module 9 common concerns 3

Question 1

fall fears

Answer 1

most feared sequela of fall is fx

quality of life can be affected by fear of falls

Question 2

falls exam

Answer 2

postural vital signs
CV exam
Neuro exam 
- Romberg with sternal nudge 
- nystagmus 
upper extremity function and strength 
cognition 
vision
hearing 
Lower extremity 
- feet side by side, semi-tandem and tandem, balancing 10 seconds.

Question 3

failure to thrive (frailty)

Answer 3

progressive loss of energy, strength, and stamina -> dec. function and general physical and cognitive deterioration

Question 4

failure to thrive s/s

Answer 4

anorexia
wt loss
skeletal muscle loss
functional decline
depression
impaired immune function 
- weakness
- osteopenia
- balance and gait disorders
- undernutrition
- deconditioning
- slow gait speed

Question 5

failure to thrive exam

Answer 5

weakness
inability to care for self
wt and memory loss
depression 
- chronic disease with organ failure
- GI malabsorption
- cancer risk factors
- infection
- thyroid

Question 6

elder abuse

Answer 6

any abuse and neglect of persons age 60 and older by a caregiver or another person in a relationship involving expectation of trust

Question 7

self-neglect

Answer 7

behavior of an older person that results in being unable to provide for his or her needs

Question 8

7 kinds of elder abuse

Answer 8

physical
sexual
psychological
financial exploitation
neglect
abandonment
self-neglect

Question 9

elder abuse exam

Answer 9

Physical
- bruises
- pressure or rope marks
- broken bones
- burns
Sexual: 
- bruising of genitals or breast
Psychological: 
- sudden withdrawal from activities
- change in behavior or alertness 
Financial exploitation
- change in financial situation 
- checks signed by unauthorized persons 
Neglect/self-neglect 
- bedsores
- unattended medical needs
- poor hygiene or nutritional status
- hoarding
- inappropriate clothing

Question 10

osteoporosis

Answer 10

inc. bone fragility and inc. susceptibility to fx
- dec. bone mass and deterioration of bone microarchitecture
- r/t estrogen deficiency and aging

Question 11

WHO osteoporosis definition

Answer 11

BMD of 2.5 SD below the young normal mean

- postmenopausal women and men > 50

Question 12

risk factors for fx

Answer 12

inc. age
family hx
current smoking
prior fx 
glucocorticoid use
RA
excessive ETOH

Question 13

bone resorption

Answer 13

in response to PTH and other cytokines secrete RANK

• > monocytes and macrophages to differentiate into osteoclasts and proliferate
• > break down of bone, release of calcium and phosphorus into circulation

Question 14

bone formation

Answer 14

osteoblasts lay down osteoid

- this is a slow process

Question 15

bone formation/resorption in osteoporosis

Answer 15

bone resorption exceeds bone formation -> net loss of bone

- most pronounced 5-10 years after menopause

Question 16

glucocorticoids

Answer 16

causes secondary osteoporosis

• osteoblast death
• prolongs life of osteoclasts
• dec. estrogen and testosterone
• inc. metabolism of Vit. D
• dec. Ca absorption

Question 17

unmodifiable risk factors for osteoporosis

Answer 17

age
female
white or asian 
persona hx of fx 
hx of fx in 1st degree relative
dementia

Question 18

modifiable risk factors for osteoporosis

Answer 18

hypogonadism 
smoking
ETOH
caffeine
low Ca intake
low body wt
inadequate physical activity
visual impairment
glucocorticoids or anticonvulsant use 
thyrotoxicosis
recurrent falls
poor health or frailty

Question 19

nonpharm management of osteoporosis

Answer 19

Adequate Ca and Vit D
wt bearing exercise
normal body wt
avoid cigarettes and ETOH

Question 20

Hormone replacement for osteoporosis

Answer 20

only approved for the prevention of osteoporosis not for tx.
- estrogen inhibits bone resorption, dec. bone remodeling, enhances absorption of Ca

Question 21

osteopenia

Answer 21

BMD between 1 and 2.5 SD below nml

Question 22

USPSTF screening for osteoporosis women > 65

Answer 22

B