Geriatrics Flashcards

1
Q

Geriatric clinical approach includes ? three domains that affect ? and ?

What are the 3 main outcome of the assessment for this population

Older PTs care about what 3 results of a prognosis?

A

Function, Social, Psych
Well being/Quality of life

Prognosis
Patient goals
Functional status

Function Independence Dementia

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2
Q

What are the Activities of Daily Living

What are the instrumental activities of daily living?

A

Continence Feed Toilet
Transfer Bathe Dress

Drive Meds Telephone Shop
Misenplace Clean Laundry Finance

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3
Q

How is a Functional Evaluation conducted

What is the leading cause of non-fatal injuries and death in older PTs?

How often is this leading cause assessed?

A

Time to get up from chair
Walk 10ft, return to chair
>30sec= impaired mobility

Falls, Gait

Incidence and Frequency annually

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4
Q

How is gait assessed?

What are the 4 parts of the PTs gait that are assessed?

A

Can PT rise from chair w/out hands- quad strength

Symmetry Length Height
Width

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5
Q

What are the intrinsic RFs for a fall?

What are the secondary RFs

How can their near/far vision and hearing be tested?

A

Meds Vision PHOTN
Atrophy Vit D- 800IU/day

Light Footwear Trip hazard Safety

Near- Jaeger
Far- Snellen
Hearing- whisper test

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6
Q

Define the mini cognition test

What is the next step if they fail this test?

How is depression screened for?

A

3 item recall, clock drawing- 2min
Both norm- dementia unlikely

Mini mental exam- 10min
MOCA, specific- 30min

PHQ 2: two questions, one pos warrants investigation

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7
Q

What are the two questions asked during the PHQ 2 and what are they assessing?

A

Past 2 wks, felt down, depressed, hopeless- depressive mood

Past 2 wks, felt little interest or pleasure doing things- anhedonia

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8
Q

How does the eye and vision change due to increased age?

These changes lead to ? condition

Why do PTs have difficulties w/ reading in dim light

A

Lens becomes less flexible, less accommodation

Presbyopia

Dec light to retina

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9
Q

? is the leading cause of vision impairment in the US/world

What are the typical Sxs of this MC

What will be seen on PE

A

Cataracts

Blurred yellow vision w/ increase sensitivity to glare

Central opacity
Dec red reflex

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10
Q

What is the leading cause of irreversible vision loss in PTs >65y/o

What are the two types and characteristics of each

A

Age related macular degeneration

Non-neovascular, dry (MC):
Gradual central blurring
Difficult reading fine print/street signs, facial recognition
Rx: antioxidants and Zinc

Neovascular, wet:
Rapid central vision loss
Refer for Tx w/ anti-VEGF

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11
Q

How does Diabetic Retinopathy present

How is it managed

What exam is needed annually

A

Blurred vision
Field constriction
Scotoma

Observe w/ referral

Dilated funduscopic exam

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12
Q

What are 4 types of eye complaints that require immediate referral?

Cerumen impaction will present w/ ? PE findings

What age related deterioration is overlooked but a contributor to morbidity

A

Rapid Painful Monocular
Vision loss

Weber to L
Rinne BC>AC on L

Hearing loss

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13
Q

Hearing loss is independently associated w/ ? issues in PTs

What is the MC type of hearing loss

What causes conductive hearing loss in these PTs

A
Incident dementia
Accelerated cognitive decline
Poor neurocognitive function
Increase falls
Gait disturbance

Sensorineural HL- presbycusis

Perfs Impaction Effusions

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14
Q

What are the Aminoglycoside antibiotics associated w/ hearing loss?

What is the criteria for OHOTN

A

Gentamicin Amikacin Vancomycin Erythromycin Neomycin Streptomycin

SBP dec 20mm
DBP dec 10mm <3min of Sxs

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15
Q

How is cognitive impairment different from normal aging to concerning?

Define Mild Cognitive Impairement

A

Normal aging- PT remembers later w/ intact learning and subtle deficits in memory function w/out functional impairment

Cognitive function below normal for age/education but severe enough for dementia

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16
Q

MCI is characterized by what 3 parameters

A

Subjective complaints validated by second person

Evidence of objective cognitive impairment in one of more domain

Intact functional status

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17
Q

If PT presents w/ memory loss and draws all numbers on one side of a clock, ? is Dx

When does the Dx of Dementia begin and how quickly does the risk increase?

A

Vascular dementia

Starts at 60
Doublex every 5yrs

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18
Q

What are the 5 types of dementia in order of frequency and RFs for each

A

Alzheimer-
RF: Age FamHx

Lewy Body- Parkinsonism Visual hallucinations Cognitive fluctuant

Vascular-
RF: DM Age Smoking HTN Lipidemia

Frontotemporal- Personality/Social behavior changes Nonfluent speech

Neurodegenerative-
Huntingtons Metabolic abnormalities

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19
Q

What are the key features of Dementia

What is focused on during PE

PTs present w/ memory loss, temper change worse at end of day and disagrees w/ caregiver, what assessment is done

A

Gradual, stable onset
ADL interference
Inattention on gradient
Non-reversible cognitive decline

Functional assessment w/ ADL/IADLs
Neuro exam

Mini Mental state exam- 3 item recall, clock test
Both norm= r/o dementia

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20
Q

When/what PT would be considered high risk for dementia

How often are Mini Mental State Exams repeated?

What does this test indicate or suggest for Dx

A

> 80y/o

q6-12mon

Cognitive decline, suggests Dx of MCI, dementia

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21
Q

MOCA test is more influenced by ? and is more ? than MMSE

What general labs are ordered for a Dementia work up

What specific labs would be ordered?

A

Education
Sensitive, particularly for detecting MCI

CBC Chem-18 (Kidney E+ Glucose Liver)

BETCH CDR
B12 ETOH TFTs Ca HIV
CSF Drug/Tox screen RPR

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22
Q

What other Dx co-exists w/ dementia in half of PTs

Why is identifying this co-existing Dx important

How would this underlying issue be suspected

A

Depression

Can be cause of cognitive defecits
Must be ID’d/r/o prior to Dx of dementia

Memory complaints OOP to deficits

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23
Q

Define Delirium

What is the classic triad for Alzeimers

A
Sensory deficit
Other psych d/0
Delerium
Depression
Alcohol abuse
Meds- BEERS LIST

Memory impairment
Visuospatial problems
Language impairment

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24
Q

Alzheimer

A

Early: retain social function, fail complex tasks

Disorientation:
Time Place Person

Languae:
Anomic Fluent Mutism

Lost in familiar places
Behavior changes common

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25
Lewy Body Dementia
2nd MC dementia: Parkinsonism after/w/ onset Parkinson dementia is late in dz Fluctuating cognitive impairment Visual hallucination- can differ real from fantasy w/out concern REM sleep d/o and severe sensitivity to antipsychs- suggest LBD
26
Vascular Dementia
Dx base on radiographic evidence of cerebrovascular dz Sudden onset after stroke/step wise, not continuous Patchy deficit, not as severe as Alzheimer
27
Fronto Temporal Dementia
Younger onset, 50y/o, Mis-Dx as Pysch d/o Picks Dz: Behavior/Personality changes w/ intact memory Hyperorality Loss of social awareness, spares visuospatical abilites Develops new artistic talent Progressive aphasia Semantic dementia
28
What meds are used in Dementia Tx for Cognitive Impairement
``` Cholinesterase inhibitor, ChEI- Galantamine Rivastigmine Donepezil Differ in t1/2, titrate x 8-12wks S/e: GI Syncope Bradycardia Improved MMSE/MOCA 6-12mon= effective ``` Memantine- NMDA antagonist Added to ChEl when dementia reaches moderate severity S/e: HA
29
How is Vascular dementia Tx What non-pharmaceutical Tx can be done for behavior problems
Tx RFs for stroke: Tobacco HLD AFib DM Permissive HTN- SBP 150+ Consider ChEI (GRD), Memantine Bright light Music Walk Pets
30
What meds can be used for Dementia induced behavior problems?
SSRI Mood Antipsych stabilizer ChEIs Olanzapine/Risperidone- Anti-psych, best effectiveness BBW: mortality, CV events, Tardive diskinesia in dementia PTs Citalopram- SSRI Carbamazepine/Valproic Acid- mood stabilizer
31
What Tx methods are not recommended for dementia due to lack of efficacy/potential for harm? What are the criteria for major depression
Gingko biloba Estrogen NSAID Vit E Two weeks w/ at least: Depressed mood and/or Anhedonia Plus 3-4: SIGECAPS Sleep Interest Guilt Energy Concentration Appetite Psychomotor SI
32
What screening tool is used for detecting depression in in older adults? What are the DDxs?
PHQ-2 Delirium Cognitive impairment Chronic medical condition (weak/fatigue)
33
What meds are used for depression in adults and their s/e
SSRIs: Esc/Citalopram Fluoxetine Paroxetine Sertraline Citalopram: QT prolongation, Torsades- Max 20mg Fluoxetine: long t1/2, P-450 inhibitor SNRI: Des/Venlafaxine Duloxetine TCA: Amitriptyline Imipramine Doxepin Rarely used in older adults d/t s/es Mirtazapine- appetite stimulant, insomnia Buproprion- smoking cessation
34
What are the risks of SSRIs as a class What are the risks of TCAs
``` Seratonin Syndrome HTN HypoNa Inc bleeding risk w/ anti-coagulants Fall risk ``` OD OHOTN Arrhythmia Cognitive impairment
35
When do depressed PTs need to be referred to Psych What are three meds that are hydrophilic and would bind to proteins and decrease available amount? What 3 classes of drugs cause 2/3 of hospital admissions
Mania/Psychosis Failure x 2 meds Electroconvuslive therapy RF for SI TSH Warfarin Phenytoin Anticoagulant/platelets Diabetes
36
What is the two types of Pneumoccoccal vaccine given at 65y/o When are herpes zoster vaccines given? What age are cervical screenings stopped
PPSV23 and PCV 13 50y/o 65y/o
37
When are lung CTs needed for smoking PTs When is osteoporosis screened for ? How often is hyperlipidemia screened for
55-80y/o w/ 30ppy or quit <15yrs F >65y/o, initial M >70y/o, consider Initial, q5yrs
38
Urgency Incontinence Sxs Causes Tx
Detrusor over activity- Involuntary loss followed w/ urgency Stroke Alzeihmers/Parkinson BPH w/ overflow Anticholinergic
39
Stress urinary incontinence Sxs Causes Tx
Loss of urine w/ strain/exertion from sphincter failure Pelvic floor weakness (surgery/birth) Prostate surgery Hx Topical estrogen
40
Mixed urinary incontinence Sxs Causes
Involuntary loss of urine w/ urge and w/ exertion/stress Combo of urge and stress
41
Overflow incontinence Sxs Causes Tx
Weak stream, incomplete emptying BPH Impaction/fibroids Diabetic neuropathy Pelvic organ prolapse Alpha adrenergic blockers
42
PT presents w/ stress urinary incontinence, what test is used to confirm Dx? What two tests can be ordered for urinary incontinence
Bladder stress test UUI: bladder competence/detrusor over activity SUI: urethra function, post-void residual
43
How do anticholinergics contribute to urinary incontinence? How do diuretics contribute to urinary incontinence? How do opioids contribute to urinary incontinence?
Affect bladder wall/sphincter Inc volume/diuresis Receptor induced dysfunction
44
How do A-adrenergic agonists contribute to urinary incontinence? How do A-adrenergic antagonists contribute to urinary incontinence? How do CCBs contribute to urinary incontinence?
Urethral sphincter constriction Urethral sphincter relaxation Dec smooth muscle contractility
45
How is stress incontinence Tx How is Urge incontinence Tx How is overflow Tx
Kegels/Pessaries Estrogen Surgery Estrogen Antimuscarinic- Oxybutynin B-agonists- Mirabegron Alpha blocker- Doxazosin 5a inhibitors- Finasteride Cath/Surgery
46
# Define Scoliosis Define Kyphosis Define Lordosis
Spine is C or S shaped Thoracic spine curves out Lumbar spine curves inward
47
How does OA present What will be seen on PE What would be seen on x-rays
Mechanical pain worse w/ activity, better w/ rest Joint line tenderness w/ bone enlargements Narrowing, osteophytes, sclerosis and cysts
48
What meds are used for OA Tx Where are fragility Fxs due to osteoporosis likely to occur What algorithm is used to calculate a PTs 10yr Fx risk
Acetaminophen- initial choice NSAIDs- acetaminophen failure Tramadol Hip Vertebrae Wrist FRAX
49
What are the three classifications of osteoporosis
Type 1: post-menopause loss of estrogen Type 2: >75y/o, loss of Zinc, lack of Ca intake Secondary: chronic dz or medication induced (GCSS); equal in M-F
50
What DEXA measurements correlate to normal and osteoporosis When are DEXA scans recommended
Normal: -1.0 or more Penia: -1.0 - -2.5 Porosis: -2.5 or less Severe/established: -2.5 or lower and fragility Fx 65y/o or older
51
What meds are given for Osteopenia What DEXA score is osteopenia but is changed to porosis based on criteria
Ca/Vit D 1000/800 w/ weight bearing exercises Penia w/ FRAX 10yr probability of hip Fx 3% or more or, 10yr probability of other major porosis Fxs 20% or more
52
What lab tests are ordered for Secondary causes of osteoporosis
Hypogonad- T, Prl Primary HyperPara- PTH Secondary HyperPara- 25 Hydroxy Bit D, PTH Multiple myeloma- eletrophoresis, free light chains HyerThyroid- TSH Malabsorption- transglutaminase Ab Hypercortisolism- urine cortisol Mastocytosis- tryptase, urine N-methylhistidine
53
What meds are first line Tx for Osteoporosis What selective estrogen receptor modulator may be sued
Bisphosphonates- AIR-onate Zoledronic acid Raloxifene
54
Delirium
Abrupt onset that fluctuates over hrs-wks Impaired attention, alertness, orientation Disrupted sleep-wake cycle Agitated/withdrawn
55
Dementia
Insidious onset w/ slow decline over mon-yrs Attention intact early, impaired later in dz Normal sleep, alertness
56
What is pathognemonic for delirium What other key features may be seen
Acute change in baseline mental status over hrs/days ``` Fluctuating Rambling Alerted LoC Inattention Disorganized thinking ```
57
What is the leading precipitating factor to delirium What are examples of this leading cause
Medications ``` Sedative hypnotics Opiates Anticholinergics Polypharm Benzos ETOH TCAs CCS H2 receptor antagonists ```
58
? may be the first sign of serious underlying dz What must be carefully r/o
Delirium Occult infection
59
# Define the Confusion Assessment Method What are two features not seen in mild/mod dementia Worsening confusion above baseline cognitive impairment suggests ? Dx
Acute onset, fluctuating and, Inattention and Disorganized thought or Altered LoC Inattention Altered LoC Delirium
60
What are the steps of delirium Tx What meds are last line choices for Tx What needs to be avoided
ID/Tx underlying cause Eradicate contributing factors Manage Sxs Risperidone Olanzapine Benzos Haldol Quetiapine Restraints
61
What are the 4 characteristics of Parkinsons What causes these Sxs What is the name of the gait they adopt
Bradykinesia Muscle rigidity- cog wheel Posture instability- late Resting tremor- pill rolling Loss of substantia nigra and depletion of dopamine Festinating
62
? is the second MC degenerative neuro d/o after Alzheimer With an onset between 60-65, if a PT present older than ?, Dx is usually primary or secondary What is a required feature for Dx
Parkinsons >75 Bradykinesia plus 1 Sx
63
? is the MC cause of Parkinson's What presentations are red flags for secondary causes What is the strongest alerting factor
Idiopathic Symmetric Lack of tremor Atypical features Lack of response to high dose of dopamine/Levodopa
64
What are two classes of drugs that can induce Parkinsons Define Parkinson Plus Syndrome What are the first and second line meds for depression in Parkinson PTs
Antiemetic/psychotic Atypical Parkinsons- associated w/ disabling features (autonomic failure, early fall/dementia) 1: SSRI, 2: SNRI
65
Parkinson PTs may need to have ? meds d/c as Dz progresses What medication may be added for PTs that develop dystonia/involuntary movements while on carbi/levodopa
Anti-HTN Pramipexole- dopamine agonist S/e: drowsy hallucinations risk-taking behavior
66
? is the DOC for Parkinson PTs >70y/o and <70y/o Above is the DOC because ? meds work poorly in these age groups? What enzyme converts Levodopa into Dopamine
>70:Levodopa <70: Pramipexole, Ropinirole Pramipexole Amantadine Ropinirole Anticholinergics DOPA-decarboxylase
67
What features of Parkinson respond less to Levodopa than other Sxs What PT education has to occur w/ these meds MOA of Carbidopa
Axial- speech/gait 30min before meal Decarboxylase inhibitor, prevents peripheral Levodopa to dopamine
68
What are the 3 types of Tremors, PE findings and causes
Resting: tremor at rest, associated w/ hypokinesia or rigidity; Parkinsons Intention: tremor during movement, increases near target, nothing at rest; cerebellar dz, MS, chronic ETOH use Postural: tremor w/ sustained posture of extremity; Wilson's Dz
69
What medication can be added for PTs presenting w/ essential tremors How do these present What are the first and second line Txs
Propranolol S/e- HOTN Brady Broncho constriction Forearm, head, voice, trunk bilateral, postural-kinetic ``` 1st: Primidone Occupational therapy Propranolol 2nd: Gabapentin/Topiramate Unilateral thalamotomy ```
70
How do strokes present What are the two categories What are the 3 parts of the Cincinnati stroke scale
Neuro deficit or HA of abrupt onset Ischemic Hemorrhagic: Intracerebral, SubArachnoid Facial droop Arm drift Speech
71
What are the two phases of Cerebrovascular Dz diagnostics What are the Ischemic Stroke Sub-types
Acute triage: Labs, Rads Investigation after Dx of Stroke is established ``` Large artery atherosclerosis- carotid, stenosis Cardioembolism- AFib Small vessel occlusion- lacunar stroke Stroke, other- arterial dissection Stroke, undetermined- cryptogenic ```
72
What is the underlying etiology for intracerebral hemorrhages Inclusion criteria for administering tPA for ischemic strokes
HTN Cerebral amyloid angiopathy Anti-coagulation related hemorrhage Sx onset <4.5hrs 18y/o or older Dx of ischemic stroke causing neuro deficits
73
What are the considerations for pushing tPA in acute ischemic strokes What are the antiplatelet agents first chosen for non-cardioembolic CVDz
3hrs of Sx onset Extended to 4.5hrs if <80y/o BP <185/110 ASA Clopidogrel Dipyridamole and ASA
74
What meds are used as anticoagulants in AFIB What is the name of the procedure to open the carotid artery when more than ? is stenosed Define TIA
Warfarin DOACs- Rivaroxoban Apixaban Dabigatran Carotid Endartectomy >50% stenosis Transient episode of neuro dysfunction (Sxs <1hr) from focal brain/spine/retinal ischemia w/out infarct
75
What are the 3 main mechanisms of TIAs How does Takotsubo Cardiomyopathy present
Embolic- extra cranial artery, heart, aorta Lacunar/small vessel- stenosis of intracerebral vessel Low-Flat TIA- atherosclerosis of internal carotid STEMI mimickery No artery occlusion F>M
76
What would be seen on imaging of a Takotsubo PT What meds are used for chronic/long term therapy in coronary artery Dz PTs
Octopus pot- apical ventricle ballooning Statin Anti-platelet BBs ACE/ARB if HFrEF
77
What medication is used to Tx dilated cardiomyopathy What meds are used for different types of HF
BB- Bisoprodol HFrEF >50: control HTN, Na intake, daily weight, Loops HFrEF <40: BB and Sacubitril-Valsartan HFrEF <35: Spirinolactone/Eperenone; resynch, biventricular pacing
78
How are Tachyarrhythmias Tx How quickly is BP lowered during HTN emergencies using ? med
Anticoagulation Rate/Rhythm: BB, Cardioversion, Ablation, Watchman IV labetolol MAP reduced 10-20% in first hr then gradual over 23hrs Final pressure reduction by 25%
79
ACC/AHA 2017 Stage 1 HTN criteria JNC8 criteria What are 4 conditions in older PTs that complicat HTN Dx and management
SBP 130-139 or DBP 80-89 Under 60: <140/90 CKD, DM, >60: <150/90 White Coat HTN Pseudo HTN OHTON Post-Prandial HOTN
80
? is the MC indication for major cardiac surgery in older adults after coronary bypass surgery AR sounds MS sounds MR sound
AS- harsh systolic murmur; dyspnea, dizzy, syncope Decrescendo diastolic murmur to L 3/4 ICS Opening snap, mid-diastolic rumble murmur Holosystolic murmur at apex, radiates to axilla
81
When do Pts need to prophylactically prevent infective endocarditis What types of procedures warrant prophylaxis When is this prophylaxis not recommended
Prosthetic heart valve IE Hx Congenital heart Dz Valvulopathy after transplantation Manipulation of Gingiva, Periapical region or Mucosa Prior to GI/GU procedures
82
How does Peripheral Artery Dz present What Dx must this be distinguished from and how What test result helps confirm this Dx
Leg discomfort w/ movement Rest pain- late Non-healing ulcers Gangrene Spinal stenosis- worse w/ standing/walking; better sitting, knees to chest ABI <0.9= >50% stenosis ABI <0.4- ischemia
83
What medication is used for PADz? Intermittent claudication Sxs are ? related to standing while neurogenic claudicaiton is ? related to standing ? is the third MC cause of CV death in US
Cilostazol IC: never NC: always VTE
84
When is a D-dimer useful for VTEs? How are VTEs Tx How long are these Tx maintained
R/o in low risk PTs Massive PT- thrombolysis DOAC/Heparin w/ stockings 3mon w/ discrete cause 6-12mon if no cause
85
PTs w/ VTEs and no identifiable etiology for appropriate age/gender groups, what is the next step? What is the HAS-BLED acronym for
Ca screening Estimates risk for major bleeds in TPs on anticoagulation to asses risk/benefit in AFib care ``` HTN Abnormal kidney/liver function- 1pt each Stroke Bleeding Labile INRs Elderly >65 Drugs/Alcohol- 1pt each ```
86
How many points on HAS-BLED correlate to low, med. high risk What is the only medication approved for dose reduction in older PTs w/ renal impairment needing anticoagulation When is the use of Rivaroxaban c/i
0-1: low 2: mod 3-6: high Enoxaparin CrCl <15 mL/min
87
What are PE findings of Chronic Venous Insufficiency Varicose veins can range from ? to ? What would be seen on US
Hemosiderin staining Lipodermatosclerosis Atrophie blanche Telangiectasis to Ropey varicosities Venous reflux Chronic post-thrombotic change
88
Where do Chronic Venous Insufficiency ulcers usually develop? What are the classifications of Venous Dz
Superior to medial malleolus ``` CO: no visible signs of dz C1: telangiectasis/reticular veins C2: varicose veins C3: edema C4: trophic skin changes; hyper pigment, eczema atrophie C5: healed venous ulcer C6: active venous stasis ulcer ```
89
Venous Ulcers
``` Medial malleolus/Calf Minimal slough, granular/healthy Little/no pain Warm limb Normal pulse Compress, elevate, moist wound dressing ```
90
Arterial ulcers
``` Distal over toe/foot/heel Dry painful necrotic lesion w/ punched out apearance Cold limb w/ pallor No pulses Tx w/ revascularization ```
91
How is an acute COPD exacerbation managed Define COPD
``` Beta adrenergic agonist- Albuterol, mainstay Anticholinergic- Ipratropium PO GCCS- Prednisone NPPV ABX ``` Inflammatory respiratory dz w/ FEV1/FVC <70%
92
# Define Emphysema Define Chronic Bronchitis Define GOLD Criteria What is BODE Index for
Destruction of alveoli Cough/sputum x 3mon for 2 consecutive yrs Tx s by severity stages Predicts mortality
93
How is COPD Tx If needed, ? ABX are used? When do PTs need to be placed on air
Chronic: SABA/LABA, GCCS Anticholinergic Rehab Acute: Prednisone 40-60mg/day x 5d w/ ABX Mild: Macrolide, Cephalosporin Doxy or TMP Mod/Sev: Augmentin, Fqn <88% on room air
94
What are the 4 Gold Categories
1: Mild, FEV 80% or highter 2: Mod, FEV 50-80 3: Sev, FEV 30-50 4: Very Sev, FEV <30 or <50 and Chronic Respiratory failure
95
What are the four grades for COPD How is each Group Tx
1: short of breath walking up hill 2: PT has to stop and catch breath, can't keep up 3: stops after 100ft 4: too breathless to leave house A: ABA or SAMA B: LABA or LAMA C: LAMA D: LAMA or LAMA and LABA, or LABA and ICS
96
What is the Dx criteria for asthma What are the two types CDC recommends PTs >65y/o receive ? two vaccinations?
Obstructed airflow w/ FEV/FVC 0.7 or less Long standing: atopy and allergies Late onset: obesity, tobacco Pneumococcal conjugate and Polysacch-23
97
Interstitial Lung Dz
FamHx Radiation Interstitial/CT Dz Exposure Smoking Dry cough Wheeze Chronic exercise intolerance Restrictive pattern CXR- honey comb CT- ground glass
98
How is PulmHTN Dx What are the 3 Pulm HTN groups
Echo w/ Systolic Pulm artery pressure 35-40mm R heart catheterization of suspected PA-HTN 1: PulmHTN 2: due to L heart Dz 3: due to Lung Dz/Hypoxia 4: due to thromboembolic pulm-HTN 5: multifactorial
99
How does Pancreatic Ca present What is it's MC
``` Jaundice Cachexia Virchow nodes Sister Mary Joseph nodes Weight loss Lethargy ``` 4th leading cause of death from Ca
100
# Define Courvoisier Sign What type of Ca is this associated w/? What are the MC causes of Upper GI bleeds and the two types
Palpable gallbladder due to pancreatic Ca Adeno Gastric ulcer- early satiety, immediate pain after meal Duodenal ulcer- awakes at night, relieved w/ foot, MC than gastric
101
How often do GERD Sxs need to be experienced for Dx What are complications PTs can develop during Tx on PPIs
1/wk Osteoporosis C Diff Drug interactions Interstitial nephritis
102
What are the 3 categories of HypoNa and their causes
Inc ECF: Urine Na <20: Inc Interstitial Salt- LF Cirrhosis Hepatorenal/Nephrotic syndrome CHF Urine Na >20: Renal Failure- Hypertonic Saline, Steroids Early diuretics Normal ECF: Osmolality urineserum: SIADH; Drugs CNS Pulm Malignancy Dec ECF: Urine Na <20: Na loss in excess water- Diarrhea Sweat Vomit Burn Fitula SBO Urine Na >20: Na and water loss via kidney- KF, Addisons RF Osmotic/Thzd diuresis
103
HypoNa is defined as anything below ? level What med classes can cause this HyperNa is define as anything above ?
<135 SSRI Diuretic AntiPsych ACE >145
104
HypoK is defined as anything below ? HyperK is define as anything above ?
<3.5 Thx/Loops, Extrarenal (GI) Renal >5.0 Spironolactone Triamterene Amiloride ACE Renal/CHF/Cirrhosis, Hypoaldosteronism
105
What medication is added for Anti-HTN in PTs w/ CKD Routine care for CKD in the primary setting included ?
Lisonopril ``` Monitoring function Managing CKD complications Tx CVD RFs Prevent additional injury Promote general health ```
106
What is the goal for geriatric PTs w/ HTN by using ? first line medication classes What are the goals for their protein-to-creatinine ratio What is the goal for their LDL?
<130/80 w/ ACEI/ARB <0.2 or ACR <30 <100
107
What test result triad is Dx for primary hypothyroidism What triad is Dx for Hyperthyroidism What triad would be seen on results for sub-clinical hyperthyroid and what PE findings may be seen
Inc TSH, Low T3,4 Dec TSH, Inc T3,4 Dec TSH, Norm T4 Functional decline Bone loss AFib
108
How is subclinical hyperthyroidism Tx What is the mnemonic saying for HyperCa What Txs are used
Dec Levothyroxine Iodine 131 ablation Bones Stones Groans Psych overtones NS Bisphosphonates Steroids Calcitonin Parathyroidectomy Dialysis if >18mg
109
What needs to be avoided in PTs w/ HyperCa ? is a common endocrine d/o in post-menopause PTs How are these cases found and Tx
Thzds Bisphosphonates associated w/ jaw necrosis HyperParathyroidism HyperCa from adenoma removed w/ surgery
110
? are the MC causes of HyperCa in hospitalized PTs Adrenal insufficiency is most often from ? What would be seen on lab results
Metastatic ca Multiple myeloma Chronic adrenal suppression HypoNa HyperK HypoGlycemia Abnormal Cosyntropin stim test
111
Even though most adrenal incidentalomas are benign, ? tests are ordered to evaluate them Equation for Anion Gap Acronym for DDx of anion gap metabolic acidosis
Excess Cortisol Aldosterone Catecholamine production Na - (Cl + HCO3) MUDPILES Methanol Uremia DKA Paraldehyde Iron/Isoniazid Lactic acidosis Ethylene glycol Salicylates
112
Criteria for PT to be Dx w/ Diabetes What are their A1c goals depending on life expectancy
A1c 6.5 or more Fasting x 8hrs plasma glucose 126 or more Sxs of hyperglycemia and random glucose 200 or more 2hr plasma glucose 200 or more after 75g glucose <7 if older and healthy <8-9 if short life expectancy
113
What are the drug classes used instead of insulin for Diabetes Lab results show normocytic, normochromic RBCs w/ few reticulocytes, what medication is most appropriate What conditions is anemia of inflammation/chronic dz associated w/ ?
Biguanides- Metformin SGLT-2 inhibitors- CDEE-flozin GLP-1 agonists- SLLED-glutide Darbepoetin Frality Vit D deficiency HIV
114
? is the MC Ca of the urinary system What are the RFs
Bladder Ca ``` Smoking Chemicals Aniline dye Chlorination Arsenic Chronic cystitis ```
115
What is the next step for central mass found on abnormal CXR? What is the next step for a peripheral mass found on an abnormal CXR
Sputum cytology Bronchoracic biopsy Transthoracic biopsy CT guided biopsy Thoracoscopy Thoracotomy
116
Most breast Cas found in geriatrics are ? and Tx w/ ? What is the MC leukemia of the elderly and how is it Tx
ER pos Endocrine therapy AML, chemo if fit
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What is the MC leukemia in adults in western countries What is found to Dx this condition What may be found on microscopy
CLL/Small lmphocytic lymphoma Monoclonal proliferation of incompetent mature B cells Smudge cells- fragile lymphocytes
118
What type of cell finding is indicative of AML ? is the MC cause of non-solid organ Ca related death How does this MC present
Auer rod Non-hodgkin Persistent painless peripheral adenopathy
119
What are the Systemic "B" Sxs associated w/ Non-Hogkins What is the name of the cell finding indicative of Multiple Myeloma What are the MC presenting complains
Fever Weight loss Night sweats Rouleaux formation Bone pain in back/ribs
120
What are 5 common infections that are common in older adults How does acute prostatitis present PTs may find relief w/ ? ABXs
Urinary Respiratory Skin Gastro Osteomyelitis Refluxed urine into prostate causing tender prostate w/ inc urination Cipro x 4-6wks TMP/SMX FQNs Ceftriax/Doxy if STI related
121
What are the most likely microbes to cause Acute Prostatitis ? is the MC and most over-Dx bacterial infection in older adults and how does it present How is this MC Tx
E Coli Proteus Enterobacter Pseudomonas UTIs w/ urge incontinence ASx- none TMP/SMx, Macrobid FQNs for allergy/resistant strains
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Transudate lab criteria What are the MC causes
Protein 0.5 or less Pleural/serum LDH 0.6 or less Plerual fluid LD <2/3 upper limit HF Cirrhosis Nephrotic PE
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Exudate lab criteria What are the MC causes
Protein >0.5 Pleural:Serum LDH >0.6 Pleural fluid LDH >2/3 upper ``` Malignancy Pneumonia PE Pancreatitis Esophageal rupture TB Collagen dz Chylo/hemothorax ```
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What tests help w/ Dx influenza/pneumonia infections What med can be started if Sxs are <72 or severe What meds are used for pneumonia
Ag CXR Oseltamivir CAP: Azith/Doxy W/ comorbidities: Resp FQN or Beta-Lactam Macrolide HAP: Vanc, Piper-Tazo
125
What is the CURB65 acronym How is Toxic Megacolon Dx
CAP risk stratification: Confusion Urea +20 Resp +30 BP <90/60 Age >65 ``` Radiographic evidence +3 of: WBC > 10.5 HR >120 Anemia Fever >38*C ``` And one of: HOTN E+ disturbance Altered sensorium Dehydrated
126
? is the MC healthcare associated diarrhea What ABX may be used to Tx
C Diff PO Vanc Fidaxomicin
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What ABX are used for Strep/MSSA What ABX are used for Staph/MRSA
1st Gen cephalosporin Clinda/Doxy
128
How does Erythema Multiforme present What are the microbe etiologies What meds can cause this What systemic dzs can cause it
Target lesion rash on palms/soles sparing face and trunk HSV, Mycoplasma PCN, Barbituates, Sulfonamide Lupus Hepatitis Lymphoma
129
What type of skin change appearance is not common an needs to have malignancy r/o What does Seborrheic Keratosis look like How are they Tx
Benign Nevi Waxy/stuck on lesion on trunk>extemities/head Cryotherapy if discomfort to PTs
130
How is stasis dermatitis Tx What anti-virals are used for Herpes Zoster if Sxs are <72hrs old What is used for post-rash herpetic neuralgia
Class 5 steroid BID for plaques Diuretics Acyc/Valacyclovir Gabapentin
131
How are scabies Tx What can be used for the pruritis Everything has to be washed that was touched in past ? days
Permethrin cream 5% PO Ivermectin 0.2mg/kg Class 1 steroid x 7d 48hrs
132
? is the precursor to SCC How doe they appear on PE and what is this due to How is it Tx
Actinic Keratosis Sand paper texture Sun expsoure Cryotherapy Imiquimod/Fluorouracil
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Ho does BCC and SCC present on PE What two tests are required for Dx How are they Tx
Firm indurated papule, plaque or nodule Rolled shave Punch biopsy Excision
134
How does malignant melanoma present on PE What are the first line Tx for Insomnia
Brown/Black macule w/ one or more of ABCD >6mm CBT and Behavior (sleep hygiene)
135
PTs are more likely to have OSA w/ ? Dx What AHI lab results categorizes apnea as severe/mod/mil How is this Tx
Dementia Severe: >30/hr Mod: 16-30/hr Mild: 5-15/hr Mod/Sev: CPAP Mild: devices
136
How is periodic leg movement during sleep assessed What needs to be r/o
Polysomnography Fe deficiency
137
Bulk forming stool meds Stool softner Stool stimulatns
Psyllium Methylcellulose Docusate Senna Bisacodyl Castor oil
138
Stool lubricants Stool osmotics Stool prokinetics
Mineral oil Lactulose Sorbitol Polethylene glycol Tegaserod Metoclopramide
139
? is the MC non-cutaneous Ca in men How often is this surveyed after Dx
Prostate PSA q6mon x 5yrs then annually
140
What are the Sxs of BPH What meds can be used for Tx
``` HI FUN Hesitancy Intermittence/Incontinence Frequency/Fullness Urgency Nocturia ``` Alpha blockers: DATA-osin 5a-reductase: Finasteride
141
When are prostate screenings recommended What lab result indicates need for Urology referral
PSA 55-69y/o PSA >4
142
# Define Nociceptive Pain What are the 2 categories
Pain from tissue damage Somatic: injury to tissue, well localized Visceral: mediated by stretch receptors, deep/dull and poorly localized
143
What are examples of Central Pain Define Wind-Up Pain
Post-stroke Phantom limb Pain from C-fibers due to reptitive stimulation from <1stimulus/3seconds, leads to gradual increase of pain
144
XOIs for gout Uricosuric for gout
Allopurinol Febuxostat Probenecid
145
How do CPPD crystals appear What meds are used for Tx
Pos birefringent NSAID/Colchicine
146
What would be seen on PMR lab results What meds are used for management
No RF Inc ESR/CRP Steroids
147
What are the 3 categories for back pain What are red flags for immediate referral to NeuroSurgeon
Acute: <4wks Subacute: 4-12wks Chronic: >3mon Cauda Equina Cord compression Progressive/Severe Neuro Sxs
148
? is the MC systemic vasculitis in US This MC is associated w/ ? Dz This almost never occurs prior to ? age
GCA Polymyalgia Rheumatica 50y/o
149
Reflex Syncope What are the 4 types
Neurally Mediated Vasovagal Situational Carotid sinus Unknown
150
Orthostatic Syncope
Primary autonomic- Parkinson/Lewy body Drug induced- alcohol dilators diuretics phenothiazides antidepressants Secondary autonomic- DM amyloidosis Uremia Cord injury Volume depletion
151
Cardiac syncope When does syncope need to be considered the cause of a fall What is the initial assessment done?
Brady/Tachy dysrhythmia Structural dz Others Recurrent, LoC, Unexplained ECG if frequent Holter/Event monitor for less frequent Sxs
152
What are modifiable risk factors for pressure ulcers PTs that are at risk to develop these need to be assessed how often? How often are turning orders written for?
``` Immobility Functional impairment Dry skin Dec/low BMI Nutritional status ``` Daily 2hrs
153
Bedridden PTs need to have head placed nor more than __* What are the 4 stages of pressure ulcer development
30* or lowest level to prevent skin shearing 1: non-blanching 2: partial thickness 3: full thickness into fascia 4: necrosis/destruction to bone
154
When do these injuries NOT need debridment How are Ulcer Stages 1-2 managed
Stable/dry eschar and no signs of infection Clean w/ NS Transparent dressing Remove necrotic tissue
155
How are pressure ulcers stages 3-4 managed What are 4 possible adverse complications that can develop
Irrigate, debrid Heal w/ secondary intention or surgical closure Mechanical, enzymatic and autolytic debridment Cellulitis Osteomyelitis Bacteremia Sepsis
156
When/what ABX is used for pressure ulcers If ABX is used, it needs to have ? level of coverage
No healing after 14days, use Silver Sulfadizaine MRSA Anaerobes Enterococci Gram Neg
157
Deteriorating ADL/IADLs indicates ? What are two situations that require accurate functional information What is the best/most invaluable method to obtain this info
Worsening Dz process Combination of multiple Dxs Adaptive equipment Caregiver OT/PT observation
158
High functioning PTs my not demonstrate functional impairment, what method is more useful in monitoring ADLs? These changed are AKA A change in these AKAs can indicate ?
Query about target activities: Bridge Golf Fishing Advanced ADLs Dementia Incontinence Worsening vision/hearing
159
UTI Tx When are bisphosphonates c/i
Nitro/TMP No Nitro if GFR <30 GI Ca
160
MOCA Scores MMCE scores
26 or higher, norm 25-30 norm <24 bad
161
Four ototoxic meds What med can induce Secondary Acute Angle Closure Glaucoma
NSAIDs Aminoglycosides Loops Antimalarial Topiramate
162
Sequence for PTs w/ full bladder and unable to void Itching for venous stasis
US DRE Foley Group 5 steroid
163
Venous Ulcer Arterial Ulcer
asdf
164
Trigeminal neuralgia PHTN definitive Dx
New onset face pain, get MRI R sided cath
165
Don't give AfAm CCB if ? BPH HI FUN acronym
Constipation Heart block ``` Hesitant Intermittence/Incontinence Frequency Urgency Noctureia ```
166
USPSTF Grade A Slide Dec 5
HTN PHTN Classifications ``` 1- idopathic 2- MC, heart dz 3- lung dz/hypoxemia 4- thromboembolism 5- mixed ```
167
Alzheimer's w/ hallucinations need ? test
Sleep study