Geriatrics, Death/Dying, Genetic Counseling

Question 1

The “Young-old” is defined by those ages 65-___

Answer 1

74

Question 2

The “Old-old” is defined by those ages ___ and beyond

Answer 2

75

Question 3

An example of this term would be the client reacting to the provider such as they would to their child, behaving in a parental role toward the provider

Answer 3

Transference

Question 4

A provider avoiding working with the elderly because of their awareness of death and loss would be an example of

Answer 4

Counter Transference

Question 5

This diagnosis may represent the preclinical stages of dementia and is characterized by problems with memory or language severe enough to be noticed by others or to be detected on cognitive tests but NOT SEVERE ENOUGH TO INTERFERE WITH ADLS

Answer 5

Mild Neurocognitive Disorder

Question 6

This NCD results from multiple infarcts in the cortex and white matter following brain hemorrhage or ischemia. Most common dementia in men over 85.

Answer 6

Vascular Disease

Question 7

This NCD is associated with tau proteins, PERSONALITY changes including loss of social constraints.

Answer 7

Frontotemporal Lobar Degeneration (Pick’s Disease)

Question 8

This NCD is a hereditary disorder caused by a faulty gene for a protein. Manifestation of the disease occurs in 30s to 40s and death within 15yrs of onset.

Answer 8

Huntington’s Disease

Question 9

This NCD is characterized by neuro symptoms such as headaches, vision changes, and neuropathies that might signal CNS involvement.

Answer 9

HIV/AIDS

Question 10

These types of disorders are characterized by short term memory loss and decline in social and occupational functioning

Answer 10

Amnestic Disorders

Question 11

The most common NCD is

Answer 11

Alzheimer’s Disease

Question 12

This stage of Alzheimer’s is characterized by the inability to learn new material and impaired short-term memory. Apraxia (difficulty with skilled movements) becomes evident at this stage.

Answer 12

Mild Stage

Question 13

This stage of Alzheimer’s is characterized by inability to retain new information, LONG-TERM memory loss, confusion, now requires ASSISTANCE WITH ADLS

Answer 13

Moderate Stage

Question 14

This stage of Alzheimer’s is characterized by gait and motor disturbances, bedridden, unable to perform ADLs, incontinence, LTC placement

Answer 14

Severe Stage

Question 15

Elderly patients are more prone to these features of depression

Answer 15

melancholic (extreme sadness, often worse in the morning) features such as hypochondiasis, low self-esteem, worthlessness and self-accusatory trends with paranoid or suicidal ideation.

Question 16

When the cognitive impairments of the depressed patient is misdiagnosed as dementia

Answer 16

Pseudodementia

Question 17

Elderly patients are at risk of this serious side effect from antidepressants, particularly SSRIs and venlafaxine

Answer 17

Hyponatremia secondary to SIADH

Question 18

This lab should be checked 1 month after starting an elderly patient on an SSRI or venlafaxine

Answer 18

Sodium (dt risk of hyponatremia secondary to SIADH)

Question 19

Patients are at increased risk for this GI issue when on SSRIs

Answer 19

GI bleeding, especially in higher-risk pts such as those with peptic ulcer disease or on NSAIDs

Question 20

Name the 3 safest SSRIs to use in the elderly based on lowest potential to have drug-drug interactions

Answer 20

Citalopram
Escitalopram
Sertraline

Question 21

Name 3 non-SSRI antidepressants that are safer to use in elderly based on lower potential for drug-drug interactions

Answer 21

Venlafaxine
Mirtazapine
Bupropion

Question 22

Name the 3 SSRIs that have a higher risk of drug-drug interactions

Answer 22

Fluoxetine
Paroxetine
Fluvoxamine

Question 23

What is a well-validated screening tool for depression in the elderly?

Answer 23

Geriatric Depression Scale (GDS)

Question 24

If there is dementia or signifiant cognitive impairment, the gold standard for depression screening in the elderly is the

Answer 24

Cornell Scale for Depression in Dementia (CSDD)

Question 25

The single most important factor associated with increased prevalence of sleep disorders is

Answer 25

Advanced Age

Question 26

The suicide rate for this gender and race demographic is 5x higher than the general population

Answer 26

White Men

Question 27

One third of elderly patients report this being their main reason for considering suicide

Answer 27

Loneliness

Question 28

This term describes a death that is free from avoidable distress and suffering not only for the patient but for the family/caregivers that is reasonably consistent with clinical, cultural and ethical standards.

Answer 28

Good Death

Question 29

This term is used to describe a death that is characterized by needless suffering, dishonoring of the patient or family wishes or values, and a sense among participant or observers that norms of decency have been offended

Answer 29

Bad Death

Question 30

These 5 stages describe what?
Shock and denial
Anger
Bargaining
Depression
Acceptance

Answer 30

Kubler-Ross’s Stages of Death and Dying

Question 31

This term is the subjective feelings caused by the death of a loved one

Answer 31

Grief

Question 32

This term describes the process in which GRIEF IS RESOLVED and is the expression of bereavement behavior and practices

Answer 32

Mourning

Question 33

This term describes the states of being deprived of someone by death and refers to being in a state of mourning

Answer 33

Bereavement

Question 34

This “work” allows the survivor to redefine the relationship to the deceased person and to form new but enduring ties.

Answer 34

Grief Work

Question 35

Bereavement lasting more than a year and may resemble symptoms of MDD characterized by severe functional impairment, morbid preoccupation with worthlessness, SI, psychotic sxs, or psychomotor retardation

Answer 35

Persistent Complex Bereavement Disorder

Question 36

The most common type of Complicated Grief, and is highlighted by bitterness and idealization of the dead person. Often occurs when the relationship between the bereaved and deceased were extremely close, ambivalent or dependent or the bereaved has little social support to share the sorrow.

Answer 36

Chronic Grief

Question 37

How is grief differentiated from MDD?

Answer 37

Few bereaved individuals meet full diagnostic criteria for MDD. Grief is fluid and changing, in which emotional intensity gradually lessens and positive comforting aspects of the lost relationship emerge.

Question 38

Name the 3 common universal states experienced at the end of life

Answer 38

Anxiety
Depression
Confusional

Question 39

A dying patient diagnosed with schizophrenia is experiencing psychotic symptoms, likely due to delirium. Should antipsychotics be continued?

Answer 39

Yes, continue their usual antipsychotics

Question 40

Describe the 3 factors of genetic counseling according to the National Society of Genetic Counseling

Answer 40

1. INTERPRETATION of family and medical histories and how it relates to the potential of disease occurrence or reoccurrence
2. EDUCATION about inheritance, testing, management, prevention, resources and research
3. PROMOTE informed choices and adaptation to the risk or condition

Question 41

This term signifies the portion of individuals with that specific genotype that also manifest the genotype at a phenotype level.

Answer 41

Penetrance. Ex: if everyone that carries the dominant gene shows the phenotype of the gene then this would be “completely penetrant”

Question 42

This term refers to the extent of expression of the genotype.

Answer 42

Expressivity. Variable expressivity can vary from mild to severe but is never completely unexpressed in those carrying the gene

Question 43

This term consists of the application of research that links measurable genetic variants with the prediction of drug response

Answer 43

Clinical Pharmacogenomics

Question 44

The 3 things to remember when doing genetic testing include:

Answer 44

1. Obtain consent from client
2. Make sure client is aware that test is voluntary and keep the results secure
3. Make sure the test used has an acceptable level of reliability