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Summer 2 > Intro to geriatrics > Flashcards

Intro to geriatrics Flashcards

1
Q

What is current life span at birth

A

women: 79 years
men: 74 years

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2
Q

What is life expectancy at different ages

A

65: 15 years
75: 10 years
85: 5 years
95: 2-3 years

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3
Q

Who are geriatric patients

A

65+ years old

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4
Q

How is geriatric medicine different

A

older patients, must understand aging process
multidisciplinary
end of life care

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5
Q

What is aging

A

time dependent deterioration leading to:
weakness, high susceptibility to disease and adverse environmental conditions, loss of mobility and agility, age related physiologic changes

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6
Q

Changes associated with aging often result from

A

gradual loss of homeostatic mechanisms- begin in early adulthood but are not evident until they are fairly extensive
(functional loss significant when it crosses a specific level)

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7
Q

Functional performance of an organ in an old person depends on

A

rate of deterioration

level of performance needed

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8
Q

Hallmark of aging is associated with

A

**how well an organ performs during external stress, not at rest

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9
Q

These are the body’s response to aging

A

Failure if the stress response (WBC 2/2 infx, pain 2/2 MI)
Ill defined Sx rather than typical Sx (confusion, change in appetite, nausea, fatigue)
Changes sync to produce normal appearing resting state (normal SrCr despite low GFR and renal blood flow 2/2 less LBM and less Cr)

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10
Q

What vital signs should be recorded in a geriatric assessment

A 
Weight (each visit) 
Height (annually for osteoporosis) 
Temp 
Pulse/BP in each arm for 30 sec (should not be >20 diff) (can be overestimated 2/2 stiff arteries) 
RR (norm up to 35- >25= LRI)
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11
Q

What are changes in skin

A

wrinkles, decreased turgor
decreased dermal vascularity (pale, opaque)
thin, fragile skin, transparent actinic purpura over back of hands and forearms

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12
Q

What happens to nails with age

A

lose luster, yellow and thick

brittle

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13
Q

What happens to hair as you age

A

Loss of pigment in scalp hair
Genetic hair loss (men 20+ have receding hairline at temples, then vertex)
# of hairs decrease
Women 55+: coarse facial hair to upper lip and chin

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14
Q

Who do hair changes often NOT occur in

A

Native american, darker skinned people

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15
Q

What changes happen to the face

A

Brows drop below superior orbital rim
chin descends
Lose angle between submandibular line and neck
Wrinkles
Dry skin
Thick terminal hairs on ears, nose, upper lip, chin

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16
Q

What do you need to palpate on the head of old people

A

temporal arteries for giant cell arteritis

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17
Q

Changes to the eyes include

A

sunken eyeballs (atrophy of fat cushion around eye)
Lower lid fat pushes causing bulge
Dry eyes (decreased lacrimation)
Smaller pupils
VA diminishes after 50 (faster after 70)
Presbyopia
Risk for cataracts, glaucoma, and ARMD (lens related)
Thick, yellow lens= light cant get into retina= need more light to see

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18
Q

Changes to the nose include

A

Nasal tip descent

Enlarged lengthened nose

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19
Q

Changes to the ears include

A

Presbycusis (high pitch lost first)

Harder to hear in noisy environments

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20
Q

What changes occur in the mouth

A

Dark teeth (extrinsic staining, less translucent enamel)
Mouth and tongue fissures (xerostomia)
Ventral varicosities, benign glossitis, atrophied papillae on sides, large tongue to help chew if edentulous, Glossitis (low B12)
Angular chelitis (edentuous w/o dentures)
Osteoarthritis for mandibular TMJ

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21
Q

What do you remove before examining the mouth

A

dentures

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22
Q

What changes occur to the neck

A

Large thyroid gland (into sternum)
Carotid bruits, transmitted heart murmur
Resistance to passive flex/extend and lateral rotation

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23
Q

How can you tell the difference between bruits and murmur

A

Bruits: louder Heart to Neck
Murmur: louder Neck to Heart (or softer heart to neck)

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24
Q

What should you always evaluate on chest/back exam

A

all lung areas with percussion AND auscultation
Basilar rales (crackle) may be present, but SHOULD clear with deep inhale/cough
Excursion and Expansion
Scoliosis and tenderness to back

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25
What possible heart changes can occur
displacement of apical impulse (2/2 kyphoscoliosis) ASx brady (if healthy, not significant) Irregular irregular rhythm
26
What happens to cardiac output with age
Myocardial contraction less responsive to B catecholamines Drop in resting HR, BIG drop in exercise HR Increased SV to maintain low CO Diastolic dysfxn 2/2 early diastole Increased myocardial stiffness Inc. risk of HF (2/2 less atrial contraction)
27
What systolic murmurs are present in the elderly
Aortic valve sclerosis: increased risk for stroke. Radiates to carotids Aortic valve stenosis: progresses to Sx. radiates to carotids Mitral Regurg: loud at apex, radiate to axilla HCM: intense with valsalva
28
What murmurs are uncommon in ANY age
Diastolic murmurs
29
What happens to the peripheral vascular system with age
Periph arteries lengthen, tortuous, feel harder Arterial stiffness, decreased endothelial function Loss of arterial pulsations (abnormal, needs workup) Back/ Abd pain (AAA?)
30
What are common but still abnormal vascular changes in elderly
arterial and venous changes, like atherosclerosis
31
Who is most concerning for a AAA
Male smoker >65 y/o
32
Female breast exam reveals
Smaller breasts, more flaccid and pendulous Atrophy of glandular tissue (replaced by fat) Ducts around nipple are palpable and firm Axillary hair decreases
33
Male breast exam reveals
Gynecomastia | Decreased axillary hair
34
Why does exercise capacity decrease in the elderly
``` chest wall is stiffer, harder to move Resp muscle weaken Lungs lose elastic recoil Lung mass declines, RV increases Slower exhale, less effective cough reflex Kyphosis further worsens Fxn ```
35
How long do you auscultate when trying to ID AFib
one minute at least
36
"Symptomatic" valve disease includes
SOB angina fatigue syncope
37
Abdominal changes in the elderly include
Weak muscles soft, protruding abdomen increased CV risk 2/2 abdominal fat Blunted Sx of acute abdomen (less severe pain, lower fever, Reduced Sx of peritonitis- RGr)
38
Decreased activity of lipoprotein lipase is associated with
accumulation of fat in the lower abdomen and around hips, regardless of weight
39
What should your GI PE include
Palpate abdomen for hernias and weak abdominal muscles Palpate AAA (pulsatile mass? decreased distal perfusion, purple toes) Palpate for hepatosplenomegaly Suprapubic palpation and percussion (urine retention?) Sensation of anorectal area, anal wink DRE (mass, stricture, ttp, fecal impaction) Fecal occult blood test
40
Anal wink tests
SF visceral refles of pudendal nerve (S2-S4)
41
What happens in the male GU system with age
Sex interest intact (Fq declines >75) Decreased testosterone= erections dependent on tactile stimulation Penis gets smaller testicles drop lower Pubic hair decreases and is grey +/- ED in 50% (vascular causes- smoking, meds, HTN, DM) BPH
42
What causes BPH
androgen proliferation of prostate epithelial and stromal tissue starts in third decade, continues into 70's -Palpate prostate on DRE for size, tenderness, nodules, and consistency
43
What happens in the female GU system with age
``` Fxnl decline in 50's Menopause around 45-52 Hot flashes (decreased estrogen) sleep disruption, mood changes vaginal dryness, UUI, dyspareunia Grey sparse pubic hair smaller clitoris/labia Narrow, shorter vagina thin, pale, dry vag mucosa 10 yrs s/p menopause, ovaries not palpable Relaxed suspensory ligaments of adnexa, uterus, and bladder Sex interest UNCHANGED! ```
44
Prevalence of urinary incontinence increases 2/2
denervation and contractility of detrusor loss of bladder capacity urinary flow rate inability to inhibit voiding
45
What does a female reproductive PE include in elderly
Pap q 2-3 years until 65 Hysterectomy: pap still with certain factors Bimanual pelvic w/ limited hip mobility: lie on left side Examine for evidence of prolapsed urethra, vagina, cervix, or uterus Lack of estrogen= dry mucosa W/O rugae
46
Palpable ovaries 10 years after menopause suggests
cancer!
47
What happens to MSK with age
Lose cortical and trabecular bone mass (W more after menopause) Calcium resorption (2/2 high PTH) Subtle loss in height after maturity Added flexion to hips and knees (also causes decreased height)
48
Where does most height loss come form
Trunk, 2/2 intravertebral disc thinning | Osteoporosis
49
What should your MSK PE include
Examine joints for ttp, swelling, subluxation, crepitus, warmth, redness Heberdens/Bouchard nodules Subluxed MCP w/ ulnar deviation (chronic RA) Swan neck/Boutonniere (RA) Active/passive ROM Joint contractures
50
What foot problems can occur with age
``` Hallux valgus Hammer toe Claw toe all 2/2 wearing ill fitting shoes, RA, diabetes, neuro d/o *Refer to podiatry!** ```
51
What nervous system changes occur in elderly
Mental status changes motor and sensory changes reflex changes Decrease in brain volume, cortical brain cells, etc.
52
What happens to mental status with change
Impaired memory with likely normal MSE (benign forgetfulness) Process and retrieve info more slowly Takes longer to learn new tasks More susceptible to delirium *Distinguish age related changes form depression or dementia
53
What happens to cranial nerves with age (normal changes)
Small pupils, slow light reactivity, diminished miotic response to near vision Limited upward gaze Bell phenomenon (reflex upward eyes during closure) Diminished sense of smell Altered taste 2/2 decreased sense of smell. meds that cause xerostomia
54
What motor changes occur in elderly
Move and react w/ less speed/agility Benign essential tremor to head, jaw, lips, or hands (NOT parkinsons) Sarcopenia (decreased muscle mass)- esp hand muscles
55
When would motor findings be insignificant
if weakness in bilateral and does not bother patient, hasnt changed pt's fxn or activity (likely 2/2 disuse) Sarcopenia W/O decline or change in function
56
What sensory changes occur in elderly
Lost vibratory sensation (esp feet and ankles) Diminished position sense Absent gag reflex Symmetrically diminished ankle reflex (even w/ reinforcement) -less common to lose knee reflexes
57
Where do elderly NOT lose vibratory sense
shins and fingers
58
What happens to coordination with age
decreases, but is ver subtle and does not impaie function
59
What happens to posture with age
Not super affected! Elderly usually walk upright unless 2/2 disorder Slight change in walking posture- pelvis tips down, abd muscles weak, tight hip flexors, toes turn out
60
What happens to gait with age
``` shorter steps (weak calf muscles, poor balance) reduced velocity if 70+ Increased time in double stance (fear of falling) Reduced joint motion) ```
61
What are normal and abnormal gait velocities
Normal: 0.8 m/s+ or <5 seconds on a 4 meter Slow: less than 0.8 ms
62
What are some causes of gait dysfunction
``` Neurogenic clsudication (pain, numb, weak when walking- less w/ sitting) Hard to initiate walking Truncal instability Lean forward during walking Step asymmetry Step discontinuity Step length or height abnormality Stride width ```
63
What test measures stability
Romberg
64
What lab values are UNCHANGED with age
``` H&H WBC Platelets Lytes (Na, HCO3, K, Cl) BUN LFT Free thyroxine TSH Calcium Phosphorus ```
65
What are common changes in lab values with age
``` High sed rate: High glucose High-norm creatinine High Alk phos High PSA Low albumin (esp if sick) Low ferritin Low bone density on CXR ```

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