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IPAP > Geriatrics 2.0 > Flashcards

Geriatrics 2.0 Flashcards

1
Q

Clinical approach to the geriatric assessment/Dx includes ? three domains

What are the three main outcomes of the assessment

A

Functional
Social
Psychological

Prognosis
Goals
Functional status

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2
Q

? determines what interventions and likely to be beneficial or burdenson to TP

The above answer worsens above ? age and with age related conditions such as ?

A

Prognosis

> 90y/o
Dementia
Malnutrition
Functional status

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3
Q

When life expectancy is more than ?yrs, same tests and Txs are offered to geriatrics as younger populations

When does this change?

A

10yrs

<12mon- palliative care
<6mon- hospice

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4
Q

What would be an example of a single Dz process that would have a prognosis better calculated by a Dz-specific instrument

What are 4 examples of advanced directives

A

Lung Ca metatestases to brain

Medical POA
Out of Hospital DNR
Declaration Mental Health Tx
Directive to Dr and Surrogate

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5
Q

_____ can be viewed as a summary of the overall impact of health conditions on a PT

What are the ADLs

What are the IDLs

A

Functional status

Continence Feeding Transfer
Toilet Bathe Dress

Driving Money Telephone Shopping Housekeeping Laundry Food prep Taking meds

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6
Q

When does Functional Status need to be assessed

Falls and Gait are the leading cause of injuries and death in older adults and are screened when/how?

How is a PTs gait assessed

A

Loss of spouse/caregiver
After hospitalization
Severe illness

Annually for incidence/frequency

Time Up and Go- time to get up, walk 3meters and return
Abnormal >15sec

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7
Q

What PTs are at increased risk for falls?

What meds are particularly known for causing them?

A

Single fall w/ injury
One or more fall past year
Gait/balance issues

Psychotropic drugs

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8
Q

What are the three best efficacious prevention for falls?

In PTs w/ cardioinhibitory carotid sinus hypersensitivity who experience recurrent falls, what is the best suggested Tx

After d/c of predisposing medications, if PT still has PHOTN, then ? medication is recommended?

A

Medical reduction
Physical therapy
Home safety mods

Dual chamber pacemaker

Fludrocortisone

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9
Q

Intrinsic RFs for falls

Secondary RFs

How much exercise is recommended

A

Meds Vision PHOTN Atrophy Vit D

Lighting Footwear Tripping hazard Safety measures

150min/wk

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10
Q

Normal vision is ?

Impaired is ?

Legally blind is ?

A

> 20/40

20/40-200

<20/200 or
Total visual field <20*

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11
Q

Cognitive impairment is an impairment in at least two of what domains?

What test can be done in the office to screen for dementia

A 
Function
Language
Visuospacial function
Memory
Personality/Behavior

Mini Cog- three item recall and clock drawing in 2min; both normal, dementia unlikely

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12
Q

What is the next step for PTs that fail a Mini-Cog in office?

What is the in office depression screening tool?

A

Mini Mental Status Exam, 10min
MOCA- specific, 30min

PHQ 2-
Have you been feeling depressed?
Have you been experiencing anhedonia

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13
Q

DIAPPERS Acronym

A 
Deliriium
Infection
Atrophic urethritis
Pharm
Psych
Excessive excretion
Restricted mobility
Stool impaction
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14
Q

When does unintentional weight loss need to be investigated?

What are the six types of elder abuse?

What are the RFs associated w/ abuse

A

5% <1mon
10% <6mon

Sexual Abandon Finance Emotion Physical Neglect

Institution Caregiver Elder Environment

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15
Q

What are clues abuse may be occurring

How do retinal detachments present?

What type of age related process do PTs complain of

A

Behavior changes
Lack of clothing/hygiene
Unfilled Rx
Delayed injury presentation

Painless photophobia, floaters and visual field defect

Presbyopia- loss of lens flexibility/curvature, difficulty reading in low light

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16
Q

Nearly half of older adults have vision worse than 20/40 because ?

What step can PTs do to compensate for normal age related loss of vision

A

Problem w/ glasses

Bright, indirect light

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17
Q

What eye condition is the leading cause of vision impairment in the world

What would be seen on PE?

What is the only Tx

A

Cataracts- blurred yellow vision w/ increased sensitivity to glare (stain on shirt w/ otherwise appropriate dress)

White haze- mod/worse case
Dec red reflex

Surgery when <20/40
Inhibits daily living

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18
Q

What is the leading cause of irreversible vision in PTs >65

What are the two types

A

ARMD- impaired central vision

Non-neovascular/Dry, MC:
Gradual blurring of central vision w/ dec reading fine print/facial recognition
PE: Drusen lesions
Tx: Anti-Oxidants, Zinc

Neovascular/Wet:
Metamorphopsia- distorted images
Rapid loss of central vision
Tx w/ refer and anti-VEGF (Bevacizumab)

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19
Q

What are the RFs for AMD

What are two protective factors?

A

Smoking Age White FamHx

Eating green veggies/fish

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20
Q

How does Diabetic Retinopathy present

What exam is needed annually

What two protective steps can prevent Dz progression

A

Blurred vision w/ scomatoma and field constriction

Dilated, funduscopic exam

Glucose/HTN control

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21
Q

What is the early stage of Diabetic Retinopathy called?

What occurs during this early stage

What happens if this stage continues to develop

A

Non-proliferative/background retinopathy

Pericyte/endothelium damage leds to inc permeability

Retinal hypoxia increases GF leading to proliferative diabetic retinopathy

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22
Q

Define Glaucoma

When does USPTF recommend screenings

How does this condition present w/ vision changes

A

2nd MC cause of blindness:
Progressive optic neuropathy where IOP leads to atrophy of optic nerve

No screening

Loss of peripheral vision

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23
Q

Glaucoma affects ? race the most in the US

How is IOP measured

What is used to determine if angle is open or closed?

A

AfAm around 45y/o
By 80y/o, Hispanic/Latino dominant

Tonometry

Gonioscopy

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24
Q

What is normal IOP ranges

What are 3 types of vision Sxs/Changes that need ASAP referrals

A

10-21mm

Dec central vision
Ocular pain
Loss of peripheral vision

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25
Q

PT w/ cerumen impaction on L side will have ? PE findings

Sensorinueral hearing loss involves ? structures

Conductive hearing loss involves ?

A

Webber to L
Rinne BC>AC

Inner ear Cochlea Nerve

Anything preventing sound reaching inner ear (Perf Impaction Effusion)

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26
Q

Hearing loss is independently associated w/ ?

What is the majority of hearing loss categorized as

A 
Inc cognitive decline
Disturbed gaits
Poor neurocognitive function
Dementia
Falls

Sensorineural HL, Presbycusis

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27
Q

Mild memory impairment includes subjective problems like ?

How does this differ from normal aging memory loss?

A

Name recall
Object placement

Normal aging loss remembers info later w/out functional impairment

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28
Q

Prevalence of demetia starts at ? and increases every ?

What type is a common cause of early onset dementai?

A

Stars at 60, doubles q5yrs

Frontotemporal dementia, <65y/o

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29
Q

Define Mild Cognitive Impairment

How is this type characterized

What is the most severe type of cognitive impairment?

A

Cognitive function is below normal limit for age/education but not severe enough for dementia

Subjective complaint
Objective impairement
Intact functional status

Dementia

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30
Q

What is required for a Dementia Dx

A

Two domain deficits severe enough to impact in daily function

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31
Q

What are the 5 types of dementia in order of frequency

What are the 3 parts of an exam for possible dementia

A 
Alzheimer's Dz
Lewy Body
Vascular
Frontotemporal 
Neurodegenerative

Function: ADL/IADL
Neuro exam

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32
Q

What are the 43steps/tests done for screening for dementia

What genetic testing is done for research on dementia

A

Mini-Cog
MMSE
MOCA

APOE-e4

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33
Q

What are the 5 parts of a PTs Hx that needs to be focused on for dementia work up

What are subtle hints of early dementia or MCI?

A 
Spatial ability
Personality changes
Language
Ability to learn
Trouble w/ complex tasks
Frequent repetition 
Missed appointments
Increased accidents
Financial mistakes 
Dec in hobbies
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34
Q

What is the classic triad of Alzheimer’s Dz

How does this begin to be notices

A

Memory impairment
Language impairment
Visuospatial problem

Difficulty w/ complex tasks
Disorient: Time Place Person
Language: Anomic Fluent Mute
Agitation becomes common

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35
Q

Lewy Body Dementia

What are some findings that support a Dx

A 
2nd MC form of Dementia
Hallucinations 
Fluctuations
Parkinsonism
REM sleep d/o

Sensitivity to antipsychotics Autonomic dysfunction
Repeated falls
Syncope

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36
Q

Although not required, what biomarkers support a Dx of DLB

What PE finding presents after or concurent w/ PTs onset of dementia?

A

Confirmed REM sleep d/o without atonia
Dec dopamine uptake on imaging

Parkinsonism- bradykinesia, resting tremor, rigidity

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37
Q

Do not Tx DLB w/ ? meds

How is Vascular Dementia Dx

A

Antipsychotics- worsening of EPS Sxs
Neuroleptics- death risk

Radiographic evidence w/ step wise presentation after cortical stroke/focal neuro findings

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38
Q

Frontotemporal Dementia is AKA ? and presents as ?

What are the 3 sub-types

A

Picks Dz
Onset <60

Behavior Language Semantic dementia

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39
Q

Define Behavior Variant Dementia

What Sxs are highly specific to Behavior Frontotemporal Dementia that distinguish it from Alzheimers

A

Personality/Behavior changes w/ intact memory

Disinhibition
Hyperorality
Compulsive/Repetitive behavior
Personality/behavior changes
Reduced speech
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40
Q

The hyperorality of Behavior FTD is usually seen as ?

What would be seen on a MMSE exam

What other Dzs can cause cognitive impairment and dementia

A

Preferred junk food/carbs
Excessive eating

Normal scores

Parkinson’s
Huntingtons
HIV
Alcoholism

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41
Q

Parkinson’s induced dementia leaves ? intact?

How is cognitive impairment from dementia Tx

How is drug effectiveness proved?

A

Recognition memory

Cholinesterase inhibitors:
Galantamine Rivastigmine Donepezil

Stable/Improved MMSE/MOCA over 6-12mon

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42
Q

What drug is used for Mod/Sev Alzheimer’s

When is permissive HTN allowed for dementia Tx

A

Memantine, NMDA antagonist
Added to cholinesterase inhibitors when dementia is mod/sev

Vascular dementia: SBP >150 may improve cognitive function

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43
Q

What drug combo may be beneficial to Vascular Dementia

What meds are used for the behavior problems of dementia

A

Cholinesterase Inhibitors and Memantine

Antipsychotics- Olanzapine/Risperidone,
best evidence but BBW and only for refractory/serious harm concern

SSRI- Citalopram
Caution: QTc prolongation

Mood stabilizer- Carbamazepin Valproic Acid

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44
Q

What drugs are used off label for Amnestic MCI

What is the most common cause of PTs d/c this class of med?

Use caution when prescribing this class of medication to Pts w/ ?

A

Cholinesterase inhibitors- GRD

GI- N/V/D

Bradycardia

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45
Q

Cholinesterase inhibitor Donepezil is not recommended to be prescribed in dosages exceeding ?

What is the only reported s/e of Memantine

A

10mg

HA

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46
Q

Before using medications for dementia induced behavior problems, what needs to be tried?

What Tx types need to be avoided in dementia Tx

A

Music Pets Walks
Bright light exposures

Gingko NSAIDs Estrogen Vit E

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47
Q

Define GAD

What is one of the most effective Txs

What meds are used

A

Uncontrollable anxiety and worry interfering w/ daily activities x 6mon

CBT

SSRI
SNRI

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48
Q

When Tx GAD, if an SSRI does not provide benefit, what is the next step?

What anxiolytic med may be used?

A

Trial of different SSRi prior to starting second line med

Buspirone

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49
Q

Criteria for Major Depression

A

2wks of Depressed mood and 3-4 of:
SIGECAPS

Sleep Interest Guilt Energy Concentration Appetite Psychomotor SI

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50
Q

When using PHQ-2 screening for depression, what three DDx need to be considered?

What are the s/e or caution of using SSRIs for Tx of depression

A

Delirium
Cognitive impairment
Chronic medical conditions (weak/fatigue)

Citalopram- QTc prolongation
Fluoxetine- long t1/2 and P-450 suppression

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51
Q

What pharmacotherapy is used for depression

A

SSRI: F PECS
Fluox/Paroxetine
Esc/Citalopram
Sertraline

SNRI: Des/Venlafaxine
Duloxetine

TCA: Amitriptyline Imipramine Doxepin

Mirtazapine- appetite, insomnia
Buproprion- smoke cessation

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52
Q

What are two s/e of meds used for depression Tx that may last longer than the 1-4wks of other s/e

A

Weight gain
Sex dysfunction

SSRI- Nausea Sex dysfunction
HTN Fall Bleeding HypoNa SSyndrome

TCA- dry mouth OHOTN urine retention

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53
Q

How often do PTs started on anti-depressant meds need f/u

What is the only med that requires a wash out period?

Abrupt cessation of shorter-acting antidepressants like ? four may result in a discontinuation syndrome with tinnitus, vertigo, or paresthesias

A

3 x in first 12wks
q3-6mon

Fluoxetine

Citalopram Paroxetine, Sertraline Venlafaxine

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54
Q

When do PTs on anti-depressants need to be referred

Once remission of depression is achieved, how long is Tx maintained

When is this time frame changed?

A

Failure on two meds
Mania/psychosis
SI

x6mon

High risk for relapse:
>2 depressive episodes or,
depression >2yrs duration
Continue Tx x2yrs/indefinite

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55
Q

What are two types of drug reactions

What 3 drug classes are responsible for 2/3 of all medication related hospitalizations?

A

Type A, MC- expected but unwanted (BB and Brady)
Type B- idoisyncratic, anaphylaxis

Anti-coag/platelet
Diabetes

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56
Q

What are 3 types of meds that would have decreased absorption in geriatrics

A

B12 Ca Fe

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57
Q

BEERS Criteria

A

a

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58
Q

STOPP Criteria

A

b

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59
Q

START Criteria

A

c

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60
Q

How often are geriatric falls and depression screened for ?

How often are vision screenings done?

A

Annually

Initial, q2yrs

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61
Q

When are pneumococcal vaccines recommended and what two are given?

When is herpes zoster vaccine given?

A

> 65
PPSV-23 and PCV-13

> 50, 2 shots

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62
Q

When are geriatrics screened for diabetes

When are osteoporosis screenings done?

A

Initial if HTN, HyperLipid or Obese
q3yrs

F >65
M >70

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63
Q

When is hyperlipidemia screening done?

When are AAA screenings done?

When is ASA for primary cardiovascular dz prevention recomended?

A

Initial
q5yrs

65-75 w/ smoking Hx

50-69

64
Q

How often are breast cancer screenings done?

How often are colorectal screenings?

When are cervical screenings stopped?

A

q2yrs

Annual FIT
Colonoscopy q10yrs

Stop at 65y/o

65
Q

When are lung cancer screenings done?

What medications contribute to delerium?

What are the short acting insulins

A

Annually when 55-80y/o and 30ppy or quit <15yrs

THE BS SOAP
TCA H2 ETOH Benzo Steroids Sedative Opiate Atnicholinergic Polypharm

Inhaling Glu give LISP and tears ASSapart
Inhales Insuline Glulisine Lispro Aspart

66
Q

What are the Sxs of Urgency UI and the causes

What are the Sxs of Stress UI and the causes

When evaluating stress UI, what is the Dx test?

A

Involuntary loss then urgency from detrusor over activity or neuro d/o

Involuntary loss after cough/sneeze due to failed sphincter, prior surgery, deliveries

Bladder stress test

67
Q

Urge UI causes

Common Sxs

Tx

A

Stroke Alzheimers Parkinson BPH w/ overflow

Urgency, Frequency

Anticholinergics

68
Q

Stress US causes

Common Sxs

Tx

A

Urological procedures
Multiple deliveries

Urine lost w/ cough/sneeze

Topical estrogen

69
Q

Overflow incontinence causes

Common Sxs

Tx

A

BPH Fecal impaction Pelvic prolapse Fibroids Neuropathy

Poor stream Incomplete emptying

Alpha adrenergic blockers

70
Q

What can cause an atonic bladder

Common Sxs

Tx

A

Diabetic neuropathy
Stroke

Complete loss of bladder control

Catheter

71
Q

Constipation, impaction, cysto/rectocele and prolapses can contribute to incontinence by ?

Dehydration, UTIs and nephrolithiasis contribute by ?

Edema, HyperCa, HyperGlucose contribute by ?

A

Mass effect impeding bladder neck/urethra

Mucosal/bladder wall irritation

Inc urine volume

72
Q

How do COPD/Chronic bronchitits contribute to incontinence

How do delirium, dementia and depression contribute?

How does Parkinson contribute?

A

Cough induced pelvic floor weakening

Impaired cognition, consciousness or motivation

Disrupted neuro control to bladder/sphincter

73
Q

How is Stress UI assessed?

How is Urge UI assessed?

A

Supine empty stress test- lay w/ full bladder, coughs
+= leakage
Assesses urethra function/post-void residual

Urodynamics assesses bladder compliance/detrusor activity

74
Q

What urine analysis findings is not associated w/ urine incontinence and there for is not Tx w/ ?

If PT does bladder diary, how is it done

A

ASx bacteriuria
W/ ABX

3 days x 24hrs w/ time and volume

75
Q

How do A-adrenergic agonists contribute to incontinence

How do A-adrenergic antagonists contribute

How do CCBs contribute

A

Sphincter constriction

Sphincter relaxation

Dec smooth muscle contractility

76
Q

How is UI Tx

A

Lifestyle- Weight ETOH Caffeine
Behavior- training, kegel
Pharm- best for urge
Surgery/Device

Function: bladder training
Stress: Kegel  
Topical estrogen
Anticholinergic
Urge: Estrogen 
Oxybutynin (antimuscarinic)
Mirabegron (B-agonist)
Overflow- 
Doxazosin (a-blocker)
Finasteride (5a inhibitor)
77
Q

Which way does the spine point in scoliosis, kyphosis and lordosis

How does OA present?

What would be seen on images?

A

S: S or C shaped spine
K: thoracic curves out
L: lumbar curves in

Worse w/ activity, better w/ rest
Joint line tenderness/bone enlargement

Narrowing Osteophytes Sclerosis Cysts

78
Q

After life style change and warm/cold Tx, what meds can be used?

A

Acetaminophen/Paracetamol- initial med
NSAIDs if Aceta failure- Naproxen, Ibuprofen
Tramadol

79
Q

When is acetaminophen related hepatotoxicity seen in OA PTs

How can the risk of NSAID induced GI bleeds be reduced

These protective agents only protect ? part of the GI system

A

> 3g/day and ETOH/hepatotoxic meds

Cyclo-oxygenase 2 selective agents- Celecoxib Meloxicam
PPIs
Misoprostol

Above Ligament of Treitz

80
Q

When can Capsaicin cream be used for OA

What is an adjunct therapy

What topicals may be useful in PTs w/ mutiple chronic medical conditions

A

Knee
Caution w/ hand

Rubefacients: Salicylates

Topical NSAID- Diclofenac

81
Q

Where are osteoporosis fragility Fxs found

What is the FRAX algorithm

What are the 3 types of Osteoporosis

A

Hip Vetebrae Wrist

PTs 10yr probability for fragility Fx

1: post-menopause loss of E
2: >75y/o loss of Zinc, dec Ca intake
3: chronic dz/GCSS in M/F

82
Q

Per USPSTF, only conduct DEXA scans on ?

What do the DEXA results correlate to ?

A

Female >65

Normal: > -1.0
Penia: -1 - -2.5
Porosis:

83
Q

How is Osteopenia Tx

When is pharmaceutical Tx for osteoporosis indicated?

DXA is MC used to assess what two locations?

A

Ca/Vit D w/ exercise

Porosis
Penia w/ FRAX hip Fx ?3% or other Fx risk 20% or higher

Lumbar Femur

84
Q

How is Osteoporosis Tx

A

Bisphosphonates: RAIZ-onate
HRT
Romozumab

Calcitonin
Denosumab
Teri/Abaloparatide
SERM: Raloxifene

85
Q

What is pathognemonic for Delirium

What other key features will be seen?

A

Acute change in baseline mental status over hrs/days

Fluctuating
Rambling
Altered LoC
Inattention
Disorganized
86
Q

What may be the only sign of an underlying illness in frail/dementia PTs

What is the MC post-op complication in older adults?

Nearly all terminally ill PTs experience ? prior to death

A

Delirium

Delirium

Delirium

87
Q

What are the 3 types of delirium

The presence of ? form is indicative of poor prognosis

A

Hyperactive
Hyperalert
Hypoactive- often unrecognized but MC in older hospitalized PTs

Hypoactive

88
Q

Due to increased issues, what herbs in combo w/ psychoactive drugs risk delirium development

What is the most effective strategy for preventing delirium

What is the foremost precipitating factor causing delirium

A

St. John’s wort, kava, and valerian root

Non-pharm interventions

Medications

89
Q

Since delirium may be the indicator of an occult infection, what needs to be investigated?

Define the CAM Assessment

A 
Joint infection
Abdominal issue
PNA 
UTI 
New cardiac murmur

Acute and fluctuating and,
Inattention and,
Disorganized or Altered LoC

90
Q

What meds can be used in the Tx of delirium

What are the 4 presenting features of Parkinsons

A 
Neuroleptic, typical: Haldol
Neuroleptic, atypical: 
Olanzapine
Quetiapine
Risperidone
Benzo

Resting tremor- pill rolling
Bradykinesia- shuffle gait
Rigidity- cog wheel
Instability- late feature

91
Q

Parkinson’s is the 2nd MC ? and is due to ?

If this presents in PTs older than 75, what is the cause

A

Neurodegenerative d/o Dopaminergic cell loss of substantia nigra

Mean onset 60-65, later onset indicated idiopathic or secondary

92
Q

Since Parkinsons is a clinical Dx, what must be present for Dx

How does this requirement present on PE

A

Bradykinesia and one cardinal manifestation

Slow movement
Micrographia
Masked facies
Festinating gai

93
Q

? is the MC presenting Sx of Parkinson

How is postural instability tested for?

What is at the center of the PE for these PTs

A

Resting tremor 3-6 Hz

Pull test- more than 2 corrective steps is abnormal

Extrapyrimidal exam

94
Q

When would genetic testing for the Parkinson’s PARK gene be warranted?

What is the MC cause of Parkinsonism

What is the strongest alert for PTs to have Secondary PD

A

Strong FamHx
Onset <40y/o

Idiopathic PDz

Lack of response to increased Levodopa dosage

95
Q

What causes Vascular Parkinsonism

How doe these PTs present differently

A

Chronic ischemic damage
Multiple brain infarcts

Akinetic rigid syndrome, more severe in legs and gait is more prominently affected

96
Q

What are the MC causes of drug induced parkinsonisms?

Define Atypical Parkinsonism

A

Anti-emetic
Anti-psychotic
Dopamine depletors- Reserpine, Tetrabenzine

Parkinson Plus- Disabling features like autonomic failure, early falls/dementia that are not seen in PD

97
Q

How are Essential Tremors different from PD tremors

What are the two major causes of morbidity/mortality in PD PTs

A

More symmetric
Higher frequency
Extension/Flexion, not pronate/supinate

Dysphagia
Gait dysfunction

98
Q

How is the ‘wearing off’ phenomenon of PD meds Tx

What meds are used for dementia/psychosis in PD

What meds can be used for psychosis

A

Shorten dose interval
Add COMT/MAOI

ChEIs- GRD

Quetiapine Clozapine Pimavanserin*

99
Q

What meds are the first and second line agents for depression in PD?

These two need to be avoided when PTs are taking ?

What medication/systemic issue management may be d/c as PD progresses?

A

1st: SSRI
2nd: SNRI

MAOIs- Selegiline

HTN

100
Q

What 3 meds are used for last line OHOTN in PD PTs?

What complication is nearly universal in PD Pts

A

Fludrocortisone
Midodrine
Droxidopa

Constipation- Polyethylene glycol and Senokot daily

101
Q

What drug is proven to work as monotherapy to decrease the motor Sxs of PD

What are the 5 classes of drugs used in Tx and their benefits

A

Non-ergot agonist/Dompaine agonist- Pramipexole, less motor fluctuations

Dopamine agonist- less motor fluctuation
Anti-cholinergis- relieve tremors/dystonia
MAO-BIs- Sele/Rasagiline; mild anti-depressant
COMT-Is- E/T-capone; improve mobility

102
Q

What is the TxDOC for PD PTs >70y/o

This drugs is preferred because ? meds are not tolerated in this age group

What are the TxDOC for PTs <70y/o

A

Levodopa

Dopamine agonists- Pramipexole Rpinirole
Amantadine
Anticholingergics

Dopamine agonists- Pramipexole Ropinirole

103
Q

What is the benefit of Levodopa

This medication has less benefit on ? Sxs

What PT education goes w/ this Rx

A

Decreases tremor

Speech/gait

30min prior to meal on empty stomach
Sinemet CR at bedtime

104
Q

What type of diet change can help benefit PD PTs on medications

What is the only medication proven to reduce dyskinesia and frozen gaits?

A

Dec protein diet

Amantadine

105
Q

What is the MC movement d/o and its AKA

How do these present

What are the strongest RFs

A

Essential tremors;
Familial tremor

Bilateral tremor in hand/arm, head, voice and trunk

Age FamHx

106
Q

Essential tremors are variants of ? Dx

PTs will present w/ relief by doing ?

How are these Tx

A

Cervical dystonia

Alcohol

1st:
OT 
Propranolol (non-sel BB) and Primidone or 
2nd- Gaba/Topiramate
Zonisamide alternate to Top
Surgical: unilateral thalamotomy
107
Q

When do the risks for stroke begin and how rapidly does this increase?

What are the two types of strokes and their prevalence

A

Starts at 55y/o
Doubles q10yrs

Ischemic
Hemorrhagic intracerebral, subarachnoid)

108
Q

What are the 3 parts to the Cincinnati stroke scale

What are the two phases of Dx

What is the preferred imaging for work up

A

Face droop Arm drift Speech

Acute triage
Etiology investigation after Dx

CT w/out contrast

109
Q

What are the 5 sub-types of ischemic strokes

Intracerebral hemorrhages usually have ? underlying etiology

A 
Atherosclerosis- stenosis
Determined- dissection
Undetermined- cryptogenic
Embolism- AFib
Small vessel- Lacunar

HTN
Amyloid angiopathy
Anti-coag related hemorrhage

110
Q

What form of imaging is 90% sensitive for detecting intracerebral infarction

What form of imaging is the the gold standard for Dx of aneurysms/vascular malformations

A

DW-MRI

CTA
Digital subtraction angiography

111
Q

What are the 3 inclusion criteria for use of tPA reperfusion therapy

C/i for use

A

Ischemic stroke Dz w/ neuro deficit
Sxs <3hrs/4.5hrs if <80
18y/o or older

SHIP BLASTS
Stroke <3mon
Head injury <3mon
Intracranial hemorrhage
PT >15sec
BP >185/110
LP <7d
Anticoag/artery puncture <7d
Surgery <14d
Thrombocytopenia <100K
112
Q

Ischemic stroke PTs don’t need HTn intervention unless BP is over ?

? is not a barrier/RF for reperfusion therapy

A

220/120

Age

113
Q

? is the least treatable form of stroke

What is the BP goal for these PTs

What RF/barrier is present here that was not present in tPA consideration

A

Intracerebral hemorrhage

<140

> 80 inc mortality

114
Q

Neuro/Heme stable PTs should start BP reduction regimes ? long after strokes

What long term Tx is recommended to lower future issues

What mes are the mainstay of secondary prevention

A

24hrs

Statins

Antiplatelet:
ASA mono therapy- 1st
ASA + Dipyridamole and Clopidogrel mono therapy

115
Q

PTs w/ minor ischemic stroke or high-risk transient ischemic attack, early, short-term combination of ? meds reduces subsequent stroke risk

A

ASA and Clopidogrel

116
Q

When are Warfarin anticoagulants initiated after strokes

What class is as effective w/ lower risks?

? Tx is more effective in PTs w/ carotid artery stenosis than medical therapy

A

ASA bridge w/in 2wks

DOACs-
Dabi/Riva/Apixaban

Carotid Endarterectomy <2wks to prevent recurrent stroke

117
Q

How do TIAs present

What are the 3 main mechanisms

PTs w/ TIAs are at risk for having a stroke w/in ?

A

Transient neuro dysfunction from neuro/retinal ischemia but nor infarction

Flow, low Embolic Lacunar

Half w/in 2days
90days

118
Q

Define Takotsubo Cardiomyopathy presentation

What will be seen on imaging

What medication is used for the Tx of dilated cardiomyopathy

A

Mimics STEMI w/out arterial occlusion in women

Octopus pot- apical ballooning of ventricles

Bisoprolol

119
Q

What meds are used for long term coronary dz management

What medications are used for HFrEF <40%

What meds are used for HFrEF <35%

A

Statin
Anti-platelet
BBs
ACE/ARB- HFrEF

BB Sacubitril-Valsartan

ACE/ARB Spirinolactone/Eperenon
Resynch/pace

120
Q

What meds are used for HFpEF >50%

How much salt and liquid intake do these PTs need to limit to?

A

HTN Na restriction Loops

2g and 1-1.5L/day

121
Q

What are the 4 EKG changes seen in HyperK

What 3 meds are used for HyperK redistribution

What two methods are used for elimination

A

Peaked T
Dropped P
Wide QRS
Sine waves

Insulin Albuterol NaBicarb

Furosemide Dialysis

122
Q

What is the only Tx for bradycardia

What is the MC presenting complaint

A

Pacemakers

Fatigue

123
Q

Bradyarrhythmias include ? rhythms

Tachyarrhythmias include ? rhythms

A

Sinus brady
Sinus pause
TachyBrady- PSVT to Brady; worse prognosis

VT/VF Afib/flutter NSVT
PVC

124
Q

Drug of choice for endocarditis prevention

What is and is not given for TIA

A

Amoxocillin

Give ASA
No tPA

125
Q

Indications to increase insulin

Dec in ADL/IADLs indicates ?

If accurate functional info is essential for planning ?, what is the most invaluable form of info

A

DM and A1c >8

Worsening Dz process
Combo of multiple conditions

Adaptive caregiver
Caregiver help
Direct observation by OT/PT

126
Q

PT present w/ TIA, vision loss and arm weakness, first med given is ?

When is MOCA used

When is CAM used

A

ASA

MOCA- dementia

CAM- delirium

127
Q

Define HASBLED acronym

A 
Score estimates risk of bleeding on anticoags as assess AFib d/os:
HTN 
Abnormal renal/liver 1-2pts
Stroke
Bleeding
Labile INR
Elderly >65y/o
Drug/Alcohol 1-2pts
0-1: low
2: moderate
3-6: high
128
Q

How fast is BP lowered during HTN Emergencies

What is the Tx goal for these PTs

A

MAP dec 10-20% first hr
Gradual over next 23hrs

Final reduction by 25% from baseline

129
Q

What vasodilators are used for HTN Emergencies

What adrenergic inhibitors are used?

A 
Na nitropursside
Nicardipine
Fenoldopam
Nitro
Enalaprilat
Hydralazine

Labetalol
Esmolol
Phentolamine

130
Q

ANCA/AHA HTN categories

JNC8 Categories

A

Norm 120/80 or less
Elevated 120-129/<80
Stage 1: 130-139/80-89
Stage 2: >140/>90

<60/DM/CKD: <140/90
Over 60: <150/90

131
Q

INVEST Research findings

A

HTN Tx in PTs >80y/o with CAD compared to PTs <80 years, J-curve relationship between lower DBP and increased all-cause mortality, nonfatal MI/strokes

132
Q

What are 4 common conditions in older PTs that complicate HTN Dx and management

A

White Coat HTN- higher in office than out w/ NO anti-HTN meds; confirmed w/ monitoring
OrthoHOTN: risk for first fall
Post-Prandial HOTN
Pseudohypertension: high peripheral pressure compared to arterial pressure from atherosclerosis

133
Q

HTN Tx for non-AfAm PTs

HTN Tx for AfAm TPs

HTN Tx fo TPs w/ CKD should include ? meds

A

ACE/ARB CCB Tzd

Tzd CCB (Verapamil, Diltiazem)

ACEI/ARB

134
Q

When/how are HTN medication adjustments made

Triad for Aortic Stenosis

How are they Tx

A

Up-titrate or add after 1mon if BP goal not reached

Syncope Angina Dyspnea

Fluids, Consult

135
Q

What is the MC cause of aortic stenosis

If found ? finding indicated an early case of Dz

What is the MC for the most severe cases of aortic stensosis

A

Calcified aortic valve dz

Aortic valve sclerosis

Bicuspid AV

136
Q

? is the MC indication for major cardiac surgery after coronary bypass

How is this Tx

A

Aortic stenosis

AVReplacement
Transcatheter AVReplacement after CT

137
Q

How is aortic regurg Tx if PT is not a surgical candidate

What is the initial and preferred imaging when evaluating for suspected aortic regurg?

A

Chronic dilator therapy

TTE w/ referral

138
Q

When is endocarditis prophylaxis indicated prior to dental?

What types of procedures are of highest of risk to PTs

When is prophylaxis not warranted before a procedure

A

Prosthetic heart valve
IE Hx
Congenital heart Dz
Valvulopathy after transplant

Manipulation of gingiva, periapical region or oral mucosa

GU/GU

139
Q

What ABX is used for infective endocarditis prophylaxis

How does peripheral arterial dz and VTE present

How are these PTs managed

A

Amoxicillin

Pain w/ rest, MC in calf
Relief w/ movement

Hygiene/daily inspect
Refer to podiatry
Tobacco cessation
High intensity statins

140
Q

What medication is sued for peripheral artery Dz

What are the 6 Ps of acute arterial occlusion

What is the MC form of peripheral artery dz in older adults

A

Cilostazol- PD-3 inhibitor

Paresthesia Pallor Pulselessness Poikilothermia Paralysis PooP

Atherosclerosis

141
Q

? is the 3rd MC cause of CV death in US

What are 3 common RFs

Usually Duplex US is used, but what form of imaging is used to evaluate the pelvic vasculature

A

VTE

Ortho surg Immobile Malignancy

CTV and MRV

142
Q

How are VTEs Tx initially

What meds are used for long term management

How long are Txs maintained

A

Heparin/LMWH
Fondaparinux

Vit K antagonists
DOACs
LMWH

Discrete cause- 3mon
Unknown cause- 6-12mon

143
Q

When there is no etiological finding that is age/gender appropriate for a Dx of VTE, what is the next step

What is the only anticoagulant that has approved dose reduction for older PTs w/ renal impairment

A

Malignancy screening

Enoxaparin

144
Q

Rivaroxoban is c/i in PTs w/ CrCl below ?

Direct thrombin inhibitor med

What are the reversal methods for anticoagulants

A

<15mL/min

Dabigatran

VKA: Vit K, FFP, Prothrombin
Dabi: Idarucizumab
Riva/Apix: andexanet

145
Q

Vascular incompetency causes ?

Venous obstruction causes ?

How are these cases Tx

A

Reflux

Outflow

Elevation/compression
Diuretics

146
Q

What types of skin changes can occur due to chronic venous insufficiency

Where are insufficiency induced ulcers found

A

Hemosiderin stain
Lipodermatosclerosis
Atrophie blanchie

Medial malleolus

147
Q

How are venous Dzs classified

A 
C0: no visible sign of dz
C1: telangiectasis/reticular veins
C2: varicose
C3: edema
C4: skin changes
C5: healed ulcer
C6: active ulcer
148
Q

How are acute COPD exacerbation’s managed

What meds are used

A

O2 Albuterol Ipratropium Prenisone

Beta agonist- Albuterol
Anticholinergic- Ipratropium
PO GCCS- Prednisone
NPPV
ABX- mod/sev exacerbation
149
Q

Define COPD

Define Emphysema

Define Chronic Bronchitis

A

Inflammatory respiratory dz w/ limited airflow, incompletely reversible w/ dilators, and FEV1/FVC <70%

Destruction of alveoli

Cough and sputum x 3mon for 2yrs

150
Q

COPD is the ? leading cause of death

What meds are used for Tx

When do PTs need to be placed on home air?

A

4th

Chronic:
GCSS Anticholinergics LABA SABA

<88% on RA
<55mmHg

151
Q

ABCD classification for COPD

What are the grades

A

Exacerbation, L side:
>2 hospital admission
1< admissions

Under, horizontal:
MRC 0-1, Cat <10
MRC 2 or more, Cat 10 or more

1: SoB w/ walking up hill
2: can’t keep up w/ others
3: stops when walking 100ft
4: too breathless to leave home

152
Q

SABAs for COPD

LABAs for COPD

SAMAs/Anticholinergic

LAMAs/Anticholinergic

A

Albuterol
Levalbuterol

Formoterol
Salmeterol

Ipratropium
Oxitropium

Tiotropium
Umeclidinium

153
Q

What medication is reserved as 3rd line agent for COPD

What ABX are used for exacerbations

A

Methylxanthines: Theophylline

Mild: Macrolide Cephalosporin Doxy or TMP/SMX
Mod/Sev: Augmentin, FQN

154
Q

COPD Tx by group

A 
A: SABA or SAMA
B: LABA or LAMA
C: LAMA
D: LAMA or
LAMA and LABA or,
LABA and ICS
155
Q

COPD group GOLD 2B is not responding to LAMA and LABA, what meds are added

What lab work should be checked

A

ICS

Eosinophil

156
Q

What type of airflow obstruction results are seen in asthma PTs

What are the two types

A

FEV1/FVC 0.7 or less

Long- atopy/allergy
Late- obesity/tobacco

157
Q

S/Sxs of interstitial lung dz

What would be seen on PE

A

Dry cough
Wheeze
Dyspnea
Chronic exercise intolerance

Velcro rales
Adenopathy
R heart failure

IPAP (212 decks)

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