Geriatric Cases

Question 1

What are the three most common causes of weight loss in the elderly?

Answer 1

• Depression (~30%)
• GI issues (20%)
• Malignancy (15%)

Question 2

What is the mechanism of the antidepressant that causes the most weight gain?

Answer 2

5HT-2 and 5HT-3 antagonist –mirtazapine

Because of its weight-gaining side effects, mirtazapine is often given to older adults.

(Think of the guy in the Sketchy scene pigging out on food.)

Question 3

Alendronates should not be given to those with ____________.

Answer 3

renal failure

Question 4

What is needed for a diagnosis of dementia?

Answer 4

• Memory impairment
• Additional cognitive impairment (cannot do IADLs, personality changes, mood lability

Note: many people with memory impairment go on to develop dementia, but not all.

Question 5

What are the two most common causes of reversible cognitive impairment in the elderly?

Answer 5

• Drugs

* Depression

Question 6

Not trying on the serial calculations and being troubled by memory impairments are more characteristic of _____________.

Answer 6

depression; in Alzheimer’s, meanwhile, people are often oblivious to their impairments and will not be disturbed by their incapacity

Question 7

Women over ________ no longer need Pap smears.

Answer 7

65

Question 8

The ACS recommends that women over 55 get mammograms every _____ years.

Answer 8

2

Question 9

Some research indicates that women older than 65 with normal DEXAs can forego DEXAs for _____ years.

Answer 9

10

Question 10

True or false: the ADA endorses A1cs less than 8% for all patients.

Answer 10

False. In those with multiple morbidities and limited life expectancy, A1cs between 8% and 9% are ok because hypoglycemic episodes should be avoided and long-term consequences are less important.

Question 11

Metformin should be discontinued in those with GFRs less than _______.

Answer 11

30 mL/min

Question 12

What are the most common causes of delirium?

Answer 12

• Medications
• Infections
• Metabolic disturbances (e.g., low glucose)
• Cardiac or CNS events

Question 13

True or false: opiates are a common cause of delirium.

Answer 13

False. Opiates usually do not cause delirium, and under control of pain actually can trigger delirium so management of pain with opiates is recommended.

Question 14

What three interventions have been shown to reduce falls?

Answer 14

1) Reduce/remove psychotropic meds
2) Do an assessment of their living quarters for fall risks (like standing showers, loose rugs, or dangling cables)
3) Physical exercise –particularly tai chi

Question 15

What interventions have been shown to reduce hip fracture risk?

Answer 15

1) Bisphosphonates: they take six months to become effective, but they reduce fracture risk by 50%
2) Physical therapy reduces hip fracture risk by 25%

Note: raloxifene has only been shown to reduce vertebral fracture risk.

Question 16

Describe the four stages of pressure ulcers.

Answer 16

1) Erythematous, non-blanching skin
2) Involvement of epidermis and dermis
3) Involvement of epidermis, dermis, and subcutaneous skin
4) Completely through the three tissue layers and underlying fascia to involve muscle or bone