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My Clin Med 4 > Geri > Flashcards

Geri Flashcards

1
Q

Types of Insomnia (4)

A

Difficulty falling asleep,
mid sleep awakening,
early morning awakening,
non-restorative sleep

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2
Q

Symptoms of NREM insomnia (3)

A

daytime fatigue, irritability, problems concentrating

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3
Q

Acute transient insomnia length

A

<1 week

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4
Q

Short term/ sub acute insomnia length

A

1 week - 3 months

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5
Q

Chronic insomnia length

A

> 3 months

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6
Q

Non-pharm sleep treatment (3)

A

Sleep hygiene
Behavioral therapy - relaxation
Bright light therapy during day

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7
Q

Pharm sleep treatment

A

Trazadone, or Zolpidem
Benzos
OTC: Melatonin, Benadryl, acetaminophen

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8
Q

central sleep apnea causes

A

Parkinson’s, stroke, CHF

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9
Q

treating sleep apnea

A 
wt loss, 
avoid alcohol, 
avoid back sleeping, 
oral-dental device, CPAP, 
Surgical: mandibulary maxillary advancement or laser assisted uvuloplasty
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10
Q

Risk factors for Restless leg or Periodic limb movements

A

family hx, uremia, low iron stores, increased age

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11
Q

Difference between Restless leg and Periodic limb movements

A

Restless leg: irresistible urge to move legs before onset of sleep d/t motor restlessness (legs only)
PMLD: stereotypic rhythmic movements during sleep, usually legs

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12
Q

non pharm treating Restless leg

A

massage and stretching,

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13
Q

Restless leg and PMLD treatment

A 
dopaminergic agents: 
     pramipexole, 
     ropinirole,
Oxycodone
Clonazepam
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14
Q

3 components of Failure to thrive

A

Physical frailty,
Disability
Impaired neuropsychiatric function

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15
Q

frailty criteria for failure to thrive (3 of 5)

A 
Wt loss >5% of wt in 1 year
Exhaustion
weakness
slow walking speed (>7 seconds 15 foot walk)
decreased physical activity
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16
Q

treating failure to thrive

A

improve QoL
treat any underlying conditions
ensure, vitamin suppliments, megestrol, dronabinol,
methylphenidate (psychostimulant)

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17
Q

hospice criteria,(5)

A 
non-reversible wt loss 
unresolvable infection
swallowing defect
progressive dementia, 
progressive pressure ulcers
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18
Q

best corrected vision worse than ________ is visual impairment

A

20/40 and better than 20/200

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19
Q

Legal blindness is best eye corrected vision of ______

A

<20/200

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20
Q

Common diseases of visual impairment (4)

A

Cataracts
Macular degeneration
glaucoma
DM

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21
Q

Atrophic “dry” Macular degeneration sign

A

yellow drusen bodies

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22
Q

neovascular “wet”

Macular degeneration sign

A

growth of abnormal blood vessels, +/- bleeding of vessels

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23
Q

Normal eye pressure (glaucoma is more than this)

A

10-21 mmHg

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24
Q

Hearing impairment progression after 55 years

A

9 dB/ decade

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25
Q

Hearing impairment MC cause

A

Presbycusis - inner ear sensorial hearing loss

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26
Q

Syncope in elderly d/t (4)

A

diminished cerebral blood flow,
baroreceptor reflex sensitivity,
drug effects,
sensitivity to volume loss

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27
Q

Types of syncope (3)

A

Reflex, Cardiac, unknown

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28
Q

Reflex syncope types (4)

A

vasovagal , orthostatic htn, carotid sinus hypersensitivity, situational

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29
Q

cardiac syncope types

A

brady or tachy arrhythmias

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30
Q

most important Syncope diagnostic study

A

EKG (wolf-Parkinson white)

may need holter monitor

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31
Q

4 stages of Pressure ulcer

A

stage 1 - non blanchable erythema or intact skin
stage 2 - partial thickness skin loss with exposed dermis
stage 3 - full thickness skin loss, with fat visible
stage 4 - all skin, and tissue loss to expose fascia, muscle, tendon cartilage or bone

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32
Q

dementia definition

A

acquired, persistant, progressive impairment - decline of cognition
must be severe enough to interfere with daily function and independance

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33
Q

Alzheimer disease classic triad

A

memory impairment
visuospacial problems
language impairment
(motor/sensory function spared until later)

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34
Q

Disorientation to……. in early alzheimer’s

A

time, place, and person

Subtle anomic aphasia (word retrieval failure)

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35
Q

Alzheimer’s behavioral changes (4)

A

apathy and irritability
depression
agitation
psychotic symptoms (mod to advanced)

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36
Q

Vascular dementia - diagnosis

A

clinical or radiographic evidence of CerebroVascular disease

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37
Q

Lewy body Demetia - features (3)

A

parkinsonism developing after dementia,
fluctuation in cognitive impairment,
detailed visual hallucinations (can distinguish them)

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38
Q

Frontotemporal dementia features (5)

A

hyperorality, early personality/ behavioral changes,
loss of social awareness,
compulsive/ repetitive behaviors,
progressive reduction in speech

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39
Q

mini - cog recalled 1/3 words, clock normal

A

non demented

40
Q

mini - cog recalled 2/3 words, clock abnormal

A

Demented

41
Q

dementia treatment (5)

A 
treat behavioral disturbances, 
manipulate environment to support function
counsel for safety issues
cognitive rehab
exercise programs
42
Q

DNU in Dementia (2)

A

Antipsychotics

Benzos

43
Q

Delirium symptoms (5)

A 
Acute changes in Mental status, 
inattention, 
disorganized thinking
altered LOC,
Distractibility
44
Q

MC cause of reversible delirium

A

Medications - Poly pharmacy

45
Q

High risk meds for delirium (7)

A 
Oxybutynin (welbutrin)
ranitidine, 
Amitriptyline (Nortriptyline)
hydroxyzine
digoxin
benzos
Dopamine agonists
46
Q

non-pharm delirium treatment (6)

A 
Lights on/ off circadian,
calendars and clocks
windows, 
family
hearing aids and glasses
avoid restraints
47
Q

Pharm delirium treatment

A

judicious antipsych meds

Haldol (haloperidol)

48
Q

DNU in delirium

A

benzos

49
Q

Depression treatment in Elderly

A

SSRI

Citalopram, escitalopram, sertraline

50
Q

Depression without improvement for longer than _____ after loss of a loved one should be treated

A

> 2 months

51
Q

Urinary incontinence causes (3)

A

medical condition
medications (anticholinergics - due to overflow)
Lower Urinary tract disease

52
Q

urge incontinence

A

incontinence with or following urge to urinate

53
Q

Stress incontinence

A

incontinence with Valsalva- type maneuvers

54
Q

overflow incontinence

A

impaired detrusor contractility, bladder outlet obstruction, or combo

55
Q

nocturia definition

A

> 2 voids during sleeping hours

56
Q

Urinary incontinence lifestyle and behavioral changes (5)

A

avoid caffeine, bladder retraining, prompt voiding, pessaries, absorbent garments

57
Q

Urinary incontinence meds and surgical options

A

Oxybutynin,

re-suspend muscles and ligaments

58
Q

UTI in elderly symptoms (7)

A 
shivering, 
vasoconstriction, 
hypothalamic regulations,
increasing confusion, 
falling
anorexia
exacerbation of underlying illness
59
Q

Antibiotics dosing in UTI in elderly

A

NOT “start low, go slow” - treat the infection

monitor for toxicity and sub therapeutic dosing

60
Q

UTI in elderly men treatment

A

Considered complicated

DNU short -course therapy

61
Q

GERD causes (3)

A

sliding hiatal hernia,
reduced LES pressure
reduced pinching action of the Crus of the diaphragm

62
Q

GERD aggravating factors (7)

A

large meal, fatty food, caffeine, ETOH, Smoking, Obesity, Supine after meal

63
Q

GERD Signs and symptoms

A 
substernal burning with radiation to mouth/throat
sour taste
chronic cough
difficult-to-control asthma
laryngitis/hoarseness
64
Q

GERD new-onset diagnostic _____ if. _______ (4)

A 
Upper endoscopy
>50 years, 
persistant symptoms with meds
Hx of acid reflux > 5 years
persistant or incomplete resolution with treatment
65
Q

Lifestyle mods with GERD (5)

A

smaller meals,
avoid acidic food, chocolate and peppermint
don’t eat before bed 3-4 hours
minimize fats, alcohol, caffeine and nicotine
sleep with Head of bed elevated 6 inches

66
Q

GERD Pharm (3)

A

PPI (-prazole)
antacid liquid or tablets
Histamine-2 receptor antagonists (-tidine)

67
Q

GERD surgical repair

A

Laparoscopic fundoplication (Nissen Fundoplication)

68
Q

Diverticulitis mild treatment

A

IV antibiotics –> PO total 10-14 days

69
Q

Diverticulitis severe

A

Colectomy

70
Q

Constipation definition

A

infrequent or unsatisfactory defacation <3 x /week

Chronic >12 weeks

71
Q

Constipation “alarm symptoms” (7)

A 
hematochezia
family hx for IBD or Colon Ca
anemia
\+ fecal occult blood test
unexplained wt loss >10 lbs
constipation refractory to tx
new onset constipation without primary cause
72
Q

Constipation with normal colonic transit time tx

A

Fluids
Fiber
Stimulant laxative

73
Q

Constipation with slow colonic transit time tx

A

Osmotic laxative,

sorbitol, lactulose,

74
Q

Constipation softeners

A

Bulk agents - fibers, psyllium, methylcellulose

non-absorbable substances - PEG, Lactulose, MG salts

75
Q

Constipation peristaltic increasers

A

stimulants:bisacodyl, senna,
Secretory: lubiprostone, linaclotide

76
Q

Diarrhea definition

A

decrease in fecal consistency lasting >4 weeks

77
Q

Chronic causes of Diarrhea (6)

A 
fecal impaction, 
IBS
IBD
Malabsorption syndromes
Chronic infections
Colon Ca
78
Q

C. Dif colitis avoid what and why

A

Antidiarrheals

d/t risk of precipitating ileus and megacolon

79
Q

Complication of antimotility products

A

Contain atropine - Cholinergic effect

80
Q

Treating diarrhea in elderly

A

bismuth - if mild bacterial overgrowth
Severe over growth - abx 14-21 days
antidiarrheal with caution

81
Q

fecal incontinence definition

A

> 1 uncontrolled passage of stool in past month

82
Q

Causes of falls (5)

A 
sensory input impairment
judgement impairment
BP regulation impairment
reaction time slows, 
Balance and gait changes
83
Q

Risk factors for Falls in elderly

A 
History!
age>80
cognitive impairment
stroke
balance issue or gait changes
Parkinson's
polypharm
LE weakness
84
Q

common injuries with falls

A 
Soft tissue
fracture
head injury
laceration
dehydration, electrolyte imbalances, pressure sores, rhabdomyolysis and hypothermia
85
Q

Common fracture with falls

A

Wrist
Hip
Vertebrae

86
Q

Multifactorial falls assessment (9)

A 
1 - History
2 - medications
3 - gait, balance, and mobility
4 - visual acuity
5 - muscle strength
6 - HR and rhythm
7 - postural htn
8 - feet/footwear
9 - environment
87
Q

Fall prevention

A

treat underlying contributing factors
strengthen, increase balance,
Vitamin D 800 IU/Day
Calcium 1200mg/day

88
Q

Functional reach test - increased risk of falling

A

<6 inches

89
Q

Osteoporosis Vs. Osteomalacia

A
  • porosis = decrease in matrix and mineral of bone

- malacia = matrix intact, mineral decreased

90
Q

Cause of osteoporosis

A 
Increase Osteoclast activity
Hormone deficiency, 
steroid excess (exogenous or endogenous)
91
Q

Signs of osteoporosis besides fractures

A

backache,
vertebral collapse
loss of height

92
Q

vitamin D deficiency

A

mid 20-30ng/mL

Frank <20ng/mL

93
Q

Osteoporosis test

A

DXA - dual energy x-ray absorbiometry of lumbar spine, hip and distal radius

94
Q

DXA T score ranges

A

> -1 is normal

-1 - -2.5 osteopenia

95
Q

Bisphosphonate insufficiency fracture presentation

A

> 3-5 years bisphosphonate therapy, hx of weeks - month thigh or groin pain
often bilateral

96
Q

Bisphosphonate insufficiency treatment

A

Prophylactic IM rodding

97
Q

Osteoporosis treatment

A

Bisphosphonates, Calcitonin, estrogen, SERM,
wt training,
smoking cessation
Bone mineral density test q 2years F>65, M>70
Treat fractures

My Clin Med 4 (4 decks)

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