Geriatrics

Question 1

Lab findings commonly found in elder mistreatment

Answer 1

Hypernatremia
elevated BUN/Cr
elevated uric acid
low serum albumin
low cholesterol
low total lymphocyte count (sign of malnutrition)
elevated creatinine kinase

think: dehydration, poor nutrition

Question 2

How to evaluate a geriatric patient for functional decline

Answer 2

Multistep holistic approach
-Identify and characterize the disability
-Identify previous health conditions that may contribute to the disability
-Identify functional impairments (e.g. cognitive, pain, nutritional status, medication side effects

Contextualize these factors to the patient’s socioeconomic status
Use a multidisciplinary team to address ways of increasing the patient’s capacity and reducing task demand

Question 3

When to start screening for osteoporosis

Answer 3

Women >65
At-risk women >50

Question 4

Risk factors for osteoporosis

Answer 4

low body weight
previous fracture
Family Hx of osteoporosis with fracture
Hx of falls, physical inactivity
low vitamin D or calcium intake
use of certain meds (e.g. corticosteroids)

Question 5

bone measurement tests most used to screen for osteoporosis

Answer 5

DEXA of hip and lumbar spine
Quantitative ultrasound of the calcaneus – less expensive, more portable

Question 6

Are gait changes in older adults an inevitable consequence of aging?

Answer 6

no, Monica.

Question 7

mild to moderate Alzheimer’s disease: treatment

Answer 7

Cholinesterase inhibitors
- donepezil (Aricept)
- rivastigmine (Exelon
- galantamine (Reminyl)
- tacrine (Cognex)

Question 8

moderate to severe Alzheimer’s disease: treatment

Answer 8

NMDA-receptor antagonist
- memantine

Question 9

Routine evaluation of a patient with dementia

Answer 9

CBC
BMP: electrolytes, BUN/Cr, glucose
Thyroid function testing
Serum B12
LFTs
syphilis serology

Question 10

Functional Reach test

Answer 10

A patient is expected to reach further than 6 inches with fist extending while bending forward but standing at one place

Question 11

Normal changes to pulmonary functions in older adults

Answer 11

residual volume increases
functional residual capacity increases d/t increased residual volume
vital capacity decreases

Question 12

Most common type of urinary incontinence in older adults

Answer 12

urge incontinence

Question 13

urge incontinence: evaluation

Answer 13

History & physical
UA
Voiding diary
cotton-swab test
cough stress test
measurement of PVR
cystoscopy
urodynamic studies

Question 14

urge incontinence: treatment

Answer 14

changes in diet
behavioral modification
pelvic floor exercises
surgical intervention
medications: anticholinergics, antispasmodics, TCAs

Question 15

USPSTF Final Recommendation Statement: risk factors for falls

Answer 15

Hx of falls
Hx of mobility problems
Poor performance on the timed “Get Up and Go” test

Question 16

USPSTF Final Recommendation Statement: interventions to prevent falls

Answer 16

Exercise, PT
150 minutes/week of moderate intensity activity or 75 minutes/week of vigorous intensity aerobic activity
Muscle-strengthening activity 2x/week

Question 17

Common vitamin deficiency in older adults who do not consume a nutritious diet

Answer 17

Vitamin C
Can lead to scurvy

Question 18

treatment for asymptomatic UTI in elderly patients

Answer 18

no treatment for asymptomatic UTI

Question 19

mixed incontinence: management

Answer 19

Behavioral therapies including pelvic floor exercise, pelvic floor stimulation, and biofeedback are more effective than placebo or bladder muscle relaxants

Question 20

The USPSTF recommends vitamin D for what population?

Answer 20

exercise or PT and vitamin D for community-dwelling adults >65 who are at increased risk for falls