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CLINICAL YR: Geriatrics > ClinMed_Geriatrics > Flashcards

ClinMed_Geriatrics Flashcards

1
Q

(Dr. Salwa)

three components of initial workup for suspected cognitive impairment

A

cognitive testing
labs
imaging

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2
Q

(Dr. Salwa)

list in order the three cognitive tests for the workup of suspected cognitive impairment

A

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)

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3
Q

(Dr. Salwa)

What is the purpose of the initial workup of suspected cognitive impairment?

A

to rule-out reversible reasons for cognitive impairment!!!!

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4
Q

(Dr. Salwa)

what are the three types of labs done for initial workup of suspected cognitive impairment?

A

routine
selective
atypical

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5
Q

(Dr. Salwa)

what did Dr. Salwa say are the routine labs for cognitive impairment, and what reason for each?

A

CBC: r/o infection, anemia, hematologic malignancy
Vit B12:
TSH: hypothyroidism-cognitive impairment
CMP: hypo/hypernatremia, hypercalcemia
Vit D

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6
Q

(Dr. Salwa)

what is the central required diagnostic feature of dementia with Lewy bodies?

A

PROGRESSIVE COGNITIVE DECLINE, DEMENTIA

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7
Q

(Dr. Salwa)

what are the four core criteria for diagnosing dementia with Lewy bodies?

A

fluctuating cognition
visual hallucinations
spontaneous parkinsonism features
REM sleep behavior disorder (e.g. dream enactment)

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8
Q

(Dr. Salwa)

What are two pt features that are suggestive of dementia with Lewy bodies?

A

severe antispychotic sensitivity
SPECT or PET showing low dopamine transporter uptake in basal ganglia
(SPECT = single-photon emission computed tomography)

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9
Q

(Dr. Salwa)

what are five diagnostic features that are supportive of dementia with Lewy bodies?

A 
falls, repeated
syncope, or near-syncope
severe autonomic dysfunction
delusions
depression or anxiety
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10
Q

(Dr. Salwa)

What are two diagnostic features that CONFLICT with diagnosis of dementia with Lewy bodies?

A

neuroimaging showing cerebrovascular disease

Parkinsonism appearing first with dementia later

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11
Q

(Dr. Salwa)

what are six reversible causes of falls in the elderly?

A 
vision
postural bp
medication use
balance & gait
targeted c/v, MSK, neurologic exam
home hazard eval
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12
Q

(Dr. Salwa)

what are three potential interventions for vision-related causes of falls in the elderly?

A

correction of visual acuity if <20/60

cataract removal

ample lighting w/o glare

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13
Q

(Dr. Salwa)

what are four potential interventions to remove postural bp causes of falls?

A

removal of offending meds
modification of salt & fluid intake
behavioral strategies (slow change in position)
compression stockings

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14
Q

(Dr. Salwa)

what are two ways to intervene to eliminate MEDICATION USE reasons for falls in the elderly?

A

removal of offending medications (e.g. benzos, neuroleptics, sleep meds)

reduction of polypharmacy

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15
Q

(Dr. Salwa)

what are four interventions to reduce BALANCE & GAIT causes for falls in the elderly?

A

environmental modifications
PT for gait & balance training
assessment for assistive device
exercise program

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16
Q

(Dr. Salwa)

what is an intervention we can do to to reduce TARGETED C/V, MSK, NEUROLOGIC EXAM causes of falls in the elderly?

A

diagnose & treat underlying cause if identified

17
Q

(Dr. Salwa)

what interventions do we do to reduce the HOME HAZARD EVALUATION causes for falls in the elderly?

A

modify the environment: adjust poor lighting, remove loose rugs, place non-slip bathmats and rails

18
Q

(Aquifer)

A1c of less than or equal to 6% was associated with

A

more falls

a 3-fold greater likelihood of suffering a hip fracture than those with an A1c > 8%

19
Q

(Aquifer)

what is the average GFR loss per decade?

A

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.”

20
Q

(Aquifer)

what lab finding is NEVER considered a normal part of aging, and deserves workup?

A

PROTEINURIA

21
Q

(Aquifer)

imaging findings that may be seen in pts presenting w/ memory impairments:

A 
cortical atrophy (AD, nml aging)
hippocampal atrophy (AD)
hypointensity of substantia nigra (Parkinson)
enlarged ventricles
infarcts (vascular dementia)
tumors
demyelinating disease
22
Q

(Aquifer)

list 7 characteristics of delirium

A 
acute onset
altered LOC
inattention
fluctuating course
memory problems (also seen with dementia)
altered level of alertness
visual hallucinations
23
Q

(Aquifer)

attributes of dementia

A

sustained loss of intellectual function and memory
causes dysfunction in daily living
gradually progressive course
W/O disturbance of consciousness

24
Q

(Aquifer)

mneumonic for common precipitating factors that contribute to delirium:

A

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
25
Q

(Aquifer)

predisposing factors for delirium

A 
demographic characteristics
functional impairment
sensory impairment (visual, hearing)
dehydration
drugs
comorbid medical conditions
26
Q

(Aquifer)

name 7 drugs that commonly cause delirium

A 
antihistamines
opioids
benzos
antidepressants
steroids
m. relaxants
antiemetics
27
Q

(Aquifer)
lung sounds -
crackles disappear in

A

atelectasis

so have them cough and see if the crackles are gone

28
Q

(Aquifer)

S4 heart sound is often normal in older adults….why?

A

because their ventricles are often stiffer than those of younger adults

29
Q

(Aquifer)

more than half of pts over the age of 85 will have _______ (cardiac) from ______

A

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. “

30
Q

(Aquifer)

4AT rapid clinical instrument for delirium detection:

A

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

31
Q

(Aquifer)

What is ESBM UTI?

A

put in info

CLINICAL YR: Geriatrics (2 decks)

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