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GERI Flashcards

1
Q

What is the PHQ-2 depression screen?

A
  1. During the past month, have you often been bothered by feeling down, depressed, or hopeless?
  2. During the past month, have you often been bothered by little interest or pleasure in doing things?
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2
Q

What is a positive Timed Get-up-and-go test?

A

< 10 sec = normal

> 30 sec = much impaired (high fall risk)

(Test: get out of chair, walk 10 ft, turn around and walk back to chair, sit down.)

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3
Q

What are the types of urinary incontinence?

A
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4
Q

What are the major classes of drugs on the Beers list?

A

Muscle relaxants

Tricyclic antidepressants

Benzodiazepine

Etc

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5
Q

What is a stage I ulcer?

A

- Erythema that is non-blanching

  • Intact skin

→Tx: positioning

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6
Q

What is a stage II ulcer?

A

Epidermis/dermis

→Tx: occlusive dressing (eg Tegaderm)

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7
Q

What is a stage III ulcer?

A

Into the subcutaneous tissue

→ foam pad

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8
Q

What is a stage IV ulcer?

A

Into muscle/bone/supporting structures

→ debridement if necrotic tissue

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9
Q

Benefit of PNA vaccine?

A

Reduces risk of pneumococcal bacteremia.

(not the risk of “getting pneumonia”)

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10
Q

Concerns re testosterone replacement in older males?

A
  • liver dysfunction, HLD
  • erthrocytosis
  • prostate tissue growth (Prostate CA is absolute contraindication)
  • gynecomastia (**male breast CA is **absolute contraindication)
  • edema (caution in HF/cirrhosis/ renal failure pts)
  • acne
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11
Q

Loss of visual acuity, central field distortion. Dx?

A

Macular degeneration = most common cause of blindness in older americans

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12
Q

Risk factors for age-related macular degeneration?

A

Same as CV risk factors: age, HTN, smoking, hx of CVD (also blue eyes, and FH)

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13
Q

Common medications that cause hearing loss?

A

Cisplatin, aminoglycosides, loop diuretics, aspirin, NSAIDs

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14
Q

When does screening for osteoporosis begin?

A

All women get DEXA at age 65

AND

Postmenopausal women with one of the following risk factors: FH, low trauma fx, current smoker, thin

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15
Q

How much Calcium should post-menopausal women intake daily?

A

1200-1500 UI (in divided doses)

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16
Q

How much vit D should post-menopausal women intake daily?

A

400-800 UI

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17
Q

What medications cause osteoporosis?

A

Glucocorticoids

Anticonvulsants

Loop diurectics

PPIs

Too much levothyroxine

(also heparin, MTX, cyclosporin, GNRH)

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18
Q

How does HCTZ affect ostoporosis?

A

Protective against it (causes increased absorption of Ca?)

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19
Q

Delerium vs Dementia

A

Delerium - acute, fluctuating, reversible

Dementia - progressive, constant, not-reversible

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20
Q

How is a cane measured to fit a patient?

A

Floor to the greater trochanter

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21
Q

In a patient with left-sided weakness, the cane goes in which hand?

A

on the “good” side (right side in this case)

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22
Q

What is the score range of the Mini Mental Status Exam

A

Maximum is 30 points

Dementia cutoff is 24-26

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23
Q

Stages of Alzheimer’s Disease

A

Mild: memory, personality, disorientation

Moderate: aphasia, apraxia, insomnia, confusion

Severe: memory loss, motor impairment, daily activities

Terminal: immobile, dysphagia, infections

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24
Q

Dx of dementia?

A

Memory impairment

+

aphasia OR apraxia OR agnosia OR executive functinon

+

these lead to functional impairment

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25
Q

What is indication of cholinesterase inhibitors (donepezil, rivastigmine, etc)

A

Alzheimers demintia is the main use.

(Might help in other types: vascular, parkinsonian dementia, etc)

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26
Q

What exactly is the benefit of cholenesterase inhibitors in dementia?

A
  • May stabilize decline (memory, cognition) for 3-6 months. (by 9-12 months, no difference)
  • 3 point difference on MMSE at 6 months
  • Long-term, it oes appear to delay placement to NH
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27
Q

Side effects of cholinesterase inhibitors?

A

N/V/D, anorexia, COPD/asthma exacerbation

28
Q

Who covers skilled nursing facilities: Medicare or Medicaid?

A

Medicare Part A

The first 20 days are covered fully, then through day 100 partially (pt has ~$140 daily copay). This includes skilled nursing (NH, rehab hospital, etc) and rehab (PT/OT, speech, etc).

29
Q

Who covers extended Nursing Home care: Medicare or Medicaid?

A

Medicaid

(Medicare Part B will pay for MD nursing home visits; but not nursing, etc)

30
Q

Fat soluable drugs in the elderly?

A

Vd of fat soluable drugs (like diazepam) increases because less lean body mass/more fat

Vd of water soluable drugs (like EToH) decreases

31
Q

How much is “one drink”?

A

12 oz of beer

5 oz of wine

1.5 oz of distilled liquor

32
Q

In the elderly, how much does the blood alcohol level rises with one drink?

A

~0.08 (in a young person ~0.03)

33
Q

Who gets AAA screening?

A

Men from 65-74 who have smoked > 100 cigarettes in their lifetime get Ab US.

34
Q

When should a AAA get surgery?

A

5.5 cm

or 5 cm if rate of increase is 0.5 cm in that past 6 months (4.5 cm for women)

35
Q

What are the Rome constipation criteria?

A

Two or more of the following for 12 weeks:

  • Straining 25% of the time
  • Lump or hards stool 25% of the time
  • Sensation of incomplete evacuation 25% of the time
  • < 3 defications per week
  • Manual assistance required
36
Q

What is the risk with enemas?

A

Colonic perforation

Hyponatremia (with large volume enemas)

Hyperphosphatemia (some enemas contain phosphate)

37
Q

In order to qualify for skilled nurning facility, how long must the hospitalization be?

A

Qualifies after 3 day hospitalization

Paid by Medicare

38
Q

Who pays for hospice?

A

Medicare will pay for home hospice

39
Q

How long is look back period?

A

5 years (Medicaid only pays once you have run out of money. Some people will transfer their funds to a family member so that they are “out of money”. Medicaid looks back 5 years for this)

40
Q

4 placed where lesions can occur causing gait disturbance.

A

Peripheral neuropathy: distal only motor/sensory

LS spine: more pain than deficit (UMN only go to T12-L1, so no UMN signs)

C-spine: UMN signs (no cranial nerve or gray matter ie dementia)

Brain: cranial nerve and gray matter signs, EPS

41
Q

What are upper motor neuron signs?

A

spastic paralysis

Spasticity: “clasp-knife”, hyperreflexia, + babinski

Paralysis, incomplete = weakness

42
Q

Drugs that induce Parkinsonism?

A

metoclopramide, valproic acid, prochlorperazine

43
Q

Resting tremor with asymmetric rigidity?

A

Parkinson Disease

Asymmetric tremor with greater rigidity on that side = Parkonson Disease

44
Q

What is the mainstay treatment of Parkinson Disease in the elderly?

A

Carbidopa/Levodopa (Sinemet)

Carbidopa prevents periferal breakdown of levodopa

Levodopa… is dopamine (the stuff that’s missing)

Optimize Sinemet before adding others. Anticholinergics and Amantidine have little role in the elderly). Dopamine agonist more likely to cause hallucinations (although may be 1st line in younger persons)

45
Q

Presbycusis is hearing loss of what frequency?

A

High frequency hearing loss.

46
Q

Pt with thick eschar over ucler. What is the treatment: debridement or collagenase?

A

Surgical debridement (collagenase won’t get through a thick eschar)

47
Q

70F with OA reports shoulder and hip pain over the past 1 month.

A

Polymyalgia Rheumatica

Tx with low dose systemic steriods

48
Q

Dx of Polymyagia Rheumatica

A

Age ~70 (rarely < 50)

Bilateral pain in the morning in two of the following three: neck/torso,** **shoulders/proximal arms, hips/proximal legs

Elevated ESR

49
Q

DSM-5 criteria for depression

A

Depressed + 4 of the **SIG E CAPS ** x 2 weeks:

Sleep

Interest

Guilt

Energy

Concentration

Appetite

Psychomotor

Suicidal

50
Q

How to evaluate for apraxia (a feature of Alzheimer’s Dementia)?

A

Trouble with wording finding?

51
Q

How to evaluate for agnosia (a feature of Alzheimer’s Dementia)?

A

Difficulty using utensils?

52
Q

How to evaluate for agnosia (a feature of Alzheimer’s Dementia)?

A

Trouble recognizing people, lost in familiar situations.

53
Q

How to evaluate for failing executive function (a feature of Alzheimer’s)?

A

Trouble managing the checkbook

54
Q

What is mild cognitive impairment?

A

Pt complains of memory impairment. No functional issues. High risk for dementia later.

55
Q

Dementia + parkinson’s (gait) + visual hallucinations.

Dx?

A

Lewy Body Dementia

56
Q

Demenita + low grade fever + startle myoclonic jerks. Dx?

A

Creutzfeldt-Jacob Disease

–> EEG to confirm

57
Q

Which changes the least in the elderly: absorption, distribution, metabolism, or elimination?

A

Absorption

58
Q

Administration instructions for sulcralfate

A

Do not give with other drugs (within an hour, will bind other drugs –> eliminated)

59
Q

Administration instructions for Sinemet (Carbidopa/Levodopa)

A

Don’t give with protein (AA complete with levodopa)

60
Q

How does gastroparesis affect absorption?

A

Delayed gastric emptying = delayed absorption

61
Q

Administration instructions for iron

A

Need acidic environment (take with orange juice, avoid taking with PPIs)

62
Q

Propranolol is more or less efficacious in the elderly?

A

More - it’s lipophilic. Elderly have more fat compared to lean body mass… higher Vd for fat soluable drugs… lipophilic drugs like propranolol have around longer… have longer half lives

***being fat soluable, propranolol crosses the BBB which is why is works on tremor (and probably causes depression). Atenolol is not fat soluable, does not help with tremor or associated with depression as strongly.

63
Q

Which is most responsible for drug effects in the elderly: absorption, distribution, metabolism, or elimination?

A

Elimination

64
Q

Classic polypharm example involving Ach drugs

A

Acetylcholinesterase inhibitor (donepezil/Aricept) taken with anticholenergics (benadryl, atrovent, oxybutinin, antihistamine)

65
Q

Ode to the anticholinergic (side effects)

Anticholengerics: antihistamines, antiparkinson, antipsychotics, antiemetics, TCAs, antispasmotics.

A

Hot as a hare (hyperthermia),

Blind as a bat (dilated pupils),

Red as a beet (vasodilation),

Dry as a bone (dry skin)

Mad as a hatter (hallucinations/agitation)

The bowel and bladder lose their tone and the heart rate goes on alone (ileus, urinary retention, tachycardia)

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