Intro to Geriatrics

Question 1

What is geriatric medicine?

Answer 1

Medical speciality focusing on medical issues/dieseas of aging and old age

> 65 y/o

Question 2

How is geriatric medicine different?

Answer 2

older pt

understanding of aging process

multidisciplinary

end of life care

Question 3

What is aging?

Answer 3

time dependent deterioration:

weakness, increased susceptibility to disease, loss of mobility and agility , age related physiologic change

Question 4

Functional performance of an organ in an older person depends on…

Answer 4

the rate if deterioration

the level of performance needed

Question 5

The hallmark of aging is assoc. with…

Answer 5

how an organ perform during external stress NOT how it performs at rest

Question 6

Examples of atypical presentation in older persons? What is this due to?

Answer 6

failure to mount a white count or ever in response to infx, no pain with MI

due to failure of the stress response

Question 7

Changes in aging can work together to…

Answer 7

produce a normal appearing resting state

I.e. normal Cr despite decreased in GFR and renal blood flow

Question 8

How often should you check weight? Height?

Answer 8

at each visit

at least annually

Question 9

Why can BP be overestimated in elderly?

Answer 9

due to stiff arteries (pseudohypertension)

Question 10

How does skin change with aging?

Answer 10

skin becomes lax, loss of turgor

decreased vascularity in dermis > paler, more opaque

backs of hands/forearm: thin, fragile, loose and transparent skin with actinic purpura

Question 11

How do nails change with age?

Answer 11

loose luster, may yellow and thicken, brittle

Question 12

How does hair change with age?

Answer 12

scalp hair loses pigment

decrease in # of scalp hairs

women ~55 y/o will notice coarse facial hairs on upper lip and chin

Question 13

How can pupils change with age? other eye changes?

Answer 13

become smaller an may be slightly irregular

dry eyes, presbyopia, cataract,, glaucoma and macular degeneration

thickening and yellowing of lens impeded light flow to the retina –> need more light to see

Question 14

Changes with nose?

Answer 14

descent of nasal tip

enlarges

Question 15

changes with ears?

Answer 15

presbycusis

Question 16

Mouth changes with age?

Answer 16

darken teeth

fissures in the mouth/tongue

changes in tongue (ex. varicosities)

angular chelitis

TMJ- eval for osteoarthrosis

Question 17

Thyroid changes? What else should you check in the neck?

Answer 17

can enlarge downward

carotid bruits, transmitted heart murmur

check neck for flexibility

Question 18

On respiratory exam…..can be present at the lung bases but should clear with deep inhalation and cough

Answer 18

basilar rales (crackles)

Question 19

Changes in HR with age?

Answer 19

bradycardia

check for irregular irregular rhythm

Question 20

Systolic murmurs in elderly?

Answer 20

aortic valve sclerosis

aortic valve stenosis

mitral regurgitation

hypertrophic cardiomyopathy

Question 21

Breast changes with ages?

Answer 21

breast become smaller, more flaccid and pendulous

granular tissue atrophies and is replaced by fat

ducts surrounding the nipple may become palpable as stringy strands

males can develop gynecomastia

Question 22

Abdominal changes with age?

Answer 22

abd muscle weaken

soft, more protruding abd

changes in abd fat distribution

Question 23

How can aging blunt the manifestations of acute abd disease?

Answer 23

pain can be less severe

lower/absent severe

guarding/rebound reduced or absent

Question 24

When does ovarian func. begin to decline?

Answer 24

around the 5th decade, menstrual periods cease btwn ages 45-52 y/o

Question 25

Why do women get urinary incontinence?

Answer 25

Denervation and contractility of the detrusor muscle

Loss of bladder capacity

Urinary flow rate

Inability to inhibit voiding

Question 26

Musculoskeletal change with age?

Answer 26

M/W lose cortical and trabecular bone mass

Question 27

Age related findings of the feet?

Answer 27

Hallux valgus

Hammer toes

Claw toe

Question 28

Toe deformities can result from…

Answer 28

ill fitting foot wear, RA, DM, neurological disorder

Question 29

Nervous system changes with age?

Answer 29

affects all aspects of nervous system

Brain volume, cortical brain cells, and intrinsic regional connecting networks decrease, and both anatomical and biochemical changes occur

Question 30

Bell phenomenon may be absent in older adults, what is this?

Answer 30

reflex upward movement of eyes during closure

Question 31

Where is vibratory sense frequently loss?

Answer 31

in the feet and ankles

not skins or fingers

Question 32

Aging effect on walking?

Answer 32

typically little effect, elder lying walk upright unless there is a disorder present

Question 33

Normal gait velocity? Slow gait velocity?

Answer 33

> 0.8 m/s or <5seconds on a 4 meter walkway

<0.8m/s