Geriatrics Transitions & Miscellaneous

Question 1

What professional organizations offer recommendations for cancer screening?

Answer 1

USPSTF
ACS (american cancer society)
ACP (american college of physicians)
ACOG (american college of obstetricians and gynecologists)
ACCP (american college of chest physicians)
AUA (american urologic association)

Question 2

when does colon cancer screening start

Answer 2

45 (or 50)
up to age 75-85

Question 3

what are the colon cancer screens available

Answer 3

FIT- annual
Sigmoidoscopy - every 5 years
colonoscopy - every 10 years

Question 4

when does breast cancer screening begin?

Answer 4

40 (or 50) up to age 75

mammogram every 1-2 years

Question 5

when are cervical cancer screenings begun

Answer 5

start at age 21
up to age 65

Question 6

what are the cervical cancer screenings available and how often?

Answer 6

Pap - every 3 years
HPV + Pap every 5 years

Question 7

when do lung cancer screenings begin

Answer 7

age 50 in current and former smokes with 20+ pack years
screen up to 75-80

low dose CT scan yearly

Question 8

when does prostate cancer screening begin?

Answer 8

age 50 (to 55)
up to age 70

Question 9

what does a AAA repaire decrease

Answer 9

mrotality in men 65- 75 years of age
for men >75, mortality exceeds benefits

Question 10

what are the recommendations for AAA screening?

Answer 10

one-time screening with ultrasound in men 65-75 who have ever smoked

Question 11

when should be screen for hyperlipidemia

Answer 11

if patient have additional risk factors for heart disease and are aged 65-75

Question 12

how often should fasting glucose be tested in patients with symptoms of diabetes and those at risk of diabetes

Answer 12

symptoms of diabetes: every year
risk factors: every 3 years

Question 13

what screening is recommended for ALL adults

Answer 13

hypertension screening

Question 14

who are at an increased risk of chlamydia/gonorrhea

Answer 14

all sexually active women > 25 at increased risk

Question 15

when do we screen for Hep C

Answer 15

adults 18-79

Question 16

when is it recommended for women to be screened for osteoporosis

Answer 16

women 65 years or older
or sooner if RF such as daily steroids, decreased estrogen exposure or infrequent meses

Question 17

what are the potential harms of screenings?

Answer 17

worry/anxiety
cost and use of resources
additional procedure/risk of infection
exposure to raditation
complication of sedation/anesthesia
injury
aggressive treatment to slow growing tumors

Question 18

what is the pneumococcal recommendations

Answer 18

all adults over 65 should get PCV13 followed 6-12 months later by PPSV23
also recommended for smokers, diabetics, chronic liund disease

Question 19

what are the influenza vaccine recommendations

Answer 19

recommended annually for all people over 6 months of age.
high dose vaccine may be more effective in adults over 65.

Question 20

what is the Tdap vaccine recommendation

Answer 20

Td or Tdap every 10 years for all adults.
OR Td every 10 years and a one time booster of pertussis vaccine over age 65

Question 21

what is the zoster vaccine recommendation

Answer 21

RZV (2 dose recombinant zoster vaccine) recommended for adults >50 yo

Question 22

what is the most common neurologic complication in geriatric patients

Answer 22

delirium

Question 23

what is the most common type of complication in the geriatric surgical population

Answer 23

neurologic complication

Question 24

what are the most important risk factors associated with post-operative delirium

Answer 24

advanced age and dementia

Question 25

what is often associated with post-operative delirium

Answer 25

abnormal pre-operative lab values (electroyltes, glucose, low hemoglobin levels)

Question 26

what are iatrogenic risk factors for delirium in ICU patients

Answer 26

sedative medications and possibly use of opioids

Question 27

what are lung expansion modalities to decrease complications in the elderly

Answer 27

chest physiotherapy deep breathing exercises incentive spirometry and OPEP continuous positive airway pressure (CPAP)

Question 28

what is the goal of lung expansion modalities

Answer 28

increase post-operative functional residual capacity and expand partially or completely collapsed alveoli

Question 29

when are preoperative ECGs indicated

Answer 29

in patient with cardiac risk facotrs and active disease undergoing at least intermediate surgery

Question 30

what are the post operative adverse events associated with perioperative hypothermia

Answer 30

poor wound healing, suscptibility to infections, shivering, discomfrot and increased cardiovascular stress and subsequent complications

Question 31

when should the BEERS criteria be consulted

Answer 31

medication management in older population - polypharmacy

Question 32

what are contributing factors to delirium

Answer 32

infection, medications, electroylte abnormalitites, ETOH/drug withdrawal, pain/fear

Question 33

why might providers be reluctant to address the issue of an older persons driving capabilities

Answer 33

lack of training in injury prevention or rehabilitation fear of losing a patient legal concerns

Question 34

what medications are associated with increased driving risk/impaired skills

Answer 34

opioids benzos antidepressants hypnotics antipsychotics antihistamines glaucoma agents NSAIDs (pain not becasue of impairment) Muscle relaxants

Question 35

what are medical illnesses that impair driving

Answer 35

celiac disease DM pulmonary disease alcoholism dementia cerebrovascular disease parkinsons arthritis visual/hearing impairment sleep apena seizure d/o various neuromuscular disorders

Question 36

how can we assess safety for an older patients driving abilities

Answer 36

visual acuity, visual fields, hearing, cognition MSK function alcohol use attention and judgement visual spatial skills (clock-drawing) medication review

Question 37

what is PGD

Answer 37

prolonged grief disorder perisistant and impairing form of grief that occurs when there are impediments to adaption

Question 38

what are indicators of PGD

Answer 38

pervasice intense yearing or longing peristent preoccupaton with the decreases (persists at least 6 months) emotional pain, sadness, guilt, anger, denial, blame, anhedonia, emotional numbness dx made when emotion impairs functioning

Question 39

What are the risk factors for prolonged grieving

Answer 39

maladaptive grief-related emotions, cognitions or behaviors psychiatric dz hx lower SES hx of childhood attachment difficulties current physical illness or pronounced psychological stress older adults (male, less educated, "oldest old", poor cognitive performance, hx of depression)

Question 40

what are four identifiable forms of grief

Answer 40

pre-death, acute, integrated, prolonged/complicated