Geriatrics

Question 1

Who are the geriatric patients?

Answer 1

Anyone 65 y/o or older

Question 2

How is geriatric medicine different?

Answer 2

Older patient
Understanding of the aging process
Multidisciplinary
End of Life care

Question 3

What is aging?

Answer 3

(Time Dependent Deterioration)
Weakness 
Increased susceptibility to disease and adverse environmental conditions 
Loss of mobility and agility 
Age-related physiologic changes

Question 4

Changes associated with aging are often a result of what?

Answer 4

Gradual loss of homeostatic mechanisms

Question 5

When do loss of homeostatic mechanisms begin?

Answer 5

In early adulthood, but don’t become evident until they are fairly extensive

Question 6

Functional performance of an organ in an older person depends on 2 things, what are they?

Answer 6

Rate of deterioration

Level of performance needed

Question 7

Overall, what is the hallmark of aging associated with?

Answer 7

How an organ performs during external stress (NOT at rest)

Question 8

Atypical presentations in older persons are due to what? What are some examples?

Answer 8

Failure of stress response

Examples include: Unable to mount white count or fever in response to infection OR no pain with MI

Question 9

What are some ill-defined symptoms that take the place of typical symptoms?

Answer 9

Confusion
Change in Endurance
Loss of Appetite
Nausea

Question 10

What is an example of changes in aging working together to produce normal appearing resting state?

Answer 10

Normal serum creatinine despite decreasing GFR and renal blood flow (this is due to a concomitant decrease in lean muscle mass and therefore creatinine production)

Question 11

When and how should Vital Signs be measured?

Answer 11

Weight at each visit
Height annually (osteoporosis)
Temperature
Pulses/BP in both arms for 30 seconds (checks for orthostatic hypotension)
Respiratory Rate (normal in elderly can be as high as 25 bpm, greater than this can be first sign of lower respiratory tract infection)

Question 12

Why is BP overestimated in elderly?

Answer 12

Due to stiff arteries causing pseudohypertension

Question 13

Changes in skin include?

Answer 13

Wrinkles, skin becomes lax and loses turgor
Vascularity in dermis decreases (paler and more opaque looking)
Backs of hands and forearms become thin, fragile, loose and transparent with actinic purpura
Onion skin

Question 14

Changes in nails include?

Answer 14

Lose Luster
may become yellow and thicken (especially toes)
Brittle

Question 15

Changes in hair?

Answer 15

Series of changes
Scalp hair loses pigmentation
Hair loss on scalp is usually genetic (men as young as 20 may have hairline recession at temples, hair loss at vertex follows)
Hair decreases in both genders as we age
Women at 55 y/o will notice coarse hairs on upper lip and chin

Question 16

Changes in Face?

Answer 16

Eyebrows tend to drop below superior orbital rim
Chin descends
Loss of angle between submandibular line and neck
Wrinkles
Dry skin
Thick terminal hairs on ears, nose, upper lip and chin

Question 17

Which artery needs to be palpated for tenderness/thickening and why?

Answer 17

Temporal arteries. To see if they have temporal arteritis (giant cell arteritis)

Question 18

When does visual acuity gradually start to decline?

Answer 18

After 50 y/o and more rapidly after 70 y/o

Question 19

What is presbyopia?

Answer 19

Loss/impairment/blurring of near vision associated with aging

Question 20

Cataracts affects how many people in their 60’s and how many in their 80’s?

Answer 20

1 in 10 in their 60’s

1 in 3 in their 80’s

Question 21

Why do older people require more light to see?

Answer 21

Due to thickening and yellowing of lens, which impedes the light flow to the retina

Question 22

Why does narrow-angle glaucoma occur in older patients?

Answer 22

Because the lens continues to thicken over the years, it pushes the iris forward and further narrow the angle between the iris and cornea

Question 23

Changes in the nose?

Answer 23

Progressive descent of nasal tip

Enlarging and lengthening of the nose may happen due to cartilage separation

Question 24

What is presbycusis?

Answer 24

Loss of high pitched sound associated with aging with little functional changes

Question 25

Angular chelitis in edentulous patients are usually due to what?

Answer 25

Fungal infections

Question 26

Smooth painful tongue in older patients may be due to what?

Answer 26

Vitamin B12 deficiency

Question 27

If an older patient has TMJ what should you be concerned with?

Answer 27

Degenerative osteoarthritis

Question 28

In older patients, the thyroid gland enlarges and extends where?

Answer 28

It enlarges downward into the sternum (and can go unnoticed)

Question 29

Why is there a displacement of the apical impulse in older patients?

Answer 29

Due to kyphoscoliosis

Question 30

What condition intensifies with valsalva maneuvers?

Answer 30

Hypertrophic cardiomyopathy