Geriatrics

Question 1

What 7 things to consider as part of a geriatric assessment?

Answer 1

Meds
Functional ability
Fall risk vision
Cognitive and mental health
Vaccinations
Other physical health
Social support

Question 2

indications for a geriatric assessment include age and what 7 things?

Answer 2

Chronic comorbididies
Chronic mental health problems
Cognitive changes
Goes to the doc a lot
Change in living that might lead to fall
Uses multiple pharmacy
Change in overall health

Question 3

What is the best approach to help a geriatric patient?

Answer 3

Team approach

Question 4

What is a major concern with meds and elderly patients? 2 main ideas here?

Answer 4

One because they take so many meds, older people generally cannot tolerate all the adverse effects as well so that will lead to problems.
Second, older people are seeing many more doctors and using different pharmacies and there is not good med management so drug to drug adverse effects is a big deal.

Question 5

What are the 2 drug to drug interactions to know?

Answer 5

Ginkgo can increase bleeding

St John Warts can cause crazy high levels of serotonin when taking a SSRI

Question 6

3 things to consider with the metabolism of drugs in older patients?

Answer 6

Reduced hepatic blood flow
Reduced kidney blood flow
Many older patients have some degree of chronic kidney disease

Question 7

What are the three categories of the beers criteria?

Answer 7

Meds to always avoid in older people
Meds that are inappropriate for older patients with certain medical conditions
Meds used with caution

Question 8

What is the stopp criteria for prescribing meds to older patients?

Answer 8

Similar to beers but included drug to drug interaction and duplication of drugs within classes
Screening tool of older persons prescriptions

Question 9

What is the START criteria for prescribing meds?

Answer 9

Screening tool to alert docs to the right treatment

22 evidence based prescribing indicators for older patients

Question 10

What is the general idea of medication assessment for an older patient?

Answer 10

Have them bring in everything they are taking, prescribed, OTC supplements, everything and discuss it all.

Question 11

What are we talking about when we say functional ability of an older person?

Answer 11

How is there ability to perform activities of daily living

Question 12

What are the two useful scales to use for testing functional ability?

Answer 12

Katz independence index and Lawton

Question 13

4 common pathologies for visions for the elderly?

Answer 13

Glaucoma
MD
Cataracts
diabetic retinopathy

Question 14

What two vision conditions to refer to eye doc?

Answer 14

Diabetic retinopathy and risk of glaucoma

Question 15

2 tests/evaluations to use for fall risk assessment?

Answer 15

Tinneti balance and gait

Get up and go test

Question 16

What are some things we can do during the physical exam to test for cognition?

Answer 16

Mental status
Cranial nerves
Gait and balance
Strength 
Sensation
Reflexes

Question 17

2 screening tools for cognition?

Answer 17

Mini mental exam and MOCA

Question 18

How can we best screen for depression in the elderly?

Answer 18

Use the two question method first.
In the past month have you been bothered by feeling down
In the past month have you been bothered by having little interest in doing anything
If either are yes go with the PHQ9 questionnaire

Question 19

What is the most common hearing condition in the elderly?

Answer 19

Age related sensorineural hearing loss

Question 20

2 clinical signs of old people having hearing loss?

Answer 20

Hearing loss with ringing in the ears

Vertigo/off balance

Question 21

2 things we can do on physical exam for hearing and 1 treatment?

Answer 21

Look in the ears, whisper test

Hearing aids

Question 22

3 things to assess for incontinence?

Answer 22

History
PE
Postvoid residual volume, stress test

Question 23

3 ways to treat stress incontinence? 4 ways to treat urge? 2 ways to treat overflow?

Answer 23

Fluid restrictions, strengthen pelvic floor, anticholinergic
Fluid restrictions, pelvic floor, pessary, and alpha agonist
Indwelling catheter and alpha antagonist

Question 24

What are the two recommendations the USPSTF gives for screening or osteoporosis?

Answer 24

DEXAMETHASONE scan on women 65 and older

Screen women younger than 65 whose 10 year fracture risk is high (use Frax fracture risk assessment tool).

Question 25

3 things to treat/manage osteoporosis?

Answer 25

Lifestyle modifications
Bisphosphonate therapy
Hormone therapy

Question 26

What year to stop colonoscopy, Pap smear, and mammogram?

Answer 26

75
65
65

Question 27

Patients 65 and older need to be up to date on the following 4 vaccines?

Answer 27

Tetanus
Flu
Pneumococcal
Herpes zoster

Question 28

How do we calculate maintenance fluid for a patient?

Answer 28

4 ml for 1-10kg + 2 ml for 11-30 kg + 1 ml for every kg after 30
This is ml/hr

Question 29

What is the equation to calculate body water deficit?

Answer 29

(Patient sodium -140) * (.6 x weight in kg)
All over 140
This will be liters