High Yield I Flashcards by Z C

Top three causes of mortality in elderly

Heart disease
Cancer
COPD

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

50%

9% of 65-69 year olds!

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Life expectancy in 1900 vs 2001

49 to 78

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

23 Years
35 years
45 years

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

41.9 workers
vs
2.9 workers

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How much did nursing homes cost total?

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

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% of geriatric pt with three or more chronic ilnesses

50%

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What is Latrogenesis?

Beers criteeria

Latrogenesis = Less is more.

Beers criteria = Drug interactions/ polypharmacy.

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

10-30%

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What percentage of seniors have alzheimers?

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

5th cause of death
affecting 5.4 million

Costs 236 billion.

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What is the Activity psycosocial theory?

Maintenance of an alterations in regular activities.

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What is the Life course psychosocial theory?

Progressive adjustment to changes with increased age.

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What is the continuity psychosocial theory?

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

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Error catastrophe theory

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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Rate of living theory

Aging caused by rate of metabolism through free radical production.

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

85%

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What did the Nun study prove?

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

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Which neurotransmitters are lost with age?

Dopamine and serotonin.

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A decrease in DHEA can lead to what condition?

What happens in geriatric patients regarding glucose sensitivity and insulin?

Can lead to osteoperosis

Become insulin resistant with glucose intolerance.

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What can lead to geriatric increased risk for hyperkalemia?

Descreased plasma renin and aldosterone.

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

Resting heart rate should remain normal.

Maximum heart rate will decline naturally with age.

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Which two factors decrease in geriatric lungs?

FVC and FEV

due to decreased lung lasticity.

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What is occuring with osteoblasts vs osteoclasts in osteoperosis?

How does Fluoride effect bone density?

Decreased osteoblastic activity with increased osteoclastic activity.

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

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Olfactory sensation is reduced by what percentage?

50%

Percentage of people >65 years old that have alzheimers dementia

6-8% Nearly 45% of those aged >85 have Alzheimers diseas(Tau and amyloid plaques)

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

15-20%

What is the second most common form of dementia? What type of inclusion body is it associated with?

Lewy body dementia characterized by cytoplasmic alpha synuclein inclusion bodies.

What inclusion body causes frontotemporal dementia?

Tau or ubiquitin proteins.

Two biggest risk factors for alzhiermers disease?

Age | Family history

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

Early onset dementia

APOE 2/3/4 on chromosome 19 are causations of what? What about APOE 4 and APOE2 specifically?

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

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

Demonstrate motivation during cog testing Express cognitive complaints that exceed measured deficits. Maintain language and motor skills.

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

Vascular dementia.

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

Lewy body dementia.

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.

Frontotemporal dementia.

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

Alzheimers/ Dementia

Which two forms of dementia should not be treated pharmacologically?

Frontotemporal and vascular dementia.

Rivastigmine can be used to treat which specific dementia?

Parkinson dementia.

Anticholinergic medications for alzheimers/Dementia should be.....

Avoided like the black plague!

Normally brain neurons will decrease by what percentage?

0-50%

Normally Maximum breathing capacity will change by what percent?

80%

Normally Lower esophageal failure will change by what percent?

50% decrease

Most common valvular lesion is?

Aortic stenosis!

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?

Up to 70% decrease Parotid gland decreases by 50% 50% decrease in glomeruli 50% decrease in GFR Renal plasma blood flow 40% lower

How much percentage does the brain lose in weight? Cerebral blood flow decrease percentage?

10% is lost in weight 20% decrease by age 70

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

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

What is presbycusis?

Irreversable sensorineural hearing loss that occurs with age.

What percentage of muscle loss occurs?

30-50%

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

A decrease in filaggrin

Which is better absorbed in patients with Xerosis

Hydrophobic substances are well absorbed whereas hydrophilic are not.

What percentage of falls ocur in persons over 65? Over 80?

30% in persons over 65 who live independently 50% in persons over 80.

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

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

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

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

What are the hallmarks of psychotic depression?

Sustained paranoid, guilty, or somatic delusions. In elderly always look out for the unwaranted somatic symptoms.

Ctalopram and escitalopram sertraline are?

SSRIs serotonin reuptake inhibitors to treat moderate to severe depression.

What is the most common antidepressant prescription errors?

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

Describe bipolar disorder type II

Recurrent major depressive episodes intersperesed with periods of hypomania.

What is bipolar disorder type I?

Mania with or without depression.

What is bipolar disorder type II?

Major depressive disorder without mania but with hypomania.

Lithium carbonate can be used to treat which two disorders?

Bipolar Depression and Mania

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

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.

Glutamate activity in the elderly...?

Hyperactive all others decrease Ach Dopa Seratonin etc....

CMS approves antipsychotics for which disorders?

"SHiT" Schitzo Huntingtons Tourretes.

which two medications are used to treat cognitive decline?

Acetylcholinesterase inhibitors | NMDA receptor antagonists (memantine)

Which medications can be used for sundownin?

Benzodiazepines | Selective serotonin reuptake inhibitors.

the crockcroft gault equation is used to descibe what?

The clearance of pharmaceutical drugs from the body.

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

About 40%!

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

57%!

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

about 28%! | 100,000 admissions per year because of this with over 50% of them being >80 years old.

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

1/4- 1/2! | 25-50%

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

17% | Think 15-20

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

Body mass index that is greater than 25

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

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

PPI induced B12 loss is a risk factor for what?

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

First sign of respiratory infection?

Tachypnea | Breathing faster than normal.

Urinary tract infection in men....

Demands consideration for infection in entrire genitourinary tract.

In old age infection is....

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

Diverticulitis should be treated with....?

Needs hospitilization and broad spectrum antibiotic therapy.

What is considered a fever for an elderly patient?

>99 degrees (32.2 C) orally | > 99.5 rectally (32.5 C)

Which bacterial infection is most common for respiration infections?

Streptococcus pneumoniae Gram - Haemophilus Staph aureus there as well

Which flu antiviral is most commonly used?

Oseltamivir

Which bacilli type most commonly causes UTIs?

Gram negative bacteria.

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

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

Lifetime risk of herpes zoster?

20% in people >50

In VZV what is hutchinsons sign?

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

Ramsay-Hunt syndrome?

Herpes zoster to the external ear or tympanic membrane. | Causes facial palsy with or without tinnitus,vertigo and deafness

What percentage of actinic keratoses progresses to squamous cell cancer?

20%