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Geriatrics > Final > Flashcards

Final Flashcards

1
Q

By 2030, it is estimated that __% or #__ Americans will be older than 65.

A

22%

70.2 million

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2
Q

The average life expectancy for women in the US is ___.

A

79.5

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3
Q

The average life expectancy for men in the US is ___.

A

72.7

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4
Q

What are 5 theories of aging?

A 
Cellular "supply limits" theory
Free radical damage theory
Autoimmune theory
Programmable cell death theory
Telomere length theory
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5
Q

What mutation is in 50% of all cancers?

A

p53 gene

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6
Q

The process of cell division has what effect on telomere length?

A

Shortens it

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7
Q

What role does telomeres have in the life of a cell?

A

After a certain number of divisions, the telomeres become too short to participate in chromosome duplication -> cell death

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8
Q

Can you artificially increase the length of telomeres?

A

Yes, but results are disappointing

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9
Q

What is an activity that can increase telomere length?

A

Meditation

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10
Q

In which cells is telomerase expressed?

A

Certain adult stem cells, precursor cells to sperm, activated WBCs

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11
Q

Greater telomerase activity is associated with ___

A

more rapid accumulation of coronary artery plaque

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12
Q

What is the relationship between PPIs and NSAIDs?

A

PPIs are protective against ulcer formation d/t NSAIDs

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13
Q

What is the relationship between H2 inhibitors and NSAIDs?

A

H2 inhibitors speed up ulcer formation and gastritis d/t NSAID use

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14
Q

SSRI use is associated with what deficiencies?

A

B-vitamins, B6, B12, Folic acid,

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15
Q

PPI and H2 blocker use is associated with what deficiencies?

A

B12, Ca, Fe, Mg

Any nutrient that depends upon acidic environment

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16
Q

Metformin use is associated with what deficiencies?

A

B12

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17
Q

Statin use is associated with what deficiencies?

A

CoQ10

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18
Q

BCP use is associated with what deficiencies?

A

B5, B6, B12

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19
Q

Seizure medication use is associated with what deficiencies?

A

Folic acid

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20
Q

Population: Kyphosis

A

F>M, older age

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21
Q

Anatomical changes: Kyphosis

A

Slight knee/hip flexion -> shortened stature

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22
Q

What is a major cause of peripheral vision loss?

A

Glaucoma

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23
Q

What are two major causes of central vision loss?

A

Cataracts, macular degeneration

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24
Q

What type of glaucoma is more common outside of the United States, especially in Asian countries?

A

Closed-angle glaucoma

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25
Q

SSx: Acute angle closure glaucoma

A

Sudden ocular pain and decreased vision, red eye, N/V, fixed/mid-dilated pupil, seeing halos around lights

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26
Q

Acute angle closure is ___

A

an ocular emergency

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27
Q

What is the MC type of glaucoma in the United States?

A

Open-angle glaucoma

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28
Q

SSx: Open-angle glaucoma

A

Gradual visual field loss, increased cup-disc ratio, painless, no acute attacks

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29
Q

Pop: Open-angle glaucoma

A

Uncommon <40
~1% aged 40-65
5% >65

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30
Q

What nutrient deficiency is related to diminished taste?

A

Zn

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31
Q

How should you talk to a patient with difficulty hearing?

A

Low-pitched voice

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32
Q

Exostoses

A

Formation of new bone on bone surface

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33
Q

MC type of arthritis

A

Osteoarthritis

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34
Q

PARQ: Alpha agonist

A

Sit up slowly so BP can adjust for the first 6 weeks

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35
Q

Why are beta blockers contraindicated in elderly patients with diabetes?

A

Blunts hypoglycemic response

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36
Q

In addition to diabetes, what other condition is contraindicated for beta blocker use in the elderly?

A

COPD

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37
Q

In most instances, what should be the initial antihypertensive therapy in the elderly?

A

Low-dose diuretic

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38
Q

What is a first-line option in elderly patients who present with isolated systolic hypertension?

A

CCB

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39
Q

Innervation: Detrusor muscle

A

S2-S4

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40
Q

Parasympathetic innervation of the detrusor muscle causes ___.

A

Bladder contraction, evacuation of urine

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41
Q

Comorbidity: incontinence

A

Pressure sores, social isolation, depression, UTI, falls

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42
Q

What is the MC reason for acute urinary incontinence?

A

Bladder infection

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43
Q

What are the 4 main causes of acute urinary incontinence?

A

Delirium
Restricted mobility
Infx, inflammation, impaction
Pharmaceuticals

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44
Q

What is the MC cause drug-induced incontinence?

A

Diuretics

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45
Q

Acute onset of incontinence in a pt with ___ is a medical emergency.

A

known or suspected malignancy

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46
Q

Triad of acute urinary incontinence, acute/subacute dementia, wide-based gait indicates ___.

A

Normal pressure hydrocephalus

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47
Q

What is the MC form of chronic incontinence in the geriatric population?

A

Urge incontinence

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48
Q

Urge incontinence is AKA ___

A

“spastic” or “overactive” bladder

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49
Q

Stress incontinence triggers

A

coughing, sneezing, laughing, bending over

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50
Q

What conditions can be associated with urge incontinence?

A

Parkinson’s disease, Alzheimer’s disease, stroke, surgery, MS, irritation to bladder wall

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51
Q

What conditions are associated with overflow incontinence?

A

Diabetic neuropathy, spinal cord injury

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52
Q

PE: Overflow incontinence

A

Absence of anal reflex and “saddle” sensation

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53
Q

Overflow incontinence is AKA ___.

A

Neurogenic or atonic bladder

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54
Q

What conditions are associated with functional incontinence?

A

Confusion, dementia, poor eyesight, poor mobility

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55
Q

Initial work-up in all cases of incontinence

A

UA -> culture/sensitivity

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56
Q

What treatment is a valid option for all types of incontinence?

A

Kegel exercises

57
Q

Work-up: Hematuria

A

UA
Scope
Cytology
S-sonogram (KUB)

58
Q

Tx: Stress incontinence related to vaginal atrophy

A

Topical estrogen

59
Q

What drug class is commonly used in urge incontinence?

A

Anticholinergic

60
Q

Anticholinergic medications are contraindicated with which comorbidity?

A

Acute angle glaucoma

61
Q

What is the MC cause of injury-related morbidity in the elderly?

A

Falls

62
Q

__% of all fall-related deaths occur in the elderly.

A

70%

63
Q

What conditions can contribute to falls?

A

BP fluctuations, orthostatic hypotension, post-prandial hypotension

64
Q

What receptors tend to degenerate with age, contributing to falls?

A

Cervical mechanoreceptors

65
Q

PE: Elderly pt at high-risk for falls

A

Loss of LE proprioception, diminished ankle reflexes

66
Q

The risk of falling increases with ___.

A

increased chronic disability

67
Q

There are approximately ___ vertebral fractures every year.

A

700,000

68
Q

Primary vs. Secondary osteoporosis

A

Primary - d/t aging

Secondary - d/t other conditions

69
Q

Risk factors: osteoporosis

A

FHx, hyperthyroidism, excess supplemental thyroid, Cushing’s disease, Hyperparathyroidism, Glucocorticoid use, prolonged immobilization

70
Q

Increased luceny may not be present on X-rays in osteoporosis until ___

A

30-40% of bone mass has been lost

71
Q

T-score

A

STD DEV score for healthy 30 year old adult

72
Q

Z-score

A

STD DEV score for matched peer (age, sex, race)

73
Q

Normal T-score

A

> -1

74
Q

Osteopenia: T-score

A

-1 to -2.5

75
Q

Osteoporosis: T-score

A

< -2.5

76
Q

NTX is measured in ___

A

urine, blood

77
Q

CTC is measured in ___

A

blood

78
Q

Elevated NTX correlates with __

A

diminished bone density

79
Q

What is a FRAX score used for?

A

10-year probability of bone fracture risk at hip/spine/shoulder/extremity

80
Q

How is FRAX score calculated?

A

BMD at femoral neck + clinical risk factors

81
Q

How common is osteoporosis in post-menopausal women?

A

1 in 4

82
Q

Why do men appear to show a diminished response to medications for osteoporosis?

A

Usually do not get treatment until advanced stage

83
Q

Lifestyle recommendations: Osteoporosis

A

Weight-bearing exercise, quit smoking

84
Q

What forms of calcium may be better absorbed in patients with diminished levels of stomach acid?

A

Calcium citrate/lactate/gluconate

85
Q

Is vitamin D protective against osteoporosis?

A

Only in combination with calcium

86
Q

What other nutrient, when given with vitamin D and calcium, may be protective against bone loss?

A

Mg

87
Q

When supplementing with vitamin K, keep patients on ___ until K wears off.

A

Heparin

88
Q

S/E of bisphosphonates

A

Esophagitis, Osteonecrosis of the jaw, Myalgias

89
Q

Bisphosphonates have been shown to reduce the risk of ___.

A

Spinal/hip fractures

90
Q

HRT and bone fractures

A

Decreased bone fractures

Increased heart disease

91
Q

Example of SERM

A

Raloxifine

92
Q

S/E of Raloxifine

A

Increased risk for development of DVT/PE

93
Q

Raloxifine did not cause a decrease in ___.

A

Non-vertebral fractures

94
Q

Which drugs for osteoporosis are used for treatment only?

A

Calcitonin, Calcimar

95
Q

Which drugs for osteoporosis are used for treatment and prevention?

A

Raloxifine, Fosamax

96
Q

Intermittent administration of low-dose PTH causes ___

A

increased bone remodeling and bone density

97
Q

What should you do with a patient before starting them on Denosumab therapy?

A

Establish suficient vitmain D and calcium levels

98
Q

Contraindications: Denosumab

A

Hypocalcemia -> inc. risk for jaw osteonecrosis

99
Q

What sign may be absent in pneumonia in the elderly?

A

fever

100
Q

Compared to younger patients, elderly patients with pneumonia are more likely to ___

A

be bacteremic
develop complications
die

101
Q

What symptom is less common in UTIs in the elderly?

A

Dysuria

102
Q

Urosepsis frequently manifests as ___ when systemic signs are absent (fever/chills).

A

confusion, altered mental status

103
Q

What is a common presentation for cardiac ischemia in the elderly?

A

Dyspnea

104
Q

When anginal pain is present in cardiac ischemia in the elderly, what is unique about it?

A

May occur in the back of shoulders or epigastric area

105
Q

What % of elderly patients with MIs present with “silent MIs”?

A

> 25%

106
Q

What are some atypical presentations of MI in the elderly?

A 
V w/ or w/o abdominal pain
Vertigo
Confusion
Syncope, near-syncope
Falling
107
Q

Renal failure in the elderly? Think __.

A

MI

108
Q

What % of elderly patients with PUD have “silent” form?

A

30-50%

109
Q

What is a good motto to remember difference between peptic and duodenal ulcers?

A

Starve a peptic, feed a duodenal

110
Q

What is the MC clinical presentation of geriatric pts hospitalized with duodenal ulcer?

A

Melena

111
Q

Atypical SSx: PUD in the elderly

A

Anorexia, weight loss, confusion, GI bleeding/perforation

112
Q

Which is more likely to perforate: anterior or posterior ulcer?

A

Anterior

113
Q

What should you suspect in any elderly pt w/ unexplained abdominal pain w/ sepsis or GI bleeding?

A

PUD

114
Q

SSx: Fecal impaction

A

Anorexia, N/V
Paradoxical D, stool incontinence
Abdominal pain
Bladder sxs

115
Q

SSx: Hypothyroid

A 
Failure to thrive
Wt loss
Constipation
Falling
Muscle weakness
CHF
Anemia
Depression
Carpal tunnel syndrome
116
Q

What common symptoms of hyperthyroidism are present in less than 50% of elderly pts?

A

tachycardia, tremulousness, sweating

117
Q

SSx: Hyperthyroidism

A

Apathy, inactivity

118
Q

> 65? What 3 tests do they need?

A

Carotid artery US, TSH, abdominal aorta US

119
Q

Don’t increase thyroid meds by more than ___.

A

25 mcg

120
Q

SSx: Hyperparathyroidism

A 
GI complaints (N/V, wt loss, dyspepsia, C, anorexia)
Depression, anxiety, dec. memory, personality change, delirium
121
Q

Causes: delirium

A 
Medications
Pneumonia
CHF
MI
PE
Sepsis (esp. urosespsis)
Dehydration
Hypoxemia
122
Q

Diagnosis of dementia requires at least two of these must be affected:

A 
Memory
Language
Personality
Emotion
Motor skills
123
Q

Levels of SHBG (increase/decrease) with age.

A

Increase

124
Q

T -> ? -> DHT

A

5-alpha reductase

125
Q

T -> ? -> E2

A

Aromatase

126
Q

What is andropause?

A

Hormonal changes and subsequent mental/physical/emotional changes that occur in aging men

127
Q

E2 interacts with ___ to cause an 8-fold increase in ___, causing ___

A

SHBG
cAMP
Increased growth of prostate tissue

128
Q

SSx: Andropause

A

Dec. libido, disturbed sleep, depression, fatigue, irritability, hot flashes, thinning skin, inc. osteoporosis/atherosclerosis/ht disease

129
Q

Routes: Testosterone

A

Injection, Patch, Gel, Oral

130
Q

Bioavailability of oral testosterone

A

Limited unless bioengineered, which can cause LV disease/CA

131
Q

S/E: Testosterone

A

Acne, breast tenderness/enlargement, Erythrocytosis, Sleep apnea, Led edema, Worsening of ht dz, cardiac hypertrophy, prostate CA

132
Q

What is a natural aromatase inhibitor extracted from Passionflower?

A

Chrysin

133
Q

Contraindications: Testosterone

A

Presence of PrCA or PMHx of PrCA

Presence of BrCA or PMHx of BrCA

134
Q

DHEA levels peak at age ___

A

25

135
Q

MOA: Viagra

A

Inc. NO level

136
Q

What are organic causes of impotency?

A

DM, hypothyroidism

137
Q

What AA is a precursor to NO?

A

L-arginine

138
Q

Drug classes for BPH

A

5-alpha reductase inhibitor

Alpha-1 blocker

139
Q

What is a natural 5-alpha reductase inhibitor?

A

Saw palmetto

Geriatrics (1 decks)

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