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Geriatrics > Final Exam > Flashcards

Final Exam Flashcards

1
Q

T/F: In 2000, 14% or 35.3 million Americans were older than 65 years of age

A

True

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2
Q

Is is estimated that what percent of Americans will be older than 65 by 2030

A

22%, 70.2 million people

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3
Q

What is the average life expectancy for men?

A

**7 years less than women at 72.7 years

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4
Q

What is the average life expectancy for women?

A

79.5 years

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5
Q

What are the theories (5) of aging

A 
cellular "supply limits"
free radical damage
autoimmune theory
programmable cell death theory
telomere length
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6
Q

What is the cellular theory of aging?

A

decreased supply of nutrients to the cell

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7
Q

what is the free radical damage theory of aging?

A

uncontrolled build up of free radicals

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8
Q

what is the autoimmune theory of aging?

A

B and T cells weaken with age, then malfunction

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9
Q

what is the programmable cell death theory?

A

intrinsic or extrinsic signals either INDUCE or SUPPRESS apoptosis

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10
Q

what is the telomere length theory of aging?

A

telomeres are essential for chromosome duplication during cell division, however - the process of cell division permanently destroys a tiny fragment of the telomere with each division

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11
Q

What does the process of cell division permanently destroy with each division?

A

a tiny fragment of the telomere

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12
Q

Can we add telomerase or drugs that mimic the effects of telomerase to a cell culture to lengthen telomeres?

A

YES

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13
Q

What is inflammaging?

A

inflammatory process that is central to aging

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14
Q

What are Miller&Chamberlain’s personal take on health related internet sites that is shared with their patient?

A

spend as little time was possible on any site selling the product. Look for external resources

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15
Q

What deficiency is associated with metformin?

A

B-12 deficiency;

main s/e of metformin is lactic acidosis (problematic in elderly)

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16
Q

What are key anatomical changes in posture for geriatrics?

A 
increased kyphosis (F>M)
slight flexion at the knees and hips (shortens)
increased cervical extension**
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17
Q

what are common skin conditions in geriatrics?

A

vitiligo becomes more common

decubitus ulcer risk increases

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18
Q

why does risk for decubitus ulcers increase?

A

diminished number and function of sweat glands

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19
Q

What is often a precursor to corneal infections?

A

reduced tear formation (a common finding in the elderly)

drying of the cornea

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20
Q

Which condition causes PERIPHERAL vision loss?

A

Glaucoma**

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21
Q

This condition is uncommon below the age of 40, but affects 1 % of the population aged 40-65, and 5% of individuals 65+

A

Chronic Glaucoma

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22
Q

Which conditions experience CENTRAL vision loss?

A

Cataracts

Macular Degeneration

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23
Q

What tone may be beneficial to use with patients who are hard of hearing?

A

it may benefit you to speak in a lower pitched voice rather than increasing your volume**

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24
Q

osteoarthritis can be accompanied by exostosis which is? and can cause?

A

formation of new bone on a surface of a bone
CAUSES chronic pain ranging from mild to debilitating.
- dependent on size, shape, location

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25
Q

If you prescribe a long term anti-inflammatory to a patient, what shouldn’t you prescribe? Why?

A

H2 blocker

increases gastritis and ulcer

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26
Q

What have been shown to be cyto-protective?

A

PPI

Mesoprosal

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27
Q

In most instances, what should be used as initial anti-hypertensive therapy in the elderly?

A

low-dose diuretic therapy

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28
Q

Which instances would you NOT prescribe a low-dose diuretic as initial anti-hypertensive therapy?

A

Pt has:
DM (blocks hypoglycemic sx)
COPD (exacerbates dz)

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29
Q

When drug therapy is indicated, what is NOW considered as a 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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30
Q

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

A

No

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31
Q

What is the acronym for the causes of Acute Urinary Incontinence?

A
  • Delirium
  • Restricted mobility
  • Infection, inflammation, impaction
  • Pharmaceuticals
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32
Q

What is the most common cause of acute urinary incontinence?

A

Bladder infection

33
Q

what is the most common drug class to cause incontinence?

A

diuretics

34
Q

Acute onset of incontinence in a patient with a known or suspected malignancy is

A

MEDICAL EMERGENCY

35
Q

When you see a triad of: urinary incontinence, dementia (acute, sub-acute), and wide based gait - think?

A

Normal Pressure Hydrocephalus

36
Q

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

A

Urge incontinence

37
Q

What is the three “S” workup for hematuria

A

Scope (direct visual of bladder - CA)
Cytology (morning void - RCC)
Sonogram (US of bladder and KI - often better resolution than CT)

38
Q

What exercise should be implemented for all causes of incontinence?

A

Kegels

39
Q

What is contra-indicated in patients with untreated Angle Closure Glaucoma?

A

Oxybutynin and other anti-cholinergic medications

40
Q

what increases risk of falling?

A

increased chronic disability

41
Q

T/F - it is uncommon for an elderly patient to be afebrile when septic

A

False**

- it is NOT uncommon, most elderly do not get febrile.

42
Q

what are reliable clues (2) for the presence of pneumonia in the elderly population

A

dullness to percussion**

increased respiratory rate (>26)

43
Q

When comparing elderly presentation to young adults, what differs for pneumonia?

A

Elderly are more likely to be:**

bacteremic, develop complications (empyema, meningitis), more likely to DIE

44
Q

what are the common presenting symptoms for cystitis in elderly, and what common symptom is often absent?

A

generally present with Urinary Frequency and Urinary Incontinence

  • Dysuria is a less common symptom
45
Q

In the elderly what is a more common presentation of cardiac ischemia?

A

dyspnea is more common than angina pectoris

46
Q

Atypical presentations of a MI in the elderly are (5)

A 
vomiting (w or w/o abdominal pain)
vertigo
confusion
syncope (near-syncope)
falling
47
Q

what are additional presenting symptoms of MI in the elderly?

A

ACUTE RENAL FAILURE*

Acute CHF or exacerbation of previous CHF

48
Q

30-50% of elderly patients with PUD have ____?

A

30-50% of elderly patients with PUD have Silent ULCERS**

49
Q

What are typical symptoms of fecal impaction?

A

anorexia**
nausea
vomiting

other ssx:
paradoxical diarrhea, stool incontinence, bladder sx (incontinence, retention, freq) abdominal pain (maybe)

50
Q

What are common ssx of hypothyroidism in the elderly?

A 
DEPRESSION
failure to thrive
weight loss**
constipation
Falling
Muscle weakness
CHF
anemia
dementia
coma
recent onset edema
carpal tunnel
anemia
51
Q

What dominates the clinical picture of hyperthyroidism in the elderly patient?

A

apathy and inactivity**

apathetic hyperthyroidism

52
Q

Gastrointestinal complaints are the MC ssx of ____ what are they?

A 
hyperparathyroidism has common GI complaints of:
N/V
anorexia
WL
abdominal pain
dyspepsia
constipation
53
Q

What are possible mental and emotional symptoms of hyperparathyroidism?

A 
depression
anxiety
decreased memory (recent, esp)
personality change
delirium
acute psychosis
54
Q

What are causes of delirium

A 
MC MEDICATIONS
pneumonia
CHF
MI
Pulmonary embolism
Sepsis
fecal impaction/surgical abdomen
endocrine disorders
dehydration
electrolyte abN
Hypoxemia
55
Q

What five functions must be affected to dx dementia?

A 
Need 2/5:**
memory
language
personality
emotion
motor skills
56
Q

What is andropause?

A

increased conversion of T to E due to increased aromatase enzyme**

57
Q

Estradiol interacts with sex hormone binding globulin (SHBG) to cause?

A

an 8-fold increase in intracellular cAMP in human prostate tissue and increased growth

58
Q

What are adverse events related to testosterone administration?

A 
EXACERBATION OF HEART DZ***
acne/oily skin
breast tenderness/enlargement
erythrocytosis
sleep apnea
leg edema
cardiac hypertrophy
prostate cancer
59
Q

What does testosterone administration exacerbate heart disease?

A

accelerates atherogenesis

60
Q

how many vertebral fractures are noted in osteoporosis?

A

700,000

61
Q

What does Secondary Osteoporosis imply?

A 
decreased bone mass is due to 
other conditions, 
medications, 
malabsorption or 
prolonged immobilization **
62
Q

what additional conditions would result in an increased risk for osteoporosis?

A 
hyperthyroidism**
supplemental thyroid
Cushing's disease
Glucocorticoid use
Hyperparathyroidism
63
Q

What is a T-score?

A

number of SDs above or below the mean for HEALTHY 30 YR OLD ADULT

64
Q

What is a Z-score?

A

number of SDs above or below the mean for the PATIENT’S AGE, SEX and ETHNICITY

65
Q

What is a normal T-score?

A

Normal > -1**
T-score -1 - (-2.5) = osteopenia
T-score < -2.5 = osteoporosis

66
Q

When does conventional treatment treat for osteoporosis?

A

T score < -2.0 OR**

T-score < -1.5 AND known RISK FACTORS*

67
Q

FRAX is?

A

diagnostic tool to evaluate 10 year probably of bone fracture
- assesses femoral head (hip fracture risk), shoulder, spine and extremities

68
Q

Studies suggest Vitamin D can protect against osteoporosis ONLY IF

A

in combination with Calcium**

69
Q

What has been shown to reduce the risk of both spinal and hip fracture**

A

bisphosphates**

- including women who have had prior bone fractures

70
Q

what are potential side effects of bisphosphates?

A

erosive esophagitis
osteonecrosis of the jaw (has been reported)
myalgia

71
Q

Selective Estrogen Receptor Modulators (SERMs) selectively block*?

A

conformational changes of the estrogen receptors**

72
Q

Raloxiphine (Evista) is indicated for ?

A

Prevention AND Treatment of osteoporosis

- however, NO statistically significant decreases in non-vertebral fractures were noted

73
Q

what are you at increased risk for with Raloxiphine (Evista)?

A

DVT

PE

74
Q

What must be reached before starting a patient on Denosumab (prolia)

A

sufficient levels of **
Calcium &
Vitamin D

75
Q

T/F Calcitonin is approved for prevention of osteoporosis?**

A

FALSE**, calcitonin is NOT approved for osteoporosis prevention, only treatment

76
Q

What increases amount of bone remodeling and increased bone density through a paradoxical reaction?

A

intermittent administration of recombinant human PTH in LOW DOSES**
- XS or continuous PTH generally have been shown to cause severe bone loss, paradoxically, low dose admin increases bone density

77
Q

What drugs (2) for osteoporosis are purely TREATMENT

A

Calcitonin:Miacalcin

Calcimar**

78
Q

Which drug is both treatment and prevention

A

Alendronate:Fosamax
ALSO
-Raloxifene (vista)
(listen in notes as both and as only prevention)

Geriatrics (1 decks)

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