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High Yield Geriatrics Exam I > High Yield I > Flashcards

High Yield I Flashcards

1
Q

Top three causes of mortality in elderly

A

Heart disease
Cancer
COPD

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2
Q

% of patients 85 and over that require assitance with living.

A

50%

9% of 65-69 year olds!

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3
Q

Life expectancy in 1900 vs 2001

A

49 to 78

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4
Q

Medium age in 1901?
Median age in 2001?
Predicted median age for 2101?

A

23 Years
35 years
45 years

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5
Q

How many workers supported one SS retiree in 1945 vs 2010?

A

41.9 workers
vs
2.9 workers

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6
Q

How much did nursing homes cost total?

A

206.6 billion
with
100 bill from medicaid 42.2 billion from medicare,

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7
Q

% of geriatric pt with three or more chronic ilnesses

A

50%

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8
Q

What is Latrogenesis?

Beers criteeria

A

Latrogenesis = Less is more.

Beers criteria = Drug interactions/ polypharmacy.

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9
Q

By middle age what percentage of function has decreased? (40-64)

A

10-30%

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10
Q

What percentage of seniors have alzheimers?

A

7%

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11
Q

Dementia is the …. cause of death and effects how many americans in the year 2016?

A

5th cause of death
affecting 5.4 million

Costs 236 billion.

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12
Q

What is the Activity psycosocial theory?

A

Maintenance of an alterations in regular activities.

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13
Q

What is the Life course psychosocial theory?

A

Progressive adjustment to changes with increased age.

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14
Q

What is the continuity psychosocial theory?

A

The use of familiar strategies as an adaptive way to deal with changes.

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15
Q

Error catastrophe theory

A

The damage is because of RNA and protein damage leading to misproper reading of genes.

Leads to a spread of mistakes.

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16
Q

Rate of living theory

A

Aging caused by rate of metabolism through free radical production.

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17
Q

Percentage of elders >65 that are not showing memory loss and function independently?

A

85%

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18
Q

What did the Nun study prove?

A

That patients with the same amount of plaques and tangles may have had very different presentations of alzheimers.

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19
Q

Which neurotransmitters are lost with age?

A

Dopamine and serotonin.

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20
Q

A decrease in DHEA can lead to what condition?

What happens in geriatric patients regarding glucose sensitivity and insulin?

A

Can lead to osteoperosis

Become insulin resistant with glucose intolerance.

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21
Q

What can lead to geriatric increased risk for hyperkalemia?

A

Descreased plasma renin and aldosterone.

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22
Q

A Geriatrics resting heart rate and max heart rate will change in what ways?

A

Resting heart rate should remain normal.

Maximum heart rate will decline naturally with age.

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23
Q

Which two factors decrease in geriatric lungs?

A

FVC and FEV

due to decreased lung lasticity.

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24
Q

What is occuring with osteoblasts vs osteoclasts in osteoperosis?

How does Fluoride effect bone density?

A

Decreased osteoblastic activity with increased osteoclastic activity.

Fluoride increases cortical density but not cancelous and can lead to chalky bone.

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25
Q

Olfactory sensation is reduced by what percentage?

A

50%

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26
Q

Percentage of people >65 years old that have alzheimers dementia

A

6-8%

Nearly 45% of those aged >85 have Alzheimers diseas(Tau and amyloid plaques)

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27
Q

What percentage of vascular dementia co-occurs with alzheimers?
Termed “Mixed dementia”

A

15-20%

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28
Q

What is the second most common form of dementia?

What type of inclusion body is it associated with?

A

Lewy body dementia characterized by cytoplasmic alpha synuclein inclusion bodies.

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29
Q

What inclusion body causes frontotemporal dementia?

A

Tau or ubiquitin proteins.

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30
Q

Two biggest risk factors for alzhiermers disease?

A

Age

Family history

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31
Q

Amyloid precursor protein and Presenilin proteins (PS1 and PS2) are signs for what condition?

A

Early onset dementia

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32
Q

APOE 2/3/4 on chromosome 19 are causations of what?

What about APOE 4 and APOE2 specifically?

A

Late onset alzheimers
APOE 4- dose related risk
APOE2 - Protective

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33
Q

People with depression differ with those that have dementia in what three ways?

A

Demonstrate motivation during cog testing
Express cognitive complaints that exceed measured deficits.

Maintain language and motor skills.

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34
Q

Cortical or subcortical changes on MRI, Dysexecutive syndrome, and sudden or stepwise onset describes what sort of dementia?

A

Vascular dementia.

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35
Q

Gradual onset memory, visuispatial loss with hallucinations and parkinsonism motor symptoms with possible global atrophy describe what form of dementia?

A

Lewy body dementia.

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36
Q

Cognitive symptoms including executive, language, and behavioral dysfunction including dysinhibition and hyperorality are all descriptions of which type of dementia?

*Atrophy of the frontal and temporal lobes as well.

A

Frontotemporal dementia.

37
Q

Donepezil, rivastigmine, galantamine, and memantine are all drugs used to treat what?

Cholinesterase inhibitors?

A

Alzheimers/ Dementia

38
Q

Which two forms of dementia should not be treated pharmacologically?

A

Frontotemporal and vascular dementia.

39
Q

Rivastigmine can be used to treat which specific dementia?

A

Parkinson dementia.

40
Q

Anticholinergic medications for alzheimers/Dementia should be…..

A

Avoided like the black plague!

41
Q

Normally brain neurons will decrease by what percentage?

A

0-50%

42
Q

Normally Maximum breathing capacity will change by what percent?

A

80%

43
Q

Normally Lower esophageal failure will change by what percent?

A

50% decrease

44
Q

Most common valvular lesion is?

A

Aortic stenosis!

45
Q

Cardiac output normally decreases by what percentage by age 70?

Percentage of parotid gland decrease?

decrease in Glomeruli?

Decrease in GFR?

Renal plasma blood flow?

A

Up to 70% decrease

Parotid gland decreases by 50%

50% decrease in glomeruli

50% decrease in GFR

Renal plasma blood flow 40% lower

46
Q

How much percentage does the brain lose in weight?

Cerebral blood flow decrease percentage?

A

10% is lost in weight

20% decrease by age 70

47
Q

Episodic working memory, and executive domains are normally affected by aging, is this correct?

A

Yes

Executive functioning declines with age, and more dramaticaly after age 70.

48
Q

What is presbycusis?

A

Irreversable sensorineural hearing loss that occurs with age.

49
Q

What percentage of muscle loss occurs?

A

30-50%

50
Q

An increase in what substance leads to dry and flaky skin?

A

A decrease in filaggrin

51
Q

Which is better absorbed in patients with Xerosis

A

Hydrophobic substances are well absorbed whereas hydrophilic are not.

52
Q

What percentage of falls ocur in persons over 65?

Over 80?

A

30% in persons over 65 who live independently

50% in persons over 80.

53
Q

Can PHQ-9 be used to reliably asses screening and response to treatment?

A

Yes PHQ-9 is for major depression diagnosis, evaluation of treatment, and for screening.

54
Q

What is the weakness of the PHQ-9 Depression screening test?

A

Not a reliable test for patient with moderate to severe dementia.

55
Q

What are the hallmarks of psychotic depression?

A

Sustained paranoid, guilty, or somatic delusions.

In elderly always look out for the unwaranted somatic symptoms.

56
Q

Ctalopram and escitalopram sertraline are?

A

SSRIs serotonin reuptake inhibitors to treat moderate to severe depression.

57
Q

What is the most common antidepressant prescription errors?

A

Failure to increase the dose to the recommended level within the first two weeks.

58
Q

Describe bipolar disorder type II

A

Recurrent major depressive episodes intersperesed with periods of hypomania.

59
Q

What is bipolar disorder type I?

A

Mania with or without depression.

60
Q

What is bipolar disorder type II?

A

Major depressive disorder without mania but with hypomania.

61
Q

Lithium carbonate can be used to treat which two disorders?

A

Bipolar Depression and Mania

62
Q

When comparing the GDS and the PHQ-9 tests….

A

GDS- Self administered, canot prove efficacy, does not ask about suicidal thoughts.

PHQ-9 does all that GDS does not.

Neither of these tests can be used in patients with significant cognitive impairment.

63
Q

Glutamate activity in the elderly…?

A

Hyperactive all others decrease
Ach
Dopa
Seratonin etc….

64
Q

CMS approves antipsychotics for which disorders?

A

“SHiT”
Schitzo
Huntingtons
Tourretes.

65
Q

which two medications are used to treat cognitive decline?

A

Acetylcholinesterase inhibitors

NMDA receptor antagonists (memantine)

66
Q

Which medications can be used for sundownin?

A

Benzodiazepines

Selective serotonin reuptake inhibitors.

67
Q

the crockcroft gault equation is used to descibe what?

A

The clearance of pharmaceutical drugs from the body.

68
Q

What percentage of nursing home patients has at least one potentially inappropriate drug?

A

About 40%!

69
Q

What percentage of VA discharges have a Rx for one or more unnecessary drugs?

A

57%!

70
Q

Adverse drug events are cause of what percentage of acute geriatric hospital admissions?

A

about 28%!

100,000 admissions per year because of this with over 50% of them being >80 years old.

71
Q

The percentage of older adults that make mistakes when taking medications?

A

1/4- 1/2!

25-50%

72
Q

% of patients in car accidents that are older than 65?

A

17%

Think 15-20

73
Q

a body mass idex of what warrants screening for diabetes every three years?

A

Body mass index that is greater than 25

74
Q

When comparing carotid artery stenting with carotid endartectomy which is better?

A

generally carotid endarrectomy has better results with less of a chance of risk of stroke.

75
Q

PPI induced B12 loss is a risk factor for what?

A

Risk factor for dementia and build up of amyloid beta deposits in the brain.

76
Q

First sign of respiratory infection?

A

Tachypnea

Breathing faster than normal.

77
Q

Urinary tract infection in men….

A

Demands consideration for infection in entrire genitourinary tract.

78
Q

In old age infection is….

A

Often presents with a subtle change in overall functional status without localized issues.

79
Q

Diverticulitis should be treated with….?

A

Needs hospitilization and broad spectrum antibiotic therapy.

80
Q

What is considered a fever for an elderly patient?

A

> 99 degrees (32.2 C) orally

> 99.5 rectally (32.5 C)

81
Q

Which bacterial infection is most common for respiration infections?

A

Streptococcus pneumoniae
Gram - Haemophilus
Staph aureus there as well

82
Q

Which flu antiviral is most commonly used?

A

Oseltamivir

83
Q

Which bacilli type most commonly causes UTIs?

A

Gram negative bacteria.

84
Q

Shortened duration of ….. and increased duration of …. results in decreased hair density

A

Shortened duration of anagen with increased duration of telogen leads to a decrease in hair density.

85
Q

Lifetime risk of herpes zoster?

A

20% in people >50

86
Q

In VZV what is hutchinsons sign?

A

Vesicles on the tip of the nose representing involvment of the nasociliary branch of the trigeminal.

87
Q

Ramsay-Hunt syndrome?

A

Herpes zoster to the external ear or tympanic membrane.

Causes facial palsy with or without tinnitus,vertigo and deafness

88
Q

What percentage of actinic keratoses progresses to squamous cell cancer?

A

20%

High Yield Geriatrics Exam I (1 decks)

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