Geriatrics Flashcards by Ariel Temporal

Activities of daily living

bathing
dressing
eating
transferring from bed to chair
continence
toileting

How well did you know this?

Not at all

Perfectly

What is the daily recommended dose for calcium supplementation?

1200-1500mg/day

How well did you know this?

Not at all

Perfectly

Describe the daily dosing increments for calcium supplementation

500mg TID with each meal

How well did you know this?

Not at all

Perfectly

When does the US Prevention Screen Task Force recommend stopping screening for breast cancer?

At 75 years

How well did you know this?

Not at all

Perfectly

When does the American Geriatric society recommend stopping screening for breast cancer?

At 85 years

How well did you know this?

Not at all

Perfectly

At what age do we stop performing colonoscopies? Why?

- Because of the risk of perforation

How well did you know this?

Not at all

Perfectly

According to colon cancer screening guidelines, how often should we perform a Flex Sig and FOBT?

Flex Sig every 5 years

- FOBT every 3 years

How well did you know this?

Not at all

Perfectly

If we choose to screen our patients for colon cancer using only FOBT, how often should we perform that test?

Every year

How well did you know this?

Not at all

Perfectly

If we choose to screen our patients for colon cancer using colonoscopy, how often should we perform it?

Every 10 years for ages 50-75

- Every 2 years for high risk patients

How well did you know this?

Not at all

Perfectly

At what age do we stop screening women for cervical cancer, as long as they’ve had negative PAPS in the past and have no risk factors?

65-70 years

How well did you know this?

Not at all

Perfectly

If a 70yo woman has no prior pap smear results, how many must we perform with negative results before we stop screening for cervical cancer altogether?

How well did you know this?

Not at all

Perfectly

How often does Medicare cover pap smears and pelvic exams?

Every 24 months

- Or every 12 months if pt is high risk

How well did you know this?

Not at all

Perfectly

What can we do to screen men for prostate cancer?

DRE and PSA yearly

How well did you know this?

Not at all

Perfectly

At what age do we begin screening men for prostate cancer?

50 years

How well did you know this?

Not at all

Perfectly

How often does Medicare cover PSA screening tests?

Every 12 months

How well did you know this?

Not at all

Perfectly

Age-related SN hearing loss

Presbycusis

How well did you know this?

Not at all

Perfectly

Most common form of SN hearing loss

Presbycusis

How well did you know this?

Not at all

Perfectly

Key features of presbycusis

Bilateral, symmeric, high-frequency hearing loss

How well did you know this?

Not at all

Perfectly

MC cause of conductive hearing loss

Cerumen impaction

How well did you know this?

Not at all

Perfectly

Good drug to give patients SP surgery to prevent constipation

Colace (a surfactant)

How well did you know this?

Not at all

Perfectly

Most frequently used type of laxative

Stimulants

How well did you know this?

Not at all

Perfectly

Initial tx of choice for depression

SSRIs

How well did you know this?

Not at all

Perfectly

TX of choice for depression with insomnia

Trazadone

How well did you know this?

Not at all

Perfectly

Depression tx class that are not well tolerated in the elderly

TCAs

How well did you know this?

Not at all

Perfectly

Depression tx that increases appetite

Rameron

You should suspect depression in patients with weight loss over what percent in 6 months?

> 10%

When do most traffic accidents involving seniors occur?

- Turning left across traffic - At intersections - In daylight hours - In good road conditions

MC perpetrators of elder abuse

Adult children and spouses

How much does postprandial glucose increase each decade in the elderly?

Increases by 10mg/dL per decade

Why do we need lower doses of T4 to treat hypothyroidism in elderly?

Because there's a decreased thyroxine clearance

What cholesterol changes occur in elderly women, and why?

Increased levels of LDLs due to an abrupt termination of sex hormone production

Erythematic change of the skin due to acute or prolonged heat exposure

Erythema ab igne

Significant fact to remember about Fluoroquinolones

Elderly require reduced doses...especially with renal dysfunction

Best antihypertensive for the elderly

HCTZ

HCTZ dose for HTN

12.5-25 mg/day

What % of calories should come from fat?

20-35%

How many grams of fiber should a patient consume per 1000calories?

14g

Drug used to prevent the first event of non-fatal MIs in patients with HTN

Beta blockers

What characteristic of Dementia Syndrome of Depression might lead you to make that diagnosis, rather than Alzheimer's Disease?

DSD has a much more abrupt onset

Hypothyroidism tx

Low dose Synthroid

IADLs

- Transportation - Shopping - Cooking - Managing money - Using the telephone - Taking medications - Housecleaning - Laundry

How often do we administer the tetanus vaccination?

One dose every 10 years

How often do we administer the Diptheria vaccine?

One dose every 10 years

How often do we administer the Influenza vaccine?

Annually

How often do we administer the Pneumococcal vaccine?

- One dose, unless given < 65 years | - In that case, revaccinate after 5 years

How often do we administer the Herpes Zoster vaccine?

Once after age 60

What labs change with age?

- Postprandial blood sugar - Serum cholesterol - ESR - T3 - Renal function tests

Leading cause of severe vision loss in patients >75

Macular degeneration

Central vision loss that begins in one eye, then becomes a bilateral deficit

Macular degeration

What physiologic changes leads to orthostatic hypotension in the elderly?

Decreased baroreceptor sensitivity

BMD scan is recommended for all women over what age?

65 years and older

Preferred tx for mild-moderate pain

Acetaminophen

Max dose of Acetaminophen

3-4g/d

Best drugs for inflammatory pain

NSAIDs

Best drugs for moderate-severe pain

Opioids

What types of side effects might you see with opioid use for pain management?

CNS side effects (sedation, confusion, reduced concentration, nausea, constipation)

Drugs good for local pain

Topical Capsaicin or 5% Lidocaine

The lens loses elasticity, thus losing the ability to focus and increases difficulty of seeing objects up close (pathology)

Presbyopia

Skin lesion that looks brown-black and like it's stuck onto the skin

Seborrhea keratosis

Where does seborrhea keratosis typically occur?

Can occur anywhere

Skin lesion secondary to thinning skin and dermal capillary rupture

Senile purpura

What percent of actinic keratosis skin lesions will become SCC if left untreated?

5-10%

Pt has a solitary, thick nodule on an erythematous base. No central depression or ulceration. Suspicion?

Squamous cell carcinoma

Most common type of skin cancer?

Basal cell carcinoma

Patient has a non-erythematous nodule with telangiectasias. You node a small depression in the middle. The nodule has a slight pearly color to it. Suspicion?

Basal cell carcinoma

Often one of the first skin changes observed in aging patients

Sagging of the lateral aspects of the eyebrows

Dry skin is most common on what parts of the body?

- Anterior legs | - Extensor surfaces of arms and legs

White epidermal cysts, approximately 1mm in diameter seen on sun-damaged skin

Milia

1-5mm bright red papules

Cherry hemangiomas

Where are cherry hemangiomas most common?

On the trunk

Blue papules that tend to occur on the lower lips and ears

Venous lakes

Components of continence

- Effective function of the lower urinary tract - Adequate cognitive and physical control - Motivation - Appropriate environment

Cause of urge incontinence

Involuntary bladder contraction

Cause of stress incontinence

Increased abdominal pressure

Cause of overflow incontinence

Overflow of urine from an over-distended bladder; unable to empty the bladder due to a neuropathy or obstruction

When doing a post-void residual volume study, what residual volume is indicative of overflow issues?

> 300mL

Drug tx for urge incontinence

Oxybutynin, Imipramine

Drug tx for stress incontinence

Vaginal estrogen cream | Alpha-stimulating agent

MC source of bacteremia in the elderly

UTI

MC infection in nursing home patients

UTI

What types of medications can increase a patient's risk for a UTI? Why??

- Anticholinergics | - Urinary retention

How long do we typically treat patients for UTIs?

10-14 days

What lab should we check before initiating Warfarin therapy?

Albumin concentration

First-line tx for osteoporosis

Calcium and Vitamin D supplementation

What types of drugs can lower serum calcium levels, leading you (the provider) to suggest supplementation?

Anti-ulcer/GERD medications

What's the most sensitive and cost effective procedure for colon cancer screening?

Colonoscopy every 10 years

Gold standard for hearing screening

Whispered voice test

Weber test results for conductive hearing loss

Sound will lateralize to the bad ear

Rinne test results for conductive hearing loss

BC > AC or BC = AC

Weber test results for SN hearing loss

Sound will lateralize to the good ear

Rinne test results for SN hearing loss

AC > BC

Laxative that's safe and reasonable for long-term use

Polyethylene glycol (PEG, Miralax), which is a hyperosmolar agent

Drug that's particularly effective in treating resistant constipation

Polyethylene glycol (PEG, Miralax), which is a hyperosmolar agent

Which type of laxative is least recommended?

Stimulants

What type of laxative should be avoided if you suspect obstruction or impaction?

Stimulants

What endocrine disorder can sometimes make you think that a patient is depressed?

Hypothyroidism

How can we screen for hypothyroidism, how often should we do it, and when should we start?

- TSH levels - Every 5 years - Starting at age 50, or if the patient develops a complaint that could be caused by thyroid disease

How often will Medicare pay for a BMD screening?

Every 2 years

Ototoxic drugs

- Aminoglycosides - Antimalarials - Antineoplastics - Salicylates - Loop diuretics

Ototoxic drugs that cause reversible damage

- Antimalarials - ASA - Loop diuretics

Is it common or uncommon for basal cell carcinoma to metastasize?

Uncommon

MC type of chronic urinary incontinence?

Urge incontinence