Final Flashcards
What signifies hearing loss with an audioscope set at 40dB?
inability to hear 1000 or 2000Hz in both ears or either frequency in one ear
What is often the first sign of illness in the elderly?
Functional loss (decreased mobility, increased falls, confusion, incontinence)
What are physical activity indicators to check?
- Level of activity
- Ability to do household chores
- Go up AND down stairs
- Walk outside and around town
- Wash, dress and groom oneself
What are the 7 common background problems in elderly patients?
- Nephrotoxic agents (NSAIDS) accumulate and cause side effects
- Hepatic mass and function decline and reduction of reserve (drug toxicity danger)
- Malnutrition (increase in protein bound serum drug conc.)
- Delerium (infection, pain, oversedation)
- Disability (may be worsened by stress/pain/illness)
- Pressure sores (immobilization, incontinence, malnutrition)
- Falling (weakness, hypotension, deconditioning, pain)
What are factors that may delay cognitive decline?
- High level of education
- Physical exercise
- Staying intellectually engaged
- Maintaining social networks (friends)
- Healthy diet
What are the consequences of decreased cell response to growth factors in the elderly?
- Diminished immunity and wound healing
2. Diminished production and proliferation of lymphocytes
What are the consequences of diminished endocrine function?
- Increased glucose tolerance
- Decreased clearance of thyroid hormone
- Increased LDLs
- Altered drug pharmokinetics/dynamics
- Decreased production of sex hormones
What are the consequences of decreased renal function in the elderly?
- Diminished ability to conserve water or salt
- Decreased clearance of a water load
- Increased tendency for inappropriate antidiuretic secretion
- Diminished excretion of some drugs
What are consequences of altered cardiopulmonary function in the elderly?
- Decreased myocardial contractility
- Increased end-diastolic and end-diastolic volumes
- Decreased baroreceptor activity
- Decreased airway support and elasticity
- Increase residual volume/lung compliance
Which blood pressure will rise throughout life
Diastolic (140/90 is normal in those over 60)
Normal temp for elderly patients?
97.4 F
What is the fifth vital sign?
Pain (undereported/undertreated)
- Reduced sensitivity in those over 50
- Decreased temp sensitivity
- Increased light touch sensitivity
which decreases with age T-cell function or number?
Function
What should you know about pneumonia and influenza
- Most common cause of infectious death
- Confusion main symptom in 2/3
- Fever present in only 10-30%
- Cough with purulent sputum in 40% of cases
Frontal bossing is associated with ….?
Paget’s
Lymphadenopathy in the the elderly should make you think ….?
Malignancy
eye pain in the elderly should make you think …?
Glaucoma or temporal arteritis (check temporal arteries)
What are some good functional vision screen questions?
1. Can you see: Regular newsprint Street name signs Medicine bottle labels Faces of friends from across the room
5 Leading causes of blindness in the elderly?
- Glaucoma
- Macular degeneration
- Senile cataracts
- Diabetic retinopathy
- Optic nerve atrophy
Cataracts facts
- Vision = hazy, develops slowly
- Blue seems green, yellow seems white
- Needs to shade eyes
- Surgery is 95% successful
Cataract risks
- aging
- Long term exposure to sunlight
- Smoking!!
- high cholesterol
- diabetes
- oral cortisone (long term)
- eye injury
What is the most common cause of irreversible eyesight loss late in life
Macular degeneration
Glaucoma facts
- Loss of peripheral vision
- Tends to be familial
- Normal pressure 12-21 mmHg
- Open angle: 90% Tx w/eye drops or laser
- Angle closure: iris folds back and blocks canal of schlemm
Eye conditions that affect CONTRAST before ACUITY
- Glaucoma
- Cataracts
- Age related macular degeneration
Where does primary hearing loss with age occur?
The inner ear and the auditory nerve
Strategies for testing patient hearing?
- Whispering
- Weber-Rinne
- Giving commands outside the patients visual field
Vestibular changes with aging
- Vestibular ocular reflex does less processing
- Decreased response to gravity and linear acceleration
- BPPV more common
- Vestibular symptoms precede 50% of falls
What is the functional triad of oral health?
- Masticatory efficiency
- Speech
- Appearance
Which drugs are cleared by the liver?
- Antidepressants
- Calcium channel blockers
- Morphine
- NSAIDS
- Diazepam
- Warfarin
Diabetes in the elderly facts
- Number 1 cause of blindness in elderly
2x more likely to stroke or MI - Five times more likely to have foot problems
- Seven more times likely to get kidney dysfunction
What are tumors that peak in the elderly?
- MM: 50-70
- Osteosarcoma 75+
- Chondrosarcoma 40-70
- Chordoma 40-70
- Fibrous dysplasia
- Paget’s 40+
- Hemangioma
- Osteoma
Most common sites of metastasis?
- Breast
- Prostate
- Kidney
- Thyroid
- Lung and bronchus
What is the 3rd most common site of metastasis?
the spine (after the lung and liver)
Pointers for the orthopedic examination of the elderly?
- Expect physiologic changes
- Increase suspicion of disease
- Take communication and mobility issues into account
- Order tests, images and re-exam sooner and more often
What impairments in sensation should be expected in the elderly?
- decreased muscle strength, DTRs, nerve conduction velocity
- Slowed motor skills
- Deficits in balance and coordination (Increased fall risk)
- Decreases in vibration, touch and pressure sense
What are the 3 motor D’s of the neurological test of the elderly?
- Orthopedic Deformity
- Disease
- Disuse
May all result in atrophy!
What is a good indicator of survivability in the elderly?
Hand grip strength (linked to premature mortality, disability, health complications)
How much does muscle mass decline in elderly patients?
25-40% by age 80 (more in UE). Also increases in CT in muscles
What is the consequence of more fat in muscle fibers of the elderly?
More uptake of lipophilic drugs with more action
Common sense alterations to the ortho exam in the elderly
- Expect some loss of ROM (AROM/PROM)
- Test balance
- Less force is needed
- Gentler hand contacts
- Begin more superficial with soft tissue
Heberden nodes? Bouchard
H = DIP B = PIP
Hyperextension of DIP with flexion of PIP
boutonniere deformity (RA)
Abnormal movements during muscle testing?
Jerky or cogwheel rigidity, increased tone
Which muscles are particularly affected by sarcopenia
The muscles of the hand
Why is vibration often lost below the knees in elderly patients?
Spinal cord small vessels become sclerotic (proprioception should be unaffected)
how much cortical bone is lost yearly? trabecular?
2-3% per year after 65 for CB
1-2% for TB
Who should be tested for bone mineral density (BMD)?
All men over 70 and women over 65 (unless risk factors present)
Primary headaches tend to ____ while secondary headaches _____
abate, become more common with age
Hypnic headache
Rare, benign, recurrent sleep related headache disorder that occurs almost exclusively in patient older than 50
50% of adults presenting with brain tumors complain of ___
Headache
What should you rule out if you suspect rib fracture?
Pneumothorax, flail chest
Most common levels for compression fractures
C5-7, T9-12, T12-L2
Visceral causes of LBP (AAA, pancreatic cancer)
Usually non-positional, progressive and associated with normal exam of Lx spine and hips
Best screening tests for visceral causes of LBP?
ESR and CBC (abnormal)
Why should you suspect a disc infection in cases of LBP in the elderly
Although rare, they present with signs/symptoms similar to L4-S1 neuro abnormalities and tend to be positional
Red flags for LBP
- Pain with fever
- Interrupts sleep (esp. getting out of bed and pacing)
- Corticosteroids
- not relieved be rest
- Unexplained weight loss
- no response to treatment in 1 month
- New BB dysfunction
What is a sign of lumbar compression fractures?
loss of lumbar lordosis
Exquisite tenderness over SP?
Compression fx, epidural abscess, septic discitis, metastatic cancer
Which elderly patients with radiculopathy should get MRI or CT?
Potential surgical condidates or epidural steroid injections
Most common causes of sciatica in elderly patients?
- Spinal stenosis
- Spondylosis
- Spondylolisthesis
- Tumor, infection (after 4 weeks)
Treatment for DISH
no medical therapy
Why is prolonged bed rest contraindicated in the elderly
5-6% muscle mass loss PER DAY
What should you know about sacral fractures in the elderly?
- Women more common
- Often spontaneous
- Plain films usually negative
- Bone scan may show H-shaped uptake
- Excellent prognosis with rare neuro deficits or pain beyond 4-6 weeks
Most common extremity injuries in the elderly?
- Tendonitis/bursitis
- Rotator cuff tears
- Humeral, forearm fractures
- Hip fractures
- Shoulder dislocations
Good screen for shoulder ROM
put hands on back of head and then behind back like trying to tie an apron
Atrophy of supra/infraspinatus is a strong indicator of _____
malnutrition
First ROM to decrease in the elbow
Extension
Anterior leg pain, hip flexor weakness (and pain) and a presentation that suggests unilateral femoral nerve should be investigated for
diabetes (can be first manifestation of the disease)
Hip flexor weakness with back pain
suggests carcinoma of the spine, more convincing if bilateral
Signs of stasis dermatitis
Brawny, hyperpigmented, brownish discolored skin with edema. Typically in patients over 50 with varicose veins
