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GERIATRICS > FINAL 2012 > Flashcards

FINAL 2012 Flashcards

1
Q
  1. Approximately ___ of older women and ____%of older men have some form of incontinence?
A

a. Female 1/3rd (33%)
b. Male 15-20%
i. If institutionalized rises to 60-80%

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2
Q
  1. As the bladder fills afferent nerves carry information of bladder volume to the spinal cord thus closing the neck of the bladder and relaxing the bladder dome is known as _______?
A

Sacral Micturition Center (SMC)

i. Functional loss of SMC can lead to incontinence

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3
Q
  1. In women ______ is the pressure that holds urine in the bladder?
A

a. Maximum Urethral Pressure (MUP)

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4
Q
  1. A decrease in Maximum Urethral Pressure is associated with ___ and ____, resulting in dysuria and urgency? (predisposing the development of UTIs)
A

a. Estrogen

b. Laxity in pelvic musculature

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5
Q
  1. The term _____ relates to a rapid onset of the symptoms of incontinence usually as the result of drug use or illness?
A

a. Acute Incontinence

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6
Q

Persistent incontinence is NOT related to illness, what are the four classifications of persistent incontinence?

A

a. Stress (involuntary, exp.=cough, laugh, exercise)
b. Urge (tumors, stones, CNS disorders; stroke, dementia)
c. Overflow(anatomical obstruction via diabetes or spinal cord injury)
d. Functional

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7
Q
  1. Urinary accidents associated with inability to toilet because of impairment of cognitive/physical functioning, psychological unwillingness or environmental barriers are what classification of Persistent Incontinence?
A

a. Functional

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8
Q
  1. Stress, Urge and Overflow result from one or two basic abnormalities in lower GU tract infections; what are the two abnormalities?
A

a. Failure to store urine (hyperactive/poorly compliant bladder/diminished overflow resistance)
b. Failure to empty bladder (poorly contractile bladder/increased outflow resistance)

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9
Q
  1. _____ Incontinence can occur at any age but is more common in the elderly especially with women?
A

a. Stress

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10
Q
  1. The need to void 2 or more times during usual sleeping hours is defined as?
A

a. Nocturia

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11
Q
  1. History shows that about __-__% of the elderly incontinent patients have an “unstable bladder”?
A

a. 40-75%

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12
Q

When an incontinent patient with a neurological disorder has no sense of urgency and incontinence can occur at anytime is caused by?

A

a. Detrusor hyper-flexia

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13
Q
  1. Sub-group of older incontinent patients with detrusor motor instability who also have impaired bladder contractility where only 1/3rd of less of the bladder volume is emptied with involuntary contractions is what condition?
A

a. Detrusor Hyperactivity w/ Impaired Contractility (DHIC)

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14
Q
  1. Common causes of Overflow Incontinence would include?
A

a. Prostatic enlargement
b. Diabetic neuropathic bladder
c. Urethral stricture

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15
Q
  1. What’s the term given to older women with a combination of stress and urge incontinence?
A

a. Mixed incontinence

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16
Q
  1. Examination of _____ innervations is paramount in looking for the possible cause of incontinence?
A

Lumbosacral

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17
Q
  1. __-___% of geriatric patients with frequent urinary incontinence also have episodes of fecal incontinence?
A

a. 30-50%

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18
Q
  1. An individual that has less than 3 bowel movements per week would be classified as having?
A

Constipation

i. Causes= poor diet, lazy toilet habits, physical inactivity and chronic laxative abuse

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19
Q

Accidents are the 5th leading cause of death in people >65yoa, what are the major causes of accidents and resultant disability are?

A

a. Gait instability
b. Falls
i. Nearly 1/3rd have had a fall each year
ii. 1/40 will be hospitalized and about half will remain alive a year later

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20
Q

Falls account for ___ of accidentally caused deaths?

A

2/3rds

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21
Q

The most frequent complications of falls are fractures; what is the order of frequency in sites of fractures due to falls?

A

a. Hip
b. Femur
c. Humerus
d. Wrist
e. Ribs
f. Soft tissue injury

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22
Q
  1. _____ due to disuse and detraining can contribute to an unsteady gait and the geriatrics ability to effectively provide instant mid-fall corrections?
A

Muscle weakness

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23
Q

A drop in systolic blood pressure of 20mm Hg or more when moving from a lying to a standing position is defined as?

A

a. Orthostatic Hypotension

i. Can be found in about 15-30% of geriatrics

24
Q

What are the steps to determine if your patient has orthostatic hypotension?

A

a. Take pulse and BP w/ pt. supine
b. After 1min. take pulse and BP again w/ pt. seated
c. After 1-3min. take pulse and BP w/ pt. standing

25
Q
  1. Orthostatic hypotension may be caused by?
A

a. Low Cardiac Output from heart failure of hypovolumemia
b. Autonomic dysfunction from Diabetes
c. Impaired venous return
d. Prolonged bed rest with deconditioning of muscles/reflexes
e. Several types of drugs (diuretics, anti-depressants, alcohol)

26
Q

Cardiovascular dysfunction where sudden weakness of the legs leads to a fall no coincident with a loss of consciousness; can even be caused by change of head position (vertebrobasilar insufficiency) is known as?

A

Drop Attacks

27
Q

State of momentary light headedness/disorientation to surroundings is known as dizziness T/F?

A

True

i. Vertigo-sensation of rotational movement, mc assoc. w/ inner ear disorders (Meniere’s) or w/ TIA or postural changes.

28
Q
  1. Symptoms of a subdural hematoma are?
A

a. Headache
b. Progressive stupor
c. Hemiparesis

29
Q

Most common causes of immobility are?

A

a. Musculoskeletal (DJD, OP, hip fractures)
b. Neurological (drowsiness and ataxia)
c. Cardiovascular disorders (CHF, Coronary artery or peripheral artery Dz.)

30
Q
  1. The most serious and probably the most life-threatening complication of immobility are _____ problems that lead to a worsening state of immobility?
A

Cardiopulmonary

31
Q

Generalized loss of bone mass without changing relative composition of bone is known as?

A

a. Osteoporosis
i. Type I: postmenopausal, affects trabecular bone
ii. Type II: senile OP, trabecular + cortical bone, low levels of 1,25 dihydroxy vit. D

32
Q

About __% of bone mass loss must occur before the x-ray appears abnormal and labeled as having OP

A

a. 30% ( OP affects 30% of women and 20% of men)

33
Q

What are the four factors that contribute to the development of pressure sores (decubitus ulcers)?

A

a. Pressure
b. Shearing forces
c. Friction
d. Moisture (bathing, sweat, urine)

34
Q

T/F Irreversible damage to tissue can occur after only 2 hours of continuous pressure that exceeds capillary pressure?

A

True

35
Q

More than 90% of pressure sores are found in the lower extremities especially in the?

A

a. Sacral/coccygeal areas
b. Ischial tuberosities
c. Greater trochanter

36
Q

By the age of 60, nearly 1/5 Americans have symptomatic coronary artery dz caused by ____?

A

Atherosclerosis

37
Q

In elderly ____ is the leading cause of death and the most common cause of hospitalization?

A

Heart disease

38
Q

Autopsy of Korean War soldiers killed showed 40% of those in their 20s had _____ of one or more coronary arteries?

A

a. Athromatous involvement

39
Q

Study of people aging 30-80, found there was no change in cardiac output at rest and only a small increase in stroke volume, but during maximum exercises in older people their heart rate response _____?

A

Decreased

40
Q

HBP causes 1 in every 8 deaths ranking hypertension the ___ leading killer in the world?

A

a. 3rd

i. 2/3rd of those >65 have hypertension

41
Q

Those who have blood pressure readings of 160/95 mm Hg have a (optimal:120/80 mm Hg)

A

a. 3x increase for coronary and peripheral vascular Dz
b. 4x increase for CHF
c. 7x increase for stroke

42
Q

When systolic and diastolic BP fall into different categories, the ____ category should be selected to classify the individuals BP status?

A

Higher

43
Q

If diastolic pressure in the arms is >90mmHg, you should suspect a possibility of Coarctation of the aorta/aortic insufficiency, you should measure _____?

A

a. BP in legs
i. Normally BP in legs will read 15-20 mmHg higher than arms
ii. Atherosclerosis can account for a 10-15 mmHg higher BP error

44
Q

BP of >160mmHg systolic and

A

a. Isolated Systolic Hypertension

i. This definition; 40-50% of people>65 are hypertensive

45
Q

On average beginning at the age of 45 systolic pressure rises at a rate of ___ each year until reaching the age of 70?

A

c. 0.5-1.0

46
Q

LDL to HDL ratio should be about ____?

A

5:1 (preferably 3:1)

47
Q

Arthrosclerosis may interfere with the flow of blood through the brachial artery during BP screening leading to an erroneous high BP reading termed as?

A

Pseudohypertension

48
Q

If patient presents with pseudohypertension you want to raise the cuff pressure above the systolic reading and note if the radial pressure remains palpable, this procedure is called?

A

a. Osler Maneuver

49
Q

The first symptoms of a patient being hypertensive (>179/110mmHg) are?

A

a. Blurred vision
b. Headaches
c. Dyspenea
d. Giddiness
i. Pt. can present w/ 1 or more of these symptoms

50
Q

Quitting smoking can lower BP by ____mmHg?

A

a. 5-10mmHG

51
Q
  1. ____ is the most common cause of disability in the US and the ___ leading cause of death?
A

Stroke; 3rd

52
Q

The incidence of having a stroke rises steeply with age and is about ___greater in the 75-89 age group than it is in the 55 to 64 age group?

A

10x

53
Q

Vertebrobasilar constrictions contributing to stroke commonly have what symptoms?

A

a. Diplopia d. Vertigo
b. Ataxia e. Binocular vision
c. Dizziness f. Nausea/Vomitting

54
Q

T/F most neurologic return occurs during the 1st month after a stroke compared to the 3rd month having little if any further return is expected?

A

True

55
Q

The primary cause of heart failure in older patients in reference to BP is _____ dysfunction?

A

Diastolic

56
Q

Iron deficiency anemia is most commonly seen in the _____ population?

A

a. Geriatric

i. Hypochromia, microcytosis, low reticulocyte count

57
Q

Is Folate or Vit. B12 more commonly deficient in geriatrics?

A

a. Folate (especially those who live alone)

b. Vit. B12 deficiency- insufficient amounts of animal protein

GERIATRICS (4 decks)

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