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Final Exam Flashcards

1
Q

What is used as initial antihypertensive therapy in the elderly

A

Low-Dose Diuretic therapy

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2
Q

What is the first line drug of choice in treating elderly patients who present with isolated systolic hypertension

A
  • long-acting calcium channel blocker
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3
Q

is the development of incontinence considered to be a normal part of aging?

A

No

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4
Q

What are the 4 main causes of acute urinary incontinence?

A
  • Delirium
  • Restricted mobility
  • Infection, inflammation or impaction
  • Pharmaceuticals
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5
Q

What is the most common cause of acute urinary incontinence?

A

bladder infection

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6
Q

Acute onset of incontinence in a patient with aknown or suspected malignancy is what?.

A

a medical emergency

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7
Q

What is the triad of normal pressure hydrocephalus (NPH).

A

acute urinary incontinence, acute or sub-acute dementia and wide based gait

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8
Q

What is the most common form of chronic incontinence in the geriatric population.

A

Urge incontinence

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9
Q

How do you work up hematuria?

A
  • 3 s’s
  • Scope
  • Cytology (collect first morning void)—> rules out renal cell carcinoma
  • Sonogram (ultrasound bladder and kidney)
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10
Q

What should be practiced in all cases of incontinence?

A

Kegel exercises

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11
Q

What is contraindicated in the use of anticholinergics?

A

acute angle glaucoma

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12
Q

The risk of falling increases with what?

A

increased chronic disability.

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13
Q

By the year 2030, it is estimated that what?

A

22% or 70.2 million Americans will be older then age 65.

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14
Q

The average life expectancy for men is?

A

approximately 7 years less at 72.7 years.

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15
Q

Why do we age?

A 
The simple answer is: We don’t know.
Multiple theories on aging abound, including, but not limited to:
The cellular “supply limits” theory
The free radical damage theory
The autoimmune theory
The programmable cell death theory
The telomere length theory
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16
Q

The cellular supply theory of aging looks at what?

A

the decreased supply of nutrients to cells and tissues due to diminished blood flow into and out of cells.

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17
Q

Programmable cell death theory of aging suggest what about thesesignals?

A

These signals either induce or suppress apoptosis

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18
Q

SSRI’s lead to what nutrient and vitamin deficiency?

A

deplete the B vitamins B6, B12 and folic acid.

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19
Q

PPI’s and H-2 blockers deplete levels of what?

A

B12, calcium, iron, magnesium

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20
Q

Metformin leads to what deficiency?

A

B12 deficiency

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21
Q

Statins lead to what deficiency?

A

Coenzyme Q10

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22
Q

Birth control Pills lead to what deficiency?

A

B5, B6, B12

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23
Q

SIezure meds lead to what deficiency?

A

folic acid

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24
Q

What is a major anatomical change of aging

A

Kyphosis is increased, especially in females. There is a slight bending (flexion) at the knees and hips which leads to a shortened stature.

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25
What is the most common eye change in the elderly?
Visual acuity is often decreased and adaptation to both darkness and accommodation is often impaired.
26
Increased minimal threshold of light perception results in what?
difficulty seeing in dim light.
27
The formation of what is a common cause in for reduced vision and lessened visual acuity in settings of diminished light?
The formation of cataracts is another common cause
28
Which diseases of the eye cause central vision loss and which cause peripheral?
look up
29
When is chronic glaucoma a risk?
uncommon below the age of 40 but affects ~1 %of the population aged 40 to 65 and ~5 % of individuals over age 65.
30
How should you speak to patients with hearing loss?
It may benefit you to speak in a lower pitched voice to your patients who are hard of hearing rather than speaking more loudly
31
What deficiency plays a role in diminished taste?
zinc
32
How many vertebral fractures occur annually due to osteoporosis
700,000
33
What does secondary Osteoporosis imply?
Decreased bone mass is due to other conditions, medications, malabsorption or prolonged immobilization.
34
What conditions result in an increased risk for osteoporosis?
``` Hyperthyroidism Excess Supplemental Thyroid Cushing's disease Glucocorticoid use Hyperparathyroidism ```
35
What is the T Score for Normal bone health
T-score >-1
36
What is the T Score for Osteopenia
T-Score Between -1 and -2.5
37
What is the T Score for Osteoporosis
T- Schore < -2.5
38
When is prophylactic treatment for osteoporosis began
When Dexa Scan revelals: T-Score < -2.0 T-Score <1.5 in patients with known risk factors for osteoporosis
39
What does FRAX do?
Integrates clinical risk factors with bone mineral density at the femoral neck to calculate the 10-year probability of hip fracture as well as spine, shoulder and extremity fracture.
40
Why do men usually show diminished response to the treatment of osteoporosis?
Because men usually did not get treatment until the osteoporosis was at a more advanced stage
41
When can vitamin D protect against osteoporosis?
Only in combination with Calcium
42
What is Vitamin K required for?
Blood coagulation
43
What supplement appears to diminish bone loss when given concurrently with both calcium and vitamin D?
Magnesium
44
What are atypical presentations of MI in the elderly
``` Acute C.H.F Exacerbation of previously stable C.H.F Acute Renal Failure Vomiting with or without abdominal pain Vertigo Confusion Syncope/pre-syncope Falling ```
45
What precent of the elderly with PUD will have Silent Ulcers
30-50%
46
What is the most common presentation of cardiac ischemia in the elderly
Dyspnea
47
How does Cystitis commonly present in the elderly?
Urinary Frequency and Urge incontinence
48
Compared with young adults, the elderly is patient with pneumonia is what?
More likely to be bacteremic More likely to develop empyema or meningitis More likely to die as a result of the pneumonia
49
What are the main clues on a PE that an elderly patient has pneumonia?
Dullness to percussion over over areas of pulmonary consolidation Increased respiratory rate >26/min
50
What hormone is testosterone converted to dihydrotestosterone
5-alpha reductase
51
What hormone is testosterone converted to estradiol
aromatase
52
What is andropause
The hormonal, physical, mental and emotional changes that occur as a man ages
53
What happens when estradiol interacts with sex-hormone binding globulin?
causes eight fold increase in intracellular cAMP in human prostate tissue, causing increased growth
54
What are 6 potential effects of hormonal shifts in males
``` Reduced libido Disturbed sleep depression fatigue irritability hot flashes ```
55
What are possible adverse effects of testosterone administration
- Acne and oiliness of skin - Breast tenderness and enlargement - Erythrocytosis - Induction or exacerbation of sleep apnea - Leg edema - Exacerbation of heart disease due to acceleration of atherogenesis - Cardiac hypertrophy - Prostate cancer
56
Do the elderly always have a fever when they are septic
no
57
What are reliable clues for the presence of pneumonia in the elderly population?
dullness to percussion over areas of pulmonary consolidation and increased respiratory rate >25/min
58
Compared to young adults, the elderly patient with pneumonia is:
more likely to be bacteremic - more likely to develop complications such as empyema or meningitis - more likely to die as a result of pneumonia
59
cystitis in elderly females presents how
Urinary frequency and urge incontinence dysuria is a less common symptom
60
What is the most common presentation of cardiac ischemia in the elderly
dyspnea
61
What are atypical presentations of myocardial infarctions
-vommitting with or without abdominal pain -vertigo -confusion -syncope/near syncope -falling acute CHF exacerbation of previously stable CHF acute renal failure
62
What do you have to rule out if an elderly person has acute renal failure
MI
63
What precent of elderly patients with PUD have silent ulcers
30-50%
64
What are symptoms of fecal impaction
- Anorexia - Nausea - Vomiting - Paradoxical diarrhea and incontinence - Abdominal pain could be present - bladder symptoms
65
What are signs of hypothyroidism in the elderly?
- failure to thrive - weight loss - constipation - falling - muscle weakness - congestive heart failure - anemia - depression - dementia - coma - recent onset edema - carpal tunnel syndrome - anemia
66
What often dominates the clinical picture in hyperthyroidism
apathy and inactivity
67
What is the most common sign and symptom of hyperparathyroidism?
Gastrointestinal complaints
68
What are the main causes of delirium in the elderly?
``` medication pneumonia CHF MI pulmonary embolus sepsis surgical abdomen/fecal impaction endocrine disorders dehydration electrolyte abnormalities hypoxemia ```
69
What are the gastrointestinal symptoms of hyperparathyroidism?
Nausea and vomiting, Anorexia, Weight loss, Abdominal pain, Dyspepsia, Constipation, depression, anxiety, decreased memory, personality change, delirium, acute psychosis.
70
Dementia must have at least 2 for dx:
impairment in memeory, language, personality, emotional or motor skill.
71
Bisphosphonates do what? What are potential Side Effects?
inhibit osteoclast activity. reduce risk of spinal and hip fracture in F c prior fracture SE: Osteonecrosis of the jaw and myalgia’s are potential SE.
72
What when given with Vit D and Calcium helps to diminish bone loss
Magnesium
73
selective estrogen receptor modulators (SERMs) do what?
selectively block conformational changes of the estrogen receptors. Designed to increase BMD w/o increasing risk of estrogen related CA.
74
Raloxifene does what? SE?
anti-estrogenic activity on endometrial and breast tissue, pro-estrogenic activity on bone and lipids. No statistical decrease in non-vertebral fracture has been seen. SE increase of DVT and PE.
75
Denosumab/Prolia is used for what? Must check what before starting medication?
IM for postmenopausal F tx for osteoporosis. Must have sufficient vit D and calcium levels before starting.
76
Calcitonin
is not approved for prevention of osteoporosis.
77
paradoxically, intermittent administration of recombinant human PTH in low doses results in
an increased amount of bone remodeling and increased bone density.
78
Why does testosterone decrease with age
decreased hypothalamic release of gonadotropin-releasing hormone, decreased LH, less testosterone production, increased SHBG – less free hormones, fewer leydig cells, decreased response to LH by testes.
79
What enzyme converts Testosterone to DHT?
5-alpha-reductase,
80
What enzyme converts Testosterone to Estradiol
Aromatase increases with age increasing conversion to estrogen.
81
Strict C/I for testosterone replacement –
prostate CA current or present, breast CA current or present.
82
When does DHEA peak in men and how much does it decrease per year after?
DHEA levels peak in Men at 25 yo and decrease about 2% per year thereafter.
83
If orthostatic changes are apparent do what?
Check bp in standing position
84
Prevention or Treatment? Raloxifene:Evista
Prevention + Treatment
85
Prevention or Treatment? Alendronate:fosamax
Treatment and prevention
86
Prevention or Treatment? Calcitonin: Miacalcin
Treatment
87
Prevention or Treatment? Calcimar
Treatment
88
Prevention or Treatment? | Estrogen Conjugated: Premarin
Prevention
89
Prevention or Treatment? Esterified: estratab
Prevention
90
Prevention or Treatment? | Menest
Prevention
91
Prevention or Treatment? | Estradiol:estrace
Prevention
92
Prevention or Treatment? | Estropipate: Ortho-Est
Prevention
93
Prevention or Treatment? Ogen
Prevention
94
Prevention or Treatment? Estrogen+Progestin: Premphase cyclic
Prevention
95
Prevention or Treatment? Estrogen_progestin: premphase continuous
Prevention

Geriatrics (1 decks)

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