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Geriatrics > Geriatrics #2 > Flashcards

Geriatrics #2 Flashcards

1
Q

Criteria to Define Physical Frailty (pathway of intrinsic physiological alterations)

A

Lost >10 lb unintentionally in the last year or 5 kg.
Exhaustion
Slowness (time to walk 15 feet)
Low activity level <270kcal/week
Weakness (grip strength unsung hand dynamometer)
syndrome present when >= 3 or more
1 or 2 is considered pre-frail. 4-5 = severe frailty

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2
Q

Sarcopenia

A

Loss of lean body mass and central manifestation of physical frailty

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3
Q

Early manifestation of frailty

A

Gait speed with grip strength.

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4
Q

Key management approach for frailty and its prevention

A

Resistance or strength training
Can combine with protein supplement in patients with weight loss or under nutrition

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5
Q

Afferent pupillary defect

A

Represents significant vision loss
Swinging flashlight test (both pupils should constrict together, if dilates then +)

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6
Q

Retinal detachment s/s

A

New floater in one eye, flashing light (photopsias), distorted peripheral vision, decreased vision. “Curtain over vision”.
** not associated with ocular pain or hyperemia

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7
Q

Acute narrow-angle closure glaucoma

A

Adults >50 years old screen every 1-2 years for glaucoma
Dilated fixed pupil and cloudy cornea
Painful, red eye, decreased vision, nausea and vomiting with headache
*sympathomimetic and anticholinergic drugs can bring this on

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8
Q

Open-angle glaucoma

A

Loss of peripheral vision and then all vision loss.
Asymptomatic

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9
Q

When to refer to opthomology

A

Decreased vision (20/40 sellens chart), severe pain, photophobia, recent intraocular surgery or glaucoma surgery

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10
Q

Cataracts

A

Decrease vision, refractive shifts, reduced contrast sensitivity, glare or diploid.

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11
Q

Educative (wet) macular degeneration

A

Subretinal gray-green membrane
Sudden loss of vision with central vision loss, peripheral vision is maintained

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12
Q

Nonexudative muscular degeneration

A

Deposits of submacular yellow druses
Slow vision loss not severe usually asymptomatic
goal is to decrease risk of converting to wet form - vitamin supplements C,E, zinc, lutein

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13
Q

Diabetic retinopathy

A

Decreased/blurred vision, sudden loss of vision, floaters
Annually exams
Strict glucose control. ACE inhibitors help decrease disease progression

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14
Q

Anterior ischemic optic neuropathy

A

Acute vision loss or field loss - usually in upper or lower hemifield
Thought to be in atherscoleric disease (diabetes, hypertension) or in giant cell arthritis
*prompt systemic corticosteroid treatment is crucial to avoid vision loss.
Associated with phosphodiesterase inhibitors

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15
Q

Conductive hearing loss

A

Abnormalities of external and middle ear preventing sound reaching the cochlea
(Cerulean impaction, foreign body, bony overgrowth).
(Middle ear effusion, tympanic membrane perforation, otosclerosis)

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16
Q

Sensorineural hearing loss

A

Abnormalities of the cochlea, cochlear nerve or cochlear nuclei.
(Excessive noise exposure, ototoxic medications, vascular disease)

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17
Q

Presbycusis

A

“Old age hearing”
Bilateral sensorineural hearing loss - worse with high frequencies
- early detection the better due to brain losing ability to adapt - get hearing aides fast

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18
Q

Sensory presbycusis versus strial presbycusis vs neural presbycusis

A
  1. Steeply sloping audiogram losing higher frequencies - have trouble hearing with background noise
  2. Mild to moderate hearing loss across spectrum of frequencies - good speech discrimination
  3. Very poor speech discrimination - recommended cochlear implantation over hearing aides
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19
Q

Ways to screen for hearing loss in the primary care setting

A

Finger rub test, whisper test, simply asking about hearing loss

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20
Q

If concern for hearing loss what should be first and second step
What is the Weber and Rinne test

A

Observe for obstruction with cerulean, foreign body’s, TM perforations or fluid in middle ear.
SNHL from CHL testing - tuning fork
Weber test - vibrate on knee or elbow and place on forehead bridge of nose - should hear the sound everyone or in both ears. If symmetrical SNHL normal response or not at all. Unilateral SHNL will hear sound in better ear.
Patients with CHL or MHL will localize to the hearing impaired ear
Rinne test - use tuning fork then place on mastoid bone (sound #1) then external auditory meatus (sound 2).
Normal hearing - sound 2 is louder. SNHL - normal sound. CHL and MHL - sound #1 is louder than sound 2.

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21
Q

Who should manage SNHL and CHL.

A

Referral to audiologist.
SNHL symmetrical can be treated by PCP, everything else HAS to be referred.

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22
Q

Central presbycusis or age related central auditory processing disorder

A

Changes to auditory perception and speech communication.
(Inability to understand speech in noisy environment or in presence of competing speech)

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23
Q

Which medications cause reversible or irreversible hearing loss

A

Lasix, oral salicylates, quinines - reversible
Vancomycin and aminoiglycosides -irreversible

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24
Q

Contraindication for irrigating ear

A

Ear surgery - tubes, tympanic membrane perforation, chronic otitis

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25
Q

Vertigo

A

Episodic spinning or rotational senstation
BPPV - associated with changes in head position.
or meniers disease - episodic verigo, tinnitus, fluctuation hear loss or sensation of fullness.

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26
Q

Presyncope

A

Sensation one is going to pass out. Cerebral ischemia 2/2 to orthostatic hypotension.
Drop in systolic artieral blood pressure of at least 20 mmHG or 10 mmHG in diastolic
Cardiac, dehydration, vasovagal Parkinsonism

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27
Q

Disequilibrium

A

Imbalance or unsteadiness with walking

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28
Q

Mixed dizziness

A

Most common type of dizziness with >2 types of dizziness.

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29
Q

How to evaluate for dizziness

A

Checking orthostatic vital signs - if +, review medications
Evaluate for nystagmus - if present peripehral or central lesion of vestibula

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30
Q

Medications use in dizziness
Therapy for dizziness

A

Antihistamines (meclizine) - not for chronic or disequilibrium, has anticholinergic properties
Can make dizziness worse if used long term.
Vestibular rehabilitation

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31
Q

Risk with ophthalmic corticosteroids

A

Ocular hypertension that can lead to glaucoma 2-3 weeks.

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32
Q

Syncope - (sudden loss of consciousness) medication induced

A

A-blockers, B-blockers, CCB, ACE inhibitors, tricyclic antidepressants

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33
Q

What is a positive postural hypotension

A

A decrease in systolic BP >20 mmHg.

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34
Q

Techniques to use to increase BP to avoid LOC

A

Leg crossing, arm tensing, hand grip, buttock clenching

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35
Q

Recommended protein intake

A

0.8 g/kg/day but 1-1.2 show to protect lean mass, grip strength and reduce risk of functional decline

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36
Q

Recommend intake of vitamin D in >70 years old

A

1,000 units

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37
Q

What diet is recommended in older adults

A

Mediterranean diet

38
Q

Albumin and Prealbumin

A

Albumin is indication of longer term nutrition
Prealbumin shorter nutrition
Both not accurate in acute settings of inflammation
Risk for morbidity and mortality is albumin

39
Q

Tool to assess nutrition

A

Mini-nutritional assessment

40
Q

What is clinically significant weight loss

A

10 lbs or >5 % of body weight over 6-12 months

41
Q

Drugs for appetite stimulant

A

Little proof to support and often cause many side effects
Do not improve long-term survival

42
Q

Types of urinary incontinence

A

Urgency - leakage with urgency
Stress - leakage with effort or exertion - cough running
Mixed - combined stress and urgency
overflow - increased PVR from bladder outlet obstruction

43
Q

Treatment for urinary incontinence

A

Bladder training - pelvic floor muscle exercises
Antimuscarinic agents (anticholinergics) - oxybutin - biggest long term risk is cognitive impairment. Dry mouth with Consitpation

44
Q

Highest cure rate for Urinary incontinence

A

Surgery
Botox injection can be given but cannot give with urinary retention history

45
Q

Stage 1; 2;3;4;unstageable and deep tissue

A

Nonblaanchle erythema
Partial skin loss with explored dermis - blisters
Full thickness - fat agranulation tissue may have slough.
Full thickness - fascia, muscle, tendon, ligament ion exposure
Cannot see what the extent is - unstageable
Persistent non blancable deep red/maroon or purple

46
Q

When should you not use negative pressure therapy

A

Over necrotic or infection wounds ; if no improvement in 2 weeks, discontinue

47
Q

When should you swab a wound

A

If redness erythema fever, increased drainage - purulent drainage with high suspicion for infection

48
Q

Types of dressings:
Hydrocolliod
Semipermeable
Hydrogel
Foam
Alginate
Collegian
Silver containing
Honey

A

1 &2 - Clean wounds with no necrosis (retains moisture)
Dry wounds with some necrosis
Control of extudate to protect the wound
Control of exudate
Partial or full thickness with minimal necrosis
Contract bacteria balance
Debriding agent on non-infected wounds

49
Q

Fall within the past year is the most predictive risk for future falls

A
50
Q

Most modifiable risk factors for falls

A

Medication use/poly pharmacy

51
Q

Recommendation for patients with a fall or worried about falling

Older adult with >2 falls or a fall with injury

A

Gait, strength and balance testing.
Multifactorial fall risk assessment.

52
Q

Most common used test for strength and balance

A

Timed get up and go test

53
Q

Osteoporosis definition

A

Bone mineral density of T <= -2.5 or minimal trauma fx in patients with osteopenia (t score of <-1.0-2.5)
*lumbar spine, femoral neck, hip or 1/3 radius

Severe osteoporosis is a T score of <2.5 in the presented of >= 1 fragility fracture
Calculate FRAX score in patients with osteoporosis

54
Q

Risk fractures for osteoporosis

A

Age
Female
Low body weight
Physical inactivity
Glucosteriods
Asain ro white
Smoker , alcohol use
Low dietary calcium and vitamin d

55
Q

What hormone does calcium and vitamin D deficiency increase

A

Parathyroid hormone which increases rate of bone reabsorption

56
Q

When to screen for osteoporosis risk fractures

A

All post menopausal women and men >=50 years old

57
Q

When should you screen for osteoporosis with BMD testing

A

All women >=65 years old
Or women and men <65 years old with risk fractures or history of fracture.
Screen all men >70 years old.

  • uses central bone mineral density testing
58
Q

FRAX screen

A

Estimates 10 year probability of fracture at the hip or major osteoporotic fracture.

59
Q

Prevention of osteoporosis

A

Excerise 5 times per week for 30 minutes - weight bearing exercises
Calcium intake of 1200 (up to 2500 in heart patients is safe) , VItamin d of 600. 800 over >70.
Keep vitamin D level >30.

60
Q

Treatment of osteoporosis

A

All post-menopausal women, or men >50 who have osteoporosis per DEXA or fragility fracture
Osteopenia with fragility fax of >3% OR MAJOR osteoporic fracture >20%
>1 year life expectancy
Start within 14 days of treatment
Biphosphonates - decrease bone reabsorption and bone remodeling.
Alendronate, risedronates
Has poor absorption so must wait 30 minutes before drinking/eating.

61
Q

Side effects of biphosphonates

A

GI upset
Osteonecrosis of jaw
Aysptical fractures - get xray if develop groin/hip pain

62
Q

When do you discontinue biphosphantes

A

Drug holiday in 5 years at low risk fo fax, >-2,5 or no change on DEXA
Discontinue in elderly if no longer ambulatory or have a <2 year life expectancy

Denosemab —> no drug holiday as bone remodeling reverses after 6 months.

63
Q

Greastest risk factors for Alzheimer’s disease

A

Age and family history

64
Q

What causes dementia

A

Set of proteins within the brain affect neuronal function causing cell death.

65
Q

What things can slow cognitive decline

A

Physical activity and cognitive training

66
Q

Subjective complaints from patient or family member should be followed with cognitive assessment

A
67
Q

What are the screening test for dementia

A

Mini-cog assessment, SLUMS (st Louis university mental statue), and Montreal cognitive assessment.

68
Q

When should you order brain imaging on patients concerning for dementia

A

Not routinely used.
<65 years old, sudden onset or rapid progression, focal deficits, history of fall or recent trauma.

69
Q

Typical features of Alzheimer’s disease

A

Slow gradual onset with memory loss.
Stage 3- recognized by family
Stage 4 - medical interviewer can identify.
Stage 6- need help dressing /tolieting etc.

70
Q

Vascular dementia

A

Sudden or gradual, areas of ischemia/hemorrhagic, symptoms will depend on location of vascular changes.

71
Q

Levy body

A

Gradual onset, typically with visual hallucinations and REM sleep disorders.
Parkinson like symptoms develop later.

72
Q

Parkinson’s Disease

A

Gradual develops late stage Parkinson’s

73
Q

Frontotemporal demtnia

A

<60 years old. Have emotional changes, disinhibition, language issues before memory issues.

74
Q

Primary goal of treatment with dementia

A

Enchance quality of life, symptom improvement not curavtive.

75
Q

Medications for dementia

A

Cholinesterase inhibitors
- donepezil, rivastigmine, galantamine.
- slow the breakdown of achetycholine
- used for mild to severe dementia.
- side effects mostly GI symptoms - headaches, dizziness, orthostasis.
- no role in frontotemporal dementia
- stop if no improvement/rapid decline

76
Q

Namenda

A

Used in moderate to severe AD
CAn be used with Cholinsternase inhibitors.

77
Q

Behavioral symptoms with dementia how to treat

A

Nonpharmalogical FIRSTLINE!! - reduce stimulation, redirection.
Can use antipsychotics - but all carry black box warning with increased risk of mortality (seroquel better tolerated).

78
Q

Delirium

A

**underlying process.
Acute onset - tends to fluctuate - can last weeks to months - if >6 months likely dementia or mild neuro cognitive disorder

79
Q

Screening for delirium

A

CAM test

80
Q

Medications that can cause delirium

A

Anticholinergics (oxybutin, benztropine)
H2 blockers (Pepcid)
Bendodiapzines
Opioids
Antipsychotic medication
Antihistamines (benadryl)

81
Q

Treating delirium

A

Try to treat underlying cause
Nonpharmalogical ways first - orientation to clocks, make sure hearing aides/glasses etc on.
Use antiphycotics ONLY if unable to manage behaviors and causing harm to Staff and self.
Do not use benzodiazepines in delirium associated with hepatic encephalopathy

82
Q

Depression

A

Loss of pleasures and interest in previously enjoyable activities (anhedonia) for at least 2 weeks
Depressed mood most of the day nearly every day

  • effects females more than males.
    5-16% of the older adults live with depression
83
Q

Screening test for depression

A

PHQ9 or PHQ-2 —> >10 good sensitivity depression - start treatment. >15 warrants to and physicality consult or admission
Geriatric depression scale —> can be used in dementia. 5-8 mild, 9-11 mod. & 12-15 severe.

84
Q

Must rule out other causes of depression like

A

Hypothyroidism, anemia, vitamin deficiency and metabolic disorders

85
Q

Prolonged grief disorder/complex bereavement disorder

A

Symptoms presisted most days for the last 12 moths
- preoccupation with deceased or circumstances of the death, intesense sore or emotional pain, perisisnent hearing or longing

86
Q

Treatment of depression

A

Takes 4 weeks to see if peopel will respond by 12 weeks.
Zoloft and lexapro usually well tolerated
Paxil - highly anticholinergic

*ECT is effective and preferred treatment of choice in severe depression with suicidal thoughts or not responding to treatment

87
Q

What lab do you need to check prior to initiang SSRIS

A

NA level - risk of SIADH

88
Q

Serotonin Syndrome

A

Worsening behaviors, diaphoretic, GI upset, fever, hyper reflex is, shivering, rhabdo, seizures

89
Q

BIpolar 1 disorder

A

Persistently abnormal elevated mood - latesting at least a week
- grandiosity, flight of ideas, activity, sleep decreased, talkativeness

90
Q

Treatment for bipolar

A

Mood stabilizers /anticonvulsants
1. Lithium, depakote, tegretol -
2. Antipyschotics

91
Q

Bipolar II

A

Hypomanic episode and past depressive episodes
Hyponmaic episodes last only 4 days - no 1 week like bipolar II mania

Antidepressants, steroids can cause this in older adults

Geriatrics (2 decks)

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