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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
Q

What possible heart changes can occur

A

displacement of apical impulse (2/2 kyphoscoliosis)
ASx brady (if healthy, not significant)
Irregular irregular rhythm

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26
Q

What happens to cardiac output with age

A

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)

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27
Q

What systolic murmurs are present in the elderly

A

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
Q

What murmurs are uncommon in ANY age

A

Diastolic murmurs

29
Q

What happens to the peripheral vascular system with age

A

Periph arteries lengthen, tortuous, feel harder
Arterial stiffness, decreased endothelial function
Loss of arterial pulsations (abnormal, needs workup)
Back/ Abd pain (AAA?)

30
Q

What are common but still abnormal vascular changes in elderly

A

arterial and venous changes, like atherosclerosis

31
Q

Who is most concerning for a AAA

A

Male smoker >65 y/o

32
Q

Female breast exam reveals

A

Smaller breasts, more flaccid and pendulous
Atrophy of glandular tissue (replaced by fat)
Ducts around nipple are palpable and firm
Axillary hair decreases

33
Q

Male breast exam reveals

A

Gynecomastia

Decreased axillary hair

34
Q

Why does exercise capacity decrease in the elderly

A 
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
Q

How long do you auscultate when trying to ID AFib

A

one minute at least

36
Q

“Symptomatic” valve disease includes

A

SOB
angina
fatigue
syncope

37
Q

Abdominal changes in the elderly include

A

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
Q

Decreased activity of lipoprotein lipase is associated with

A

accumulation of fat in the lower abdomen and around hips, regardless of weight

39
Q

What should your GI PE include

A

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
Q

Anal wink tests

A

SF visceral refles of pudendal nerve (S2-S4)

41
Q

What happens in the male GU system with age

A

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
Q

What causes BPH

A

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
Q

What happens in the female GU system with age

A 
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
Q

Prevalence of urinary incontinence increases 2/2

A

denervation and contractility of detrusor
loss of bladder capacity
urinary flow rate
inability to inhibit voiding

45
Q

What does a female reproductive PE include in elderly

A

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
Q

Palpable ovaries 10 years after menopause suggests

A

cancer!

47
Q

What happens to MSK with age

A

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
Q

Where does most height loss come form

A

Trunk, 2/2 intravertebral disc thinning

Osteoporosis

49
Q

What should your MSK PE include

A

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
Q

What foot problems can occur with age

A 
Hallux valgus 
Hammer toe 
Claw toe 
all 2/2 wearing ill fitting shoes, RA, diabetes, neuro d/o 
*Refer to podiatry!**
51
Q

What nervous system changes occur in elderly

A

Mental status changes
motor and sensory changes
reflex changes
Decrease in brain volume, cortical brain cells, etc.

52
Q

What happens to mental status with change

A

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
Q

What happens to cranial nerves with age (normal changes)

A

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
Q

What motor changes occur in elderly

A

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
Q

When would motor findings be insignificant

A

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
Q

What sensory changes occur in elderly

A

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
Q

Where do elderly NOT lose vibratory sense

A

shins and fingers

58
Q

What happens to coordination with age

A

decreases, but is ver subtle and does not impaie function

59
Q

What happens to posture with age

A

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
Q

What happens to gait with age

A 
shorter steps (weak calf muscles, poor balance) 
reduced velocity if 70+ 
Increased time in double stance (fear of falling) 
Reduced joint motion)
61
Q

What are normal and abnormal gait velocities

A

Normal: 0.8 m/s+ or <5 seconds on a 4 meter
Slow: less than 0.8 ms

62
Q

What are some causes of gait dysfunction

A 
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
Q

What test measures stability

A

Romberg

64
Q

What lab values are UNCHANGED with age

A 
H&amp;H 
WBC 
Platelets 
Lytes (Na, HCO3, K, Cl) 
BUN 
LFT 
Free thyroxine 
TSH 
Calcium 
Phosphorus
65
Q

What are common changes in lab values with age

A 
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

Summer 2 (8 decks)

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