ClinMed_Geriatrics Flashcards
(Dr. Salwa)
three components of initial workup for suspected cognitive impairment
cognitive testing
labs
imaging
(Dr. Salwa)
list in order the three cognitive tests for the workup of suspected cognitive impairment
1st: Mini-cog (3-word recall (1 pt ea) and clock-drawing test (2 pt))
next: MMSE or MoCA (each has a total of 30 pts)
(Dr. Salwa)
What is the purpose of the initial workup of suspected cognitive impairment?
to rule-out reversible reasons for cognitive impairment!!!!
(Dr. Salwa)
what are the three types of labs done for initial workup of suspected cognitive impairment?
routine
selective
atypical
(Dr. Salwa)
what did Dr. Salwa say are the routine labs for cognitive impairment, and what reason for each?
CBC: r/o infection, anemia, hematologic malignancy
Vit B12:
TSH: hypothyroidism-cognitive impairment
CMP: hypo/hypernatremia, hypercalcemia
Vit D
(Dr. Salwa)
what is the central required diagnostic feature of dementia with Lewy bodies?
PROGRESSIVE COGNITIVE DECLINE, DEMENTIA
(Dr. Salwa)
what are the four core criteria for diagnosing dementia with Lewy bodies?
fluctuating cognition
visual hallucinations
spontaneous parkinsonism features
REM sleep behavior disorder (e.g. dream enactment)
(Dr. Salwa)
What are two pt features that are suggestive of dementia with Lewy bodies?
severe antispychotic sensitivity
SPECT or PET showing low dopamine transporter uptake in basal ganglia
(SPECT = single-photon emission computed tomography)
(Dr. Salwa)
what are five diagnostic features that are supportive of dementia with Lewy bodies?
falls, repeated syncope, or near-syncope severe autonomic dysfunction delusions depression or anxiety
(Dr. Salwa)
What are two diagnostic features that CONFLICT with diagnosis of dementia with Lewy bodies?
neuroimaging showing cerebrovascular disease
Parkinsonism appearing first with dementia later
(Dr. Salwa)
what are six reversible causes of falls in the elderly?
vision postural bp medication use balance & gait targeted c/v, MSK, neurologic exam home hazard eval
(Dr. Salwa)
what are three potential interventions for vision-related causes of falls in the elderly?
correction of visual acuity if <20/60
cataract removal
ample lighting w/o glare
(Dr. Salwa)
what are four potential interventions to remove postural bp causes of falls?
removal of offending meds
modification of salt & fluid intake
behavioral strategies (slow change in position)
compression stockings
(Dr. Salwa)
what are two ways to intervene to eliminate MEDICATION USE reasons for falls in the elderly?
removal of offending medications (e.g. benzos, neuroleptics, sleep meds)
reduction of polypharmacy
(Dr. Salwa)
what are four interventions to reduce BALANCE & GAIT causes for falls in the elderly?
environmental modifications
PT for gait & balance training
assessment for assistive device
exercise program
(Dr. Salwa)
what is an intervention we can do to to reduce TARGETED C/V, MSK, NEUROLOGIC EXAM causes of falls in the elderly?
diagnose & treat underlying cause if identified
(Dr. Salwa)
what interventions do we do to reduce the HOME HAZARD EVALUATION causes for falls in the elderly?
modify the environment: adjust poor lighting, remove loose rugs, place non-slip bathmats and rails
(Aquifer)
A1c of less than or equal to 6% was associated with
more falls
a 3-fold greater likelihood of suffering a hip fracture than those with an A1c > 8%
(Aquifer)
what is the average GFR loss per decade?
10%
“The average older adult loses about 10% of their GFR per decade, and almost all people age 50 and above will have glomerulosclerosis on histological examination.”
(Aquifer)
what lab finding is NEVER considered a normal part of aging, and deserves workup?
PROTEINURIA
(Aquifer)
imaging findings that may be seen in pts presenting w/ memory impairments:
cortical atrophy (AD, nml aging) hippocampal atrophy (AD) hypointensity of substantia nigra (Parkinson) enlarged ventricles infarcts (vascular dementia) tumors demyelinating disease
(Aquifer)
list 7 characteristics of delirium
acute onset altered LOC inattention fluctuating course memory problems (also seen with dementia) altered level of alertness visual hallucinations
(Aquifer)
attributes of dementia
sustained loss of intellectual function and memory
causes dysfunction in daily living
gradually progressive course
W/O disturbance of consciousness
(Aquifer)
mneumonic for common precipitating factors that contribute to delirium:
CONFFUSED
CNS (stroke, sz) Organ insufficiency/ischemia Nutritional deficiency Fluid/electrolyte abnormalities Fever/infection Urinary and GI tract disorders Sensory difficulties Endocrine (thyroid, adrenal, parathyroid, pancreatic glands) Drugs/drug withdrawal
(Aquifer)
predisposing factors for delirium
demographic characteristics functional impairment sensory impairment (visual, hearing) dehydration drugs comorbid medical conditions
(Aquifer)
name 7 drugs that commonly cause delirium
antihistamines opioids benzos antidepressants steroids m. relaxants antiemetics
(Aquifer)
lung sounds -
crackles disappear in
atelectasis
so have them cough and see if the crackles are gone
(Aquifer)
S4 heart sound is often normal in older adults….why?
because their ventricles are often stiffer than those of younger adults
(Aquifer)
more than half of pts over the age of 85 will have _______ (cardiac) from ______
SYSTOLIC MURMUR at RUSB from AORTIC VALVE SCLEROSIS
“More than half of patients over the age of 85 will have a systolic murmur heard at the right upper sternal border from aortic valve sclerosis, which occurs as the aortic valve cusps thicken and become fibrotic with normal aging. “
(Aquifer)
4AT rapid clinical instrument for delirium detection:
Alertness: markedly drowsy or agitate/hyperactive
Abbreviated Mental Test 4 (AMT4): age, date of birth, place (name of hospital or bldg), current year
Attention
Acute change or fluctuating course
(Aquifer)
What is ESBM UTI?
put in info
