Geriatrics Flashcards
1
Q
“Get up and go” test is failed if it takes longer than ____ seconds.
A
30
2
Q
“Get up and go” test takes pts less than _____ seconds to pass.
A
20
3
Q
10 RF for pressure ulcers:
A
External forces on skin, host specific factors, pressure moisture, nutritional status, neurological disease, tissue susceptibility, friction, immobility, Incontinency, circulatory
4
Q
A congenital diverticulum involves:
A
all layers
5
Q
A pressure ulcer is NOT stageable if it is:
A
Covered by a eschar
6
Q
A pulsion diverticulum involves the:
A
mucosa and submucosa herniating through the muscle layer
7
Q
A worse prognosis for Bence Jones (light chain) myeloma:
A
Lambda LCD has a 3x worse prognosis than Kappa LCD
8
Q
Abnormal karyotype, especially:
A
Chromosome 13
9
Q
Abx for diverticulitis should cover (2):
A
Gram negative anaerobes (and gram + anaerobes, too)
10
Q
ACA stroke causes ___.
A
contralateral paralysis and sensory loss - lower limb
11
Q
Activities of Daily Living (ADLs) (4)
A
Dressing, Mobility, Feeding, Toileting (grooming, bathing, and continence)
12
Q
After being delirious a patient is ____ as likely to die in one year.
A
Twice
13
Q
After starting levothyroxine the TSH should be checked at:
A
2 months and 6 months
14
Q
Age-related cognitive decline (ARCD) should be:
A
the decline in cognitive function within normal limits given the person’s age
15
Q
Allodynia is:
A
Pain from stimuli that are not usually pain
16
Q
Alpha-1 blockers (Tamsulosin):
A
Relax sphincter to help with overflow incontinence
17
Q
Amantadine 100mg bid: MOA and 4 ADV in tx Parkinsonism.
A
MOA is unclear, but has serious side effects: restlessness, confusion, anorexia, postural hypotension
18
Q
An example of elder neglect:
A
A patient with multiple bed sores/ulcers with dehydration
19
Q
Anticholinergics (Oxybutynin) improve __ incontinence and worse __.
A
Make urge better and overflow worse
20
Q
Anticholinergics help with the _______ of Parkinson’s.
A
Tremor
21
Q
Are there any contraindications for OMM in the elderly?
A
No CIs on age alone. Be cautious with pts with high risk of stroke
22
Q
Assessing pain - PQRST:
A
Palliative, Quality, Region/radiation, Severity, Timing/type
23
Q
Associated symptoms of hypothyroidism: (5)
A
Bilateral carpal tunnel, Urticaria, Pulmonary HTN, Anemia, Elevated lipids
24
Q
Bacteriuria:
A
greater than 100,000 cfu/ml; send to hospital!
25
Bethanechol: 2
Stimulates cholinergic receptors and increases detrusor tone to improve urinary retention
26
Bisphosphonate MOA
bind hydroxyapatite in bone, inhibiting osteoclast activity
27
Bisphosphonates pose a great risk of:
Esophageal perforation
28
Bladder scan: normal and abnormal volumes
< 50mL left is normal; > 200mL left needs to be addressed
29
Bone loss increases in women around the time of ___.
Around the time of menopause, typically after age 50
30
Braden scale for pressure ulcers: what indicates high risk?
Less than 18 indicates high-risk
31
Break through dose needs to be:
10-20% of the total daily dose --- if more than 2 break through doses needed, increase the around the clock dose
32
BUN Ratio showing dehydration:
20:01
33
Burning pain should be treated with:
Amitriptyline (TCA)
34
C. diff is confirmed with:
stool C. diff toxin assay
35
Causes of contractures (6):
Spasticity, Heterotopic ossification, DJD, Fracture, Dislocation, Psychogenic
36
Cellulitis is caused by (2):
Group A Strep and Staph aureus
37
Clinical features of RA: 5
Ulnar deviation, MCP joints, Multiple joints, Symmetrical, Morning for no more than 30 mins
38
Clinical manifestation of infection:
Decline in mental/cognitive function
39
Clinically fever if (3 sx)
Temp is greater than 2 degrees above baseline, oral 99, rectal 99.5
40
Cognitive dysfunction is declared when the MMSE score is less than:
23
41
Contractures are:
A shortening of muscle, CT, tendons, ligaments, or skin; elastic tissue replaced with fibrous
42
Delirium characteristics:
Acute onset that "waxes and wanes"
43
Delirium is a disorder of:
Attention
44
Delirium is treated with what medication:
Haloperidol
45
Dementia medications (3)
Acetylcholinesterase inhibitors (Donepezil, Rivastigmine), NMDA receptor agonist (Memantine)
46
Dementia medications should be considered when the MMSE is:
24 or below
47
Dementia risk factors include (2)
Smoking and head injury
48
DeQuervain's thyroiditisis known to be:
Very painful and tender; Tx w/ bed rest and ASA
49
Diagnostic RA: 2
HLA-DR4 and other immune complexes
50
Distal interphalangeal joints contain what type of node?
Heberdon's Nodes
51
Diverticulosis is ____________ rectal bleeding.
Painless
52
Dose of calcium for men and women greater than 51yo?
1200mg/day
53
Drugs and EtOH cause what type of delirium?
Hypervigilant
54
Elder abuse is defined as:
Intentional or unintentional hurting, either physical or emotional, of a person who is 60+ or over 18 and incapacitated
55
EtOH and sleeping pills should be discontinued for at least:
6 weeks
56
Fecal impaction requires:
Manual disimpaction
57
Fever in the nursing home is defined as __.
SINGLE reading of 100 degrees F is specific and sensitive
58
Formula for calculating creatinine clearance:
((140-Age)*Wt in Kg)/ (72 *serum creatinine)
59
Forward movement of the body of one vertebra on the vertebra below:
Spondylolisthesis
60
Fractional excretion sodium percent for dehydration:
Less than 1%
61
Functional incontinence: 4
Functional or situational involving both urinary and fecal incontinence --- limited mobility, limited cognition ---- NOT organic cause
62
Ginkgo biloba drug interaction:
Increased bleeding, especially with warfarin
63
Ginseng hazard:
Bleeding with warfarin
64
Hashimoto radioactive iodine test would show:
Uptake may increase initially, because of trapping
65
Holistic management of arthritis: 4
Weight control, Water exercises, Address "food allergies," and Liver/CV4 for general detoxification
66
How do you differentiate contracture from hypertonicity?
Passive stretching
67
How is giant cell arteritis treated?
Immediate high dose of corticosteroids and then treat for 18-24 months while tapering dose
68
How is Polymyalgia rheumatica treated?
Low dose corticosteroids
69
How long does it take for skin erythema to occur?
Less than 2 hours on a standard mattress
70
How many weeks does it take to recover from delirium:
4-6 weeks
71
How would you treat diverticulosis without medications?
NPO
72
HVLA should be used with caution for those with: 2
Osteoporosis, RA
73
Hyperalgesia is:
Increased sensitivity to normally painful stimuli
74
Hyponatremia in the elderly is caused by:
A deceased thirst mechanism
75
Hypothyroidism is treated with:
Levothyroxine; start at 25mcg in older people, because it can cause heart failure
76
Hypoxia in joints with RA require ____ times more oxygen.
20
77
IBS subgroups (3):
Constipation predominant, Diarrhea predominant, Pain
78
Idiopathic Parkinson's disease starts with a ___________ tremor.
Unilateral
79
If an older patient cannot have a PRN prescription then:
Give long acting analgesics to control the pain.
80
If the thyroid levels get to low:
Myxedema Coma
81
IgG < 35mg/dl ( < 3 M protein) indicates __.
SMM
82
IgG greater than 35mg/dl (> 3 M protein) suggests dx of __.
MGUS
83
IgM protein greater than 3mg/mL with Lymphoplasma =
Waldenstrom's Macroblobulinemia
84
Infection is indicated by WBC count greater than _________ w/ or w/o fever, or (2):
14,000; (or bands greater than 6%; CBC greater than 1,500 cells)
85
JVP is measured:
with the vertical distance from the angle of Louis up
86
Kava hazard (2)
Dyskinesia, sedation
87
Less than 3 BMs a week are a sign of __.
Constipation
88
Lewy body dementia (3 characteristics)
Fluctuating, has visual hallucinations, and motor features similar to Parkinsonism
89
Lewy body dementia responds (poorly/well) to meds used in Parkinson's.
poorly
90
Lewy body disease is characterized by classical Parkinson's sx and:
prominent dementia with visual hallucinations
91
Light chain disease (Bence Jones) has a structural gene loss of:
Chromosome 14
92
Lower extremity facilitated segments:
T11-L2
93
MCA results in a:
Contralateral weakness/sensory loss in the FACE and ARM (sparing leg)
94
Medial compartment osteoarthritis of the knee may produce a:
Genu valgus deformity
95
Medications that can cause osteoporosis: (5)
Lithium, Long-term Heparin, Phenytoin, Prednisone, Warfarin
96
Medications that can cause Parkinsonism:
Metoclopramide (antagonize dopamine),
97
Medications that cause constipation (5). Which is most impt?
Laxative abuse, opioids, antidepressants, anticonvulsants, Cholestyramine
98
Medications that cause hypothyroidism are: (2)
Lithium and Amiodarone
99
Medications to treat Constipation (5):
Bulk forming, Emollient stool softeners, Osmotic Lax, Lubricant Lax, Stimulant Lax
100
MM Stage I:
Hemoglobin > 10, Calcium< 12, Radiograph w/ normal bone; Low M protein values (IgG < 5, IgA < 3, Bence Jones < 4)
101
MM Stage III:
Hemoglobin < 8.5, Calcium > 12, Radiograph advanced lytic bone, High M protein (IgG > 7, IgA > 5, Bence Jones > 12)
102
Most common cause of hypothyroidism: (2)
Hashimoto's; anti-TPO antibodies
103
Most effective therapy for contractures:
Manual stretching exercises
104
Multiple Myeloma MAJOR criteria (2, need 1):
30% of cells are plasma cells, monoclonal immunoglobin excess
105
Multiple Myeloma MINOR criteria (4, need 3):
b/w 10-20% cells plasma cells, monoclonal found but not enough, Holes in bone, amount of normal antibody in the blood is abnormally low
106
Neuropathic pain should be treated with: (3)
Anticonvulsants (gabapentin, carbamazepine, Valproic Acid)
107
Neurotransmitters of pain: (3)
Serotonin, NE, and Nitrous oxide
108
New onset bleeding should be considered __ until proven otherwise.
colon cancer
109
No bone pathology or renal impairment w/ globulin levels > 3.5:
MGUS
110
Non-pharm dementia treatment options (6)
Daily routine, Patience, Interaction, Performing simple tasks, Environment, Advanced directives
111
Non-pharmacological management of delirium (6):
Reorientation, Behavioral intervention, Sitters, avoid restraints, Well-lit room, avoid overstimulation
112
Normal stool frequency:
3 to 4 per day through one every 3 to 4 days
113
Norton scale for pressure ulcers: what indicates high risk?
Less than 14 indicates high-risk
114
Often times it is difficult to assess urinary incontinence because:
Patients do not often mention it on their own
115
OMM treatment on arthritis: 6
Shorten disability, Increase ROM, Decrease pain, Improve ADLs, Reduce reliance on medications, Improve postural proficiency
116
Onset and progression of vascular dementia?
abrupt and stepwise
117
Opioid constipation reversal medication:
Methylnaltrexone
118
Opioid conversion is done by converting everything to:
Oral morphine and translating that to a new dose and/or route
119
Opioids need to be monitored for:
Sedation which precedes Respiratory depression
120
Osteoarthritis is a disease which primarily affects __.
cartilage primarily
121
Osteoarthritis pathophysiology: 2
Attacks cartilage and chondrocytes cannot replace; bone hypertrophy
122
Osteoblasts _______ bone.
build
123
Osteoclasts ______ bone.
Resorb
124
Osteocyte precursor cytokine:
IL-6
125
Osteopathic principles on arthritis:
Reduce side effects of meds and enhance function
126
Osteoporosis risk factors for women (5):
Early menopause, white/asian, sedentary, small frame, EtOH abuse,
127
Overflow incontinence is most common in:
Men, secondary to prostate enlargement
128
Overflow incontinence: 2
Dribbling from incomplete bladder emptying; BPH in older men
129
Parasympathetic response on the urinary system: (3)
Voiding; bladder contraction and sphincter relaxation
130
Parkinson's Is caused by:
a degeneration of pigmented dopaminergic neurons in the substantia nigra
131
Patients over 65 take how many meds?
2-6 medications with several OTC
132
Pharmacodynamics interactions:
Altered physio response to a second drug w/o altering the drug concentration. Ex.) EtOH/NSAID = GI bleed; Insulin/Beta blocker = hypoglycemia
133
Pharmacokinetic interactions:
One drug alters the concentration of another drug by changing the metabolism. Ex.) Warfarin/paroxetine = ^INR
134
Physical findings and labs for hypothyroidism would show (4):
Hyporeflexes, High cholesterol, Positive Tinels, and Slow speech
135
Pneumonia if two conditions are met:
Respiratory rate is greater than 25 and Pulse ox is less than 90
136
Pneumovax should be given at what age if haven't received in last __ years.
All persons over 65 who have not received the vaccine in the last 5 years should receive another dose
137
Polymyalgia rheumatica (PMR) is defined as:
Pain and stiffness in the hip or shoulder
138
Polymyalgia rheumatica pathogenesis:
Immune destruction of internal elastic lamina by systemic monocyte activation
139
Polypharmacy is a growing problem because (4 reasons):
Physicians encouraged to give more aggressive tx, Multiple new drug tx for chronic conditions, New preventative treatments, Growth of alternative treatments
140
Polypharmacy is defined as the:
use of greater than 5 medications, which increases the risk of adverse events by 50%
141
Postural instability is:
a late manifestation that is characterized by a greater degree of bradykinesia and muscle rigidity
142
Pressure ulcers w/ poor healing: next test?
Obtain culture of purulent drainage or deep infected tissue
143
Pt has an externally rotated and short lower extremity:
Suspect a right hip fracture
144
Pt on Warfarin had an elevated INR:
Patient took a drug that interacted; perhaps acetaminophen
145
Pt's WBC is zero on high power field spun urine allows exclusion of __.
Exclude bacteriuria
146
Pushing the arm "in and out" exams the:
Rotator cuff
147
Pushing the arm "up and down" exams the:
Supraspinatus
148
Red flags for constipation (5):
Bleeding, Fever, Wt loss, Persistent severe pain, Malnutrition
149
Red flags for someone w/ suspected multiple myeloma: (6)
Age over 50; worse supine, worse at night, band-like, pain not relieved, constitutional sx
150
Rheumatoid Arthritis Medication treatment: 3
DMARDs, TNF-alpha blockers, NSAIDs
151
Rheumatoid Arthritis OMM treatment:6
Sympathetics, Lymphatics, Passive ROM, Joint pumps, Liver pump, CV4, Indirect techniques
152
Rheumatoid arthritis pathophysiology: 3
Synovium is targeted, infiltrated by mononuclear cells; bone breakdown
153
Rotator cuff movements for SItS:
Up, Out, Out, In
154
Selegiline is a:
MAO-I that helps slow the breakdown of dopamine. AVOID TYRAMINE rich foods.
155
Serial casting is:
Anesthetic block w/ stretching; Progressive casting to increase ROM from contractures
156
Shy-Drager Syndrome:
Symptoms of generalized autonomic dysfunction in addition to Parkinsonism
157
SSRIs may induce what metabolic change, esp if taken with __.
Hyponatremia, especially if given with a diuretic
158
Stage I HTN:
Systolic: 140-159; Diastolic: 90-99
159
Stage I pressure ulcer: change in (3), also __.
Change in skin temp, consistency, and/or sensation; nonblanching erythema
160
Stage II pressure ulcer: 3
Partial thickness skin loss involving the epidermis and/or dermis; blister, abrasion
161
Stage III pressure ulcer: (2)
Full thickness skin loss involving damage or necrosis; deep crater w/o damaging underlying tissue
162
Stage IV pressure ulcer:
Full thickness skin loss w/ extensive destruction; damage extending to muscle, bone, etc
163
Stress incontinence: 3
Leakage from impaired urethral support; multiparous, overweight women
164
Suspect C. diff if (2 sx):
exposed to abx in previous 30 days and 3+ water stools w/ abdominal pain
165
Sympathetic response on the urinary system: (3)
Distention for storage; relaxation of bladder and constriction of sphincter
166
The best way to treat contractures is with:
PREVENTION! --- move muscles and joints through full ROM on a daily basis
167
The four cardinal signs of Parkinson's disease are:
Bradykinesia, postural instability, muscular rigidity, tremor
168
The greatest risk factor for osteoarthritis is:
Age
169
The knee joint is effected by osteoarthritis the most from:
Obesity
170
The mesenteric release is a(n) ________ OMM technique.
Indirect
171
The most common cause of dementia in people over 65:
Alzheimer's
172
The most common sign of a contracture is:
Decreased ROM
173
The most common site of atherosclerosis is:
at the common carotid bifurcation (origin of the ICA)
174
The most common type of focal ischemic stroke is:
MCA
175
The most important part of osteoporosis treatment is:
Diagnosis
176
The neurotransmitter involved with delirium:
ACh
177
The strokes of small vessels are:
Lacunar --- 20% of strokes
178
The thyroid is __________ in Hashimoto's.
enlarged
179
TIA is when neurologic symptoms last:
Less than 24 hours
180
Tramadol will adversely interact with what commonly used drug?
SSRI's, causing serotonin syndrome
181
Transient urinary incontinence -- "Diappers:"
Delirium, Infection, Atrophic urethritis, Pharm, Psych, Excessive fluid output, Restrictive mobility, Stool impaction
182
Two most common symptoms of dehydration in the elderly:
Acute weight loss and hyponatremia
183
Tx of subclinical hypothyroidism:
Antibody present, TSH is greater than 10mg/mL, Symptoms
184
Uncomplicated inpatient diverticulitis treatment (3):
NPO, IV fluids, ABX
185
Upper extremity facilitated segments:
T2-T8
186
Urge incontinence: 3
Uninhibited bladder contractions or detrusor overactivity; most common cause of incontinence in older men
187
Urinalysis needed for:
Residents with long-term indwelling urethral catheters
188
Urine sodium concentration for dehydration:
Less than 25mEQ/L
189
What are the 3 major types of urinary incontinence?
Urge, Stress, Overflow
190
What are the different types of elder abuse (6):
Physical/verbal, Psychological/emotional, Neglect/abandonment, Sexual, Financial exploitation, and Healthcare fraud
191
What are the medications used to treat diverticulitis? (3)
Cipro and Metro; Alt: Piperacillin-tazabactam
192
What are TSH and T3/4 levels in hypothyroidism?
TSH is high; T3/4 would be low
193
What disease is associated with a "M spike?"
Multiple Myeloma
194
What drug can be used as a adjunct to Levodopa to reduce metabolism:
Tolcapone, a COMT-I
195
What drugs can cause dementia? (4, and which is most impt?)
Anticholinergics, Narcotics, Sedatives, Metoclopramide
196
What has a NNT of 7 for treating osteoporosis hip fractures?
Hip pads
197
What imaging modality is most effective?
CT without contrast to rule out hemorrhage
198
What is a contraindication to thrombolytic? (4)
a systolic BP greater than 185 or a diastolic greater than 110; bleeding; head trauma
199
What is something that is NOT associated with normal aging?
Hypothalamic satiety becomes less sensitive, resulting in anorexia ---- it actually becomes HYPERSENSITIVE
200
What is the best "treatment" for pressure ulcers?
PREVENTION
201
What is the best way to prevent diverticular disease?
High fiber diet
202
What is the diagnostic test of choice for diverticulosis?
CT with contrast, BUT if perforation NO BARIUM
203
What is the first thing ordered when working up suspected osteoporosis?
Plain frontal and lateral radiographs of spine
204
What is the highest risk factor for stroke?
HTN
205
What is the major complication of giant cell arteritis?
Blindness can develop from involvement of the ocular arteries
206
What is the t-score of a woman dx w/ osteoporosis?
T is less than -2.5
207
What medication reduces risk of future stroke by 30%?
Antiplatelet tx w/ Aspirin
208
What nonstandard lab should be taken in a patient with dementia?
Methylmalonic acid --- B12 precursor
209
What part of the colon is most likely to bleed?
Right side
210
What part of the colon is most often found to have diverticula?
Sigmoid colon
211
What percentage of people over 85 have dementia?
25%
212
What protein intake is necessary to help prevent pressure ulcers?
1g/kg/day in all pts with pressure ulcers
213
What should someone with pressure ulcers avoid?
Topical antiseptics such as povidon-iodine or hydrogen peroxide
214
What sx are common with Polymyalgia rheumatica? (5, with 1 most impt)
Fever is most common; also decreased ROM, pain, transient synovitis, normal muscle strength
215
What tests indicate Polymyalgia rheumatica is present?
ESR > 40; CRP > 6
216
What time of day do stroke onsets peak?
Late morning
217
What time of day is Polymyalgia rheumatica worse?
Morning hours
218
What timeframe provides the greatest success to RA treatment?
Start treating BEFORE 8 weeks
219
What values may be increased with Polymyalgia rheumatica? (4)
HLA-DR4, IL-2, IL-6, CRP
220
When should you order a follow up CT?
at 24 hours
221
When would you use a Z-score for osteoporosis? (3)
Premenopausal women, men under 50, and children
222
Which Stage has worse outcomes: A or B?
Stage B has worse outcomes, because kidney problems!
223
Who are mandated to report elder abuse? (3)
Physicians, Nurses, Social workers
224
Who first described "Total pain?"
Dame Cicely Saunders --- Physical, Psychological, Emotional, Social, Spiritual
225
Who is likely to suffer from polymyalgia rheumatica?
White women >50 yoa
226
WHO Step 1 analgesics: (3)
APAP, NSAIDs, Tramadol
227
WHO Step 2 analgesics:
APAP combined with hydrocodone, codeine, and oxycodone --- ultimately APAP dependent
228
WHO Step 3 analgesics: (5)
Morphine, oxycodone, fentanyl, hydromorphone, and methadone --- no ceiling dose
229
Why is lymphatic drainage important in arthritis?
To remove the waste products from the synovium and joint area, reducing congestion and proteins that would promote further fibrosis and inflammation
230
Why is the onset of symptoms important?
If less than 3 hours, then thrombolytic are an option
