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adult gero > exam 2 > Flashcards

exam 2 Flashcards

1
Q

8 IADL

A 
Ability to use phone
Food preparation
Laundry
Responsibility for own meds
Shopping
Housekeeping
Mode of transportation
Ability to handle finances
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2
Q

what are the 4 domains of geriatric assessment

A

mental
physical
social
functional

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3
Q

type of Age-related Macular Degeneration (AMD) where:

Slower form of vision loss
Generally less severe
Thin/distorted retina

A

dry AMD

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4
Q

Cloudy Lens
painless
can occur in one or both eyes

A

Cataract

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5
Q

with delirium, If delusions or violent, consider ____

A

Haldol

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6
Q

2 tests of attention

A

Recite days of the week backward

Recite months of the year backward

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7
Q

2 things to consider with mobility

A

Identify mobility issues
(Assistive devices)
(Activities performed ie sedentary vs active)
(Walking speed, get up and go test)

Why might this be a problem? 
(Arthritis )
(Muscle atrophy)  
(May contribute to incontinence)
(May contribute to depression)
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8
Q

with functional vision

any difficulty with oncoming headlights; difficulty coming inside on a sunny day

A

Glare

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9
Q

Screening of BMD with DEXA scan should be done every __ years

A

every 2 years

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10
Q

Silent MI
Silent acute abdomen

are examples of

A

Nonpresentation of Disease

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11
Q

3 reasons for atypical presentation in older adults

A

progression of normal aging changes
geriatric syndromes
co-morbidities

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12
Q

4 Brown (2015) Elders beliefs about Tobacco Myths

A

Tobacco helps you think more clearly
Tobacco damage is irreversible
Older adults don’t want to quit smoking
Perceived tobacco benefits

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13
Q

2 Management-Chronic Glaucoma

A

medications to decrease production of aqueous humor or Increase outflow of aqueous humor

Trabecular procedures (surgery)

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14
Q

For adults 65 or older who do not have an immunocompromising condition, cerebrospinal fluid leak, or cochlear implant and want to receive _____ ONLY

A

PPSV23

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15
Q

5 Aspects of Cognitive Function

A 
Attention
Executive function
Memory 
Visual spatial skills
Psychomotor function
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16
Q

type of delirium

Alternating symptoms between hyperactive and hypoactive

Often mistaken for psychotic or mood disorders

A

mixed

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17
Q

for adults over 65

TdAP ever ___ years

A

– every 10 years

replace one booster with Tdap if contact with child <12 months

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18
Q

Most recommendations are q 2 years for women between age___–____

A

50-75

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19
Q

sudden increase in intraocular pressure

minutes to hours/ emergency

A

Acute-closed angle glaucoma

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20
Q

Loss of volume AND discrimination of sounds

Slow onset/progressive
Bilateral
Loss of high pitched sounds
Difficult with sibilant consonants

A

Presbycusis

also known as

ARHL (Age Related Hearing Loss)

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21
Q

3 common causes for post op delirium

A

Common complication in cardiac surgery, non-cardiac surgery, hip fractures

Post op meds
(Benzodiazepines)
(Anticholinergic agents)
(Pain medications)

Low hematocrit
< 30%

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22
Q

Common cause of legal blindness

irreversible

A

Age-related Macular Degeneration (AMD)

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23
Q

orthostatic

Within __ minutes of changing position:
Systolic drop of ___ mm/Hg or Diastolic drop of > __ mm/Hg

A

Within 3 minutes of changing position:

Systolic drop of 20 mm/Hg or Diastolic drop of > 10 mm/Hg

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24
Q

for adults over 65

Influenza – every ___ years

A

yearly

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25
Q 
Sub-sternal chest pain
Radiating pain to neck, jaw, arm
SOB/dyspnea
Diaphoresis
EKG changes associated with MI

are all typical signs of

A

MI

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26
Q

Pulse > __ with a drop in blood pressure suggest what 3 things

A

hypovolemia, dehydration, ADR of anti hypertensive /psychotropic meds

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27
Q

with 3 consistent negative paps you can stop at the age of ____

A

65

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28
Q

5 interview skills for geriatric assessment

A 
Speak to the patient, not the caregiver 
Speak slowly
Let patient see your face 
Take your time 
Avoid age-ist remarks
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29
Q

unilateral conductive loss with boney overgrowth that causes hearing loss and possibly pain

A

Otosclerosis

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30
Q

Identifies potential dementia, progression of dementia

A

Mini-cog

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31
Q

type of delirium

Only 25% of all delirium cases

Agitated, delusional, altered sleep cycles

Hallucinations
Extreme emotions

A

Hyperactive

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32
Q

Controlling chronic disease
Preventing re-hospitalizations
Preventing disability

are examples of _____ prevention

A

Tertiary Prevention

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33
Q

with prostate screening:

Higher Risk: begin at age __

those with more than one first-degree relative who had prostate cancer at an early age

First degree (parents, siblings & children)

A

40

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34
Q

Classical manifestation of infection (fever, leukocytosis, tachycardia) may be absent or blunted in ___–___%

A

20-30%

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35
Q

haring loss where

Difficult to hear conversational speech

A

Moderate loss

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36
Q

Measures loudness-db

Pitch in Hz

A

Handheld audioscope/speech pathologists

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37
Q

Tinnitus

Normal: Lasts < _ minutes, < once/week

Pathologic: lasts > _ minutes, > weekly in people with hearing loss

A

5

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38
Q

UTI ___-__ times higher mortality rates in older adults

Pneumonia __ times higher mortality

A

UTI 5-10 times higher mortality rates in older adults

Pneumonia 3 times higher mortality

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39
Q

haring loss where

Difficult to hear shouting, vacuum cleaner

A

Severe

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40
Q

an adult who takes longer than ___ seconds to complete timed up and go test is at risk for falls

A

12 seconds

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41
Q

___–___% of all deaths due to sepsis occur in the elderly partially due to delay in diagnosis

A

60-70%

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42
Q

Pulse is constant or increases < 10 beats with a b/p drop suggests________

A

autonomic dysfunction

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43
Q

4 risk factors for need for Screening of BMD with DEXA scan

A

Fracture history
thin
steroid use
ETOH use

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44
Q

timed up and go test what?

A

functional mobility

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45
Q

2 factors for high risk older adults with STI

A

a history of STI

multiple sexual partners

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46
Q

peak risk for post op delirium

POD __

A

2

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47
Q

Administer 1 dose of ______ first then give 1 dose of ________ at least 1 year later.

A

PCV13

PPSV23

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48
Q

5 barriers to geriatric assessment

A 
Sensory changes
(Vision, hearing)

Health literacy

Slower cognitive processing
(response to questions)

Cognition

Passive Learners

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49
Q

4 Advanced Activities of Daily Living

A

Community activities
Working
Volunteerism
Recreation

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50
Q

4 features of CAM (Confusion Assessment Method)

A

acute onset and fluctuating course
inattention
disorganized thinking
altered consciousness

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51
Q

with prostate screening, false positives can lead to a biopsy which can cause what 5 problems

A 
Infections
bleeding
anxiety
Incontinence
Erectile dysfunction
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52
Q

deposit of lipid in peripheral cornea

A

arcus senilis (corneal arcus)

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53
Q

haring loss where

Difficult to hear whispers & soft speech in presence of noise

A

Mild hearing loss

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54
Q

Vaccination
Diet/Exercise counseling
Counseling/Education to

are examples of _____ prevention

A

primary

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55
Q

3 issues with history taking in older adults

A 
Extensive histories
Multiple chronic illnesses/multiple complaints
Vision/hearing
Atypical presentation of symptoms
Under reporting of symptoms

Health care delivered in a different generation

Caregiver (who is it?)
(Family, friends, paid)

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56
Q

with older adults MI Onset of symptoms in elderly more likely to occur at ____

A

rest/sleep

57
Q

after the age of 50 – after age 50- 2 doses (2-6 months apart

A

Shingrix

58
Q

__–__% discharged from hospital with delirium

A

25-50%

59
Q

If new risk factors begin Pap smears, such as ______

A

New sexual partner

60
Q

when you turn 65 you will go in for an _____ exam

A

Medicare wellness exam

welcome to medicare exam

61
Q

For adults 65 or older who do not have an immunocompromising condition, cerebrospinal fluid leak, or cochlear implant and want to receive ______ &__________

A

PCV13 AND PPSV23:

62
Q

with functional vision: any difficulty driving in the rain or seeing on a hazy day

A

Contrast sensitivity

63
Q

Bilateral hearing loss is almost always

A

Sensorineural loss–refer

Presbycusis/ARHL
Ototoxic Medications
Noise history
Central nervous system problems: dementia, stroke, tumors
Menierres
64
Q

with nutrition Ask if they have lost more than ___ pounds in the last 6 months to 1 year

A

10

65
Q

2 assessment tools for glaucoma

A

Visual fields test (peripheral vision)

Intraocular pressure-tonometry

66
Q

used to screen for cervical cancer

A

pap

67
Q

Thyroid disease may present with cardiac symptoms

Confusion with infections, MI

are examples of

A

S&S in Wrong Organ System

68
Q

3 Atypical Presentation of illness includes:

A

Vague presentation of illness
Altered Presentation:
(illness in wrong organ system)
Non-presentation of illness

69
Q

(ringing, roaring, or hissing in one or both ears) may occur.

A

Tinnitus

70
Q

5 management techniques for delirium

A 
If possible eliminate anticholinergics
Behavioral control	(sitter, orienting items)
Monitor bowel and bladder function
Exercise
Keep hydrated
71
Q

life’s simple 7

A 
control cholesterol 
eat better 
lose weight 
get active 
manage BP
reduce BG
stop smoking
72
Q

decreased central vision

A

Age-related Macular Degeneration (AMD)

73
Q

screening tool for alcoholism

A

Cut down
Annoy
Guilt
Eye-opener

74
Q

Night vision

Adapting to light changes

A

Decreased acuity

75
Q

one sided hearing loss is almost always

A

Conductive loss

Impacted cerumen
Obstruction
Middle ear infection/fluid
Otosclerosis

76
Q

3 management techniques for conductive hearing loss

A

Irrigation
Antibiotics
Surgery

77
Q

type of delirium

Least recognized and most underdiagnosed
Most common
Oldest old
Poorest prognosis
Present as lethargic, confused, decreased movement
A

Hypoactive Delirium

78
Q

Hypothermia may be presenting symptom in sepsis Temp < ____

A

96.8

79
Q

__% of adults with hearing loss report using a hearing aid

A

14%

80
Q

Reversible cause of blindness

A

Cataract

81
Q

Non-demented patients who develop delirium

May have higher risk of dementia over next __ years

A

5

82
Q

Asymptomatic People

Lipid screening
Fasting glucose screen
Cancer Screening
Prognosis/Life-expectancy
Patient preferences

are examples of _____ prevention

A

secondary

83
Q

when should you get colon cancer tests done

A

Test 50-75 every 10 years

84
Q

identify asymptomatic health issues/diseases/cancers that will lead to morbidity and mortality within an adult’s lifetime if not found early and treated

A

screening

85
Q

two types of Sensorineural Loss

A

Peripheral hearing loss

Central hearing loss (CNS)

86
Q

Assesses more complex activities needed for independent living

A

Instrumental Activities of Daily Living

87
Q

two type of management methods for wet AMD

A

Mono-clonal antibodies-anti-VEGF abilities (vascular endothelial growth factor)

Laser photocoagulation

88
Q

with functional vision

any difficulty seeing at dusk and at night

A

Low light

89
Q

with prostate screening:

Average risks: men > __ and expected to live > __ years

A

50

10

90
Q

disturbed consciousness

inattention

A

Delirium

91
Q

9 things to consider with review of systems

A 
Vision/hearing changes
Falls
Sleep
Ambulating difficulties
Dizziness
Incontinence
Depression 
Weight changes/anorexia
Cognitive impairment
92
Q

droopy eyes

A

blepharocholasis

93
Q

__% of sexually active older adults report at least one bothersome sexual problem

A

50%

94
Q

tool used to evaluate spirituality

A

FICA

95
Q

4 Pathophysiology of delirium

A 
Multifactorial causes
(Stress state leads to metabolic changes)
Neurotransmitter problems
(Cholinergic deficit or Dopamine excess)

Release of cytokines
(Increased in infectious and inflammatory conditions)

Aging changes r/t BBB

96
Q

5 Risk factors for atypical presentation in older adults

A

Higher risk of atypical responses in oldest –old > age 85

Nursing home residents
Multiple chronic illness
Multiple medications
Cognitive or functional impairment

97
Q

Conjunctival overgrowth

A

Pterygium

98
Q

Sensorineural Loss management

A

Hearing aids

Hearing tests covered by medicare
Hearing aids are not

99
Q

Leading cause of death in older adults
> rates of sudden death and dysrhythmias
Autonomic dysfunction

A

Acute coronary syndrome

100
Q

3 types of delirium

A

Hyperactive
Hypoactive
Mixed

101
Q

6 elements of a functional screen

A 
Loss of skills needed
Basic and  more complex instrumental activities of daily living
Safety in the home
Mobility
Mood & cognition
102
Q

type of hearing loss where age related hearing loss

Cochlear pathologies
8th cranial nerve damage

A

Peripheral hearing loss

103
Q

Incorporate geriatric assessment principles into general clinic settings

A

Geriatric Assessment (GA)

104
Q

3 Normal Eye Changes-Structural

A

Weakened muscles around or in eye
Decreased production of tears and mucin
Growths

105
Q 
Tachypnea-resp rate >25
Mental status changes
Afebrile/low temp
Functional change
Unproductive cough
Cardiac arrhythmia, MI, ischemia

are atypical signs of

A

pneumonia

106
Q

3 guidelines for screening

A

Healthy People 2020

USPSTF

Specialty Organizations
(American geriatrics society)
(American heart association/ACC)
(American cancer society)

107
Q

Gradual loss of peripheral vision

Painless

A

Chronic Glaucoma

108
Q

three types of hearing screening

A

Functional loss/disability vs auditory test results
Hearing handicap inventory for Elderly (box 25-4)
Single question screen

109
Q

3 prevention strategies

A

Screening
(Screening vs Assessment)

Chemoprophylaxis
(Immunizations)
(Other medications ie aspirin, vitamins)

Counseling
(Lifestyle)
(Geriatric issues)

110
Q

Screening of BMD with DEXA scan for what 3 groups

A

All women > 65
Post menopausal women < 65
Men >65 if history of fracture or high risk

111
Q

type of Age-related Macular Degeneration (AMD) where:

Faster and more severe vision loss
Development of new blood vessels under retina
Scotoma

A

Wet AMD

112
Q

10 things you want to cover in past medical condition

A 
Chronic/Acute Illnesses & Surgeries
Medication review***
immunizations
Family history
Social history
Caregiver status
Functional history (IADL &ADL)
Current use of community resources
Wellness
Advanced care planning
113
Q

3 Normal Aging Changes-Vision

A

Presbyopia

Decrease in pupil size

Decreased color sensitivity

114
Q

two type of management methods ford dry AMD

A

Anti-oxidant vitamins and mineral supplements
(Vitamin C, E, beta-carotene and zinc)

Visual Rehab
(Magnifiers)
(Eccentric viewing)

115
Q

Absence/Delay of typical S&S

Change in mood or cognition
(Acute onset, hours to days)

are examples of

A

Vague Presentation of Illness

116
Q

Most common cause of blindness in black people

A

Glaucoma

117
Q 
Mild or absent chest pain
Acute confusion/behavioral changes
Mild or absent dyspnea
Abdominal pain
“dizzy” -- Syncope or vertigo
Delay in seeking treatment
Profound weakness/fatigue
Change in eating pattern

you should suspect

A

MI

atypical symptoms

118
Q

3 questions you can ask for depression

A

Single question approach;
“How do you see your future?”

“Are you often sad or depressed?”
If yes, screening tool

“What do you do for fun?”

119
Q

Decreased accommodation

Lens stiffer

A

Presbyopia

120
Q

2 tools to evaluate ADL’s

A

Katz ADL

Lawton Instrumental activities of daily living

121
Q

yellow dot on eye

A

Pinguecula

122
Q

Defined as symptoms occurring outside of the traditional signs and symptoms, which may signify an impending acute illness

A

Definition of Atypical Presentation of Disease

123
Q

Multifactoral conditions that involve the interaction between age-related changes, risk factors, chronic illness, functional issues and stressors

A

Geriatric Syndromes

124
Q

type of hearing loss where mechanical loss blocking air waves

A

Conductive Loss

125
Q

Increased intraocular pressure resulting in optic nerve damage

A

Glaucoma

126
Q

with prostate screening:

High Risk: begin age __

_____ men

men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than age 65).

A

45

black

127
Q

you should continue cervical cancer screening past 65 with what 2 things

A

HIV-DES

128
Q

Sudden onset
Severe pain
Loss of vision

Red eye, cloudy cornea, dilated pupil

A

Acute Glaucoma

129
Q

assessment includes physical, cognitive, psychological, and social aspects of health

A

Comprehensive Geriatric Assessment (CGA)

130
Q

2 parts of Mini-cog

A

3 word recall

Clock drawing

131
Q

4 assessment tools for vision in older adults

A

Snellen eye chart?
Contrast sensitivity?
Performance under < illumination
Glare sensitivity

132
Q

two screening tools for delirium

A

CAM (Confusion Assessment Method)

CAM-ICU (confusion assessment method-intensive care unit version)

133
Q

mammography trials did not include women > __

A

74

134
Q

4 Colon Cancer tests

A

FOBT
Cologuard
Colonoscopy
Sigmoidoscopy

135
Q

lipid deposits around the eyes

A

Xanthalasma

136
Q

6 aspects of social support for older adults

A

This is a variation of the “social history”
ETOH, recreational drugs, opioid use

Spirituality

Living arrangements

Help for emergencies

Help for non-emergencies

Unbefriended Elders

137
Q

when your blood pressure drops after a meal

A

post prandial hypotension

138
Q

type of hearing loss where Damage to structures important in the processing of auditory information

Central nervous system –brain
Dementia/stroke

A

Central hearing loss (CNS)

139
Q

2 tools used to asses for cognitive problems

A

Minicog/MoCA

adult gero (3 decks)

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