geriatrics

Question 1

temporal arteritis (giant cell arteritis)
s/s, what to check

Answer 1

scalp tenderness, sudden vision loss in one eye (amaurasis fugax), one side temporal headache

check sedimentation rate, medical emergency dt risk of blinds

Question 2

severe bacterial infection presentation

Answer 2

NOT FEVER

Question 3

acute closure glaucoma

Answer 3

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

Question 4

CVA versus TIA

Answer 4

CVA blurry vision, weakness, slurred speech

TIA: temporary episode lasts

Question 5

actinic keratosis

Answer 5

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

Question 6

fractures of the hip

Answer 6

acute onset of limping

major cause of mortality (20% die from complications such as pneumonia)

Question 7

3 questions to ask elders for abuse:

Answer 7

do you feel safe where you live
who handles your finances
who prepares your meals

Question 8

top 3 leading cause of death >65 yo

Answer 8

3 c’s ( Cardiac, cancer, copd)

heart disease ( MI, heart failure)
cancers ( lung, colorectal)
respiratory disease ( COPD)

Question 9

cancer with highest mortality

Answer 9

lung

Question 10

screening test for lung cancer

Answer 10

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.

Question 11

colon cancer screening

Answer 11

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

Question 12

multiple myeloma s/s

Answer 12

bone pain located on the chest or back
majority have anemia
2-3x more in AA
refer

Question 13

any patient with unexplained iron def anemia, older male, post menopausal should be reffered for what?

Answer 13

colposcopy

Question 14

chemistry showing > serum calcium and/or alkaline phosphates suspicious of what?

Answer 14

cancerous metastasis of the bone

Question 15

adl versus instrumental adl

Answer 15

adl: grooming, feed, bathing
instrumental: driving, grocery shopping, laundry, cookingg

Question 16

medications with high adverse effects ( AVOID with elderly)

Answer 16

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)

Question 17

black box with atypical antipsychotics

give ex of rx.

Answer 17

** 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

Question 18

common s/e of digoxin early vs late

Answer 18

early: GI, abdominal discomfort
late: halos around light

Question 19

screening for dementia

Answer 19

folstein mini mental examl

max score of 30
low score: dementia, delirium, schizophrenia
6 subject areas; orientation, attention, recall, sentence, command, copy a design

Question 20

dementia vs delirium

Answer 20

dementia: IRREVERSABLE (alzheimers, cva, b12 def, parkinson)
delirium: reversable (high fever, infection, drugs, dehydration

Question 21

mini mental

Answer 21

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

Question 22

immunizations

Answer 22

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

Question 23

most common cause of hearing loss

Answer 23

presbycusis- sensorineural ( inner ear- cochlear hair cells and vestibulocochlear nerve)
progressive, symmetric, human loss first

Question 24

ototoxic medications

Answer 24

aminoglycosides ( gentamycin, vancomycin), asa

Question 25

which side can “hear” with cerumen

Answer 25

the side that can hear has the cerumen ( bad side)

Question 26

eye s/s that are emergency

Answer 26

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)

Question 27

glaucoma s/s

Answer 27

excessive glare of lights and interfere with driving

Question 28

hemianopsia s/s

Answer 28

wall edges or light poles seem bent/crooked, leaves food untouched consistently on one side of tray

Question 29

drugs that adversely affect vision

Answer 29

viagra ( BLUISH tint)/ishemic optic neuropathy

anticholinergics (decongestants, antihistamine)- can precipitate acute angle glaucoma

Question 30

stages of ulcer

Answer 30

1-4
1- superficial
2- damage to epidermis
3- damage to epi/dermis
4- depp ulcers with visable muscle/tendon, fascia

Question 31

dementia etiology

Answer 31

neurofibrillary plaques and tangles

“dementia with lewy bodies” is caused by lewy body brain deposits, this pt will have hallucinations

Question 32

differenial dsg for dementia

Answer 32

b12 deficiency, hypothyroid, depression, infection, drugs, metal poisoning

Question 33

dementia rx

Answer 33

aricept, namenda, exelon, cerefolin (folate, b12, acetylcysteine). NO SURE

Question 34

2 most common infections

Answer 34

uti and pneumonia

Question 35

sundowning

Answer 35

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)

Question 36

3 A’s with alzheimers

Answer 36

aphasia ( difficulty verbalizing)
apraxia ( difficulty with gross motor mvmt, i.e. walking)
agnosia (difficutly to recognize people/objects)

Question 37

death from alzheimers

Answer 37

usually due to penumonia/sepsit, hip fracture complication

Question 38

parkinson’s s/s and rx

Answer 38

tremor, rigidity, bradykinesia (depression, dt

Question 39

essential tremor

Answer 39

“action” tremor (not a resting tremor)

rx: BB ( propranolol)

Question 40

immunizations for healthy 65 yo

Answer 40

flu
pneumovax

if >65, only needs flu vaccine

Question 41

eldepryl is a specialized mao inhibitor, which meds to avoid

Answer 41

SSRI
triptans ( triptilyne)
TCA

dt seotonin syndrome

Question 42

TIA

Answer 42

neuro dysfunction cause by focal ishemia without acute infarction of the brain ( like stroke)

“mini stroke”, increase risk of stroke

Question 43

stoke

Answer 43

most common cause HTN
emboli or bleeding, permanent neurologic damage

“worst headache of my life”

Question 44

broca vs wernicke’s aphasia

Answer 44

broca- can understand, but difficulty with motor aspect (

Question 45

drugs to avoid in elderly

Answer 45

Sulfonylureas: glyburide (diabeta), chlorpropamide ( Diabenase)

benadryl, seroquel, zyprexa, elavil, tofranil,