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Med > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

Increased hormones in elderly

A

NE
insulin
PTH
vasopressin

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2
Q

Decreased hormones in elderly

A

Thyroid

Adrenal CSs

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3
Q

Indicators of failure to thrive in elderly

A

Malnutrition
Physical impairment
Cognitive impairment
Depression

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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
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5
Q

ADLs

A 
Ambulating
Bathing
Continence
Dressing
Eating
Transferring
Toileting
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6
Q

IDALs

A 
Shopping
Housework
Accountin/managing finances
Preparing food
Transportation
Telephone 
Taking medications
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7
Q

DDx of cognitive impairment in elderly

A

Delirium
Dementia
Pseudodementia of depression

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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
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9
Q

Transient causes of incontinence

A 
Delirium 
Infection 
Atrophic urethritis/vaginitis
Pharmaceuticals
Excessive urine output 
Restricted mobility 
Stool impaction
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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
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11
Q

Medications with most impact on falling

A

Antidepressants
Antipsychotics
Benzodiazepines

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12
Q

In no Hx of fall during the past year

A

Assessment of gait and balance

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13
Q

If single fall during past year

A

Gait and balance test

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14
Q

If Hx of recurrent falls

A 
1-focused Hx
2- PEx
3- environmental assessment 
4- functional assessment 
5- interventions based on findings
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15
Q

Major predictors of outcome

A

sBP

Pulse pressure

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16
Q

Initiation of pharmacotherapy for age 60 or higher

A

150/90

If comorbid diabetes: 140/90

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17
Q

1st line of pharmaco in elderly

A

Diuretics

Add BB if angina or CHF
Add ACEI/ARB if atherosclerosis, DM, CHF, CKD

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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
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19
Q

Sign that should raise concern about malnutrition

A

BMI <22 in women
BMI <23.5 in men
Temporal wasting
Triceps skin fold

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20
Q

Sign that should raise concern about malnutrition

A

BMI <22 in women
BMI <23.5 in men
Temporal wasting
Triceps skin fold

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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

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22
Q

Tx of malnutrition

A 
Underlying
High calorie intake
Supplementation 
Food/drink thickeners
Vitamins/minerals: B12, Ca, VitD
Speech/language pathologist
Nutritionist
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23
Q

Tx of constipation

A

Fibre intake
Fluid intake
Discourage chronic laxative use

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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

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25
Q

1st step in costipation

A

Is there fecal impaction?

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26
Q

If fecal impaction present

A

Manual disimpaction
Enemas
Suppositories
Bowel regimen to prevent recure

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27
Q

If no fecal impaction

A 
Remove costipating medications
Fluid
Activity/exercise
Fiber intake (20-30 g/d)
Timed toilet training
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28
Q

If no response to 1st line

A 
Milk of Magnesia
Lactulose
Peh/Lyte
Senna compounds
Bisacodyl

No respose, High dose PEG

No responwe, lubiprotone, biofeedback, alvimopan, methylnaltrexone

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29
Q

Supplements causing constipation

A

Iron

Ca

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30
Q

Stool incontinence inv

A 
If cause not apparent 
Is it true incontinence/frequency/urgency?
Stool studies
Endorectal U/S
Colonoscopy
Sigmoidoscopy 
Anoscopy
Anorectal manometry/functional testing
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31
Q

Mx of fecale incontinence due to physiological changes with age:

A 
Loperamide, 
Diet/bulking agents for loose stool, 
Increase fluid intake
Biofeedback
Retraining of pelvic floor muscles
Surgery
32
Q

neurogenic fecal incontinence Mx

A 
Medication
Abdominal massage 
Digital stimulation 
Biofeedback 
Behavioural training 
Prevent autonomic dysreflexia
33
Q

Mx of fecal incontinence due to cognitive problem

A

Regular defecation program

Psychiatric consult

34
Q

Meds causing pressure ulcer

A

Antihypertensives

35
Q

Prevention of pressure ulcer

A

Frequent repositioning
Pressure reducing devices
Nutrition
Managing incontinence

36
Q

Stages of pressure ulcer

A

1, persistent erythema
2, partial thickness (epiderm, derm)
3, full thickness (hypoderm)
4,full thickness (damage to muscle, bone, supporting structures)

37
Q

Tx of pressure ulcer

A

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
Q

Red flags for elder abuse

A

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
Q

Mx of elderly abuse

A

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
Q

Immunizations for people 65 and older

A

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
Q

Elder abuse signs

A 
Poor eye contact
Withdrawn nature
Malnourishment
Hygiene issues 
Cuts
Bruises
Inappropriate clothing
Medication compliance issues
42
Q

Functional approach to driving

A

Unimpaired vision
Adequate cognition
Ability to maintain consciousness
Physical mobility

43
Q

Driving with
Hx of impaired driving with alcohol,
High probability of future impaired driving

A

Should not drive

44
Q

Driving with Alcohol dependence/abuse

A

Advise not to drive

45
Q

Alcohol withdrawal seizure

A

Must complete rehabilitation program

Must remain abstinent and seizure-free for 6 mo

46
Q

Driving with HTN

A

If sustained BP>170/110, evaluated carefully

47
Q

Driving with hypotension

A

If sustained BP<90/60, if syncopal, discontinue driving until treated

48
Q

Asymptomatic CAD

A

No restriction

49
Q

Stable angina

A

No restriction

50
Q

STEMI

A

No driving for 1 mo following discharge

51
Q

NSTEMI with significant LV damage

A

No driving for 1 mo following discharge

52
Q

CABG

A

No driving for 1 mo following discharge

53
Q

NSTEMI with minor LV damage

A

No driving for 48h if PCI, 7d if no PCI

54
Q

Unstable angina

A

No driving for 48h if PCI, 7d if no PCI

55
Q

TIA

A

should not allow driving until complete assessment

56
Q

Stroke

A

Should not drive for at least 1 mo

57
Q

Mild-mod COPD

A

No restrictions

58
Q

COPD requiring O2 supplementation

A

Road test with supplemental O2

59
Q

Mod-sev dementia

A

Contraindication

Inability to perform 2 or more IADL or any ADL

60
Q

Mild dementia

A

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
Q

DM controlled with diet/OHA

A

No restrictions

62
Q

DM on insulin

A

Drive if no severe hypoglycemic episode in the last 6 mo

63
Q

Hearing problem

A 
If
Acute labyrinthitis
Positional vertigo with horizontal head movements 
Recurrent vertigo 
Advise not to drive until resolved
64
Q

Musculoskeletal disorders

A

Report etiology, prognosis, extent of disability

65
Q

Post operative, conscious sedation

A

No driving for 24 h

66
Q

Post operative, general anesthesia

A

No driving for >24 h

67
Q

First sigle unprovoked seizure

A

No driving for 3 mo until complete neurological assessment

68
Q

Epilepsy

A

Can drive if seizure-free on meds

69
Q

Sleep disorder

A

If believed to be at risk, but refuses investigation with a sleep study or appropriate treatment, should not drive

70
Q

Visual acuity for driving

A

Contraindicated if <20/50 (both eyes examined simultaneously)

71
Q

Visual field for driving

A

Contraindication: <120° along horizontal meridian, 15° above and bellow fixation with both eyes examined simultaneously

72
Q

Depression Tx as an end-of life symptoms

A

Psychostimulants:
Methylphenidate
Ketamin

73
Q

Hiccups in end-of-life setting

A 
Dry sugar
Breading in paper bag
Chlorpromazine
Haloperidol
Metoclopramide
Baclofen
Marijuana
74
Q

Increased sensitivity to these drugs:

A 
Warfarin
Digoxin 
Sedatives 
Antipsychotics 
Narcotics
75
Q

Decreased sensitivity to

A

BB

76
Q

Benzodiazepine of choice in the elderly

A

LOT
Lorazepam
Oxazepam
Temazepam

Med (25 decks)

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