Geriatric Micro

Question 1

Immune senescence

Answer 1

Immune response declines with age

Mostly depressed T cell and depressed T cell/macrophage interaction

Question 2

What are the most marked defects of immunity in the elderly

Answer 2

• Poor antibody production
• Drying and Thinning of the skin and mucous membranes
• Poor production of IL-2 and T cell

Question 3

Global undernutrition is present in 30-60% of pts over 65

Answer 3

ok…lymphocytes are directly proportional to nutrition level

Question 4

Fever may be absent in almost half of all old ppl with infection

Answer 4

ok

Question 5

Fever in elderly =

Answer 5

2 over baseline
oral over 99
rectal over 99.5

Question 6

Elderly pts with bacteremia are less likely to have have chills or sweating, and fever is commonly absent

Answer 6

ok

Question 7

What is a more common source of bacteremia in older ppl than in young andults

Answer 7

GI and GU

Question 8

Pts over 65 account for over half of pneumonia cases

Answer 8

ok

Question 9

Huge shift in bacteria population in hospital to gram negative rods

Answer 9

ok…. these end up being major causes of pneumonia for old ppl

Question 10

Annual flu vaccine recommended for all adults over

Answer 10

50

Question 11

Lower tract UTI in women treated how

Answer 11

3 days with flouroquinolones

amoxicillin for enterococcus

Question 12

Upper tract UTI in women treated how

Answer 12

7-21 days of therapy

Question 13

Older men with UTIs are treated longer than women, why?

Answer 13

Usually treated for up to 14 days because of risk of prostatitis. If prostatitis is suspected the therapy is generally given for over 6 weeks

Question 14

Prevalence of positive TB skin test in nursing homes is 30-50% because of high rates of early exposure.

Answer 14

Thus most active cases of TB in older adults is due to reactivation

Question 15

Induration over 15mm 48-72 hours after placement of a PPD indicates a positive TB test always

Answer 15

ok

Question 16

Induration over 10 is positive in nursing home residents, immigrants from high TB countries, underserved populations, and persons with risk factors

Answer 16

And Induration over 5 is positive in HIV pts, those with close contact to TB, and those with chest x rays consistent with TB

Question 17

most likely septic arthritis pathogen

Answer 17

s. aureus

Question 18

treatment of septic arthritis

Answer 18

do arthrocentesis to figure out what org is….give antibiotics.

Treat as soon as possible

Question 19

Ostemyelitis organism

Answer 19

staph aureus

Question 20

Are surface swab cultures of pressure ulcers useful in diagnosing osteomyelitis

Answer 20

NO WAY….just tells you what is in the wound, not what is in the bone. Bone biopsies are required

Question 21

What is the problem with AIDS HAART therapy in older adults

Answer 21

Causes cv issues because of what it does to cholesterol levels

Question 22

HIV is the most treatable infectious cause of dementia so treat the shit

Answer 22

ok

Question 23

Meningitis treatment

Answer 23

ADD amoxicillin to protect aginst listeria

Question 24

Treatment of choice for neurosyphillis

Answer 24

penicillin….if they are alergic try to de-sensitize them

Question 25

If old person has the flu what do you do

Answer 25

M2 inhibitors or neuraminidase if initiated within 24 hours of symptoms

Question 26

Flu prophylaxis

Answer 26

oseltamavir