Introduction

Question 1

What might lead to slower cardiac conduction in older patients?

Answer 1

Fibrosis or ischemia

Question 2

What is meant by the term “irritable” conduction system?

Answer 2

Easily excitable, for example an anxious episode could cause tachyarrhythmias

Question 3

What is seen on the arterial side of an older patient’s CV system?

Answer 3

Stiffness (less compliance)
Atherosclerosis

Question 4

What is seen on the venular side of an older patient’s CV system?

Answer 4

Valve failure
Thrombosis, PE

Question 5

What causes carotid TIA/CVA?

Answer 5

Occlusion

Question 6

What causes vertebral TIA/CVA?

Answer 6

Hypotension

Question 7

What are some CNS changes seen in older patients?

Answer 7

• ↓ neuronal conduction rate
• ↓ strength of transmission
• ↓ adaptation to physiologic stressors
• Threshold for arousal blurred
• ↑ recovery time in autonomic system (return to baseline)

Question 8

What are problems/causes with aging kidneys?

Answer 8

• Inadequate fluid intake
• Fluid loss due to vomiting/diarrhea
• Shock due to hemorrhage
• Cardiac failure
• Sepsis
• Injudicious use of diuretics
• Sodium phosphate enemas

Question 9

What are causes of gynecologic problems in older women?

Answer 9

• Estrogen deprivation
• Atrophy
• Decreased secretions

Question 10

What are some gynecologic problems in older women?

Answer 10

• Urinary incontinence
• Dyspareunia
• S/S menopause

Question 11

What are issues with testosterone supplementation?

Answer 11

• Cardiovascular disease*
• Diabetes

Question 12

What is the leading cause of death in people age >65?

Answer 12

Heart disease

2nd place is malignant neoplasms

Question 13

What is homeostenosis?

Answer 13

Diminished homeostatic reserve capacity of all organ systems

Question 14

What are some examples of geriatric syndromes?

Answer 14

• Dementia
• Delirium
• Urinary incontinence
• Falls
• Pressure ulcers
• Polypharmacy
• Iatrogenesis

Question 15

What are features of deliurium?

Answer 15

• Sudden onset, definite beginning
• Days to weeks
• Secondary to something (UTI, withdrawal, dehydration, etc…)
• Reversible
• Usually worse at night
• Impaired attention, consciousness, orientation (usually), language, memory
• Medical attention needed RIGHT AWAY!!!

Question 16

What are some features of dementia?

Answer 16

• Slow and gradual, uncertain beginning
• Usually permanent
• Chronic brain disorder
• Usually worse at night
• Unimpaired attention, consciousness (until severe)
• Impaired orientation/memory and mild language difficulty
• Need for medical attention is not as urgent

Question 17

What are characteristics of frailty?

Answer 17

• Weight loss
• Self-reported exhaustion
• Low energy expenditure
• Slow gait speed
• Weak grip strength

Question 18

What describes the relationship between medications and frailty?

Answer 18

There is a significant association between an increased number of medications and frailty. The causal relationship is unclear and bidirectional.

Question 19

What is a rule made for elderly symptoms made by the Brown University LTC Quality Letter?

Answer 19

Any symptom in an elderly patient should be considered a drug side effect until proven otherwise

Question 20

What is the consequence of drug therapy in older persons that it aims to prevent?

Answer 20

Iatrogenic cascade

Question 21

What are the categories to consider in geriatric medication assessment (think TIMER tool)?

Answer 21

• Cost and coverage
• Adherence
• Safety
• Attaining therapeutic goals

Question 22

What are the 5 M’s of geriatrics?

Answer 22

Mind
Mobility
Medications
Multi-complexity
Matters most

Question 23

What are the 3 H’s for elderly quality of life?

Answer 23

Healthy
Happy
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