Geriatric Medicine

Question 1

IADLs

Answer 1

instrumental activities of daily living
-shopping, meal prep, finance, housekeeping, laundry, drive, med management, communication

Question 2

ADLs

Answer 2

activities of daily living (without assist)
-eat, toilet, dress, mobility, transfer, hygeine, bathe

Question 3

4 Ms

Answer 3

mobility
medicines
mentation
matters most

Question 4

change of condition

Answer 4

-teach RN staff to recognize then notify using SBAR

Question 5

SBAR

Answer 5

situation
background
assessment
recommendation

Question 6

unique aspects of HPI

Answer 6

-medications
-mobility (devices?)
-mentation (what kind of impairment)
what matters most = goals of care, quality of life, wellbeing

Question 7

causes of lower respiratory infection in geriatrics

Answer 7

PNA, Covid, RSC, flu, aspiration

Question 8

how many people >80 yo have a murmur?

Answer 8

1/3
-stenosis, sclerosis, mitral regurg, atrial septal defects, tricuspid regurg

Question 9

common abdominal pathologies

Answer 9

-AAA
-SBO
-PUD
-bowel incontinence
-perforation, ischemia, inflammatory

Question 10

common GU pathologies

Answer 10

prostate hypertrophy
catheter use
vaginal or labial atrophy or prolapse
incontinence
frequent & recurrent UTIs

Question 11

neurologic pathologies

Answer 11

-cataracts or macular degeneration
-hearing aids (presbycusis)
-dementias
-CVAs
-Parkinson’s
-fall with head injury

Question 12

unique, prevalent, multifactorial geriatric syndromes

Answer 12

falls
sepsis
UTI
delerium-sundowning
-polypharmacy
-frail
failure to thrive
dementia
pressue skin injury
neglect, abuse, isolation

Question 13

Falls

Answer 13

usually b/n bed & bathroom
-gait & balance
-neuro exam
-CV exam
tests: CBC, CMP, EKG, HbA1c, holter monitor, vit D, Cr
*PT & OT eval, home eval

Question 14

UTIs

Answer 14

cystitis, pyelo, urosepsis
-UA w/ mirco & C&S, start abx, fluids
*McGeer criteria to prevent overtx
-avoid indwelling cathsexcept obstructive uropathy or neurogenic bladder

Question 15

constipation

Answer 15

meds - opioids, anticholinergics, antidopaminergic, Ca2+ blockers
*manual disimpaction often required

Question 16

skin breakdown

Answer 16

1. intact skin with non blanchable redness
2. partial thickness loss, open ulcer with pink wound bed
3. full thickness loss, subQ tissue present, tunneling & slough
4. full thickness with exposed underlying structures, bone, muscle, tendon
5. unstageable - sloughing or eschar & underlying structures can’t be visualized

Question 17

dementia

Answer 17

-dementia vs delusions (sundowners)
-depression
-sensory impairment = increased safety risks
ex. - Alzheimers, LewyBody, Parkinson’s related, mixed, multi-infarct, TBI, alcoholic encephalopathic, pseudo-dementia
*rule out other etiology first

Question 18

Polypharmacy

Answer 18

-greater than 5 meds, 10-20 common
-geriatricians usually discontinue meds bc on too many – consider risk to benefit ratio
start low and go slow

Question 19

advanced directives

Answer 19

-what matters most = durable medical POA
-patient capacity = letters for family to understand it
DNR = do not resuscitate
DNI = do not intubate
MOST = medical orders for scope of tx (CO)
POLST = physician orders for life sustaining treatments