Healthcare Maintenance

Question 1

Primary Preventive Medicine

Answer 1

remove or reduce disease risk factors

ex) immunizations, smoking cessation, “sitting is the new smoking”

Question 2

Secondary Preventive Medicine

Answer 2

promote early detection or precursor of disease

ex) routine PAP, self-breast and self-testicular exams

Question 3

Tertiary Preventive Medicine

Answer 3

limit the impact of established disease

ex) partical mastectomy

Question 4

Osteoporosis Prevention

Answer 4

calcium and vitamin D supplements, weight-bearing exercise program, bisphosphonates

Question 5

Physical Inactivity

HHA an CDC Recommend

Answer 5

• adults and older adults engage in 150 minutes of moderate intensity activity per week
• Clinicians should incorporate motivational interviewing - the “5 A’s”

Question 6

the “5 A’s”

Answer 6

• Ask (identify who can benefit)
• Assess (current activity level)
• Advise (individualize plan)
• Assist (provide written exercise prescription and support)
• Arrange (appropriate referral and follow up)

Question 7

Overweight and Obesity

Answer 7

• we have to initiate the conversation
• we have to recognize our biases
• decrease stress
• metabolic syndrome

Question 8

Metabolic Syndrome Prevalence

Answer 8

1/4 of US population

Question 9

Metabolic Syndrome

Answer 9

3 out of 5 criteria must be met

• waist measurement >40 men and >35 women
• Triglyceride >150
• HDL <40 men and <50 women
• BP >130/85
• FBS>100

Question 10

Clinical Preventive Services

Answer 10

• mammography
• colorectal cancer
• Pap
• HPV
• Serial CT

Question 11

Mammography

Answer 11

women 50 - 74 years old

every 2 years

Question 12

Colorectal cancer

Answer 12

50 to 74 years old
gFOBT, FIT, FIT-DNA - annually
Flexible sigmoidoscopy - every 5 years
Colonoscopy - every 10 years

Question 13

PAP

Answer 13

21 to 65 years old

every 3 years

Question 14

HPV

Answer 14

30 to 65 years old

every 5 years

Question 15

Serial CT

Answer 15

smoking 30 YPH

55-80 years old annually

Question 16

Blood Pressure

Answer 16

• systolic hypertension with a widened pulse pressure (difference between systolic and diastolic)
• diastolic pressure stops rising in 6th decade
• older population more at risk for developing orthostatic hypotension

Question 17

Fever

Answer 17

starts at 100.4 degrees

Question 18

Skin/Nails

Answer 18

turgor and actinic purpura

Question 19

Turgor

Answer 19

dehydration status

Question 20

Actinic Purpura

Answer 20

purple patches or macule that occur due to blood leaking out through poorly supported capillaries

Question 21

Olfactory

Answer 21

significant deficits cause food to lose taste and people eat less which increases risk of orthostatic hypotension

• 50% of patients 65-80 years old
• 75% of patients older than 80 years old

Question 22

Ocular

Answer 22

• corneal arcus
• presbyopia
• vitreous degeneration
• retinal detachment
• muscular degeneration
• cataracts
• glaucoma

Question 23

Corneal Arcus

Answer 23

caused by lipid deposits at the limbus

Forms a white ring around eye

Question 24

Presbyopia

Answer 24

begins around 40 years old due to inability to accommodate and focus on near, distant vision remains fairly constant
-vitreous fluid helps you see but as you age the angle changes which reduces the amount of fluid

Question 25

Vitreous Degeneration

Answer 25

opacities "floaters" develop in vitreous fluid

Question 26

Retinal Detachment

Answer 26

Photopsia (bright flashers) and floaters

Question 27

Macular Degeneration

Answer 27

centralized loss of vision

Question 28

Cataracts

Answer 28

become thicker and may yellow which causes color discrepancy

Question 29

Glaucoma

Answer 29

can occur due to the growth of the lens - pushing iris forward causing narrow-angle glaucoma - increased intra-ocular pressure

Question 30

Hearing

Answer 30

sensory or conductive loss

Question 31

Sensory loss

Answer 31

presbycusis - age related hearing loss occurs around 50 years old -most common cause of sensorineural hearing loss

Question 32

Early stages of prebycusis

Answer 32

high frequency hearing loss

Question 33

Presbycusis - gradually

Answer 33

sounds in the middle and lower rangs

Question 34

Prebycusis - progressions

Answer 34

loss of all frequencies

Question 35

Conductive loss

Answer 35

cerumen impaction

Question 36

thoracic

Answer 36

lung mass declines with predisposes risk of atelectasis and pneumonia

Question 37

Systolic bruits

Answer 37

middle upper portion of carotid arteries indicate possible partial arterial obstructions from atherosclerosis

Question 38

Cardiac output

Answer 38

HR decreases = stroke volume increases = maintain CO

Question 39

extra heart sounds

Answer 39

S3 and S4

Question 40

S3

Answer 40

physiologically a 3rd heart sound is common in children and young adults -If S3 heard in adult >40 years old indicative of heart failure

Question 41

S4

Answer 41

possibly due to decreased ventricular compliance

Question 42

Aortic sclerosis

Answer 42

thickening at base of cups with fibrous tissue and calcification -causes a BRISK carotid upstroke

Question 43

Aortic stenosis

Answer 43

valve leaflets are calcified and immobile resulting in obstruction -causes a DELAYED carotid upstroke

Question 44

Aortic sclerosis and stenosis

Answer 44

both carry increased rick of CV morbidity and mortality

Question 45

Mitral regurgitation (MR)

Answer 45

systolic murmur that occur about 10 years later than aortic sclerosis

Question 46

Musculoskeletal

Answer 46

loss of height is significant with age, mostly due to thinning of intervertebral discs and vertebral bodies shortening or collapsing from osteoporosis -this causes kyphosis and increased anteroposterior diameter of chest (barrel chested) which then caused shortness of breath

Question 47

Brain atrophy

Answer 47

usually begins to occur after 60 years old | -often accompanied by an inflammatory response

Question 48

Mental changes

Answer 48

benign forgetfulness and functional impairment

Question 49

Benign forgetfulness

Answer 49

names of people or objects, details of specific events | -usually due to stress, assure patients this is not Alzheimer's

Question 50

Functional impairment

Answer 50

retrieve and process data slower | -more susceptible to delirium due to infection or mediations

Question 51

Benign tremor

Answer 51

- faster - disappears - no muscle rigidity

Question 52

Parkinson's disease

Answer 52

- slower - present at rest - muscle rigidity

Question 53

Approaching the older patients

Answer 53

geriatric conditions/syndromes - cognitive impairment - falls/dizziness - depression - urinary incontinence - functional impairment