Geriatrics Flashcards
1
Q
Increased hormones in elderly
A
NE
insulin
PTH
vasopressin
2
Q
Decreased hormones in elderly
A
Thyroid
Adrenal CSs
3
Q
Indicators of failure to thrive in elderly
A
Malnutrition
Physical impairment
Cognitive impairment
Depression
4
Q
FTT inv in elderly
A
Limited lab/radiology MMSE, ADL, IADL scales Up and go test Geriatric depression scale Nutritional assessment Medication review Chronic disease evaluation Environmental assessment
5
Q
ADLs
A
Ambulating Bathing Continence Dressing Eating Transferring Toileting
6
Q
IDALs
A
Shopping Housework Accountin/managing finances Preparing food Transportation Telephone Taking medications
7
Q
DDx of cognitive impairment in elderly
A
Delirium
Dementia
Pseudodementia of depression
8
Q
Prevention of delirium in elderly
A
Ensure optimal vision and hearing Adequate nutrition and hydration Regular mobilization Avoid unnecessary medication Monitor for drug interactions Avoid bladder catheterization if possible Adequate sleep
9
Q
Transient causes of incontinence
A
Delirium Infection Atrophic urethritis/vaginitis Pharmaceuticals Excessive urine output Restricted mobility Stool impaction
10
Q
Fall assessment
A
Comprehensive geriatric assessment Labs, as directed by Hx, PEx: CBC Lytes BUN, Cr Glucose Ca TSH B12 U/A Cardiac enzymes ECG CT head
11
Q
Medications with most impact on falling
A
Antidepressants
Antipsychotics
Benzodiazepines
12
Q
In no Hx of fall during the past year
A
Assessment of gait and balance
13
Q
If single fall during past year
A
Gait and balance test
14
Q
If Hx of recurrent falls
A
1-focused Hx 2- PEx 3- environmental assessment 4- functional assessment 5- interventions based on findings
15
Q
Major predictors of outcome
A
sBP
Pulse pressure
16
Q
Initiation of pharmacotherapy for age 60 or higher
A
150/90
If comorbid diabetes: 140/90
17
Q
1st line of pharmaco in elderly
A
Diuretics
Add BB if angina or CHF
Add ACEI/ARB if atherosclerosis, DM, CHF, CKD
18
Q
Mamalnutrition definition
A
Involuntary wt loss Hypoalbuminemia Hypocholestrolemia Insufficient energy intake Loss of muscle mass Fluid accumulation Loss of subcutaneous fat Decreased hand grip function
19
Q
Sign that should raise concern about malnutrition
A
BMI <22 in women
BMI <23.5 in men
Temporal wasting
Triceps skin fold
20
Q
Sign that should raise concern about malnutrition
A
BMI <22 in women
BMI <23.5 in men
Temporal wasting
Triceps skin fold
21
Q
Malnutrition W/U in elderly
A
CBC, ESR, Lytes, Ca, Mg, PO4, TSH, LFT (INR, Alb, bilirubin), Cr, U/A, B12, folate, transferrin, lipid profile, CXR
22
Q
Tx of malnutrition
A
Underlying High calorie intake Supplementation Food/drink thickeners Vitamins/minerals: B12, Ca, VitD Speech/language pathologist Nutritionist
23
Q
Tx of constipation
A
Fibre intake
Fluid intake
Discourage chronic laxative use
24
Q
Constipation definitiin
A
<3 bowel movements in a week / hard stool
At least 12 wk ( does not need to be consecutive)
Symptoms must have occured in the last 3 mo
Symptom onset more than 6 mo before Dx
25
1st step in costipation
Is there fecal impaction?
26
If fecal impaction present
Manual disimpaction
Enemas
Suppositories
Bowel regimen to prevent recure
27
If no fecal impaction
```
Remove costipating medications
Fluid
Activity/exercise
Fiber intake (20-30 g/d)
Timed toilet training
```
28
If no response to 1st line
```
Milk of Magnesia
Lactulose
Peh/Lyte
Senna compounds
Bisacodyl
```
No respose, High dose PEG
No responwe, lubiprotone, biofeedback, alvimopan, methylnaltrexone
29
Supplements causing constipation
Iron
| Ca
30
Stool incontinence inv
```
If cause not apparent
Is it true incontinence/frequency/urgency?
Stool studies
Endorectal U/S
Colonoscopy
Sigmoidoscopy
Anoscopy
Anorectal manometry/functional testing
```
31
Mx of fecale incontinence due to physiological changes with age:
```
Loperamide,
Diet/bulking agents for loose stool,
Increase fluid intake
Biofeedback
Retraining of pelvic floor muscles
Surgery
```
32
neurogenic fecal incontinence Mx
```
Medication
Abdominal massage
Digital stimulation
Biofeedback
Behavioural training
Prevent autonomic dysreflexia
```
33
Mx of fecal incontinence due to cognitive problem
Regular defecation program
| Psychiatric consult
34
Meds causing pressure ulcer
Antihypertensives
35
Prevention of pressure ulcer
Frequent repositioning
Pressure reducing devices
Nutrition
Managing incontinence
36
Stages of pressure ulcer
1, persistent erythema
2, partial thickness (epiderm, derm)
3, full thickness (hypoderm)
4,full thickness (damage to muscle, bone, supporting structures)
37
Tx of pressure ulcer
Optimize nutritional status
Minimize pressure on wound
Analgesia
Debridement if necrosis ( mechanical, enzymatic, autolytic)
Sharp debridement urgently if risk of sepsis/cellulitis
Dressing (to absorb exudate, barrier against friction)
Maintain moist wound environment
Tx infection (topical genta, silver, mupirocin)
Bx chronic wounds
Refer to wound care
If diabetic: cast walker, orthopedic shoes, orthotics for offloading
38
Red flags for elder abuse
Delay in seeking medical attention
Disparity in histories
Implausible or vague explanations
Frequent emergency room visits for exacerbations of chronic disease
Presentation of functionally impaired pt without designated caregiver
Lab findings inconsistent with Hx
Bruising
Broken bones
Injuries
Suspicious changes in accounts: POA, wills
Deserted in public place
39
Mx of elderly abuse
Interview pt alone
Assess safety
Determine capacity to make decisions about living arrangements
Establish need for hospitalization or alternate accommodation
Involve multidisciplinary team
Educate and assisst caregiver
40
Immunizations for people 65 and older
Td q 10 y
Pneumococcal vaccine
-if no previous vaccination, PCV13, then PPSV23 the followimg year
-if previously received PCV, no 2nd dose.
Influenza, every autumn
Zoster: one time dose
41
Elder abuse signs
```
Poor eye contact
Withdrawn nature
Malnourishment
Hygiene issues
Cuts
Bruises
Inappropriate clothing
Medication compliance issues
```
42
Functional approach to driving
Unimpaired vision
Adequate cognition
Ability to maintain consciousness
Physical mobility
43
Driving with
Hx of impaired driving with alcohol,
High probability of future impaired driving
Should not drive
44
Driving with Alcohol dependence/abuse
Advise not to drive
45
Alcohol withdrawal seizure
Must complete rehabilitation program
| Must remain abstinent and seizure-free for 6 mo
46
Driving with HTN
If sustained BP>170/110, evaluated carefully
47
Driving with hypotension
If sustained BP<90/60, if syncopal, discontinue driving until treated
48
Asymptomatic CAD
No restriction
49
Stable angina
No restriction
50
STEMI
No driving for 1 mo following discharge
51
NSTEMI with significant LV damage
No driving for 1 mo following discharge
52
CABG
No driving for 1 mo following discharge
53
NSTEMI with minor LV damage
No driving for 48h if PCI, 7d if no PCI
54
Unstable angina
No driving for 48h if PCI, 7d if no PCI
55
TIA
should not allow driving until complete assessment
56
Stroke
Should not drive for at least 1 mo
57
Mild-mod COPD
No restrictions
58
COPD requiring O2 supplementation
Road test with supplemental O2
59
Mod-sev dementia
Contraindication
Inability to perform 2 or more IADL or any ADL
60
Mild dementia
Assess
Specialized driving testing centre
If deemed fit to drive, re-evaluate q 6-12 mo
If poor performance on MMSE, clock drawing, Trail B, investigate more
61
DM controlled with diet/OHA
No restrictions
62
DM on insulin
Drive if no severe hypoglycemic episode in the last 6 mo
63
Hearing problem
```
If
Acute labyrinthitis
Positional vertigo with horizontal head movements
Recurrent vertigo
Advise not to drive until resolved
```
64
Musculoskeletal disorders
Report etiology, prognosis, extent of disability
65
Post operative, conscious sedation
No driving for 24 h
66
Post operative, general anesthesia
No driving for >24 h
67
First sigle unprovoked seizure
No driving for 3 mo until complete neurological assessment
68
Epilepsy
Can drive if seizure-free on meds
69
Sleep disorder
If believed to be at risk, but refuses investigation with a sleep study or appropriate treatment, should not drive
70
Visual acuity for driving
Contraindicated if <20/50 (both eyes examined simultaneously)
71
Visual field for driving
Contraindication: <120° along horizontal meridian, 15° above and bellow fixation with both eyes examined simultaneously
72
Depression Tx as an end-of life symptoms
Psychostimulants:
Methylphenidate
Ketamin
73
Hiccups in end-of-life setting
```
Dry sugar
Breading in paper bag
Chlorpromazine
Haloperidol
Metoclopramide
Baclofen
Marijuana
```
74
Increased sensitivity to these drugs:
```
Warfarin
Digoxin
Sedatives
Antipsychotics
Narcotics
```
75
Decreased sensitivity to
BB
76
Benzodiazepine of choice in the elderly
LOT
Lorazepam
Oxazepam
Temazepam
