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Neurology > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

When should we screen for depression?

A 
Sleep issues
Decrees interest
Energy 
Concentration
Appetite 
Somatic symptoms, cognitive impairment, psychosis
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2
Q

When should we do head imaging due to cognition?

A 
If age greater than 60
Rapid unexpected decline in function
Short duration dementia
Recent and significant head trauma
History of cancer
Use of anticoagulants
Unexplained neuro findings 
New localizing signs
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3
Q

When should you screen for osteoporosis?

A

If less than 65 and risk factors

Or everyone over 65

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4
Q

Initial screen for weight loss in acute setting

A 
CBC with differential
Urinalysis
Hemoglobin A1C
Creatinine and electrolytes
Liver panel
Calcium
CRP
TSH
FIT
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5
Q

CAM criteria

A
  1. Acute onset and fluctuating course
  2. Inattention
  3. Disorganized thinking
  4. Altered LOC

Need 1+2 and either 3/4

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6
Q

Risk factors for delirium on admission

A
  1. Sensory impairment
  2. Severe illness
  3. Cognitive impairment
  4. Dehydration
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7
Q

Risk factors for delirium in hospital

A
  1. Malnutrition
  2. Physical restraints
  3. Catheters
  4. Polypharmacy
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8
Q

Risk factors for delirium pre-op

A
  1. Age >70
  2. EtOH abuse
  3. Poor cognitive function
  4. Poor functional status
  5. Abnormal Na, K, Glucose
  6. AA surgery
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9
Q

Management of delirium

A
  1. Meds: avoid benzos, merperidine, anticholinergics
  2. Regular tylenol to reducse opiod dose for pain
  3. Avoid catheters, physical restraints, do regular toileting and comfort rounds
  4. Manage fluids and electrolyres
  5. Feed appropriately
  6. Use glasses, hearing aids etc
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10
Q

What are some major physiological changes that occur with age?

A
  1. Cardiac: stiffer vessels, higher BP, less response to beta stimulation
  2. Resp: Decrease elasticity, decreased strength of diaphragm
  3. MSK: decreased muscle bass, loss of calcium from bone
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11
Q

Which drugs may increase the risk of falling?

A 
Sedatives
antidepressants -ssris
antipsychotics
anti hypertensives
diurectives
NSAIDS
anticholinergics
alchohol
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12
Q

What has the best evidence for fall intervention?

A

Exercise program

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13
Q

How is driving assessed?

A 
Safety record
Attention skills
Family Report
Ethanol
Drugs
Reaction time
Intellectual impairment
Vision/visuospatial function
Executive function
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14
Q

Is dementia a contraindication to driving?

A
  1. Only if moderate to severe

2. If mild reassess every 6-12 months

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15
Q

How does age affect drug pharmacology?

A
  1. Absorption may be slower but not sig. changed
  2. Distribution: larger in fat, less in water
  3. Metabolism: decreased first pass metabolism s higher serum drug concentrations
  4. Distribution: decreased renal function so decreased excretion
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16
Q

Adverse drug reaction

A

Noxious/unintended result of a drug, elderly at much higher risk. See Beers list.

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17
Q

Which medications interact significantly with warfarin

A
  1. Antibiotics
  2. Antifungals
  3. Antidepressants
  4. Antiplatelet agents
  5. Amiodarone
  6. Anti-inflammatories
  7. Acetaminophen
  8. Alternative drugs (herbals
18
Q

What are the types of elder abuse?

A 
Physical
Psychological
Material/financial exploitation
Neglect
Violation of rights
19
Q

Personal directive:

A

Written before loss of capacity

Covers non-financial decisions

20
Q

Power of attorney

A

makes financial decisions

21
Q

What changes in sexuality occur with aging?

A

Men: decreased libido, erections take longer to achieve and are more difficult to maintain, decreased intensity of orgasm
Women: vulvovaginal atrophy, decreased lubrication

22
Q

what counts as a fever in the elderly?

A

> 37.2 C oral

23
Q

Frailty

A

An increased state of vulnerability to external stressors

Phenotype: slow gait, weight loss, decreased strength, decreased activity, exhaustion

24
Q

Risks of prolonged bedrest

A
  1. Loss of muscle mass, strength, aerobic capacity
  2. Loss of plasma volume- orthostatic hypoT
  3. Reduced ventilation
  4. Accelerated vertebral bone loss
  5. Functional incontinence
  6. Pressure sores
  7. Malnutrition and dehydration
  8. Change in quality of life
25
Q

What are the medical indications for a urinary catheter/

A
  1. Urinary retention unmanageable
  2. Monitoring urinary output
  3. Bladder hemorrhage
  4. Surgery
  5. Palliation
  6. Bad sacral ulcers
26
Q

What are the common causes of transient urinary incontinence?

A
  1. Thin, dry vagina/atrophy
  2. Obstruction (stool)
  3. Infection
  4. Limited mobility
  5. Emotional disorder
  6. Therapeutic meds (diuretics)
  7. Endocrine/excess output
  8. Delirium/confusion **
27
Q

What characterizes the causes of chronic urinary incontinence?

A
  1. Urge-large volumes +urgency
  2. Stress-loss on exertion but small vol.
  3. Overflow-urge but only small vol. passed
  4. Functional- cognitive, physical, environmental barriers
  5. Mixed - stress + urge
28
Q

What are treatments for causes of chronic urinary incontinence?

A
  1. Urge-bladder training, scheduling toilets, anti-cholinergic
  2. Stress-kegels
  3. Overflow-intermittant catheterization
  4. Functional- tx underlying cause
  5. Mixed - anticholinergic
29
Q

Red flags for urinary incontinence?

A
  1. Organ prolapse
  2. Hematuria
  3. Palpable bladder after voiding
  4. Suspected pelvic mass
30
Q

Most common cause of fecal incontinence?

A

Fecal impaction

31
Q

pharmacological treatment for chronic constipation?

A

Osmotic laxatives (PEG, lactulose)** safe chronic*
Stimulant laxatives, bulk forming (Biscodyl, senna) not safe chronically
Suppositories

32
Q

Risk factors for chronic constipation?

A
  1. Endocrine (hypokalemia, hypothyroid, diabetes, hypoMg, hyperparathyroid)
  2. Meds- opiods, anticholinergics, antacids, iron, levadopa/carbidopa
  3. Dehydration
  4. Neuro changes
33
Q

Well elderly- obesity

A

Measure height, weight, BMI

-behavioural interventions in those that are obese

34
Q

Well elderly- prostate

A

Do not do regular PSA

35
Q

Well elderly-Colorectal cancer

A
  1. FIT for patients 50-74, q 1-2 years

2. Colonoscopy if FIT positive

36
Q

Well elderly-depression

A

Screen if clinical clues

37
Q

Well elderly- cervical cancer

A
  1. Screen q 3 years until 69

2. Don’t screen over 70 if 3 good tests

38
Q

Well elderly-breast cancer

A

Mammography q 2-3 years 50-74

39
Q

Well elderly-HTN

A

screen bp every visit

40
Q

Well elderly-DM

A

screen HBA1C q 3-5 years in high risk

41
Q

Well elderly-Vaccinationes

A 
pneumococcal (routine if >65)
herpes zoster (optional)

Neurology (28 decks)

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