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NUNP 547 - Older Adult > NP(F) Book review- Older Adults > Flashcards

NP(F) Book review- Older Adults Flashcards

1
Q

Most common cause of dementia and the elderly

A

Alzheimer’s 60 to 80%

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2
Q

Second most common form of Alzheimer’s

A

Vascular dementia

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3
Q

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

A

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

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4
Q

Best imaging when evaluating dementia

A

MRI

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5
Q

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

A

Folstein mini mental state exam

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6
Q

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

A

Severe

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7
Q

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

A

Moderate

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8
Q

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

A

Mini cog test

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9
Q

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

A

No dementia if score 3 to 5

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10
Q

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

A

Dementia

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11
Q

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

A

Both

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12
Q

The three A’s of Alzheimer’s

A

Aphasia, apraxia, agnosia

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13
Q

Vascular dementia is also known as

A

Multi infarct

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14
Q

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

A

True

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15
Q

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

And a decrease in what neurotransmitter?

A

Neurofibrillary plaques
Tangles
Acetylcholine

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16
Q

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

A

Dopamine

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17
Q

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

A

Cholinesterase inhibitor – they increase acetylcholine synthesis
Ie. Donapezil

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18
Q

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

A

Memantine

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19
Q

First line treatment of Parkinson’s disease

A

Carbidopa levodopa – dopamine precursor

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20
Q

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

A

True

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21
Q

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?

A

Parkinsonism hyperpyrexia syndrome

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22
Q

What is the first line treatment for essential tremor

A

Propranolol

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23
Q

What vitamin deficiency causes Korsakoff Warneke dementia

A

B1/thiamine

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24
Q

Essential tremor is an example of what kind of trimmer

A

Action, or postural tremor

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25
Q

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

A

B12

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26
Q

What is a common, disconcerting side effect of levodopa

A

Dyskinesia

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27
Q

Cholinergic drugs can do want to Parkinson’s disease symptoms

A

Exacerbate/worsen

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28
Q

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

A

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

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29
Q

Initial treatment of COPD

A

SABA

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30
Q

How to calculate “pack year”

A

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

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31
Q

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

A

COPD

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32
Q

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

A

True

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33
Q

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

A

Acute angle closure glaucoma

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34
Q

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?

A

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

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35
Q

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

A

Retinal detachment

Send to ED

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36
Q

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

A

Cholesteatoma

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37
Q

Optic disc swollen with blurred edges-

A

Papilloedema due to increased intercranial pressure

38
Q

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.

A

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

39
Q

Visual changes in primary open angle glaucoma

A

Gradual loss of peripheral vision

40
Q

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

A

Primary angle closure glaucoma

41
Q

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

A

Primary angle closure glaucoma

42
Q

Leading cause of blindness in the elderly

A

Age related macular degeneration

43
Q

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.

A

Age related macular degeneration

44
Q

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

A

Pulm embolism

45
Q

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

A

Lower- vesicular- soft, low

Upper- bronchial- louder

46
Q

List 3 Conditions that are obstructive pulmonary disfunction

A

Asthma, COPD, bronchiectasis

47
Q

List 3 Conditions that are restrictive pulmonary disfunction

A

Pulmonary fibrosis, interstitial lung disease, diaphragm obstruction

48
Q

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

A

Chronic bronchitis

49
Q

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

A

Emphysema

50
Q

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

A

Anti-cholinergics i.e. Atrovent, spiriva

51
Q

Medication step up approach in COPD (3)

A
  1. SABA +/- SAMA
  2. LABA or LAMA
  3. LABA + LAMA
52
Q

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

A

ICS + LABA

53
Q

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

A

Strep pneumo + H.flu

54
Q

Components of CURB-65-

What score indicates hospital admission-

A

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

55
Q

Pt receives PPSV23, when do recommend the prevnar 13?

A

8 weeks

If Prevnar 13 first- admin PPV23 1 year after

56
Q

Peak expiratory flow rate is calculated using what 3 characteristics.

A

Height, Age and Sex

57
Q

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

A

Decrased TSH

Increased fT3, fT4

58
Q

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

A

TSH/ thyroid function

59
Q

What are the classic lab findings of hypothyroidism

A

High TSH, low fT4

60
Q

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

A

Anti- TPO

61
Q

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

A

Microvascular- Retinopathy, nephropathy, neuropathy

Macrovascular- Atherosclerosis, coronary artery disease

62
Q

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

A

Diverticulitis

63
Q

Describe Rovsing sign

A

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

64
Q 
Abdo contents found in 
RUQ- 
LUQ-
RLQ-
LLQ-
Supra Pub-
A

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

65
Q

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

A

10 years

Barrets esophagus- precancerous condition

66
Q

H. Pylori quad therapy

A

CLAMP

Clarithromycin
Amoxicillin
Metronidazole
PPI
X 2 weeks
67
Q

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.

A

Giant cell arteritis

68
Q

Temporal arteritis treatment

A

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

69
Q

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

A

90 days

48 hours

70
Q

FAST mnemonic

A

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

71
Q

Homonymous hemianopsia-

Test to identify-

A

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

72
Q

Brocas aphasia –

Warnicke’s aphasia –

A

Brocas= expressive aphasia- can understand but cant speak

Wernickes= receptive aphasia- cant understand- impaired righting and reading

73
Q

Ventricular Gallop, aka——-?

A

S3- heart failure

74
Q

S3 can be normal finding in who?

A

Children, pregnant women, and some athletes

75
Q

Atrial gallop aka ——-?

A

S4

76
Q

Which heart sound sounds like

“Kentucky”

“Tennesee”

A

Kentucky- S3

Tenessee- S4

77
Q

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

A

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.

78
Q

Systolic Murmurs

A

MR. ASS

Mitral Regurg/ Aortic Stenosis = systolic

79
Q

Diastolic Murmurs

A

MS. ARD

mitral Stenosis/ Atrial Regurg = Diastolic

80
Q

Where is a split S2 best heard?

A

Pulmonic area/upper left sternum

81
Q

What valves cause S1 & S2?

A

S1- Motivated- mitral, tricuspid- AV valves

S2- Apples- aortic, pulmonic, - semi lunar valves

82
Q

S3 indicates-

S4 indicates-

A

S3- CHF

S4- LVHypertrophy

83
Q

What CHADSVaSC score indicates need for anticoagulation?

A

2 or more

84
Q

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

A

3 days

85
Q

3 possible side effects lf spironolactone

A

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

86
Q

3 contraindications of beta blockers

A

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

87
Q

4 Possible side effects of calcium channel blockers

A

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

88
Q

Side effects of thiazide diuretics- 3 & 3

Contraindication 1?

A

Hyper- hyperglycemia + hyperuricemia + hypertriglyceridemia

Hypo- hypokalemia + hyponatremia + hypomagnesemia

Dont give in sulfa drug allergy & anuria

89
Q

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

A

Superficial thrombophlebitis

90
Q

First line treatment for superficial thrombophlebitis?

A

NSAIDS + warm compress + elevate

91
Q

Normal ABI score?

A

0.91- 1.3

NUNP 547 - Older Adult (19 decks)

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