Bates Geriatric with Review stuff she said in class Flashcards
____________ are less influential on myocardial contraction/
Beta-adrengergic catecholamines
What is S3 after 40y/o due to?
heart failure from volume overload in left ventricle (coronary artery disease, cardiomyopathy or valvular disease, such as mitral regurg)
When is S4 present in healthy older people?
Possible ventricular compliance and impaired ventricular filling; HTN
What is the most common murmur of elderly?
Systolic aortic murmur
How does aging affect aortic cusps?
Causes fibrous tissue which leads to calcification and audible vibrations
What is the difference between aortic sclerosis and aortic stenosis?
Sclerosis has fibrosis and calcification that doesn’t impede blood flow; stenosis has calcified and immobile aortic valve leaflets that cause outflow obstruction
What is the best to determine it is aortic sclerosis and not aortic stenosis?
There can be a brisk carotid upstroke due to delayed upstroke
What are people with an aortic sclerosis or aortic stenosis at higher risks for?
CV morbidity and mortality
What is mitral regurgitation?
Calcification of mitral valve ring which impedes normal valve closure during systole
Is loss of arterial pulsations typical?
No, it isn’t typical and needs careful evaluation
If an older adult male has abdominal or lower back pain, smokes, and has coronary disease, what is he at higher risk for?
AAA
What can giant cell or temporal arteritis lead to?
Loss of vision and complaints of HA and jaw claudication
How does aging affect the symptoms of acute abdominal disease?
Blunts symptoms: pain is less severe, fever is less prounounced, signs of peritoneal inflammation (muscle guarding or rebound tenderness) may diminish or are absent
What are some changes with aging seen in male genitalia?
Decreased testosterone, erections depend on touch not erotic cues, penis shrinks, testicles drop further into scrotum, pubic hair decreases/grays
What is the top cause of ED?
Vascular changes
What age do menstrual periods stop?
45-52 years
What is BPH?
Benign prostate hyperplasia; proliferation of epithelial and stromal tissue
When does BPH start?
3rd decade
Symptoms of BPH
hesistancy, dribbling, incomplete emptying
What is sarcopenia?
loss of lean body mass and strength with aging
Benign forgetfulness
difficulty recalling names of people or objects or certain details of specific events
What can delirium in the elderly be a clue for?
Infection or problems with medications
What are normal CNS findings in elderly, that would be abnormal in young people?
changes in hearing, vision, extraocular movements and pupillary size, shape, reactivity
What is the difference between a benign tremor and parkisonian tumor?
Benign tremors are slightly faster and disappear at rest; are not associated with muscle rigidity
Where do older adults frequently lose some or all vibratory sense?
feet and ankles
What type of hearing do most elderly lose?
high tone discrimination
What is the hyperthyroidism symptom triad in pts 50+?
fatigue, weight loss, and tachycardia
What are characteristics of geriatric syndromes?
multifactorial origin, typically older/frail adults, precipitated by acute event, episodic, followed by functional decline (collection of symptoms and signs common in older adults not necessarily related to a specific disease)
What are examples of geriatric syndromes?
delirium, cognitive impairment, falls, dizziness, depression, urinary incontinence, functional impairments
What are ADLs?
Activities of Daily Living (bathing, dressing, toileting, transferring, continence, feeding)
What are IADLs?
Instrumental Activities of Daily Living (Using the telephone, shopping, preparing food, housekeeping, laundry, transportation, taking medicine, managing money
What are clinical clues to alcohol use disorders in older adults?
Memory loss, cognitive impariment, depression, anxiety, neglect of hygiene/appearance, poor appetitie, nutritional deficits, sleep disruption, HTN refractory to therapy, blood sugar control problems, seizures, impaired balance and gait, fails, recurrent balance and gait, falls, recurrent gastritis and esophagitis, difficulty managing warfarin dosing
What does CAGE stand for?
Cutting down, Annoyance when criticized, Guilty feelings, Eye openers
What are the exercise recommendations for elderly?
Moderate intensity exercise for 10-30 minutes per day or 150 minutes per week
What are 4 important vaccines for elderly?
Influenza
Pneumonia
Zoster
Tetanus/diptheria
What are the 8 components of 10-minute geriatric screener?
vision, hearing, leg mobility, urinary incontinence, nutrition/weight loss, memory, depression, physical disability
What is commonly seen with BP?
SBP and peripheral vascular resistance increase, whereas DBP decreases
What is orthostatic hypotension defined as?
Drop in SBP of >20mmHg or
Drop in DBP of >10mmHg
What does respiratory rate > or equal to 25 mean?
Lower respiratory infection (also heart failure or COPD)
What is asteatosis?
dry, flaky, rough, and itchy skin
What are pseudoscars?
white depigmented patches on extensor surface of hands and forearms
What is actinic purpura?
well demarcated vividly purple macules or patches
What is a raised yellowish lesion that feels greasy and velvety or warty?
seborrheic keratoses
Why do pressure sores develop in bed ridden patients?
obliteration of arteriolar and capillary blood flow to skin or from shear forces during movement across sheets or when lifted upright incorrectly
What is senile ptosis?
weakening of levator palpebrae
What is a benign whitish ring around the limbus of the eye?
arcus senilis
What is the leading cause of blindness?
cataracts
What does increased anteroposterior diamter, purse-lipped breathing, dyspnea with talking or minimal exertion suggest?
COPD
What problems have carotid bruits?
aortic stenosis and carotid stenosis
What is sustained PMI associated with? What is diffuse PMI associated with?
Sustained- LVH
diffuse PMI- heart failure
A systolic crescendo-descrecendo murmur in second right intercostal space means…
aortic sclerosis or aortic stenosis
What has systolic crescendo-descrecendo murmur with delayed pulses when comparing brachial and radial pulses?
aortic stenosis
A harsh holosystolic murmur at apex suggests _______
mitral regurgitation
A abdominal aorta width of greater or equal to 3cm or pulsatile mass denotes ________
abdominal aortic aneurysm
What may bluish swellings on the labia be?
varicosities
A prolapse of fleshy erythematous mucosal tissue at the urethral meatus is
caruncles
Restriction of Mobility of the cervix indicates
inflammation, malignancy, or surgical adhesion
What is the timed “get up and go” test? What is it for?
ask patient to get up from chair, walk 10 feet, turn, and return to chair; to check gait and balance (risk of falling); should be able to complete in 10 seconds
Evidence of flexed posture, tremor, rigidity, bradykinesia, micrographia, shuffling gait, and difficulty rising from chair indicate ________
Parkinson’s
What is a basal cell carcinoma?
translucent nodule that eventually spreads and leaves a depressed center with a firm elevated border
What is squamous cell carcinoma?
Firm reddish lesion often emerging in a sun-exposed area
What are actinic lentigines?
liver spots
What is the ankle-branchial index used to assess?
PAD
What does macular degeneration cause?
poor central vision and blindness
What does the patient say when testing for tactile fremitus?
ninety-nine or one-one-one
When is fremitus decreased or absent?
COPD, obstructed bronchus, pleural changes from effusion, fibrosis, air (pneumothorax), or an infiltrating tumor
When does asymetric decreased fremitus occur?
unilateral pleural effusion, pneumothorax, neoplasm due to decreased transmission of low frequency sounds
When does asymmetric increased fremitus occur?
unilateral pneumonia from increased transmission through consolidated tissue
When percussing lungs, when do you hear dullness?
with fluid or solid tissue replacing air (i.e. lobar pneumonia, pleural effusion, hemothorax, empyema, fibrous tissue or tumor)
When percussing lungs, when do you hear generalized hyper resonance?
overinflated lungs of COPD or asthma
When percussing lungs, when do you hear unilateral hyper resonance?
large pneumothorax, possibly large air-filled bulla in the lung
Tympany in the abdomen when percussing equals?
gas in GI tract, if with protruberant abdomen though, then possible intestinal obstruction
Dullness when percussing the abdomen equals?
fluid or feces; also pregnant uterus, ovarian tumor, distended bladder, or large liver/spleen
What is the problem if there is dullness in both flanks?
possible ascites
What is consolidation?
When the alveoli fill with fluid or blood cells
What conditions have consolidation?
pneumonia, pulmonary edema, or pulmonary hemorrhage
What is the percussion note with consolidation?
dull
What is tactile fremitus and transmitted voice sounds like with consolidation?
increased tactile fremitus over involved area, with bronchophony, egophony, and whispered pectroliquy
What does Weber test test for?
Lateralization between ears
What is Rinne test for?
Compare air conduction and bone conduction
What should the normal result be for Rinne?
Air conduction > bone conduction
