Geriatrics and Palliative Care Flashcards
1
Q
This is a functional mobility test where the patient is asked to rise from the chair, walk approximately 10 feet, turn around, and return to/sit back in chair.
A
“Get up and Go Test”
2
Q
This test is when the patient is asked to extend arms forward without moving the feet, and the distance is measured. It can help us to understand whether an older adult is able to manage and prepare meals.
A
Functional reach test
3
Q
This is the ability to meet one’s own needs, in wither basic skills or in more complex skills such as home management?
A
Functional ability
4
Q
This is the decreased ability to meet one’s own needs.
A
Functional decline
5
Q
For geriatric patients, the nutritional exam should focus on?
A
A- anthropometrics
B- biochemical parameters
C- Clinical assessment
D- Dietary history
6
Q
Anthropometrics includes:
A
Skinfold thickness
Arm circumference
7
Q
Normal skinfold thickness of the triceps/ subscapular are:
A
Males: greater than 12mm older than 75
Females greater than 25mm older than 75
Values of less than 50% or greater than 150% of standard are indicative of malnutrition or obesity
8
Q
Arm circumference assesses:
A
Muscle mass as a measure of protein stores
9
Q
Normal arm circumference?
A
Males: 29.3 cm or more
Females 28.5cm or more
10
Q
Labs to measure for nutritional status:
A
Albumin, serum transferrin, Lymphocyte count, and hypersensitivity responses
11
Q
Normal albumin level?
A
4-6 gm/dl
12
Q
Albumin level indicating a protein-calorie malnutrition?
A
under 3.5
13
Q
Albumin level indicating severe malnutrition?
A
Under 2.5
14
Q
Serum transferrin is an indicator of?
A
acute malnutrition
15
Q
Normal range of serum transferrin?
A
190-375 mg/dl
16
Q
Lymphocyte count is ___ in malnutrition?
A
Depressed
17
Q
Lymphocyte count in mild malnutrition:
A
1200-1500
18
Q
Lymphocyte count in moderate malnutrition:
A
800-1200
19
Q
Lymphocyte count in severe malnutrition:
A
<800
20
Q
How to assess social support in geriatric patients?
A
OARS: social resources questionnaire which assesses the type of social supports and the availability of support as perceived by the patient.
21
Q
How to assess mental status in older adults?
A
Folstein Mini-mental status
Blessed dementia scale
22
Q
Folstein Mini-mental status exam focuses on:
A
Orientation Registration Attention Calculation Immediate recall Language Visuopatial abilities
23
Q
What is a normal Folstein Mini-mental status exam score?
A
27.6-30
24
Q
What score on the Folstein MMS indicates depression?
A
25
25
What score on the Folstein MMS indicates dementia?
9.7
26
This mental exam helps determine if someone is presenting with mild cognitive impairment or dementia.
Clock-drawing test
27
This mental exam is based on the behavioral symptoms of dementia with the higher the score indicating the greater functional impact of dementia?
Blessed Dementia scale
28
The functional rating scale for the symptoms of dementia (FAST) can predict:
Need for nursing home placement
| Scores over 30 may reflect this need.
29
Predictive items for nursing home placement with FAST?
Bowel or bladder incontinence
Incoherent speech
Inability to bathe and groom oneself
30
What are the major risk factors for dementia?
DM, HTN, and HLD
31
Most common types of dementia?
Alzheimer's, multi-infarct, and alcoholic dementias
32
Progressive dementias have the development of multiple cognitive deficits manifested by memory impairment and at least one of the following:
Aphasia
Apraxia
Agnosa- inability to recognize objects
Disturbances in executive functioning
33
What is the most common form of dementia?
Alzheimer's
34
Neuropathological hallmark of AD?
Amyloid plaques
35
Neurotransmitters in AD?
Acetylcholine and glutamine
36
Possible etiologic factors in the development of AD?
```
Aluminium
estrogen
NSAIDs
Vitamin E
Viral agents
```
37
This stage of AD includes memory loss, poor judgement, perceptual disturbances, withdrawal and depression:
Early stage
38
This stage of AD is when recent and remote memory worsens, restlessness, perseveration, loss of impulse control, and increased aphasia develop?
Midstage
39
This stage of AD is when incontinence, apraxia, little recognition of family, and loss of most self-care abilities occurs?
Late stage
40
What is the most important risk factor in vascular dementias such as multi-infarct?
HTN
41
What scale is helpful in determining AD from MID?
Hachinski Ischemic rating scale
42
With MID, is prognosis better or worse than AD?
Better- chances of social survival are better and the essence of the person's personality are more intact.
43
Types of alcoholic dementias?
Weirnicke-Korsaloff's syndrome- thiamine deficiency- cannot form new memories
Alcohol-induced pellagra: niacin and/or tryptophan deficiency
Hepatic encephalitis
44
This type of dementia affects people more in middle age and has more profound deficits in self-awareness, self-monitoring, and self-knowledge compared to patients with AD.
Frontotemporal Dementia or Pick's disease
45
CT or MRI often reveal what in patients with frontotemporal dementia?
Symmetrical or asymmetrical atrophy of the anterior temporal and frontal lobes.
46
Atrophy is AD is symmetrical or asymmetrical?
Symmetrical
47
This is an acute confusional stage with the cause usually an underlying physical illness.
Delirium
48
Diagnostic criteria in delirium include:
Disturbances in consciousness (reduced clarity and inability to focus, sustain, or shift attention.
49
This is associated with triad of dementia, gait disturbance, and urinary incontinence with a pathologically enlarged ventricular size and normal opening pressure on lumbar puncture?
NPH- normal pressure hydrocephaly
| * treated with a VP shunt
50
Medications used for dementia?
Aricept (Donepezil)- slows sx but doesn't prevent progression
Memantine (Namenda)- exerts neuroprotective effect
Cholinesterase inhibitors and can be used in combo
51
Depression and fall risk factors:
```
Poor self-rated health
Poor cognitive status
Impaired ADLs
2 or more clinic visits in a year
Slow walking speed
```
52
Interventions likely to be beneficial in fall reduction?
```
Environmental risk reduction with multidisciplinary team.
Cognitive behavioral therapy
Home hazard modifications
Withdrawal of psychotropics
Tai chi
```
53
DROPP mnemonic for fall history:
```
D- Diseases/drugs
R- Recovery
O- Onset
P- Prodrome
P-Precipitants
```
54
If patient was unconscious during a fall consider what workup?
Syncopal workup
55
If patient was lightheaded during a fall consider what?
CV, orthostasis, drugs, anxiety, or depression
56
For true vertigo, consider what?
BPV, labyrinthitis, meniere's
57
50% of those who lie on the floor for more than 1 hour after a fall, die within ___ of fall regardless of injury.
6 months
58
PT referral should be considered when:
```
The patient:
Has increased grabbing of furniture
Has a major change in function
Has a recent illness
Has a hospitalization or surgery
Has a change in environment
```
59
Beta blockers for HTN can worsen:
COPD
60
Thiazides can precipitate:
Gout
61
Diseases of GI tract, liver, and kidneys can alter drug:
pharmacokinetics
62
Rules for geriatric prescribing:
1. Start low and increase slowly
2. Half-life of many drugs is prolonged in the elderly
3. Use the fewest number of drugs possible
4. Watch for toxicity
5. Adverse drug events may manifest atypically in the elderly
6. Know that CNS changes may be a marker for toxicity
63
Due to high incidence of adverse drug reactions, lower doses in the following are often helpful in enhancing compliance and efficacy:
ACE inhibitors
Statins
Antidepressant medications
64
This is active total care of patients whose disease is not responsive to curative treatment. Control of pain, of other symptoms, and of psychological, social, and spiritual problems is paramount. The goal of this is to provide the best possible quality of life for patients and their families.
Palliative care
65
This extends the principles of hospice to a broader population that could benefit from this type of care earlier in their illness.
Palliative care
66
Cues that could prompt a referral for palliative care?
Unacceptable level of pain or other symptoms or distress
Uncontrolled psychosocial or spiritual issues
Frequent visits to the ED for the same diagnosis
More than one hospitalization for the same diagnosis in the last 30 days.
67
Hospice provides:
An interdisciplinary team
Expert pain and symptom management
Psychological and spiritual care, volunteers, and bereavement support.
68
Hospice eligibility requirements:
2 physicians must certify the patient has a life-limiting diagnosis and patient is not expected to live more than 6 months.
69
Hospice eligibility for heart failure:
NYHA class IV criteria which indicates an inability to carry on any physical activity with symptoms of heart failure even at rest.
70
What is the most common cause of hearing loss in people over 80 years old?
1. Otosclerosis
2. Cerumen impaction
3. Presbycusis
4. Otitis media
3. Presbycusis
71
Which of the following is not a risk factor for falling in community-living older adults?
1. Body mass index (BMI) of 25 kg/m2
2. Previous falls
3. Gait instability
4. Vision impairment
1. Body mass index (BMI) of 25 kg/m2
72
Which of the following medications should be used as first-line therapy in the treatment of depression in patients older than 60?
1. Sertraline
2. Duloxetine
3. Nortriptyline
4. Mirtazapine
1. Sertraline
73
Which of the following statements is true about financial capacity in elderly patients?
1. Financial abuse is a form of elder abuse.
2. Losing the ability to make financial decisions is an expected part of aging.
3. Losing the ability to make financial decisions occurs late in the course of cognitive impairment.
4. A durable power of attorney for health care document can be used by a patient's health care agent to make financial decisions.
1. Financial abuse is a form of elder abuse.
74
Which of the following statements is true about driving in older adults with cognitive impairment?
1. Adults with severe dementia can drive safely during daylight hours.
2. The mini mental status exam (MMSE) can be used to infer driving capacity.
3. Tests of visuospatial skills are the most relevant predictors of driving impairment.
4. Cessation of driving does not affect quality of life in older adults.
3. Tests of visuospatial skills are the most relevant predictors of driving impairment.
75
Which of the following is not a risk factor for the development of dementia?
1. Cardiovascular disease
2. Family history of dementia
3. Increased age
4. Moderate alcohol intake
4. Moderate alcohol intake
76
An 85-year-old man with a history of well-controlled hypertension presents to primary care clinic with his daughter to discuss memory loss. They have both noticed that he is increasingly forgetful. He has forgotten some doctors' appointments and forgot to pay his electric bill. He is able to perform all of his activities of daily living (ADLs), and has no trouble with swallowing or language. What is the most likely diagnosis?
1. Normal aging
2. Mild cognitive impairment
3. Alzheimer disease
4. Vascular dementia
2. Mild cognitive impairment
77
What is the most common type of dementia?
1. Alzheimer disease
2. Vascular dementia
3. Lewy body dementia
4. Frontotemporal dementia
1. Alzheimer disease
78
What is the most common complication in advanced dementia?
1. Feeding difficulties
2. Pneumonia
3. Hip fracture
4. Urinary tract infections
1. Feeding difficulties
79
Which of the following patients with dementia is eligible for hospice care under current Medicare guidelines?
1. Cannot dress without assistance, is continent of bowel and bladder, and has decreased oral intake without weight loss
2. Has fewer than 6 intelligible words per day, can ambulate with assistance, history of cystitis
3. Can hold head up independently but cannot sit up independently, two hospitalizations for aspiration pneumonia
4. All of the above
3. Can hold head up independently but cannot sit up independently, two hospitalizations for aspiration pneumonia
