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Garcia Flashcards

1
Q

Timed get up and go test is a screening tool to assess what?

A

Gait

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2
Q

Skin on the lower extremity is cool, dry, shiny and hair loss is common.

Distal pulses are diminished or absent

A

Peripheral artery disease

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3
Q

Stages of grief: (DABDA)

A
  1. Denial
  2. Anger
  3. Bargaining
  4. Depression
  5. Acceptance
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4
Q

How should constipation be managed in the elderly?

A
  • Hydrate
  • Exercise
  • Fiber
  • Stool softeners (Colace)
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5
Q

Herpes Zoster immunization

A

Age 60 or older (one dose)

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6
Q

Low grade fever and general abdominal pain may be the only sx in presentation of what?

A

Appendicitis

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7
Q

Most common locations of pressure ulcers when supine:

A
  • Occuput
  • Scapula
  • Sacrum
  • Heels
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8
Q

By age 80, 80% of men have BPH. In men that have BPH sx. What testing should be performed?

A
  • DRE
  • UA
  • Renal function tests
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9
Q

The mainstay of alzheimers treatment are what?

A

Cholinesterase inhibitors

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10
Q

The consistent decline in all organ reserves reduces an elderly pts ability to what?

A

respond adaptively to environmental changes and new illnesses

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11
Q

The leading cause of nonfatal injuries, unintentional injuries and death in older persons.

A

Falls

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12
Q

Transient urinary incontinence may be caused by what?

(DIAPPERS)

A
  • Delerium
  • Infection
  • Atrophic vaginitis/urethritis
  • Pharm
  • Psych
  • Excess fluid output
  • Restricted mobility
  • Stool impaction
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13
Q

How is total body water affected by aging?

A

Decreased

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14
Q

The emphasis in geriatric care is placed on what?

A

Maintaining high functional status (independence) and the best quality of life

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15
Q

What often reflects abnormal CNS function secondary to systemic infection and metabolic disorders?

A

Delirium

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16
Q

Pt saying:

Why bother with anything? I’m going to die soon, what’s the point? I miss my wife, why go on?

Is in what stage of dying/grief?

A

Stage 4 Depression

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17
Q

Intrinsic risk factors for pressure ulcers:

A
  • Immobility/inactivity
  • Incontinence
  • Malnutrition
  • Naturally aging skin
  • Other medical problems (PVD, DM, Dementia)
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18
Q

Abrupt smoking cessation is concerning for cancer where?

A

Lung

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19
Q

Parkinsons pt w/ psychosis/agitation.

What med?

A

Quetiapine (seroquel)

Risperidone (Risperdal)

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20
Q

Stage of dying: the process of dying

  • Life expectancy <6mo
  • Thought preoccupied w/ unrelenting loss of function and abilities
  • Renewed focus on life after death for oneself and those who remain alive
A

Stage 3

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21
Q

The most important element in making a diagnosis (May be difficult to obtain)

A

Pt History

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22
Q

Full thickness, deep crater involving necrosis of subcutaneous tissue that may extend to the underlying fascia is what stage ulcer?

A

Stage 3

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23
Q

The clinical approach to the elderly that goes beyond the traditional H and P must include what?

A

functional, social, and psychological domains that affect well-being and QOL

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24
Q

What falls under palliative medical care?

A
  • Nutritional support
  • Incontinence and constipation
  • Pain management
  • Symptom management
  • Emotional/Spiritual
  • Family support
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25
Q

The Activities of daily living are? (7)

A
  • Bathing
  • Dressing
  • Transferring
  • Toileting
  • Grooming
  • Feeding
  • Mobility
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26
Q

What is the best way to assess renal function in the elderly?

A

Creatinine clearance

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27
Q

Pts w/ CHF (HFrEF) and Angina or A-Fib should be given what medication as their initial Txt?

A

Beta Blockers (-olol)

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28
Q

What are the risk factors for adverse drug reactions? (6)

A
  • Increasing age
  • Women
  • Small body size
  • Duration of therapy
  • Patient non-compliance w/ therapy
  • Underlying disease states
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29
Q

Initial medication type in a pt w/ MI or HTN

w/ diabetes, ischemic heart disease, or CKD

A

ACEI (-PRIL)

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30
Q

Increased afterload can lead to what?

A

atherosclerosis and pulmonary vascular resistance

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31
Q

How can you help to prevent adverse drug reactions?

A

use the least amount of drugs at the lowest effective dose possible.

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32
Q

The overall goal of palliative medical care is?

A

to enhance the pts QOL

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33
Q

The most common valvular disorder in the elderly is what?

A

Mitral Regurgitation

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34
Q

The Geriatric review of systems consists of: (8)

A
  • Cognitive function
  • Urinary incontinence
  • Functional status
  • Mobility
  • Nutrition
  • Vision
  • Hearing
  • Depression+Mental Health
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35
Q

The left ventricle is less compliant and the chamber wall thickens leading to what?

A

Decreased preload

CHF sx may occur w/ decreased HR response

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36
Q

SIGECAPS

A
  • Sleep
  • Interest
  • Guilt
  • Energy
  • Concentration
  • Appetite
  • Psychomotor slowing
  • Suicide
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37
Q

The instrumental activities of daily living are? (7)

A
  • Using telephone
  • Preparing meals
  • Managing finances
  • Taking medications
  • Doing housework/laundry
  • Shopping
  • Managing transportation
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38
Q

The rate of aging is affected by

1/3 = ?

2/3 = ?

A

Genetic factors = 1/3

Environmental factors = 2/3 (Sedentary, Increased caloric intake)

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39
Q

Tool for measuring IADLs?

A

Lawton scale

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40
Q

What patients would you consider thiamine supplementation in?

A

Delirium

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41
Q

The primary cause of permanent cognitive impairment among older pts and decline in mental ability severe enough to interfere w/ independence and daily life

A

Dementia AKA- Major Neurocognitive disorder

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42
Q

New onset of incontinence w/ delerium

Low WBC count

hypo/normothermic

A

Urosepsis

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43
Q

Most common locations of pressure ulcers in pts on their side (lateral):

A
  • Ear
  • Acromion process
  • Elbow
  • Trochanter
  • Medial and Lateral condyle
  • Medial and lateral malleolus
  • Heels
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44
Q

How is an influenza outbreak in a nursing home managed?

A
  • Isolate symptomatic pts
  • Encourage staff to stay home if ill
  • Vaccinate any susceptible pts
  • Consider anti-viral prophylaxis
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45
Q
  • No prominent aphasia, apraxia, or agnosia
  • Disorders of movement and gait are early findings
  • Tumors can cause this type

What type of dementia?

A

Sub cortical

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46
Q

What age group has the highest rate of alcohol-related deaths?

A

65+

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47
Q
  • Prominent amnesia, aphasia, apraxia, agnosia
  • Fine motor movement is preserved until late in Dz
  • Significant deficits in social functioning
  • Diagnosis of exclusion

Describes what?

A

Alzheimers Dz

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48
Q

Settings where Hospice is offered:

A
  • Home
  • Facility (Nursing home, Hospital, Hospice center)
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49
Q

What does hospice not do?

A

provide funeral services

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50
Q

What lab values decrease w/ aging?

A
  • PaO2
  • Albumin
  • Vit B-12
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51
Q

In elderly pts, decrease in sinus node function increases the risk of what?

A
  • sick sinus syndrome
  • atrial dysrhythmias
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52
Q

Delerium pt w/ psychosis/agitation.

What med?

A

Haloperidol (low dose)

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53
Q

Some pressure ulcers on the heel do not need debridement. What do they look like?

A
  • Stable
  • Dry eschar
  • No signs of infection
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54
Q

The fastest growing segment of US population are?

A

Older adults

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55
Q

Barriers to eliciting a helpful history:

A
  • Fear of loss of Autonomy
  • Cultural and language differences
  • Education and life experiences
  • Fear of pain, financial costs, etc
  • Hearing and vision difficulties
  • Depression and apathy
  • Misunderstanding the significance of Sx
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56
Q

New York Heart association classes for HF:

A
  1. No limitation
  2. Slight limitation
  3. Marked limitation
  4. Unable
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57
Q

What symptom is an unreliable sign of meningitis in the elderly?

A

Neck stiffness

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58
Q

What commonly causes the basilar crackles heard on auscultation in an elderly pt?

A

opening of collapsed alveoli

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59
Q

What medication should be avoided in elderly pts w/ COPD?

A

Theophyllin

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60
Q

Dementia w/ psychosis and agitation may be treated w/ Quetiapine (Seroquel) or Risperidone (Risperdal)

What nonpharm methods may be effective?

A

Reassurance, distraction, structured schedule may be effective to control psychosis and agitation.

61
Q

Dementia is defined as what?

A

Memory impairment plus one of:

  • Aphasia
  • Apraxia
  • Agnosia
  • Disturbed executive functions
62
Q

Large varicose veins or spider veins

Skin is warm, dry, shiny and has a bluish red hue

A

Chronic venous insufficiency

63
Q

The symptom score sheet for BPH assesses what?

A

the degree of sx and their impact on QOL

64
Q

The top three causes of death in adults over the age of 65 is?

A
  1. Heart disease
  2. Cancer/Stroke?
  3. COPD
65
Q

Unless contraindicated, the minimal management of Acute coronary artery disease is:

A
  • daily aspirin
  • ACEI
  • B-blocker
  • lipid lowering drugs
66
Q

Hyperkalemia is a complication of what?

A

Acute renal failure

67
Q

What are the most common chronic diseases afflicting the elderly? (8)

A
  • Adult onset diabetes
  • Arthritis
  • Kidney and bladder problems
  • Dementia
  • Parkinson’s disease
  • Glaucoma
  • Lung disease
  • Cataracts
68
Q

Dementia that affects memory/amnesia, language, problem-solving, and reasoning is?

69
Q
  • New weight loss
  • Recent change in taste
  • Decreased appetite

Are concerning for what?

70
Q

The cause of the majority of influenza fatalities is?

71
Q

What body change would cause an elderly pt have high amounts of synthroid in their blood?

A

Lower serum albumin levels

72
Q

Calcium channel blockers should be avoided in what elderly pts?

73
Q

Tool for measuring ADLs?

A

Katz index

74
Q

Drugs of choice for MI and HTN in the elderly?

A

Long acting dihydropyridine Calcium channel blockers

(amlodipine, felodipine, nifedipine)

75
Q

Non blanching erythema of intact skin is what stage ulcer?

76
Q

Partial thickness involving the epidermis and dermis, superficial.

Is what stage ulcer?

Appears as a blister or abrasion

77
Q

If no ulcer healing is achieved after 14 days of conservative interventions you should consider what?

A

Topical Abx

78
Q

A person saying:

I’d give anything to have him back. If he would come back, I would be a better person.

Is in what stage of dying/grief?

A

Stage 3 Bargaining

79
Q

Stage of dying: end of life inevitability

  • Life expectancy <5 years
  • Thoughts are conciliatory and directed to resolution
  • Frequent awareness of mortality
80
Q

SOB, pulmonary edema, CHF, cardiac rupture, and shock are common complaints related to what?

81
Q

Criteria for an influenza outbreak in a nursing home:

A

Three or more pts w/ fever to 101F and flu sx within 3 days

82
Q

What assessment is more sensitive for detecting arthritis, muscle weakness, and neurological impairments than components on any standard neurological exam.

A

Gait and balance assessment

83
Q

On physical exam of elderly pts, what transient pulmonary finding is common?

A

Basilar crackles

84
Q

Actinic keratosis is the precurser to what?

A

squamous cell cancer

85
Q

Medical conditions may present first or only as functional losses/disturbances that can be detected in an appropriate ________ ____________ is done at every encounter.

A

Geriatric assessment

86
Q

Result of dopamine deficiency and shrinking of the substancia nigra describes

A

Parkinson’s Dz

87
Q

Peripheral artery disease Txt in the elderly:

A

Risk factor reduction

Exercise

Daily ASA

88
Q

Risk factors for adverse drug events:

A
  • Increasing age
  • Women
  • Small body size
  • Duration of therapy
  • Patient compliance
  • Underlying diseases
89
Q

A progression of emotional states experienced by both terminally ill pts after Dx and by loved ones after a death

Are not stops on a linear timeline of grief

A

Stages of dying

90
Q

Easy way to assess hearing in clinic

A

whispered voice test

91
Q

Txt for BPH:

A
  • Alpha 1a receptor blockers (Tamsulosin, Alfuzosin)
  • 5-alpha reductase inhibitors (Dutasteride, Finasteride)
  • Surgery (TUIP, TURP, Prostatectomy)
92
Q

What are clues that can indicate abuse or neglect?

A
  • Delays between injury and txt
  • Lack of appropriate clothing or hygiene
  • Changes in pt behavior when caregiver is present
  • Unfilled Prescriptions
93
Q

Skin with scaly rough adherent sandpaper textured lesions on sun exposed areas.

A

Actinic Keratosis

94
Q

The most common presenting sx of acute coronary artery disease in pts over 80yo is what?

95
Q

Txt for chronic venous insufficiency:

A
  • Compression socks
  • Ulcer care
  • Weight loss
  • Exercise
  • Foot and nail care
  • Avoid prolonged sitting or standing
96
Q

Extrinsic factors that cause pressure ulcers:

A
  • Pressure
  • Friction
  • Shearing
  • Maceration of skin due to excess moisture
97
Q

1st line Txt for Depression in dementia?

A

Sertraline (Zoloft)

98
Q

New onset of serous otitis media is concerning for cancer where?

99
Q

Reactivation of latent varicella-zoster virus in a dorsal root ganglion, causing painful vesicles along a dermatome

A

Herpes zoster (shingles)

>50% of cases involve pts >60yo

100
Q

Unintentional weight loss in an elderly pt that requires further evaluation is?

A

>5% body weight

101
Q

What assessment can quickly evaluate an elderly pt for dementia?

A

Mini-Cog exam (3-item recall, clock drawing)

102
Q

This change affects protein binding of some drugs. Fewer protein binding sites are available, increasing free serum drug levels. (i.e., Synthroid)

A

Lower serum albumin levels

103
Q

Diminished mastication strength, bone density, and periodontal tissue.

Reduced salivary flow, and increased risk of dental disease including poor fitting dentures increases the risk of what?

A

Malnutrition

104
Q

What medications are associated w/ Acute renal failure?

A
  • Aminoglycoside Abx
  • NSAIDs
  • ACE inhibitors
105
Q

What tools are available to assess vision?

A

Snellen eye chart

Jeager card

106
Q

Urinary incontinence is not a normal event in aging. What are the subtypes of incontinence?

A
  • Total- lose urine all the time
  • Stress- increased abd pressure, pelvic floor laxity
  • Urge- need to urinate >7x/day or >2x/night
  • Overflow- Chronic urinary retention (BPH, strictures)
107
Q

50% of the medical costs in an elderly pts last year of life occur when?

A

last 60 days of life

108
Q

25% of all medicare costs are incurred when?

A

Last year of life

109
Q

Influenza immunization

110
Q

Stage of dying: the act of dying

Life expectancy <1mo

10 signs of near death:

Loss of appetite, decreased thirst, increased fatigue, dehydration, increased weakness, social withdrawal, disorientation, swollen extremities, cool tips of fingers and toes, molted veins

111
Q

When should you refer a pt to palliative medical care?

A

If pts prognosis is <18mo

or

At time of diagnosis w/ serious illness

112
Q

Elderly pt w/ depression.

What med?

A

Sertraline (Zoloft)

Escitalopram (Lexapro)

113
Q

What changes should you expect in an elderly pts GFR?

A

Decreased GFR

due to progressive loss of renal mass, w/ basement membrane and mesangium thickening

114
Q

Optimal turning schedule for preventing pressure ulcers:

A

every 2 hours

115
Q

5 Principles of care for older adults are:

A
  1. The impact of decreased physiology reserve
  2. Importance of functional and cognitive status
  3. Using goals of care and prognosis in clinical decision making
  4. The social context of care
  5. Impact of multiple conditions, medication, and settings
116
Q

What lab values do not change with aging?

A
  • pH
  • PaCO2
  • LFTs
  • Thyroid function tests
  • Coags
  • Platelets
117
Q

Most common locations for pressure ulcers in pts lying prone:

A
  • Elbow
  • Ear, Cheek, Nose
  • Breasts (female)
  • Genitals (male)
  • Iliac crest
  • Patella
  • Toes
118
Q

Specific preventative interventions for individual pts should be based on:

A
  • evidence-based guidelines
  • pt’s estimated life expectancy
  • pt’s values and goals
119
Q

How does the presentation of major depressive disorder in the elderly differ from the presentation in the young?

A

More insidious presentation in the elderly

120
Q

What is the preferred influenza prophylaxis or treatment?

A

Oseltamivir (Tamiflu)

121
Q

The CAM is used for diagnosing delerium. What are the criteria?

A
  1. Acute onset and fluctuating
  2. Inattention
  3. Disorganized thought
  4. Altered level of consciousness

Both 1 and 2 w/ 3 or 4 = Delirium

122
Q

How should you base medication dosing in the elderly?

A

Creatinine clearance (GFR)

123
Q

Stage of dying: Life focus

  • Life expectancy >20years
  • Thoughts are forward-reaching, growth oriented, there’s no end in sight.
124
Q

CHF is most commonly associated w/ what?

A

prolonged systolic HTN

125
Q

Elderly patients who present for acute care with vague, atypical symptoms and have multiple risk factors for CAD…

A

Have an MI until it’s ruled out (EKG, Cardiac enzymes)

126
Q

Frequently missed in the elderly

Afebrile in many cases

May have severe infection but not appear ill

127
Q

Polyarticular and upper extremity involvment are more common in elderly pts w/ Gout. How is it treated?

A

NSAID other than indomethacin

or prednisone

128
Q

Variables to consider when initiating medications in elderly pts:

A
  1. Frailty of the pt
  2. Pts ability to follow instructions
  3. The complexity of their current medication regimen
  4. Supporting care (family, spouse)
129
Q

Elderly pts have reduced ability to regulate body temperature, and/or reduced ability to respond to infection due to what?

A

Skin changes- decreased thickness of Dermis

130
Q

On auscultation of the lungs in an elderly pt, basilar crackles are a common finding. What can the pt do that may clear these?

A

Taking some deep breaths

(crackles that disappear after deep breaths are normal)

131
Q

Dementia that affects motivation, emotionality/depression, clumsiness, irritability, or apathy is?

A

Subcortical

132
Q

The greatest risk factor for depression in the elderly is?

A

Hx of depression

133
Q

What should be avoided in treatment of pressure ulcers?

A

Skin cleaners/ antiseptics (destroy granulation tissue)

134
Q

What lab values increase w/ aging?

A
  • ESR
  • Alk Phos
  • autoantibodies
135
Q

What are the functions of Hospice care?

A
  • Provider- Pain management
  • Nursing- meds, triage, bowel/bladder management, wound care, hygiene
  • Counseling- spiritual, personal
  • Planning- financial, family care
136
Q

All elderly pts w/ new A-Fib/Flutter need to get what?

137
Q

How does aging affect liver function tests?

A

It doesn’t.

Abnormal LFTs = Liver pathology

138
Q

What are the generalized body changes in the elderly?

A
  • Decreased lean body mass
  • Decreased body water content
  • Increase in fat per unit of body weight
139
Q

When should you refer a pt to Hospice?

A

When you believe that a pt has 6mo or less to live

140
Q

How does new disease present in elderly pts?

A

Sudden changes in ability to conduct ADLs or IADLs may indicate the presence of a new illness or exacerbation of existing condition.

141
Q

Elderly pt w/ depression and difficulty sleeping.

What medication?

A

Mirtazapine (remeron)

142
Q

Because the Sx of hypothyroidism are similiar to normal age related changes in a euthyroid person, screening should be done routinely.

How is hypothyroidism managed in the elderly?

A

Levothyroxine at a low dose increased slowly

143
Q

A pt asking:

Why me? Its not fair! How could this happen to me? Who is to blame? Why would this happen to me?

Is in what stage of dying?

A

Stage 2 Anger

144
Q

If a pt is unable to give a good history, what is another way to obtain their history?

A

Asking a relative or caregiver

145
Q

Changes in this allows lipophilic drugs to penetrate easier, causing unintended side effects. (i.e., TCAs, barbituates, opiates)

A

Changes in CNS function

146
Q

Pts w/ CHF (HFrEF) and HTN should get what agent as initial therapy?

A

ACEI (-PRIL)

147
Q

The PHQ-2 screen is a sensitive test for depression. What questions are included?

A
  • Over the past 2 weeks, have you felt down, depressed, or hopeless?
  • Over the past 2 weeks, have you felt little interest or pleasure in doing things?
148
Q

The number one cause of dementia?

A

Alzheimer’s Dz

Geriatrics (2 decks)

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