geriatrics

Question 1

dementia

Answer 1

decline in mental function

loss short term memory… long term is good + one or more other cognitive deficits

Question 2

Mild cognitive impairment-

Answer 2

pt complains of memory problems and has mild deficits but does not meet criteria for dementia

Question 3

Mild dementia-

Answer 3

pt has all the criteria for dementia, but it not as progressive; does not have the capacity to consent, but can assign someone to make the decision for them

Question 4

Delirium-

Answer 4

acute onset, fluctuating course, deficits in attn NOT memory

Question 5

alzheimers sx

Answer 5

Early problems in memory and visuospatial abilities, but retain social graces
Personality changes and behavioral difficulties (wandering, inappropriate sexual behavior, aggression) develop as disease progresses
Delusions and depression occur as disease progresses
End stage: mutism, cant hold head up, hard to eat and swallow, dec appetite, weight loss

Question 6

Subcortical dementia?

Answer 6

Dementia of parkinson’s disease and some vascular dementia

Question 7

Subcortical dementia sx?

Answer 7

Slow psychomotor activities (walking, dexterity)
Dec attn
Cant problem solve
Personality changes

Question 8

Dementia with lewy body?

Answer 8

Overlapping of alzheimers and parkinsons

Acute onset with rapid decline

Question 9

Dementia with lewy body

sx

Answer 9

Primary signs: Rigidity and bradykinesia
Cognitive impairment
Visual hallucinations
Treating hallucinations may worsen extrapyramidal sx

Question 10

Dystonia-

Answer 10

spasms and muscle contractions

Question 11

Akathisia-

Answer 11

motor restlessness

Question 12

Tremor-

Answer 12

unintentional shaking

Question 13

Tardive dyskinesia-

Answer 13

involuntary, irregular jerky mvmts

Question 14

Many diseases…. Picks disease and dementia associated with ALS are a few

Answer 14

Fronto-temporal dementia

Question 15

Pick bodies in nerve cells in damaged areas of the brain

Answer 15

Fronto-temporal dementia

Question 16

Fronto-temporal dementia sx

Answer 16

Affects personality, emotions, behavior, and language
Visuospatial is preserved (its not in alzheimers)
Early personality changes (not in alzheimers)

Question 17

Lab findings of dementia

Answer 17

Cbc, electrolytes, UA, calcium, creatinine, glucose, TSH, vit B12
Imaging like CT or MRI
Prob need CT first bc of insurance

Question 18

Prognosis dementia

Answer 18

3-15 yrs after alzheimers dx
More rapid decline with Lewy Body
Hospice for end stage

Question 19

Common in hospitalized or ECF pts
Somatic complaints
More delusions
Geriatic depression scale

Answer 19

depression

Question 20

delirium criteria

Answer 20

Rapid onset and fluctuating course
Deficit in attn NOT memory
Hypo or hyperactive
Dementia frequently coexists

Question 21

cause delirium

Answer 21

Underlying medical condition like hypoxia, infection or metabolic abnormality

Question 22

Delirium risks

Answer 22

Sundowning- hospital removes pt from their known environment

Question 23

sx Delirium

Answer 23

confusion assessment method (CAM) or richmond agitation sedation scale
Acute onset and fluctuating course
Inattn
Disorganized thinking OR changed LOC
Need all

Question 24

Delirium workup

Answer 24

Check all meds particularly opioids, BDZ, antihistamines
If needed
EKG, cbc, electrolytes, Cr, glucose, Ca, albumin, LFT, TSH
Serum Mg, serum drug levels, UA, urinary toxin screen, abg, blood cultures
CXR, CT
Lumbar puncture

Question 25

Delirium trmt

Answer 25

Prevention is best
Treat underlying cause
Antipsychotic agents such as haloperidol and quetiapine
Clears in a couple days
Delirium of unknown cause? Admit pt

Question 26

leading cause of death in pts over 65

Answer 26

complications from falls

Question 27

cause of falls

Answer 27

MC too much meds
Usually interaction with pt and environment
Balance and ambulation

Question 28

mc fx

Answer 28

wrist hips vertebrae

Question 29

trmt falls

Answer 29

Canes, rollers, walkers
Phones at floor level, portable phone, lightweight call system
Refer for PT/OT, eye exam, home eval
hospitalization if unexplained

Question 30

malnutrition?

Answer 30

Unintended weight loss of 5% body weight in 1 month or 10% in 6 months

Question 31

if someone if malnurished determine

Answer 31

if its muscle or bone

Question 32

causes of malnutrition

Answer 32

Premouth (shopping and prep)

Mouth sores, no teeth, dentures don’t fit, can’t taste, dysphasia, depression, no appetite

Question 33

MC deficient vitamins are

Answer 33

C, D, B12, and other B vitamins

Question 34

Vit d deficiency is associated with

Answer 34

myalgias, arthralgias, immune probs

Question 35

Frailty syndrome

criteria

Answer 35

Need ⅗ of the following criteria
Slow gait speed
Low hand grip strength
Exhaustion
Weight loss
Nrg expenditure

Question 36

Frailty syndrome

trmt

Answer 36

Supplements

Artificial nutrition

Question 37

risks for pressure ulcers

Answer 37

Immobility MC

Dec sensory perception, moisture, poor nutrition, friction

Question 38

Hospital stay for acute illness

cause of …

Answer 38

pressure ulcers

Question 39

prevention Pressure ulcers

Answer 39

Reposition

Good nutrition

Question 40

eval Pressure ulcers

Answer 40

Risk fx, stage, size, depth, exudate and type, appearance, surrounding infection

Question 41

trmt Pressure ulcers

Answer 41

Hyperbaric O2- inc blood supply
Remove necrotic debris
Comfort if on hospice
Large or non healing may need plastics

Question 42

Behavioral changes in presence of caregiver
Delays between injuries and trmt
Inconsistencies btwn injury explanation and observation
Bad hygiene
Not filling meds

Answer 42

Pt mistreatment and self neglect

Question 43

Pt mistreatment and self neglect

what do you do about this

Answer 43

report to adult protective services

Question 44

Unclear if pt has decision making capacity?

Answer 44

Refer to mental health professional