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Geriatrics > Final Exam > Flashcards

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
Q

What is the most common eye change in the elderly?

A

Visual acuity is often decreased and adaptation to both darkness and accommodation is often impaired.

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26
Q

Increased minimal threshold of light perception results in what?

A

difficulty seeing in dim light.

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27
Q

The formation of what is a common cause in for reduced vision and lessened visual acuity in settings of diminished light?

A

The formation of cataracts is another common cause

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28
Q

Which diseases of the eye cause central vision loss and which cause peripheral?

A

look up

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29
Q

When is chronic glaucoma a risk?

A

uncommon below the age of 40 but affects ~1 %of the population aged 40 to 65 and ~5 % of individuals over age 65.

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30
Q

How should you speak to patients with hearing loss?

A

It may benefit you to speak in a lower pitched voice to your patients who are hard of hearing rather than speaking more loudly

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31
Q

What deficiency plays a role in diminished taste?

A

zinc

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32
Q

How many vertebral fractures occur annually due to osteoporosis

A

700,000

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33
Q

What does secondary Osteoporosis imply?

A

Decreased bone mass is due to other conditions, medications, malabsorption or prolonged immobilization.

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34
Q

What conditions result in an increased risk for osteoporosis?

A 
Hyperthyroidism
Excess Supplemental Thyroid
Cushing's disease
Glucocorticoid use
Hyperparathyroidism
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35
Q

What is the T Score for

Normal bone health

A

T-score >-1

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36
Q

What is the T Score for

Osteopenia

A

T-Score Between -1 and -2.5

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37
Q

What is the T Score for

Osteoporosis

A

T- Schore < -2.5

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38
Q

When is prophylactic treatment for osteoporosis began

A

When Dexa Scan revelals:

T-Score < -2.0

T-Score <1.5 in patients with known risk factors for osteoporosis

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39
Q

What does FRAX do?

A

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
Q

Why do men usually show diminished response to the treatment of osteoporosis?

A

Because men usually did not get treatment until the osteoporosis was at a more advanced stage

41
Q

When can vitamin D protect against osteoporosis?

A

Only in combination with Calcium

42
Q

What is Vitamin K required for?

A

Blood coagulation

43
Q

What supplement appears to diminish bone loss when given concurrently with both calcium and vitamin D?

A

Magnesium

44
Q

What are atypical presentations of MI in the elderly

A 
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
Q

What precent of the elderly with PUD will have Silent Ulcers

A

30-50%

46
Q

What is the most common presentation of cardiac ischemia in the elderly

A

Dyspnea

47
Q

How does Cystitis commonly present in the elderly?

A

Urinary Frequency and Urge incontinence

48
Q

Compared with young adults, the elderly is patient with pneumonia is what?

A

More likely to be bacteremic
More likely to develop empyema or meningitis
More likely to die as a result of the pneumonia

49
Q

What are the main clues on a PE that an elderly patient has pneumonia?

A

Dullness to percussion over over areas of pulmonary consolidation

Increased respiratory rate >26/min

50
Q

What hormone is testosterone converted to dihydrotestosterone

A

5-alpha reductase

51
Q

What hormone is testosterone converted to estradiol

A

aromatase

52
Q

What is andropause

A

The hormonal, physical, mental and emotional changes that occur as a man ages

53
Q

What happens when estradiol interacts with sex-hormone binding globulin?

A

causes eight fold increase in intracellular cAMP in human prostate tissue, causing increased growth

54
Q

What are 6 potential effects of hormonal shifts in males

A 
Reduced libido
Disturbed sleep
depression
fatigue
irritability
hot flashes
55
Q

What are possible adverse effects of testosterone administration

A
  • 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
Q

Do the elderly always have a fever when they are septic

A

no

57
Q

What are reliable clues for the presence of pneumonia in the elderly population?

A

dullness to percussion over areas of pulmonary consolidation and increased respiratory rate >25/min

58
Q

Compared to young adults, the elderly patient with pneumonia is:

A

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
Q

cystitis in elderly females presents how

A

Urinary frequency and urge incontinence

dysuria is a less common symptom

60
Q

What is the most common presentation of cardiac ischemia in the elderly

A

dyspnea

61
Q

What are atypical presentations of myocardial infarctions

A

-vommitting with or without abdominal pain
-vertigo
-confusion
-syncope/near syncope
-falling
acute CHF
exacerbation of previously stable CHF
acute renal failure

62
Q

What do you have to rule out if an elderly person has acute renal failure

A

MI

63
Q

What precent of elderly patients with PUD have silent ulcers

A

30-50%

64
Q

What are symptoms of fecal impaction

A
  • Anorexia
  • Nausea
  • Vomiting
  • Paradoxical diarrhea and incontinence
  • Abdominal pain could be present
  • bladder symptoms
65
Q

What are signs of hypothyroidism in the elderly?

A
  • failure to thrive
  • weight loss
  • constipation
  • falling
  • muscle weakness
  • congestive heart failure
  • anemia
  • depression
  • dementia
  • coma
  • recent onset edema
  • carpal tunnel syndrome
  • anemia
66
Q

What often dominates the clinical picture in hyperthyroidism

A

apathy and inactivity

67
Q

What is the most common sign and symptom of hyperparathyroidism?

A

Gastrointestinal complaints

68
Q

What are the main causes of delirium in the elderly?

A 
medication
pneumonia
CHF
MI
pulmonary embolus
sepsis
surgical abdomen/fecal impaction
endocrine disorders
dehydration
electrolyte abnormalities
hypoxemia
69
Q

What are the gastrointestinal symptoms of hyperparathyroidism?

A

Nausea and vomiting, Anorexia, Weight loss, Abdominal pain, Dyspepsia, Constipation, depression, anxiety, decreased memory, personality change, delirium, acute psychosis.

70
Q

Dementia must have at least 2 for dx:

A

impairment in memeory, language, personality, emotional or motor skill.

71
Q

Bisphosphonates do what? What are potential Side Effects?

A

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
Q

What when given with Vit D and Calcium helps to diminish bone loss

A

Magnesium

73
Q

selective estrogen receptor modulators (SERMs) do what?

A

selectively block conformational changes of the estrogen receptors.

Designed to increase BMD w/o increasing risk of estrogen related CA.

74
Q

Raloxifene does what?

SE?

A

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
Q

Denosumab/Prolia is used for what? Must check what before starting medication?

A

IM for postmenopausal F tx for osteoporosis. Must have sufficient vit D and calcium levels before starting.

76
Q

Calcitonin

A

is not approved for prevention of osteoporosis.

77
Q

paradoxically, intermittent administration of recombinant human PTH in low doses results in

A

an increased amount of bone remodeling and increased bone density.

78
Q

Why does testosterone decrease with age

A

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
Q

What enzyme converts Testosterone to DHT?

A

5-alpha-reductase,

80
Q

What enzyme converts Testosterone to Estradiol

A

Aromatase increases with age increasing conversion to estrogen.

81
Q

Strict C/I for testosterone replacement –

A

prostate CA current or present, breast CA current or present.

82
Q

When does DHEA peak in men and how much does it decrease per year after?

A

DHEA levels peak in Men at 25 yo and decrease about 2% per year thereafter.

83
Q

If orthostatic changes are apparent do what?

A

Check bp in standing position

84
Q

Prevention or Treatment?

Raloxifene:Evista

A

Prevention + Treatment

85
Q

Prevention or Treatment?

Alendronate:fosamax

A

Treatment and prevention

86
Q

Prevention or Treatment?

Calcitonin: Miacalcin

A

Treatment

87
Q

Prevention or Treatment?

Calcimar

A

Treatment

88
Q

Prevention or Treatment?

Estrogen Conjugated: Premarin

A

Prevention

89
Q

Prevention or Treatment?

Esterified: estratab

A

Prevention

90
Q

Prevention or Treatment?

Menest

A

Prevention

91
Q

Prevention or Treatment?

Estradiol:estrace

A

Prevention

92
Q

Prevention or Treatment?

Estropipate: Ortho-Est

A

Prevention

93
Q

Prevention or Treatment?

Ogen

A

Prevention

94
Q

Prevention or Treatment?

Estrogen+Progestin: Premphase cyclic

A

Prevention

95
Q

Prevention or Treatment?

Estrogen_progestin: premphase continuous

A

Prevention

Geriatrics (1 decks)

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