Final Exam Flashcards by Piper Dobner

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

True

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

22%, 70.2 million people

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What is the average life expectancy for men?

**7 years less than women at 72.7 years

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What is the average life expectancy for women?

79.5 years

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What are the theories (5) of aging

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

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What is the cellular theory of aging?

decreased supply of nutrients to the cell

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what is the free radical damage theory of aging?

uncontrolled build up of free radicals

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what is the autoimmune theory of aging?

B and T cells weaken with age, then malfunction

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what is the programmable cell death theory?

intrinsic or extrinsic signals either INDUCE or SUPPRESS apoptosis

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what is the telomere length theory of aging?

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

a tiny fragment of the telomere

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

YES

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What is inflammaging?

inflammatory process that is central to aging

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

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

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What deficiency is associated with metformin?

B-12 deficiency;

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

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What are key anatomical changes in posture for geriatrics?

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

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what are common skin conditions in geriatrics?

vitiligo becomes more common

decubitus ulcer risk increases

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why does risk for decubitus ulcers increase?

diminished number and function of sweat glands

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What is often a precursor to corneal infections?

reduced tear formation (a common finding in the elderly)

drying of the cornea

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Which condition causes PERIPHERAL vision loss?

Glaucoma**

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

Chronic Glaucoma

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Which conditions experience CENTRAL vision loss?

Cataracts

Macular Degeneration

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

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

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

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

H2 blocker | increases gastritis and ulcer

What have been shown to be cyto-protective?

PPI | Mesoprosal

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

low-dose diuretic therapy

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

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

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

Long-Acting Calcium Channel Blocker

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

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

- Delirium - Restricted mobility - Infection, inflammation, impaction - Pharmaceuticals

What is the most common cause of acute urinary incontinence?

Bladder infection

what is the most common drug class to cause incontinence?

diuretics

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

MEDICAL EMERGENCY

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

Normal Pressure Hydrocephalus

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

Urge incontinence

What is the three "S" workup for hematuria

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

What exercise should be implemented for all causes of incontinence?

Kegels

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

Oxybutynin and other anti-cholinergic medications

what increases risk of falling?

increased chronic disability

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

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

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

dullness to percussion** | increased respiratory rate (>26)

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

Elderly are more likely to be:** | bacteremic, develop complications (empyema, meningitis), more likely to DIE

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

generally present with Urinary Frequency and Urinary Incontinence - Dysuria is a less common symptom

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

dyspnea is more common than angina pectoris

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

``` vomiting (w or w/o abdominal pain) vertigo confusion syncope (near-syncope) falling ```

what are additional presenting symptoms of MI in the elderly?

ACUTE RENAL FAILURE* | Acute CHF or exacerbation of previous CHF

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

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

What are typical symptoms of fecal impaction?

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

What are common ssx of hypothyroidism in the elderly?

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

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

apathy and inactivity** apathetic hyperthyroidism

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

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

What are possible mental and emotional symptoms of hyperparathyroidism?

``` depression anxiety decreased memory (recent, esp) personality change delirium acute psychosis ```

What are causes of delirium

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

What five functions must be affected to dx dementia?

``` Need 2/5:** memory language personality emotion motor skills ```

What is andropause?

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

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

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

What are adverse events related to testosterone administration?

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

What does testosterone administration exacerbate heart disease?

accelerates atherogenesis

how many vertebral fractures are noted in osteoporosis?

700,000

What does Secondary Osteoporosis imply?

``` decreased bone mass is due to other conditions, medications, malabsorption or prolonged immobilization ** ```

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

``` hyperthyroidism** supplemental thyroid Cushing's disease Glucocorticoid use Hyperparathyroidism ```

What is a T-score?

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

What is a Z-score?

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

What is a normal T-score?

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

When does conventional treatment treat for osteoporosis?

T score < -2.0 OR** | T-score < -1.5 AND known RISK FACTORS*

FRAX is?

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

Studies suggest Vitamin D can protect against osteoporosis ONLY IF

in combination with Calcium**

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

bisphosphates** | - including women who have had prior bone fractures

what are potential side effects of bisphosphates?

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

Selective Estrogen Receptor Modulators (SERMs) selectively block*?

conformational changes of the estrogen receptors**

Raloxiphine (Evista) is indicated for ?

Prevention AND Treatment of osteoporosis | - however, NO statistically significant decreases in non-vertebral fractures were noted

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

DVT | PE

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

sufficient levels of ** Calcium & Vitamin D

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

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

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

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

What drugs (2) for osteoporosis are purely TREATMENT

Calcitonin:Miacalcin | Calcimar**

Which drug is both treatment and prevention

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