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Patient Care II > Final Exam > Flashcards

Final Exam Flashcards

1
Q

focus when assessing the older adult should be on

A

healthy or successful aging and promotion of long-term health and safety

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2
Q

older adult goals of care

A

maximizing health span, not just life span, and maintaining function

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3
Q

primary aging

A

changes in physiologic reserve that occur over time independent of changes induced by disease

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4
Q

BP changes common in older adults

A

systolic HTN with widened pulse pressure due to stiffened vessels and auscultatory gap

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5
Q

heart rate changes common in older adults

A

decline in function of pacemaker cells affecting physiologic response to stress

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6
Q

skin changes common in older adults

A

fragile, loose, and transparent on hands and forearms with actinic (solar or senile) purpura due to loss of subcutaneous tissue (fat) with aging

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7
Q

nail changes common in older adults

A

lose luster, yellow, and thickened nails (especially toes)

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8
Q

hair changes common in older adults

A

depigmentation, receding hairline, and loss of hair on trunk, pubic area, axillae, and limbs

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9
Q

eye changes common in older adults

A

eyeballs recede into orbit, corneas lose luster, pupils become smaller, dry eyes are common, presbyopia, increased risk of glaucoma, macular degeneration, and cataracts

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10
Q

ear changes common in older adults

A

decreased hearing - loss of higher tones, increased cerumen impaction causing hearing loss

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11
Q

mouth changes common in older adults

A

decreased salivary secretions, decreased sense of taste often due to medications

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12
Q

changes in thorax/lungs common in older adults

A

decrease in exercise capacity due to cardiac, pulmonary issues or both, increased difficulty moving joints/contracting muscles, chest wall stiffens, kyphosis due to osteoporosis

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13
Q

changes in cardiovascular system common in older adults

A

bruits from partial arterial obstruction due to atherosclerosis, extra heart sounds - S3 after age 40 suggests heart failure whereas S4 can be heard in healthy older people but suggests decreased ventricular compliance and impaired ventricular filling, scarring of SA node, systolic murmurs due to aortic sclerosis and stenosis

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14
Q

changes in breasts common in older adults

A

diminish in size and glandular tissue atrophies and becomes replaced by fat, calcifications occur in ducts surrounding nipples

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15
Q

changes in abdomen common in older adults

A

fat accumulates in lower abdomen and near hips causing signs of abdominal disease to be blunted

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16
Q

important general changes common in older adults

A

pain is less severe and fever is less pronounced

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17
Q

changes in GU system common in older men

A

erectile dysfunction in 1/2 of older men, benign prostatic hyperplasia (BPH) causing proliferation of prostate epithelial and stromal tissue typically beginning in the third decade of life where only half of men have symptoms

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18
Q

changes in GU system common in older women

A

menopause between ages 48-55, loss of estrogen tone causing vaginal dryness, hot flashes, urge incontinence, dyspareunia

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19
Q

musculoskeletal changes common in older adults

A

shortening and loss of height in the trunk due to the thinning of vertebral discs and shortening of vertebral bodies from osteoporosis, decrease in muscle bulk and power, decreased ROM due to osteoporosis and joint degeneration

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20
Q

neurologic changes common in older adults

A

all aspects can be affected including benign forgetfulness which can occur at any age

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21
Q

important geriatric syndromes

A

cognitive impairment, delirium, incontinence, malnutrition, falls, gait disorders, frailty, sleep disorders, sensory deficits, fatigue, dizziness, and depression

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22
Q

geriatric syndromes can lead to

A

functional decline, dependence, disability, institutionalization, and death

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23
Q

one thing that is vital to assess in older adults

A

functional status

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24
Q

questionnaire used to assess functional status in older adults

A

Katz index of Independence in ADLs

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25
Q

risk of adverse drug reactions increases with

A

increased number of medications (82% with 7 or more meds!!)

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26
Q

prescribing cascade

A

when an adverse drug reaction is misinterpreted as a new medical condition and a new medication is prescribed

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27
Q

independent risk factor for hip fractures

A

use of medications that affect the CNS

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28
Q

Beers criteria

A

has 5 categories and is used to assess inappropriate drug prescribing in older adults

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29
Q

most modifiable risk factor for falls

A

medication use

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30
Q

test used to evaluate gait, strength, and balance in older adults

A

Timed Up and Go (TUG)

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31
Q

TUG score indicating someone at risk for falling

A

score of greater than or equal to 12 seconds

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32
Q

MOCA test

A

test used to assess early cognitive decline, not good for late

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33
Q

Mini-mental status

A

test used to screen for cognitive decline, best used to monitor

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34
Q

Mini-Cog test

A

test used to assess for cognitive decline in older adults - should start with this one

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35
Q

mood changes/depression are

A

NOT a part of normal aging

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36
Q

malnutrition is associated with

A

increased mortality in older adults and those hospitalized

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37
Q

major cause of social and emotional distress in older adults

A

urinary incontinence

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38
Q

causes of decal incontinence in older adults

A

decreased strength of the external sphincter, increased rectal compliance, medications, lactose intolerance, and poor mobility

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39
Q

pneumococcal vaccine recommendation in older adults

A

age 65 or older should receive 1 dose of either PCV15 or PCV20 (with 1 dose of PPSV23 at least 1 year after if PCV15 is used)

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40
Q

pneumococcal vaccine recommendation in adults 19-64

A

recommend in those with certain underlying medical conditions including chronic heart, lung, or liver disease, diabetes, or cigarette smoking

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41
Q

colorectal cancer screening in older adults

A

all adults age 45 -75 years old

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42
Q

breast cancer screening in older adults

A

biennial mammography ages 50-74

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43
Q

lung cancer screening in older adults

A

age 55 - 80, 30 pack years, current or quit in last 15 years

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44
Q

prostate cancer screening in older adults

A

individual discussion with patient

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45
Q

cervical cancer screening in older adults

A

can stop at age 65 if previous screening was adequate and negative

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46
Q

diabetes screening in older adults

A

age 40-70 in those with increased BMI

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47
Q

osteoporosis screening in older adults

A

postmenopausal women age < 65 years at higher risk and all women age > 65 years and older

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48
Q

screening for elder abuse in older adults

A

ask patients direct, specific questions

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49
Q

AAA screening in older adults

A

men age 65 - 70 years who have ever smoked

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50
Q

frequency of guaiac-based fecal occult blood test (gFOBT) in colorectal cancer screening

A

yearly

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51
Q

frequency of fecal immunochemical tests for hemoglobin (FIT) in colorectal cancer screening

A

yearly

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52
Q

frequency of FIT-DNA testing (Cologuard) for colorectal cancer screening

A

every 1-3 years

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53
Q

frequency of flexible sigmoidoscopy for colorectal cancer screening

A

every 5 years

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54
Q

frequency of colonoscopy

A

every 10 years

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55
Q

best test for colorectal cancer screening is

A

the one that the patient will do

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56
Q

time that advanced care planning should be done

A

at all ages not just in older adults

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57
Q

advanced directives are acted on

A

ONLY if the patient loses the ability to make decisions for themselves

58
Q

main types of advanced directive

A

durable power of attorney (DPOA), living will, POLST, and DNR/DNI

59
Q

gravida

A

a woman who is or has been pregnant regardless of pregnancy outcome

60
Q

nulligravida

A

a woman who has never been pregnant and is not currently pregnant

61
Q

primigravida

A

a woman who is pregnant for the first time or has been pregnant once

62
Q

multigravida

A

a woman who has been pregnant more than once

63
Q

nullipara

A

a woman who has never given birth and who has never been pregnant beyond 20 weeks

64
Q

primipara

A

a woman who has given birth only 1 time with a gestation of 20 weeks or more

65
Q

multipara

A

a woman who has given birth 2 or more times past 20 weeks

66
Q

TPAL

A

breakdown of P (para) into term deliveries, preterm deliveries, abortions, and living children

67
Q

presumptive pregnancy

A

unsure

68
Q

probable pregnancy

A

most likely

69
Q

positive pregnancy

A

without a doubt

70
Q

presumptive signs of pregnancy

A

subjective signs that patient describes to provider that may not be due to pregnancy (Ex: missed period or unusual bleeding, N/V, breast changes, increased urinary frequency)

71
Q

probable signs of pregnancy

A

enlargement of the uterus, softening of the uterine isthmus, bluish or cyanotic appearing cervix and upper vagina due to increased vascularity, softening of the cervix due to increased vascularity, asymmetric bulge or soft prominence of the uterus caused by placental development, positive HCG test, skin changes - melasma/chloasma

72
Q

Hegar’s sign

A

softening of uterine isthmus (probable sign)

73
Q

Chadwick’s sign

A

bluish pr cyanotic appearing cervix (probable)

74
Q

Goodell’s sign

A

softening of cervix due to increased vascularity (probable)

75
Q

Piskacek’s sign

A

asymmetric bulge or soft prominence of uterus caused by placental development (probable)

76
Q

positive signs of pregnancy

A

fetus is identified on US, fetal heartbeat detected by Doppler or auscultation, objective detection of fetal movement by provider, delivery of the baby!!

77
Q

early pregnancy symptoms

A

amenorrhea, nausea/vomiting, breast enlargement, fatigue, urinary frequency, pelvic discomfort/pressure

78
Q

time in pregnancy at which uterus enlarges and softens

A

6 + weeks

79
Q

time in pregnancy at which uterus becomes palpable above symphysis pubis in lower abdomen

A

12 + weeks

80
Q

quickening

A

first detection of fetal movement occurring between 18-20 weeks in a primigravida and between 14-18 weeks in a multigravida

81
Q

time in pregnancy at which fetal heart tones can be detected

A

detected at 6 weeks by US and at 9-12 weeks by Doppler

82
Q

time at which intrauterine pregnancy can be detected by vaginal US

A

as early as 4-5 weeks

83
Q

definitive evidence of pregnancy

A

positive urine or serum hCG test, identification by US, or detection of fetal heart tones by Doppler

84
Q

hCG urine test

A

qualitative test with high false negative rate which will be positive 1 week after missing the period (week after period was due) best done on early morning urine specimen

85
Q

hCG serum test

A

qualitative or quantitative and is more sensitive than the urine test, will be positive before urine test is positive

86
Q

in a typical pregnancy hCG levels

A

double every 48-72 hours

87
Q

EDD calculation

A

Naegele’s rule = add 7 days to first day of LMP, then subtract 3 months, then add a year

88
Q

most accurate method to calculate EDD

A

first-trimester ultrasound (before 22 weeks) to confirm dates

89
Q

time of first prenatal visit

A

8-10 weeks gestation to confirm pregnancy, determine EDD, determine desire for pregnancy/attitude

90
Q

frequency of prenatal visits

A

first visit at 8-10 weeks followed by visits every 4 weeks for the first 28 weeks, then every 2-3 weeks until 36 weeks, and every week after 36 weeks

91
Q

key components of first prenatal visit

A

depression screening, BP and weight measurement (BMI), physical exam and pelvic exam to assess pelvimetry (pubic arch, ischial spines, sacrum, diagonal conjugate)

92
Q

size of uterus at 12 weeks

A

at symphysis pubis

93
Q

size of uterus at 16 weeks

A

halfway between pubis and umbilicus

94
Q

size of uterus at 20 weeks

A

at umbilicus

95
Q

size of uterus beyond 20 weeks

A

grows 1 cm for every week of gestation

96
Q

time in pregnancy at which fundus reaches maximal height

A

36 weeks (xiphoid process)

97
Q

prenatal vitamins

A

folic acid, vitamin D, Iron, and calcium

98
Q

foods to avoid in pregnancy due to risk of Listeria

A

unpasteurized milk and foods made with unpasteurized milk including soft cheeses, raw fish (sushi), refrigerated smoked seafood, unwashed raw produce, hot dogs and luncheon meats

99
Q

fish okay in pregnancy

A

shrimp, salmon, catfish, and pollock (low in mercury)

100
Q

vaccination recommended in every pregnancy

A

Tdap

101
Q

vaccines contraindicated in pregnancy

A

live attenuated vaccines such as MMR, varicella, Zostavax, live flu

102
Q

Leopold’s maneuvers

A

used to determine fetus position in pregnancy

103
Q

time in pregnancy to screen for gestational diabetes

A

24-28 weeks

104
Q

time in pregnancy to screen for group B strep

A

35-37 weeks (swabbing both the vagina and rectum)

105
Q

order of breast exam

A

inspection always before palpation

106
Q

positions required to inspect breasts

A

with patient arms at side, arms over head, hands pressed against hips, while leaning forward, while supine

107
Q

positions required to palpate breasts

A

with patient supine and one arm above head and while leaning forward

108
Q

axillary nodes palpated during breast exam

A

central, pectoral, and lateral and subscapular groups

109
Q

cytobroom cervical sampling technique

A

insert cytobroom so that the tip of the broom is in the cervical os and that the lateral bristles fully bend against cervix, gently rotate in clockwise direction 360 degrees 5 times, remove broom and place head in path specimen vial

110
Q

part of penis that contains the urethra

A

corpus spongiosum

111
Q

function of testes

A

produce sperm and testosterone

112
Q

tunical vaginalis

A

serous membrane covering the testis, except posteriorly

113
Q

function of epididymis

A

reservoir for storage, maturation, and transport of sperm

114
Q

anorectal junction aka pectinate/dentate line

A

boundary between somatic and visceral nerve supplies

115
Q

what demarcates the anus from the rectum?

A

the anorectal junction aka the pectinate/dentate line

116
Q

location of prostate in males

A

lies against the anterior rectal wall where only the lateral lobes and median sulcus are palpable

117
Q

peripheral zone of prostate

A

main body of gland located posteriorly

118
Q

central zone of prostate

A

located around the ejaculatory ducts

119
Q

transitional zone of prostate

A

located around the urethra

120
Q

smegma

A

white, cheesy material that can accumulate under the foreskin normally

121
Q

which testicle is typically higher?

A

right testicle

122
Q

palpation technique for the testes

A

one-handed using thumb and first 2 fingers

123
Q

hernia

A

a protrusion, bulge, or projection of an organ or part of an organ through the body wall that normally contains it

124
Q

reducible hernia

A

organ/bowel can be pushed back into the correct position

125
Q

incarcerated hernia

A

organ or part of organ is trapped and can’t be pushed back to correct position

126
Q

strangulated hernia

A

loss of blood supply to the trapped part of the organ

127
Q

type of hernia most common in men

A

inguinal groin hernias

128
Q

type of hernia that has more severe complications but is less common

A

femoral hernias

129
Q

indirect inguinal hernia

A

begins above the inguinal ligament and the bowel travels through the inguinal canal and into the scrotum, most common type

130
Q

direct inguinal hernia

A

begins above the inguinal ligament near the pubic tubercle and external inguinal ring (within Hesselbach’s triangle), less common

131
Q

position required to examine for a hernia

A

patient is standing

132
Q

normal prostate consistency

A

rubbery and non-tender

133
Q

vaccines recommended in MSM and transgender patients who have sex with men

A

2-3 doses of HPV up to age 45, 2 doses of Hep A, and 3 doses of traditional Hep B or 2 doses of Heplisav

134
Q

MSM are at increased risk for

A

HPV, HIV, gonorrhea, chlamydia, syphilis, hepatitis, giardia, and other STDs

135
Q

WSW are at increased risk for

A

HPV and all other STDs if anal sex

136
Q

women who have vaginal sex and use testosterone are at increased risk for

A

HIV, HPV, and other STDs

137
Q

screening frequency for patients at high risk for STDs

A

every 3 months

138
Q

time for PrEP to be taken up in rectal tissue

A

7 days and 21 days in all other tissue

139
Q

timing for the use of N-PEP

A

start regimen immediately within 72 hours of high risk sexual contact, taken for 28 days

140
Q

puberty stage to be able to start hormonal gender-affirming therapy with hormone blockers

A

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Patient Care II (2 decks)

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