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Geri EOR > Health maintenance > Flashcards

Health maintenance Flashcards

1
Q

cardiac changes in the elderly

A
  1. Increased wall thickness
  2. Decreased maximal heart rate; decreased cardiac output
  3. Increased systemic vascular resistance
  4. Baroreceptor dysfunction
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2
Q

endocrine changes in the elderly

A

Impaired glucose tolerance; decreased testosterone and estrogen

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3
Q

white, gray, or blue ring or arc around the cornea of the eye.

A

arcus senellis

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4
Q

what contributes to changes in drug pharmacokinetics in the elderly

A

A decline in gastric acid may affect absorption of those drugs that require a low pH for full absorption

Moderate reductions in free water and serum proteins occur w/ aging, resulting in higher active drug concentrations

Decline in liver mass and hepatic blood flow + declines in renal clearance affect drug clearance

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5
Q

vitamin deficiciency map

A

ii. Vitamins C, D, B12

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6
Q

Sarcopenia

A

Sarcopenia is the degenerative loss of skeletal muscle mass (0.5–1% loss per year after the age of 50),

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7
Q

USPST recommendations around vitamin D

A
  1. USPST recommends daily allowance for vitamin D supplementation is currently 600 IU for adults age 51-70 and 800 IU for >70
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8
Q

Hyperopia

A

Hyperopia (farsightedness

distant objects may be seen more clearly than objects that are near

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9
Q

Astigmatism

A

eye does not focus light evenly onto the retina, causes images to appear blurry and stretched out

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10
Q

RF for cataracts

A

aging (>60y), cigarette smoking, corticosteroids

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11
Q

Shafer’s sign

A

clumping of brown-colored pigment cells in the anterior vitreous humor resembling tobacco dust

indicates a retinal break or rhegmatogenous detachmen

this is an emergency

Pt will see sees floaters / gray cloud on funduscopic exam

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12
Q

Who is most at risk of Macular degeneration

A

Risk factors – age >50y, Caucasians, smokers

MC cause of permanent legal blindness & visual loss in the elderly

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13
Q

two types of macular degeneration

A
  1. Dry (atrophic)

2. Wet (neovascular or exudative)

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14
Q

what are drusen spots

A

Drusen = small, round, yellow-white spots on the outer retina

associated with macular degeneration

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15
Q

what do you typically see with wet macular degeneration

A

a. New, abnormal vessels grown under the central retina, while leak and bleed  retinal scarring

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16
Q

CM of macular degeneration

A
  1. Bilateral blurred or loss of central vision (including detailed & colored vision)
  2. Scotomas (blind spots), metamorphopsia (straight lines appear bent)
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17
Q

dx of wet/exudative macular degeneration is typically made with

A
  1. Fluorescein angiography
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18
Q

management of dry macular degeneration

A
  1. Dry = Amsler grid @ home

a. Zinc, vitamin A, C, E may slow progression

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19
Q

management of wet/exudative macular degeneration

A

a. Intravitreal anti-angiogenics ex – Bevacizumab (reduces neovascularization)

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20
Q

what are the MCC of hearing loss in the elderly

A

i. Cerumen impaction and presbycusis are common causes of hearing loss in the elderly

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21
Q

how does sensorineural loss occur and what are the results with weber and rinne test

A

Sensorineural loss – occurs w/ damage/impairment of the inner ear or neural pathways

  1. Weber test  lateralization to the unaffected side
  2. Rinne test  air conduction > bone conduction
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22
Q

if weber lateralizes to the affected ear than suspect

A

conduction issue

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23
Q

what is cor pulmonale and what might you see on a EKG

A

RVH and RAE, RAD, and R sided HF

a. MULTIFOCAL ATRIAL TACHYCARDIA

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24
Q

what is the only therapy and intervention proven to reduce mortality in COPD pts

A

Oxygen and smoking cessation

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25
Q

what atypical symptoms might you seen a pt with PNA

A
  1. Less cough, absent fever, absent or unimpressive leukocytosis
  2. Often, only confusion and tachypnea are seen
  3. CXR
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26
Q

CI to COPD anticholinergics

A

ii. CI = BPH, glaucoma

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27
Q

salmeterol is CI in

A

Albuterol, Terbutaline, Salmeterol (LABA)

CI: caution in pt’s with DM (can cause hyperglycemia)

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28
Q

why are geriatric pts more predisposed to PNA

A

decreased ciliary activity,
less effective cough,
decreased vital capacity

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29
Q

FIRST LINE for OSA

A
  1. In-laboratory polysomnography = First line
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30
Q

other than a CPAP what can you do for OSA

A
  1. Behavioral = weight loss, exercise, abstain from alcohol, changes in sleep positioning
  2. Surgical correction
    a. Tracheostomy = definitive tx
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31
Q

overall 5 year survival rate for pts with lung cancer

A

i. Overall 5 year survival rate = 15%

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32
Q

MC type of bronchogenic carcinoma

A

adenocarcinoma

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33
Q

NSCLC that is bronchial in origin and a centrally located mass. presents with bloody sputum and pleuritic CP

A

Squamous cell

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34
Q

NSCLC that arises from mucous glands, usually appears in the periphery of the lung

A

Adenocarcinoma

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35
Q

Large cell carcinoma

A

doubling time is rapid and early metastasis
Central or peripheral masses
NSCLC

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36
Q

SCLC

A
  1. Originates in the central bronchi and metastasizes to regional lymph nodes
    a. Prone to early metastases and aggressive clinical course
  2. More likely to spread early and rarely is amenable to surgery
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37
Q

clinical features of lung CA

A
  1. New or changing cough, hemoptysis, pain, anorexia, weight loss, LAD, hepatomegaly, clubbing of fingers
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38
Q

dx test if suspecting lung ca

A
  1. CXR and CT
  2. Cytologic exam of sputum
  3. Bronchoscopy – examination of pleural fluid and biopsy
  4. PET scan
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39
Q

typical mngmt strategies for Lunc Ca

A
  1. NSCLC –> surgery

2. SCLC –> combination chemotherapy

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40
Q

TIMI what is it and how do you use it

A

Useful to assess the risk of death & ischemic events in patients w/ UA or NSTEMI

a. Age ≥65y
b. ≥3 CAD risk factors (FHx, HTN, Chol, smoker, DM)
c. Known CAD (stenosis >50%)
d. ASA use in past 7 days
e. Recent (<24h) severe angina
f. Cardiac markers
g. ST elevation 0.5mm

  1. Score ≥3 = high risk
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41
Q

ECG finding with angina pectoris

A

ST depression (especially horizontal or downsloping) = classic finding

ii. Resting EKG normal in 50% of pts

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42
Q

gold standard eval of angina pectoris

A

b. GOLD STANDARD = Angiography

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43
Q

how can stress echos help in evaluating angina pectoris

A

assesses LV function, valvular dz, pts w/ pathologic Q waves

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44
Q

two occasions in which nitroglycerin is CI

A

CI = SBP <90; RV infarction, use of PDE-inhibitors

i. If no relief with 1st dose  give 2nd/3rd q5 minutes

45
Q

NSTEMI medication regimen

A 
ANTI-PLATELET 
anticoagulants
BB
nitrates
morphine

CCB (if pts can’t have BB)

46
Q

antiplatelet drugs for NSTEMI

A

ASA

Clopidogrel (Plavix)
good in pts w/ ASA allergy

GpIIb/IIIa inhibitors

  1. Eptifibatide
  2. Tirofiban
  3. Abciximab
47
Q

anticoagulants for NSTEMI

A

i. Unfractionated heparin  binds to & potentiates antithrombin III’s ability to inactivated Factor Xa, inactivates thrombin

LMWH –> same MOA; S/E – thrombocytopenia

  1. Enoxaparin (Lovenox)
  2. Dalteparin (Fragmin)
48
Q

gold standard dx for CHF

A
  1. Gold standard = cardiac cath
49
Q

S/E OF thiazide diuretics

A

SE = Dehydration, hyperuricemia, hyponatremia, hypokalemia

50
Q

PVD is most commonly due to

A

MC d/t atherosclerosis

51
Q

PAD sxs

A

Skin changes = loss of hair, shiny atrophic skin, and pallor w/ dependent rubor

Femoral and distal pulses will be weak or absent

Thigh or buttock pain w/ walking

52
Q

gold standard for peripheral arterial dz dx

A

Doppler ultrasound flow

ABI (ankle-brachial index) ≤0.9 indicates significant disease

GOLD STANDARD = Angiography

53
Q

what is the Tx for PvD

A

a. STOP tobacco use; control Diabetes, HTN, and hyperlipidemia

B-blockers, ACEI, statins, progressive exercise, ASA and/or Plavix

Cilostazol

If all above fail, then revascularization

54
Q

MNMGT of varicose veins

A
  1. Graduated elastic stockings
  2. Leg elevation and regular exercise
  3. Small venous ulcers heal w/ leg elevation and compression bandages
  4. Large ulcers may require compression boot dressing (Unna boot) or skin grafts
55
Q

ddx when dealing with a pt that has syncope

A

Arrhythmias, aortic stenosis, carotid sinus hypersensitivity, MI, hypoglycemia, orthostatic HoTN, postprandial HoTN, PE, vagal faint

56
Q

paroxysmal Afib

A
  1. Paroxysmal – self terminating within 7 days (usually <24h)
57
Q

persistant vs permanent AFIB

A
  1. Persistent – fails to self-terminate, >7 days

3. Permanent – persistent AF >1 year

58
Q

rate control AFIB

A

i. Beta blockers – Metoprolol, Esmolol
ii. CCB – Diltiazem
iii. Digoxin +/- used in the elderly

59
Q

rhythm control Afib

A

Synchronized cardioversion

Amiodarone, Ibutilide, Flecainide, Sotalol

Radiofrequency ablation – permanent pacemaker

60
Q

how does venous insufficiency occur

A

Loss of wall tension in veins –> stasis of venous blood and often is associated w/ hx of DVT, leg injury, or varicose veins

61
Q

what are the sxs of venous stasis

A

Progressive edema starting at ankle

Itching, dull pain w/ standing & pain w/ ulceration is common

Skin is shiny, thin, and atrophic w/ dark pigmentary changes & subq induration

Ulcers usually right above the ankle (stasis ulcer)

62
Q

management of venous insufficiency

A

Elevation of legs, avoidance of extended sitting or standing and compression hose

Ulcerations may be treated w/ wet compresses, compression boots or stockings, and maybe skin grafting

63
Q

what is the hallmark of IDA

A

Pica= hallmark

64
Q

what is dx lab for IDA

A

Plasma ferritin <20 ug/L

65
Q

mnmgt of IDA

A

Ferrous sulfate 325mg TID orally

Hgb/Hct within normal range in 2 months BUT therapy should be continued for up to 6 months or longer

66
Q

what are the tests associated with anemia of chronic dz

A

Normal or increased ferritin +

decreased TIBC

decreased serum Fe

67
Q

treatment of anemia of chronic dz if it is secondary to renal dz

A
  1. Tx underlying dz

2. EPO if d/t renal dz

68
Q

what is the MCC of vitamin B 12 deficiency

A

i. MCC = pernicious anemia d/t lack of intrinsic factor which is needed for vitamin B12 absorption

69
Q

Sxs of vitamin B 12 deficiency .

A
  1. Smooth tongue, glossitis, cheilosis

2. Stocking-glove parasthesias, loss of vibratory and position sense, balance problems and ataxia, dementia

70
Q

difference between B12 and folic acid deficiency

A

NO NEURO SXS in folic acid deficiency

  1. Sore tongue (glossitis)
  2. Vague GI symptoms
  3. NO NEURO SYMPTOMS
71
Q

folic acid deficiency what would you see on a smear

A
  1. Macro-ovalocytes + Hypersegmented polymorphonuclear cells = pathognomonic
  2. Howell-Jolly bodies
72
Q

what is the treatment for folic acid deficiency

A

Oral replacement (1g/day) w/ folic acid = 1st line

73
Q

18) Diagnostic of DM II

A

Fasting >126 twice
• Random or 2hr GTT >200
• Postprandial glu 250 + sxs

74
Q

MC location of prostate cancer

A

peripheral zone

75
Q

• Drusen spots; loss of central vision

A

macular degeneration

76
Q

MCC of demntia

A

Alzheimer

77
Q

22) Mild-moderate Alzheimer’s treatment

A

Ach-esterase inhibitor = Donepezil (Aricept)

also slows down alzheimer’s

78
Q

Dexa-scan osteoporosis screening what age

A

65

79
Q

Optic disc cupping w/o rise in IOP?

A

gluacoma

80
Q

what is the initial management of glaucoma

A

Acetazolamide (decreases IOP)

Timolol (topical B-blocker) iii)

Picocarpine

81
Q

II, III, and ___ are ann inferior lead

A

AvF

82
Q

elderly becoming more tachy or brady

A

tachy

83
Q

worsens after resting

OA or Ra

A

RA

84
Q

morning stf >60 mins

OA or Ra

A

RA

85
Q

osteophytes on XR OA or RA

A

OA

86
Q

asymettric joint narrowing

OA or Ra

A

OA

87
Q

boggy and warm joints

OA or Ra

A

RA

88
Q

heberden’s nodes

OA or Ra

A

OA

89
Q

affects the DIP

OA or Ra

A

OA

90
Q

constipation treatment -bulk forming l

A

psyllium

methlcellulose (Citrucel)

polycarbohil
wheat dextran

91
Q

osmotic laxatives

A 
polyethylene glycol (PEG)
aka miralax

sorbitol

lactulose

saline laxitives -MOM

92
Q

stimulant laxatives

A

bisacodyl (DUlocolax)
senna

stimulat senna

93
Q

signs of PNA and tx

A

hypotension
cough
low 02

llevofloxacin

94
Q

actinic keratosis puts you at risk for

A

• Squamous cell carcinoma

95
Q

mc fx in the elderly

A

Pathologic fra ctures: MC vertebral, hip & distal radius (Colie’s) with or without trauma.

96
Q

sudden halos and peripheral vision loss-tx

A

axetozolamide or topical BB

acute

97
Q

Gradual peripheral vision loss

A

glaucoma

PG analog

anything that ends in prost

98
Q

actinic keratosis

A

Dry, rough, scaly “sandpaper” skin lesion or erythematous, hyperkera totic (hvperpigmen ted) plaques*

can lead to squamous cell ca

99
Q

IDA is what type of cells

A

Hypochromic, microcytic RBC

100
Q

what are the bisphosphinates

A

Alendronate,
Risedronate,
Etidronate

101
Q

tachyphylaxis

A

rapidly diminishing response to successive doses of a drug, rendering it less effective. The effect is common with drugs acting on the nervous system.

102
Q

Abdominal pain, rectal discomfort, anorexia, n/v

Acute confusional state

suspect …

A

suspect fecal impaction

103
Q

Abdominal cramps, diarrhea, fever, tenderness, strikingly increased lymphocytosis

suspect

A

Abdominal cramps, diarrhea, fever, tenderness, strikingly lymphocytosis

Pseudomembranous colitis

C. diff

Caused by clindamycin
FQ

104
Q

Mngmt. for UGIB

A

Replace coag factors as needed

Octreotide 25-50micrograms bolus followed by 25-50micrograms IV for patients w/ UGIB

105
Q

Colorectal cancer

A

MC site of metastatic spread = LIVER

106
Q

what are the RF for colorectal CA

A

familial adenomatous polyposis; age >50y;

diet low in fiber and high in red/processed meat

107
Q

Clinical manifestations

of colorectal CA

A

CRC MC cause of large bowel obstruction in adults

R sided (proximal) = lesions tend to bleed and cause diarrhea

L sided (distal) = bowel obstruction, present later, changes in stool diameter, hematochezia

108
Q

transmission of Hep A

A
  1. Transmission = Fecal-oral (international travel 40%)

Geri EOR (1 decks)

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