Bates Geriatric with Review stuff she said in class

Question 1

____________ are less influential on myocardial contraction/

Answer 1

Beta-adrengergic catecholamines

Question 2

What is S3 after 40y/o due to?

Answer 2

heart failure from volume overload in left ventricle (coronary artery disease, cardiomyopathy or valvular disease, such as mitral regurg)

Question 3

When is S4 present in healthy older people?

Answer 3

Possible ventricular compliance and impaired ventricular filling; HTN

Question 4

What is the most common murmur of elderly?

Answer 4

Systolic aortic murmur

Question 5

How does aging affect aortic cusps?

Answer 5

Causes fibrous tissue which leads to calcification and audible vibrations

Question 6

What is the difference between aortic sclerosis and aortic stenosis?

Answer 6

Sclerosis has fibrosis and calcification that doesn’t impede blood flow; stenosis has calcified and immobile aortic valve leaflets that cause outflow obstruction

Question 7

What is the best to determine it is aortic sclerosis and not aortic stenosis?

Answer 7

There can be a brisk carotid upstroke due to delayed upstroke

Question 8

What are people with an aortic sclerosis or aortic stenosis at higher risks for?

Answer 8

CV morbidity and mortality

Question 9

What is mitral regurgitation?

Answer 9

Calcification of mitral valve ring which impedes normal valve closure during systole

Question 10

Is loss of arterial pulsations typical?

Answer 10

No, it isn’t typical and needs careful evaluation

Question 11

If an older adult male has abdominal or lower back pain, smokes, and has coronary disease, what is he at higher risk for?

Answer 11

AAA

Question 12

What can giant cell or temporal arteritis lead to?

Answer 12

Loss of vision and complaints of HA and jaw claudication

Question 13

How does aging affect the symptoms of acute abdominal disease?

Answer 13

Blunts symptoms: pain is less severe, fever is less prounounced, signs of peritoneal inflammation (muscle guarding or rebound tenderness) may diminish or are absent

Question 14

What are some changes with aging seen in male genitalia?

Answer 14

Decreased testosterone, erections depend on touch not erotic cues, penis shrinks, testicles drop further into scrotum, pubic hair decreases/grays

Question 15

What is the top cause of ED?

Answer 15

Vascular changes

Question 16

What age do menstrual periods stop?

Answer 16

45-52 years

Question 17

What is BPH?

Answer 17

Benign prostate hyperplasia; proliferation of epithelial and stromal tissue

Question 18

When does BPH start?

Answer 18

3rd decade

Question 19

Symptoms of BPH

Answer 19

hesistancy, dribbling, incomplete emptying

Question 20

What is sarcopenia?

Answer 20

loss of lean body mass and strength with aging

Question 21

Benign forgetfulness

Answer 21

difficulty recalling names of people or objects or certain details of specific events

Question 22

What can delirium in the elderly be a clue for?

Answer 22

Infection or problems with medications

Question 23

What are normal CNS findings in elderly, that would be abnormal in young people?

Answer 23

changes in hearing, vision, extraocular movements and pupillary size, shape, reactivity

Question 24

What is the difference between a benign tremor and parkisonian tumor?

Answer 24

Benign tremors are slightly faster and disappear at rest; are not associated with muscle rigidity

Question 25

Where do older adults frequently lose some or all vibratory sense?

Answer 25

feet and ankles

Question 26

What type of hearing do most elderly lose?

Answer 26

high tone discrimination

Question 27

What is the hyperthyroidism symptom triad in pts 50+?

Answer 27

fatigue, weight loss, and tachycardia

Question 28

What are characteristics of geriatric syndromes?

Answer 28

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)

Question 29

What are examples of geriatric syndromes?

Answer 29

delirium, cognitive impairment, falls, dizziness, depression, urinary incontinence, functional impairments

Question 30

What are ADLs?

Answer 30

Activities of Daily Living (bathing, dressing, toileting, transferring, continence, feeding)

Question 31

What are IADLs?

Answer 31

Instrumental Activities of Daily Living (Using the telephone, shopping, preparing food, housekeeping, laundry, transportation, taking medicine, managing money

Question 32

What are clinical clues to alcohol use disorders in older adults?

Answer 32

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

Question 33

What does CAGE stand for?

Answer 33

Cutting down, Annoyance when criticized, Guilty feelings, Eye openers

Question 34

What are the exercise recommendations for elderly?

Answer 34

Moderate intensity exercise for 10-30 minutes per day or 150 minutes per week

Question 35

What are 4 important vaccines for elderly?

Answer 35

Influenza Pneumonia Zoster Tetanus/diptheria

Question 36

What are the 8 components of 10-minute geriatric screener?

Answer 36

vision, hearing, leg mobility, urinary incontinence, nutrition/weight loss, memory, depression, physical disability

Question 37

What is commonly seen with BP?

Answer 37

SBP and peripheral vascular resistance increase, whereas DBP decreases

Question 38

What is orthostatic hypotension defined as?

Answer 38

Drop in SBP of >20mmHg or | Drop in DBP of >10mmHg

Question 39

What does respiratory rate > or equal to 25 mean?

Answer 39

Lower respiratory infection (also heart failure or COPD)

Question 40

What is asteatosis?

Answer 40

dry, flaky, rough, and itchy skin

Question 41

What are pseudoscars?

Answer 41

white depigmented patches on extensor surface of hands and forearms

Question 42

What is actinic purpura?

Answer 42

well demarcated vividly purple macules or patches

Question 43

What is a raised yellowish lesion that feels greasy and velvety or warty?

Answer 43

seborrheic keratoses

Question 44

Why do pressure sores develop in bed ridden patients?

Answer 44

obliteration of arteriolar and capillary blood flow to skin or from shear forces during movement across sheets or when lifted upright incorrectly

Question 45

What is senile ptosis?

Answer 45

weakening of levator palpebrae

Question 46

What is a benign whitish ring around the limbus of the eye?

Answer 46

arcus senilis

Question 47

What is the leading cause of blindness?

Answer 47

cataracts

Question 48

What does increased anteroposterior diamter, purse-lipped breathing, dyspnea with talking or minimal exertion suggest?

Answer 48

COPD

Question 49

What problems have carotid bruits?

Answer 49

aortic stenosis and carotid stenosis

Question 50

What is sustained PMI associated with? What is diffuse PMI associated with?

Answer 50

Sustained- LVH | diffuse PMI- heart failure

Question 51

A systolic crescendo-descrecendo murmur in second right intercostal space means...

Answer 51

aortic sclerosis or aortic stenosis

Question 52

What has systolic crescendo-descrecendo murmur with delayed pulses when comparing brachial and radial pulses?

Answer 52

aortic stenosis

Question 53

A harsh holosystolic murmur at apex suggests _______

Answer 53

mitral regurgitation

Question 54

A abdominal aorta width of greater or equal to 3cm or pulsatile mass denotes ________

Answer 54

abdominal aortic aneurysm

Question 55

What may bluish swellings on the labia be?

Answer 55

varicosities

Question 56

A prolapse of fleshy erythematous mucosal tissue at the urethral meatus is

Answer 56

caruncles

Question 57

Restriction of Mobility of the cervix indicates

Answer 57

inflammation, malignancy, or surgical adhesion

Question 58

What is the timed "get up and go" test? What is it for?

Answer 58

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

Question 59

Evidence of flexed posture, tremor, rigidity, bradykinesia, micrographia, shuffling gait, and difficulty rising from chair indicate ________

Answer 59

Parkinson's

Question 60

What is a basal cell carcinoma?

Answer 60

translucent nodule that eventually spreads and leaves a depressed center with a firm elevated border

Question 61

What is squamous cell carcinoma?

Answer 61

Firm reddish lesion often emerging in a sun-exposed area

Question 62

What are actinic lentigines?

Answer 62

liver spots

Question 63

What is the ankle-branchial index used to assess?

Answer 63

PAD

Question 64

What does macular degeneration cause?

Answer 64

poor central vision and blindness

Question 65

What does the patient say when testing for tactile fremitus?

Answer 65

ninety-nine or one-one-one

Question 66

When is fremitus decreased or absent?

Answer 66

COPD, obstructed bronchus, pleural changes from effusion, fibrosis, air (pneumothorax), or an infiltrating tumor

Question 67

When does asymetric decreased fremitus occur?

Answer 67

unilateral pleural effusion, pneumothorax, neoplasm due to decreased transmission of low frequency sounds

Question 68

When does asymmetric increased fremitus occur?

Answer 68

unilateral pneumonia from increased transmission through consolidated tissue

Question 69

When percussing lungs, when do you hear dullness?

Answer 69

with fluid or solid tissue replacing air (i.e. lobar pneumonia, pleural effusion, hemothorax, empyema, fibrous tissue or tumor)

Question 70

When percussing lungs, when do you hear generalized hyper resonance?

Answer 70

overinflated lungs of COPD or asthma

Question 71

When percussing lungs, when do you hear unilateral hyper resonance?

Answer 71

large pneumothorax, possibly large air-filled bulla in the lung

Question 72

Tympany in the abdomen when percussing equals?

Answer 72

gas in GI tract, if with protruberant abdomen though, then possible intestinal obstruction

Question 73

Dullness when percussing the abdomen equals?

Answer 73

fluid or feces; also pregnant uterus, ovarian tumor, distended bladder, or large liver/spleen

Question 74

What is the problem if there is dullness in both flanks?

Answer 74

possible ascites

Question 75

What is consolidation?

Answer 75

When the alveoli fill with fluid or blood cells

Question 76

What conditions have consolidation?

Answer 76

pneumonia, pulmonary edema, or pulmonary hemorrhage

Question 77

What is the percussion note with consolidation?

Answer 77

dull

Question 78

What is tactile fremitus and transmitted voice sounds like with consolidation?

Answer 78

increased tactile fremitus over involved area, with bronchophony, egophony, and whispered pectroliquy

Question 79

What does Weber test test for?

Answer 79

Lateralization between ears

Question 80

What is Rinne test for?

Answer 80

Compare air conduction and bone conduction

Question 81

What should the normal result be for Rinne?

Answer 81

Air conduction > bone conduction