NP(F) Book review- Older Adults Flashcards by Brittany Morrison

Most common cause of dementia and the elderly

Alzheimer’s 60 to 80%

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Second most common form of Alzheimer’s

Vascular dementia

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Lab tests to rule out other causes of changing level of consciousness when you’re valuating possible dementia

Syphilis, B12, TSH, CBC, heavy metals i.e. mercury

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Best imaging when evaluating dementia

MRI

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A cognitive exam with the following components- Orientation, short term memory, attention in calculation, recall, writing a sentence, copying a design

Folstein mini mental state exam

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A patient scores less <10 on MMSE- what class is this?

Severe

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A patient scores 10 to 20 on MMSE, what is this level?

Moderate

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A cognitive performance scale that includes the following steps Dash three word recognition, clock drawing, three word recall

Mini cog test

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A patient scores four on a mini cog test – how would this be interpreted

No dementia if score 3 to 5

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A patient scores one on a mini cog test, how would this be interpreted

Dementia

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The sundowning phenomena involves patients becoming agitated, confused, combative in the evening, and resolves in the morning.
Is this seen in delirium or dementia?

Both

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The three A’s of Alzheimer’s

Aphasia, apraxia, agnosia

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Vascular dementia is also known as

Multi infarct

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T/F- Memory loss shows up earlier than executive functioning deficits and Alzheimer’s disease.

True

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Alzheimer’s is attributed to The accumulation of ——- &———

And a decrease in what neurotransmitter?

Neurofibrillary plaques
Tangles
Acetylcholine

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Parkinson’s is a neurotogenerative disease with Marc decrease of ——— receptors.

Dopamine

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What medications are used in the treatment of mild to moderate Alzheimer’s

Cholinesterase inhibitor – they increase acetylcholine synthesis
Ie. Donapezil

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What medication may be added to cholinesterase inhibitors in moderate Alzheimer’s

Memantine

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First line treatment of Parkinson’s disease

Carbidopa levodopa – dopamine precursor

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True or false – sudden withdrawal or dose reductions of levodopa, or dopamine agonist, may be associated with akinetic crises or parkinsonism’s hyperpyrexia syndrome

True

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You abruptly reduce the dose of carbidopa levodopa in a patient with Parkinson’s, they report symptoms of fever, autonomic dysfunction, muscular rigidity and altered mental status. What do you suspect is the diagnosis?

Parkinsonism hyperpyrexia syndrome

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What is the first line treatment for essential tremor

Propranolol

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What vitamin deficiency causes Korsakoff Warneke dementia

B1/thiamine

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Essential tremor is an example of what kind of trimmer

Action, or postural tremor

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The patient with Parkinson’s is on Levadopa, what lab will you continue to monitor?

B12

What is a common, disconcerting side effect of levodopa

Dyskinesia

Cholinergic drugs can do want to Parkinson’s disease symptoms

Exacerbate/worsen

Drug clearances affected by all of the following except: A. Renal impairment B. less efficient liver cytochrome P450 system C. Malabsorption D. relatively lower fat to muscle tissue ratio

D- With age there is a relatively higher fat to muscle tissue ratio, which extends half-life a fat soluble drugs.

Initial treatment of COPD

SABA

How to calculate “pack year”

Number of packs smoked per day x Number of years a person has smoked

The flu vaccine and Pneumovax are recommended as primary prevention measure in what patient population?

COPD

True/ False- Decongestants are contraindicated with hypertension in coronary artery disease.

True

Elderly patient with acute onset of severe I pain with headache, nausea, vomiting, haloes around lights, decreased vision.

Acute angle closure glaucoma

On a patient presenting with eye pain, exam reveals a mid dilated pupil that is oval shaped, a cloudy cornea, and cupping of the optic nerve. What is your next intervention?

Referred patient to the emergency department, assume acute angle closure glaucoma

Sudden onset of a shower of floaters, describes looking through a curtain, sudden flashes of light. Name the suspected diagnoses and initial management.

Retinal detachment | Send to ED

Cauliflower like growth + foul-smelling ear discharge + hearing loss on affected side?

Cholesteatoma

Optic disc swollen with blurred edges-

Papilloedema due to increased intercranial pressure

Gradual onset of increased intraocular pressure due to blockage of the drainage of aqueous humour inside the eye causing ischaemic changes to the retina if untreated.

Primary open angle glaucoma – most common type 60 to 70%

Visual changes in primary open angle glaucoma

Gradual loss of peripheral vision

Sudden blockage of a queous humour causing significant increase in IOP resulting in ischaemia and permanent damage to optic nerve - CN II

Primary angle closure glaucoma

Older patient complains of acute onset of decreased/blurred vision with severe eye pain and frontal headache +/- nausea and vomitting

Primary angle closure glaucoma

Leading cause of blindness in the elderly

Age related macular degeneration

Elderly patient who smokes Complains of gradual or sudden and painless loss of central vision in one or both eyes. They report that straight lines appear distorted or curved and that they’re peripheral vision is preserved.

Age related macular degeneration

An older patient with a history of atrial fibrillation complains of sudden onset dyspnoea coughing and rapid heart rate. What’s the suspected diagnosis?

Pulm embolism

What type of normal breath sounds would you expect to hear from the lower and upper lobes?

Lower- vesicular- soft, low | Upper- bronchial- louder

List 3 Conditions that are obstructive pulmonary disfunction

Asthma, COPD, bronchiectasis

List 3 Conditions that are restrictive pulmonary disfunction

Pulmonary fibrosis, interstitial lung disease, diaphragm obstruction

Coughing with excessive mucus prosuction for at least 3 or more months fir a minimum of 2 or more consecutive years

Chronic bronchitis

Permanent alveolar damage and loss of elastic recoil resulting in chronic hyper inflation of the lungs

Emphysema

Impatient with narrow angle glaucoma, BPH, or bladder neck of struction, what class of medications should not be prescribed? (Inhalers)

Anti-cholinergics i.e. Atrovent, spiriva

Medication step up approach in COPD (3)

1. SABA +/- SAMA 2. LABA or LAMA 3. LABA + LAMA

In patients with severe airflow limitations (GOLD 3-4) With frequent exacerbations, what medication’s are indicated for a long-term therapy?

ICS + LABA

When selecting an antibiotic for a patient with COPD, consider coverage against what two bacteria?

Strep pneumo + H.flu

Components of CURB-65- | What score indicates hospital admission-

Confusion, elevated BUN, Resps >30, BP <90/60, older than 65 yrs >1 = hospital

Pt receives PPSV23, when do recommend the prevnar 13?

8 weeks If Prevnar 13 first- admin PPV23 1 year after

Peak expiratory flow rate is calculated using what 3 characteristics.

Height, Age and Sex

What TSH and thyroid hormone levels would you expect to see in hyperthyroidism

Decrased TSH | Increased fT3, fT4

Lithium, amiodarone, high doses of iodine, interferon – alpha are all medications that indicate the monitoring of what lab value?

TSH/ thyroid function

What are the classic lab findings of hypothyroidism

High TSH, low fT4

In a patient with suspected Hashimoto’s thyroiditis, what test can be ordered?

Anti- TPO

Name 3 examples of the following- secondary to diabetes Microvascular changes Macrovascular changes

Microvascular- Retinopathy, nephropathy, neuropathy | Macrovascular- Atherosclerosis, coronary artery disease

Elderly patient with acute onset high fever, anorexia, nausea, vomiting and left lower quadrant abdominal pain. Possible diagnosis?

Diverticulitis

Describe Rovsing sign

Deep palpation of the left lower quadrant of the abdomen results and referred pain to the right lower quadrant= + rovsing sign

``` Abdo contents found in RUQ- LUQ- RLQ- LLQ- Supra Pub- ```

RUQ- liver, gall bladder, ascending colon, R kidney, tail of pancreas LUQ- stomach, pancreas, descending colon, L kidney (higher than R) RLQ- appendix, ileum, cecum, R ovary LLQ- sigmoid colon, L ovary Supra Pub- bladder, uterus, rectum

Any patient with —— years or more history of chronic heartburn should be referred to G.I. for endoscopy to rule out———.

10 years | Barrets esophagus- precancerous condition

H. Pylori quad therapy

CLAMP ``` Clarithromycin Amoxicillin Metronidazole PPI X 2 weeks ```

An older man complains of a headache on his temple, scalp tenderness on the same side, and a sore jaw when chewing that improves when he starts chewing.

Giant cell arteritis

Temporal arteritis treatment

High-dose prednisone for several weeks, refer to rheumatology for management

Up to 20% of patients with a TIA will have a stroke within ——- days, and 25-50% will occur within—-?

90 days | 48 hours

FAST mnemonic

Facial droop Arm weakness Speech difficult/ dysphagia Time to call 911

Homonymous hemianopsia- | Test to identify-

Loss of half of visual field- same half missing in both eyes- most common cause is stroke. Test via visual fields by confrontation

Brocas aphasia – | Warnicke’s aphasia –

Brocas= expressive aphasia- can understand but cant speak Wernickes= receptive aphasia- cant understand- impaired righting and reading

Ventricular Gallop, aka——-?

S3- heart failure

S3 can be normal finding in who?

Children, pregnant women, and some athletes

Atrial gallop aka ——-?

Which heart sound sounds like “Kentucky” “Tennesee”

Kentucky- S3 Tenessee- S4

T/F- S4 in the elderly is always considered pathologic, regardless of symptoms.

False- S4 heart sound aka atrial kick- Can be considered normal in the elderly due to age related increased stiffness in the ventricles. If there are no signs or symptoms of heart/valvular disease it is considered a normal variant.

Systolic Murmurs

MR. ASS Mitral Regurg/ Aortic Stenosis = systolic

Diastolic Murmurs

MS. ARD mitral Stenosis/ Atrial Regurg = Diastolic

Where is a split S2 best heard?

Pulmonic area/upper left sternum

What valves cause S1 & S2?

S1- Motivated- mitral, tricuspid- AV valves S2- Apples- aortic, pulmonic, - semi lunar valves

S3 indicates- | S4 indicates-

S3- CHF | S4- LVHypertrophy

What CHADSVaSC score indicates need for anticoagulation?

2 or more

After changing warfarin dose, it make take up to _ days to see change in INR

3 days

3 possible side effects lf spironolactone

Gynecomastia/galactorrhea Hyperkalemia GI sympt (NV diarrhea, stomach cramping)

3 contraindications of beta blockers

Asthma COPD 2/3rd degree heart block (ok in 1st) Sinus bradycardia

4 Possible side effects of calcium channel blockers

Headaches Ankle edema Heart block/ brady Reflex tacycardia - dihydroperadines ie. amlodapine

Side effects of thiazide diuretics- 3 & 3 Contraindication 1?

Hyper- hyperglycemia + hyperuricemia + hypertriglyceridemia Hypo- hypokalemia + hyponatremia + hypomagnesemia Dont give in sulfa drug allergy & anuria

Adult patient complains of an acute onset of an indurated vein, localized redness, swelling, tenderness. Patient is afebrile with normal vital signs.

Superficial thrombophlebitis

First line treatment for superficial thrombophlebitis?

NSAIDS + warm compress + elevate

Normal ABI score?

0.91- 1.3