geriatrics Flashcards
temporal arteritis (giant cell arteritis) s/s, what to check
scalp tenderness, sudden vision loss in one eye (amaurasis fugax), one side temporal headache
check sedimentation rate, medical emergency dt risk of blinds
severe bacterial infection presentation
NOT FEVER
acute closure glaucoma
sudden onset of severe eye PAIN, headache, n/v
eye is RED with profuse TEARING, blurred vision
call 911
tonometry done in ER to measure IOP
CVA versus TIA
CVA blurry vision, weakness, slurred speech
TIA: temporary episode lasts
actinic keratosis
precursor for squamous cell carcinoma
rough pink lesions that DO NOT heal.
biopsy to dsg, small lesions can be treated with cryo
large amount- use 5fu
fractures of the hip
acute onset of limping
major cause of mortality (20% die from complications such as pneumonia)
3 questions to ask elders for abuse:
do you feel safe where you live
who handles your finances
who prepares your meals
top 3 leading cause of death >65 yo
3 c’s ( Cardiac, cancer, copd)
heart disease ( MI, heart failure) cancers ( lung, colorectal) respiratory disease ( COPD)
cancer with highest mortality
lung
screening test for lung cancer
none
if s/s present ( sob, dull achy chest pain, recurrent pneumonia) order chest radiograph ( to look at nodules), next is CT, gold standard biopsy.
colon cancer screening
2nd most common cancer related to death
screening:
start at age 50 with baseline colonoscopy q 10 years, signmoidscopty every 5 years, high sensitive Fecal occult blood annually
multiple myeloma s/s
bone pain located on the chest or back
majority have anemia
2-3x more in AA
refer
any patient with unexplained iron def anemia, older male, post menopausal should be reffered for what?
colposcopy
chemistry showing > serum calcium and/or alkaline phosphates suspicious of what?
cancerous metastasis of the bone
adl versus instrumental adl
adl: grooming, feed, bathing
instrumental: driving, grocery shopping, laundry, cookingg
medications with high adverse effects ( AVOID with elderly)
diphenhydramine ( benadryl) dt drowsiness ( claritin better option)
TCA: amitriptyline (elavil) most sedating
ALL TCA give at night
hypnotics: avoid long acting ( Halcion), prefer ambient
BB: propranolol
Digoxin (warfarin sodium)
muscle relaxers (soma, skelaxin, norflex)
high ANTICHOLINGERGIC EFFECT: antihistamines, atipsychotics, atropine,
** BLack box for ATYPICAL antipsyhotics: high risk of mortality with eldery. ( i.e.: seroqueL)
black box with atypical antipsychotics
give ex of rx.
** BLack box for ATYPICAL antipsyhotics: high risk of mortality with eldery. ( i.e.: seroqueL, risperidol, ambilify)
Atypical antipsychotics are typically used to treat schizophrenia or bipolar disorder, dementia
common s/e of digoxin early vs late
early: GI, abdominal discomfort
late: halos around light
screening for dementia
folstein mini mental examl
max score of 30
low score: dementia, delirium, schizophrenia
6 subject areas; orientation, attention, recall, sentence, command, copy a design
dementia vs delirium
dementia: IRREVERSABLE (alzheimers, cva, b12 def, parkinson)
delirium: reversable (high fever, infection, drugs, dehydration
mini mental
orientation (date, day, week state, country, etc)
attention & calculation ( subtract 100-7 5x’s, spell “world” backwards
recall ( name 3 objects, repeat in 5 minutes)
write a sentence
3 stage command
copy a design
immunizations
pneumococcal >65 yo- one per lifetime if healthy ( if 50 should receive 1 dose tdap regardless of time since last immunization)
zoster (>60)
** MUST have hx of chicken pox of varicella titer before giving vaccine
most common cause of hearing loss
presbycusis- sensorineural ( inner ear- cochlear hair cells and vestibulocochlear nerve)
progressive, symmetric, human loss first
ototoxic medications
aminoglycosides ( gentamycin, vancomycin), asa
which side can “hear” with cerumen
the side that can hear has the cerumen ( bad side)
eye s/s that are emergency
acute onset of floaters with blurred vision (s/s retinal detachment)
yellow/green tint to everything ( digoxin toxicity)
acute onset of severe eye pain, tearing, redness, n/v (acute glaucoma)
glaucoma s/s
excessive glare of lights and interfere with driving
hemianopsia s/s
wall edges or light poles seem bent/crooked, leaves food untouched consistently on one side of tray
drugs that adversely affect vision
viagra ( BLUISH tint)/ishemic optic neuropathy
anticholinergics (decongestants, antihistamine)- can precipitate acute angle glaucoma
stages of ulcer
1-4 1- superficial 2- damage to epidermis 3- damage to epi/dermis 4- depp ulcers with visable muscle/tendon, fascia
dementia etiology
neurofibrillary plaques and tangles
“dementia with lewy bodies” is caused by lewy body brain deposits, this pt will have hallucinations
differenial dsg for dementia
b12 deficiency, hypothyroid, depression, infection, drugs, metal poisoning
dementia rx
aricept, namenda, exelon, cerefolin (folate, b12, acetylcysteine). NO SURE
2 most common infections
uti and pneumonia
sundowning
seen in BOTH delirium and dementia
starts at dusk/sundown
pt becomes combative, confused, agitated
resolves in the morning
tx: avoid quiet and dark rooms
well lit room with radio/tv/clock
familiar surroundings
avoid drugs that affect cognition (antihistamine, sedatives, narcotics)
3 A’s with alzheimers
aphasia ( difficulty verbalizing)
apraxia ( difficulty with gross motor mvmt, i.e. walking)
agnosia (difficutly to recognize people/objects)
death from alzheimers
usually due to penumonia/sepsit, hip fracture complication
parkinson’s s/s and rx
tremor, rigidity, bradykinesia (depression, dt
essential tremor
“action” tremor (not a resting tremor)
rx: BB ( propranolol)
immunizations for healthy 65 yo
flu
pneumovax
if >65, only needs flu vaccine
eldepryl is a specialized mao inhibitor, which meds to avoid
SSRI
triptans ( triptilyne)
TCA
dt seotonin syndrome
TIA
neuro dysfunction cause by focal ishemia without acute infarction of the brain ( like stroke)
“mini stroke”, increase risk of stroke
stoke
most common cause HTN
emboli or bleeding, permanent neurologic damage
“worst headache of my life”
broca vs wernicke’s aphasia
broca- can understand, but difficulty with motor aspect (
drugs to avoid in elderly
Sulfonylureas: glyburide (diabeta), chlorpropamide ( Diabenase)
benadryl, seroquel, zyprexa, elavil, tofranil,
