Geriatric Flashcards
New onset or sudden increase in number of floaters or specks on the visual field, flashes of light and the sensation that a curtain is covering part os the visual field
Retinal detachment
What are risk factors for retinal detachment
- extreme nearsightedness
- history of cataract surgery
- family or person history of retinal detachment
A unilateral temporal headache with tenderness or induration over temporal artery. Can be accompanied by sudden visual loss in one eye (amaurosis fugax), scalp tenderness, jaw claudication. Can be associated with polymyalgia rheumatica.
Temporal arteritis
What is the gold standard for diagnosis of temporal arteritis
temporal artery biopsy
What are screening tests for temporal arteritis
- CRP
- ESR
Acute onset of severe eye pain, severe headache, nausea and vomiting, with reddened eyes and profuse tearing. Complains of blurred vision and halos around the lights
-acute angle closure glaucoma
Sudden onset of neurologic dysfunction that worsens within hours.
-deficits include: burred vision, hemianopia (loss of vision in half of the visual field), severe headache, slurred speech, 1 side upper and/or lower extremity numbness or weakness and confusion
CVA
What are the 2 types of CVA, which is more common
- ischemic and hemorrhagic
- ischemic is more common
Small rough, scaly, pink-to-reddish lesions that enlarge slowly over years located in sun-exposed areas such as cheeks, nose, back of neck, arms and chest
Actinic keratosis
Acute onset of limping, guarding and/or inability or difficulty with bearing weight on the affected side. New onset of hip or groin pain; may be referred to thigh or knee. Unequal leg length and external rotation of affected leg.
-have a history of osteoporosis/osteopenia
Hip fracture
What is the presentation of colorectal cancer
- unexplained IDA
- blood on rectum
- hematochezia
- melena
- abdominal pain
- change in bowel habits
Rectal pain can present with
- tenesmus
- rectal pain
- diminished-caliber stools
Caution that in older adults/eldery with bactermia or sepsis may be
afebrile
Atypical presentations for infection in the eldery includes
- sudden decline in mental status
- new onset of incontinence
- falling
- worsening inability to perform activities of daily living
- loss of appetite
The most common infection in adults >65 is
-UTI
What are the top 3 leading causes of death in adults >65
- Heart disease (MI, HF, arrhythmias)
- Cancer (lung and colorectal)
- Chronic lower respiratory diseases (COPD)
Cancer with the highest mortality rate in both genders is
Lung and bronchial cancer
What are common risk factors for lung cancer
- smoking
- radon exposures
- occupational exposures to carcinogens
- outdoor pollutants
The USPSTF recommends lung cancer screening as
and it should be discontinued when
55 to 80 who have at least a 30-pack year smoking history who currently smoke or who quit within the last 15 years by annual low-dose computed tomography
discontinued when patient stops smoking for 15 years or longer or develops a health issue that limits life expectancy
What is the presentation of lung cancer
- new onset productive cough with large amounts of thin mucoid phlegm and occasional blood tinged phlegm
- worsening SOB
- dyspnea
- dull achy chest pain
- weight loss
In a patient with suspected lung cancer what is the treatment plan
- Order CXR
- Then CT scan if needed
- Gold standard: Lung biopsy
- CBC, Chem panel, LFTs, bilirubin, creatinine
What is the recommended screening for colorectal cancer
-start at age 50 with baseline colonoscopy repeast q7-10 years or sigmoidoscopy q5 years or high-sensitivity fecal occult blood test annually
What is multiple myeloma
-cancer of the bone marrow that affects the plasma cells of the immune system
How is multiple myeloma characterized (hint: CRAB)
elevated Calcium levels
Renal insufficiency
Anemia
Bone disease
What is the classic case of multiple myeloma
- bone pain with generalized weakness
- bone pain usually on the central skeleton
- worsens with movement, rarely occurs at night
What is the presentation of pancreatic cancer
- weakness
- weight loss
- anorexia
- abdominal pain
- jaundice
Vaccines may/may not be as effective in the elderly because of ____ antibody response
Vaccines may not be as effective in the elderly because of decreased antibody response
In elderly patients with bacterial pneumonia the following may be different for a typical presentation
- fever and chills may be missing
- increased O2 requirement may be most prominent sx
- may have weakness, confusion, loss of appetite, weight loss
What are risk factors for urinary incontinence
- obesity
- increasing parity
- vaginal delivery
- menopause
- age
- smoking
- diabetes
What is the 1st line treatment of urinary incontinence
lifestyle modifications for all types:
- smoking cessation
- dietary: avoid ETOH, coffee, tea, carbonated drinks, excessive fluid intake
For stress incontinence the plan includes
-kegels, decongestants if no contraindications
For urge incontinence the plan includes
-trial of anticholinergics (oxybutynin/ditropan), TCA (imipramine)
What is stress incontinence
-increased intra-abdominal pressure causes involuntary leakage of small to medium volume of urine
What is urge incontinence
-sudden and strong urge to void immediately before involuntary leakage of urine. Also known as overactive bladder
What is overflow incontinence
- frequent dribbling of small amounts of urine for overly full bladder due to blockage of flow (ie. BPH) or underactive detrusor muscle (ie. MS/Spinal cord injury)
- tx the underlying cause
What are secondary causes of constipation
- drugs
- neurologic disease
- IBS
- DM
- Hypothyroid
- low fiber
- dehydration
Drugs that cause constipation are
- iron supplements
- beta-blockers
- CCBs
- antihistamines
- anticholinergics
- antipsychotics
- antacids with calcium
What is the treatment plan for constipation
- toilet hygiene
- diet changes; increased fiber
- bulk forming fibers
- increased physical activity
- increase fluid intake if no complications
- consider laxatives
In a patient presenting with dementia and cognitive impairment rule out secondary causes by ordering
- syphilis
- B12
- TSH
Scores of MMSE
0-10 severe
10-20 moderate
20-25 mild
25-30 questionable significance
What does the MMSE cover
- orientation
- short term memory
- attention and calculation
- recall
- language
- complex command
When a person is asked to interpret a proverb this is testing
abstract thinking
Wernicke-Korsakoff syndrome is caused by
Vitamin B1 or thiamine deficiency
First line treatment for an essential tremor is
Propranolol
An essential tremor is an
action or postural tremor not a resting tremor
What is delirium
a reversible temporary process that is brief acute and dramatic, secondary to a medical condition, drug, intoxication or adverse reaction to medicine
what is sundowning phenomenon
- condition occurs in delirium and dementia
- starting at dusk/sundown the patient becomes very agitated, confused, combative, symptoms resolve in the morning
What is the management of sundowning phenomenon
- avoid quiet and dark rooms
- have well lit room with radio, tv and clock
- have familiar surroundings
- avoid drugs affecting cognition
- maintain routines
- observe and minimize triggers
- use distractions
What is dementia
- an irreversible brain disorder that involves loss of learned cognitive and physical/motor skills
- specifically executive function
3 A’s of Alzheimers
- Aphasia (difficulty expressing and understanding language)
- Apraxia (difficulty with gross motor movements)
- Agnosia (unable to recognize familiar people or obkects)
Medications for alzheimers
mild to mod (MMSE 10-26) trial of cholinesterase inhibitor such as donepezil, rivastigmine, galantamine or N-ethyl-d-aspartate (NMDA)
Mod to advance MMSE <17 add memantine to cholinesterase
What is parkinson’s
progressive neurodegenerative disease with marked decreased in dopamine production
What is the classic 3 sx of parkinsons
Tremor (worse at rest), muscular rigidity, bradykinesia
What is the first line treatment for parkinsons
Carvidopa-levodopa
What is abulia
loss of motivation or desire to do tasks
What is akathisia
intense need to move because of severe feelings of restlessness
What is akinesia
reduced voluntary movements
What is Anomia
problems recalling words or names
What is Asterognosis
inability to recognize familiar objects placed in the plam
What is Dyskinesia
abnormal involuntary jerky movements
What is Dystonia
Abnormal movements and muscle tone
What medications are potentially inappropriate for older adults
- alpha blockers
- antihistamines
- TCAs
- Atypical antipsychotics
- Antispasmodics
- Benzos
- lubrican laxatives
- NSAIDs
- PPIs
- Sedative-hypnotics
- Sulfonylureas
