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NUNP 547 - Older Adult > Approach to older adults > Flashcards

Approach to older adults Flashcards

1
Q

Lens accommodation begins to decrease between what ages?

A

40-50 years old

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2
Q

Hearing decline begins at what age?

A

12 years

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3
Q

Bone mineral content plateaus a what age?

A

20 years

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4
Q

What does the rule of 4ths measure?

A

Causes of functional decline

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5
Q

What is the rule of 4ths?

A

1/4 disease, 1/4 disuse, 1/4 misuse, 1/4 physiologic

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6
Q

10 Geriatric Giants

A 
Delerium
Depression
Dizziness
Dysphagia
Falls
Frailty
Polypharmacy
Incontinence
Syncope
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7
Q

ADL’s

A 
DEATH
Dressing 
Eating
Ambulating (walking, up/down stairs)
Toileting
Hygiene
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8
Q

IADL’s

A 
SHAFTTT
Shopping
Housework
Accounting
Food preparation
Transport 
Telephoning
Taking medications
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9
Q

Describe how to perform/measure Tinetti balance and gait evaluation

A

Observe patient from getting up from chair without arms, walk 10ft and turn around and return to sitting (should take < 16 seconds)

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10
Q

Immunizations to consider for older adults

A

Tdap - 1 time
Td - Q 10 years
Hep A & B - high risk groups
Influenza annually
Pneumovax 23 (1 dose > 65 and repeat dose if high risk) /13 (if high risk)
Shingrix ( > 50 years, not covered)
Varicella - no history of infection/vaccination, 2 doses 6 weeks apart

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11
Q

Breast cancer screening for average risk age 50-74

A

Mammogram Q 2 years

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12
Q

Breast cancer screening for average risk >/= 75 years

A

Discuss benefits/limitations, eligible Q2-3 years

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13
Q

Breast cancer screening age 40-74 with first degree relative with breast cancer

A

Q 1 year mammogram

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14
Q

Screening mammograms are recommended ____ if you are between _____ and at least one of the following applies to you:

You are a BRCA1 or BRCA2 carrier;
You are an untested first degree relative of BRCA1 or BRCA 2 carrier;
You have a very strong family history1 of breast cancer; or,
You have had prior chest wall radiation.

A

Yearly, 30-74 years

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15
Q

All of the following are NOT eligible for mammogram EXCEPT:

a) have breast implants
b) pregnant or breastfeeding
c) have had mammogram on one breast in last 12 months
d) have had mammogram on both breasts in last 12 months
e) new breast complaints ie. lump or discharge

A

C

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16
Q

Cervical cancer screening frequency and age to start/stop

A

Q3 years, 25-69 years

17
Q

A 70 year old comes into the clinic asking about cervical screening. They have not been screened in the last 10 years and have no history of cervical cancer or abnormalities. What is your next steps?

A

Complete PAP and can discontinue when there has been 3 negative screens in past 10 years

18
Q

Colon cancer screening for average risk asymptomatic 50-74 years

A

FIT Q2 years (follow up all + FIT with colonoscopy) OR

colonoscopy Q10 years

19
Q

Acute mesenteric ischemia: typical S+S (may be more vague in elderly)

A

Pain out of proportion to PE findings
N/V/D
may have post prandial pain

20
Q

AAA - typical S+S (may be more vague in elderly)

A

HypoTN
Abdo or back pain
pulsatile abdominal mass
hematuria

21
Q

Bowel obstructions: typical S+S (may be more vague in elderly)

A 
abdo pain
constipation
vomiting
sometimes
overflow diarrhea

Commonly missed surgical emergency

22
Q

Name this GI condition based on the below S+S

Typical presentation

  • Fever, nausea
  • Change in bowel regimen (constipation, diarrhea or tenesmus)
  • LLQ pain, leukocytosis
  • +/- lower GI bleeding

Elderly presentation

  • GU S+S
  • afebrile
  • normal PE
  • +/- lower GI bleeding
A

Diverticulitis

** most common cause of GI bleeding in the elderly

23
Q

What percentage of elderly patients with appendicitis DO NOT present with the classic S+S:
- RLQ pain, fever, leukocytosis, anorexia

A

2/3rds

< 1/3 of elderly patient with appendicitis present with the classic S+S

24
Q

Peptic ulcer disease
A) typical presentation
B) elderly presentation

A

A) Abdo pain, rigidity, melena
B) often don’t have abdo pain or rigidity

*** moral of the story, ask about poop colour

25
Q

What is the most common location of acute mesenteric ischemia (hint, remember A+P for GI arterial circulation… what artery innervates the majority of the GI tract)

A

Superior mesenteric artery (small intestines and the ascending and transverse colon)

26
Q

Acute cholecystitis is the most common sx emergency in the elderly name the typical S+S of this condition and explain how elderly pts may present differently

A

Typical presentation: Fever, RUQ pain, N/V, leukocytosis, abnormal LFT
Elderly may have NONE of the above S+S….

27
Q

What cardiac conditions increase your risk of acute mesenteric ischemia (HINT: which cardiac conditions increase risk of thromboemobolism)

A

Atrial fibrillations
dilated cardiomyopathy
arrhythmias
valcular disease

28
Q

What symptom is indicative of a narrowing supermesenteric artery (i.e. intestinal equivalent of stable angina/CAD)

A

post prandial abdod pain

intestinal angina

29
Q

S+S of AAA can mimic what two common conditions

A

renal colic

acute back pain

30
Q

Name some cuases of small bowel obstructions

A

Hernias
Adhesions
Neoplasms
Gall stone ileus

31
Q

Name some causes of large bowel obstructions

A

Neoplasms
Diverticulitis
Volvulus

32
Q

Name common conditions that mimic S+S of divertitculitis

A

UTIs
renal colic
appendicitis

33
Q

Non-abdominal causes of abdo pain related to each of the below systems

A) Cardiac
B) Pulmonary
C) Metabolic
D) GU
E) Misc
A

A) MI, CHF, pericarditis
B) pneumonia, PE, pleural effusion, pneumothorax
C) DKA, addisonian crisis, hypercalcemia
D) cystitis, pyelonephritis, prostatitis, urinary retention
E) Herpes zoster (difficult to diagnosis pre vasicular phase)

34
Q

Best imaging tests for mesenteric ischemia

A

Best diagnosed with angiography

CT next best if angiography not available

35
Q

Imaging for AAA

A

Abdo US or CT

36
Q

Imaging for small bowel obstructions

A

Xray > if not visible but still high index of suspesion > CT

37
Q

True or false: CT is the best choice of imaging if you suspect cholecystitis

A

False - U/S preferred

38
Q

True or False: CT is the best choice of imaging if you suspect pancreatitis or appendicitis in the elderly

A

True - no change to imaging approach with the elderly for these conditions

39
Q

Tx for outpatient managment of diverticulitis in the elderly?

A

[Septra &
Metronidazole]

Or

[Ciprofloxacin &
Metronidazole]

Or

Amoxicillin-clavunate

** from bugs and drugs, couldn’t find anything in text or notes (5-7 days of treatment for all abx options)

NUNP 547 - Older Adult (19 decks)

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