 weeks
Most common type of urinary incontinence
a) overflow
b) stress
c) urge
d) psychogenic
c) urge
overflow most rare
A PVR of >200ml is a sign of:
a) Overflow incontinence
b) UTI
c) BPH
d) Obstruction
e) a, c, e
f) a, b
e) a,c,e
How to dx stress incontinence:
a) h/o any maneuver that increases abdominal pressure
b) direct observation of urinary loss when bearing down
c) PVR >200ml
d) a and b
d) a and b
The initial tx for urge and stress incontinence should be ___________________
pelvic floor or Kegel exercises
Neurogenic urge incontinence can best be relieved by:
a) Tricyclic antidepressants
b) Oxybutynin
a) tricyclics
oxybutynin can cause cognitive dysfunction 2/2 anticholinergic effects
Stress incontinence is a result of:
a) stress
b) pelvic floor muscle weakness
c) atrophic vaginitis
d) b & c
b) caused by muscle weakness, but atrophic vaginitis can be contributory, so adding estrogen may be helpful
Acute management of obstructive or overflow incontinence:
a) indwelling F/C
b) doxazosin
c) suprapubic catheter
c) for acute and urgent mgmt: suprapubic catheter will decompress the bladder
The following drugs can cause incontinence except:
a) narcotics
b) hyponotics
c) antipsychotics and antidepressants
d) CCB
e) BBs
e) beta blockers
Which drugs cross the blood-brain barrier and cause significant cognitive dysfunction in older adults?
a) trospium
b) oxybutynin
c) tolterodine
d) darifenacin
c) tolterodine
Most common predisposing cause ofn UTI’s:
______________________
cognitive dysfunction
The most appropriate tx of a pt with a UTI in the presence of a bladder stone is:
a) trial of ABX
b) surgically remove the stone
c) lifelong tx with ABX
d) indwelling F/C with irrigation
b) surgically remove the stone
Complications of F/C include nephrolithiasis
T or F
True
Acne
Headache
Nausea
Spotting
OCP methods to manage:
Acne low androgenic to progestin ratios (drospirenone) or mod-high estrogen contents relieve acne and block excessive hair growth. Ortotricyline triphasic norgestimate, alese and Yaz are approved for tx of acne
Headaches if 2/2 fluid excess, switch to lower estrogen. Worsening migraines, d/c OCPs
Nausea r/t estrogen w/ food@ HS or low estrogen OCPs
BTB most common with low dose combo OCs and progestin only pills.. Most common during first few cycles and usu takes time for the endometrium to adjust. If BTB early (before 10th day) insufficient estrogen. If after the 10th day insufficient progestin. Could also 2/2 imbalance b/w estrogen & progestin, missed pills, drug interaction, endo resistance, infection, smoking
FOOSH Injuries include
coole’s (distal radius)
scaphoid (snuff box)
Elderly
may be 1st sign of OP
young, athlete
Tests for
ACL
MCL
LCL
ACL= anterior drawer test MCL= valgus (medial) LCL= varus (lateral)
For Achiles Tear:
a) Have pt lie prone, with feet hanging off table
b) Palpate tendon (tenderness 2-6 cm above insertion)
c) Have pt dorsiflex, plantarflex (decreased/unable if tear)
d)Thompson test/calf squeeze:
Normal=plantarflex (may occur in partial)
Abnormal=unable, complete tear
e) all of the above
�
e) all of the above
S/S FeSo4 deficiency anemia:
a) skin/conjunctival pallor
b) koilonchias (spoon nails)
c) pica
d) pagophagia (eating ice)
e) blue sclera
f) all of the above
f) all of the above
What type of anemia?
a) Thalassemia
b) Anemia of chronic disease
c) lead poisoning
d) Sickle cell
e) iron-deficiency anemia
f) sideroblastic
microcytic anemia
sideroblastic can be either macro or micro
B12 deficiency anemia indices:
a) Reticulocyte count high
b) MCV elevated
c) leukocytosis
d) neuro effects resolve with tx
retic count low to normal (not high)
MCV elevated, macrocytic
leukopenia present (not leukocytosis)
neuro effects may not always resolve w/ tx
Folic Acid deficiency:
a) microcytic
b) macrocytic
macrocytic
