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Professional Development > Part 24 > Flashcards

Part 24 Flashcards

1
Q

Glucose Tolerance Test and what is it particularly useful in diagnosing?

A
  • Only performed in patients who have been on unrestricted diet/physical activity for 3 days before testing, involves administration of 50-100g oral glucose administered after 10 hour fast
  • Gestational diabetes
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2
Q

HbA1C testing

A

Measures 70% of glycosylated hemoglobin in blood which remains for the 120 day lifespan of the RBC (avg) (does not reflect acute increase or decrease) and therefore allows for highly accurate measure of blood glucose conc.

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3
Q

__% change in A1C reflects a change of about ___mg/dL in avg blood glucose

A

1, 30

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4
Q

Microalbumin and microalbumin/creatinine ratio (and what should healthy value be?)

A
  • Microalbumin test is an early indicator of kidney failure (albumin produced in liver and should not be present in blood when kidneys functioning properly) requiring 24 hour urine collection
  • Microalbumin creatinine ratio is close to a 24 hour microalbumin test regarding accuracy without requiring 24 hour collection and is thus preferred (<30:1 ratio)
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5
Q

When is an insulin levels ordered? (3)

A
  • evaluate PCOS
  • diagnose insulinoma
  • Determine cause of hypoglycemia (order alongside c peptide to monitor endogenous insulin levels)
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6
Q

Why order a c peptide level in suspected diabetic patient?

A

Monitor insulin production by the B cells of the pancreas to determine the cause of hypoglycemia - see if body producing enough of own insulin and are insulin resistant or not

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7
Q

C peptide levels in type 1 vs type 2 diabetics

A

C peptide level will be zero in type 1 diabetics (not producing insulin), in type 2 if left uncontrolled over time will drop to zero

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8
Q

Actions of thyroid hormone (6)

A
  • Increase body’s metabolic rate and O2 consumption
  • calorigenic effect increasing heat production
  • increase heart rate and contraction strength
  • increase respiratory rate
  • stimulate appetite and breakdown of carbs, fats, proteins
  • turn on and off various nuclear receptors
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9
Q

What do the C cells (parafollicular cells) of the thyroid produce?

A

Calcitonin

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10
Q

Synthroid and armour thyroid

A

Artificial T4 and T3 and T4 respectively (T3 alone not very useful because it has such a short half life requiring frequent dosing intervals)

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11
Q

2 major plasma proteins that are responsible for transport of thyroid hormone

A
  • Thyroid binding globulin
    albumin
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12
Q

Only __ T3/4 can penetrate cellular membranes and exert biologic activity

A

Unbound

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13
Q

Primary hypothyroidism sees a ___ TSH, very low levels of TSH can suggest ___

A

elevated, hyperthyroidism

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14
Q

Causes of elevated serum T4 (4)

A
  • graves disease
  • toxic multinodular goiter
  • toxic adenoma
  • thyroiditis
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15
Q

Causes of decreased serum T4 (3)

A
  • hypothyroidism
  • amiodarone
  • post partum transient toxicosis
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16
Q

Hyperthyroidism + antithyroid antibodies suggests…

Hypothyroidism + antithyroid antibodies suggests…

A

….Graves disease
….hashimoto’s thyroiditis

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17
Q

Radionuclide scanning thyroid imaging

A

-Use of an isotope of iodine to determine if a nodule is hyperactive or underactive based on how it takes up the iodine (almost all cancers and benign lesions are cold)

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18
Q

Test of choice for thyroid nodule workup

A

Fine needle biopsy

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19
Q

C peptide

A

A protein released in equal amounts alongside insulin into the bloodstream allowing it to be a marker of insulin production (endogenous, not present with exogenous) and release in the body

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20
Q

5 P’s of arterial insufficiency

A
  • Pain
  • pulseless
  • paresthesias
  • paralysis
  • pallor
  • poikilothermia (rare 6th P)
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21
Q

Noninvasive screening for peripheral artery disease (2) and invasive (2)

A
  • Ankle brachial index
  • ultrasound
  • CTA
  • MRA
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22
Q

__% of individuals with one amputation due to peripheral arterial disease will develop ___ on the other side within 2 years

A

50, gangrene

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23
Q

Early (2) and late sensory symptoms of diabetic foot neuropathy (5)

A 
Early
-night cramps
-paresthesia
Late
-loss of touch
-deep pain
-loss of position sense
-anesthesia
-loss of deep tendon reflex
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24
Q

Charcot foot definition and mech of action

A

Condition causing weakening of bones of the foot frequently associated with significant nerve damage from something like a diabetic neuropathy

  • denervation of small foot muscles due to neuropathy
  • weakness of muscle resulting
  • disarray of bony structures
  • atrophy of leg and foot muscles
  • altered weight distribution causes callus, ulcers, pes cavus, and charcot foot
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25
Q

Pes cavus

A

High arch of foot with fixed plantar flexion that can result from altered weight distribution due to significant nerve damage from something like a diabetic neuropathy

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26
Q

Wagner system of classification of ulcers (4) and then staging (4)

A

Grade 0: pre or post ulcerative (just beginning or at the end)

1: full thickness ulcer not involving tendon, capsule or bone
2: tendon or capsular involvement without bone palpable
3: probes to bone

Stage A: noninfected
B: infected
C: Ischemic
D: infected and ischemic

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27
Q

Septic foot presentation (5)

A
  • cool clammy skin
  • altered mental status
  • hypotension
  • tachycardia
  • tachypnea
  • High WBC count
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28
Q

Septic foot treatment (2)

A
  • Broad spectrum antibiotics and cultures to eventually steer treatment direction
  • surgery (extensive debridement, wound culture)
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29
Q

Geriatrics

A

Branch of medicine focuses on health promotion and prevention and treatment of disease and disability later in life also known as gerontology, gerontologist, or a geriatrician

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30
Q

Universal physiologic changes associated with aging (6)

A
  • decreased night vision
  • decreased muscle mass
  • loss of hair pigment
  • decreased lung vital capacity
  • decreased height
  • decreased reaction time
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31
Q

Functional reserve theory

A

Idea that most of body’s organ systems have some degree of redundancy so they can continue to function even if some cells are lost to disease or insult, this diminishes as individuals age so acute insult can have more severe consequences

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32
Q

Common, but not inevitable physiologic changes associated with aging (6)

A
  • hearing loss
  • macular degeneration
  • hypertension and heart dz
  • diabetes
  • cancer
  • dementia
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33
Q

Erickson’s final task of life

A

Ego integrity vs despair (sense of whole satisfaction with ones life and healthy viewpoint regarding death) that geriatric patients undergo

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34
Q

Cataracts vs glaucoma vs macular degeneration

A
  • Cataracts is the blurring of all vision due to lens opacification, common bilaterally in aging or diabetic, painless slow progressive loss
  • glaucoma is loss of peripheral vision either acute (painful, close angle) or chronic (painless, open angle) usually asymptomatic until present with vision loss, laatanoprost is first line treatment (prostaglandin analog) but can also use acetazolamide
  • macular degeneration is loss of vision in middle of field either dry (progressive over age with drusen bodies on fundoscopic) or wet (not as common but more aggressive presenting in months with new abnormal vessels appearing on fundoscopic)
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35
Q

3 common hearing problems in geriatrics

A

presbycusis (hearing loss with age)
conductive (earwax blockage)
tinnitus (medication, acoustic neuroma (remember unilateral sensorineural hearing loss is acoustic neuroma until proven otherwise), hypertension)

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36
Q

Leading cause of death from injury among those >65

A

complications from falls

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37
Q

Gerontology vs geriatrics

A

Gerontology involves the social, psychologic, and biomedical study of aging and ALL aspects associated with it (includes social workers, etc) while geriatrics is a medical specialty

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38
Q

Senescence

A

Aging process at the cellular and organismal levels during the latter part of the life span (last 20%)

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39
Q

Life expectancy

A

Average lifespan of a specific population (location, gender, age, etc - remember the life expectancy for an individual age 80 is greater than those of age 10 because they have already survived all the car wrecks and such), at birth is 78.7 years overall

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40
Q

Female vs male life expectancy

A

females 81.2 years while male is 76.2 years

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41
Q

Life span vs health span

A

Health span is how long an individual retains their health status and capabilities to live a functional life, a goal of geriatrics is to improve this over necessarily just improving life span

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42
Q

Why do we age?

A

No concrete consistent reason known, previously thought to be related to evolution but has been discredited, likely multifactorial between genetics, metabolism, and environment, but ultimately due to a disruption in homeostasis (increase in entropy), primary aging is normal physiologic processes and secondary is acquired diseases throughout life, prevention helps save HUGE costs of healthcare - promote the idea of “healthy aging”

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43
Q

Cardiovascular physiologic changes that occur with aging (5)

A
  • decreased myocytes
  • increased collagen
  • decreased compliance
  • increased systolic pressure/LVH
  • decreased maximum heart rate
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44
Q

Pulmonary physiologic changes that occur with aging (3)

A
  • reduced chest wall compliance
  • reduced respiratory response to hypoxia
  • decreased ciliary function
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45
Q

Presbyopia

A

Reduced accommodation due to decreased compliance of the lens with age, often resulting in elderly individuals having to hold text further away in order to read (farsightedness)

46
Q

Neurologic physiologic changes that occur with aging

A
  • decrease in cortical gray matter, complexity of connections, neurotransmitter produciton
  • demyelination (slowed conduction)
  • reduced reflexes/proprioception
47
Q

Renal physiologic changes that occur with aging (2)

A
  • decline in renal blood flow approx 10% per decade after 50
  • often not noticed until much more advanced
48
Q

Skin/hair physiologic changes that occur with aging (3)

A
  • loss of pigment in hair
  • loss of elastin in skin
  • thinning of skin
49
Q

Natural selection theory of aging

A

Traditional (less scientific) idea that aging and death have been ubiquitous over time, in relative absence of disease, humans still have a maximum lifespan, and this must be because natural selection focuses on selection of favored genetics not how long an organism lives for

50
Q

Neuroendocrine theory/hypothesis of aging

A

Modern scientific programmed theorythat there is complex interplay of hormones that regulate vital life functions, but with age hormone levels decline decreasing body’s repair and maintenance systems (ex - IGF-1 role in aging rates)

51
Q

Thymic stimulating theory/hypothesis of aging

A

Modern scientific programmed theory that the thymus is the master gland of the immune system (playing a vital role in T cell function) and its size decreases with age resulting in weakening of immune system contributing to aging (birth is 200 g, by age 60 only 3 g)

52
Q

Telomere (telomerase) theory/hypotehsis of aging

A

Modern scientific programmed theory (relatively new) that postulates that telomere caps at the ends of chromosomes that do not code but act to maintain chromosomal integrity and as cells divide and chromosomes are copied telomeres are shortened leading to cell damage and death and this leads to aging, telomerase found only in germ or cancer cells could immortalize us

53
Q

Genetic control theory/hypothesis of aging

A

Modern scientific programmed theory of planned obsolescence that genetic programming within our DNA contains a biologicla clock set to go off at a predetermined time that when it does signals a cell to age and die, each individual has their own clock and lifestyle can alter it

54
Q

Hayflick limit theory/hypothesis of aging

A

Modern scientific programmed theory that derived from experiments demonstrating senescence of cultured human cells and therefore cells are genetically preprogrammed to divide a set number of times (like 40-60) then die, overfed cells divided quicker and died, and that loss of cell leads to aging and death

55
Q

Autoimmune theory/hypothesis of aging

A

Modern scientific programmed theory that postulates over time our immune system experiences decline in ability to produce antibodies to fight off disease and ability to differentiate between body’s own cells and dz cells (examples being lupus, scleroderma, cancer, etc) and this leads to damage, aging and ultimately death

56
Q

The hypothalamus as a control center theory/hypothesis of aging

A

Modern scientific programmed theory that suggests thru new research the hypothalamus plays fundamental roles in growth, development, repro and metabolism and that age related signaling blocking can slow aging in mice

57
Q

The wear and tear theory/hypothesis of aging

A

Modern scientific damage/error theory that suggests the human body is like a machine that wears out due to chronic use and cells are damaged by overuse and abuse or toxins, and that healthy young bodies can repair but with age these systems deteriorate and accumulate

58
Q

Free radical (oxidative damage) theory/hypothesis of aging

A

Modern scientific damage/error theory that states free radicals which contain free electrons become destructive in biological systems, attacking and splitting apart other paired electrons, and that free radicals attack cell membranes generating metabolic waste products and also attack collagen, elastin, proteins, DNA’s etc - free radicals are with us from birth produced by metabolic processes similar to rusting of ferrous metals and that antioxidants slow this

59
Q

Caloric restriction theory/hypothesis of aging

A

Modern scientific damage/error theory that gradual weight loss to a point of metabolic efficiency results in the maximum health and lifespan (30-40% fewer calories than normal) decrease metabolic activity and therefore free radicals (doing the minimum amount of metabolism to sustain life), high nutrient low calorie diet coupled with moderate supplements and regular exercise (CRON - caloric restriction, optimal nutrition) Has been demonstrated to be accurate in some oraganisms

60
Q

Waste accumulation theory/hypothesis of aging

A

Modern scientific damage/error theory that states that during lifespans cells produce more waste products than can properly eliminate, accumulation causes cells to age and die

61
Q

Mitochondrial theory/hypothesis of aging

A

Theory built off the free radical (oxidative damage) theory that states that there is free radical/oxidative damage but in this case specifically focusing on that in the mitochondria, and that ATP genesis produces free radicals that can then attack mitochondria and mtDNA which accumulate damage and decrease ATP production over time

62
Q

Cross linkage theory/hypothesis of aging

A

Modern scientific damage/error theory that believes cross linking occurs when older biological systems become incapable of removing excess glucose, so excess glucose promotes glycosylation which affects proteins, DNA, connective tissue in body decreasing elasticity, obstructing movement of nutrients and waste,

63
Q

Error and repair theory/hypothesis of aging

A

Modern scientific damage/error theory that states DNA typically has highly effective correcting organisms for errors in the copying of DNA essential for life, replication errors increase with age, repair mechanisms are less effective with age, and accumulation of these errors over time damages or destroys cells

64
Q

Physiology of urination

A

Requires correct functioning and interaction of CNS, sacral PNS, thoracolumbar SNS, bladder muscle (detrusor), urinary sphincter muscle, and mechanical support of the pelvic fascia and floor - if bladder pressure exceeds urethral then end up urinating (the problem of incontinence).

  • Bladder relaxation and filling and closure of bladder neck and sphincter is done by inhibiting parasympathetic tone AND sympathetic stimulation via B adrenergics
  • bladder contraction is done via parasympathetic stimulation upon sensory signal being sent that bladder is being stretched and filled, the internal sphincter relaxes
  • somatic control of relaxation of pelvic floor via the pudendal nerve including external sphincter
65
Q

Causes of acute incontinence in elderly (5) which 2 are most common?

A
  • Infection (UTI)***
  • delirium
  • polypharmacy
  • fecal impaction***
  • restricted mobility
66
Q

Urge incontinence and treatment (1)

A

Sees detrusor muscle contractions (premature parasympathetic stimulation) at low volumes** (overactivity or instability) caused from sensory stimulation, UTI’s, CNS lesions, etc

-anticholinergic drugs (oxybutyin or tolterodine)

67
Q

Stress incontinence and treatment (4)

A

Incompetent internal sphincter (normally relaxes with parasympathetic stimulation) causes leakage with increased abdominal pressure (coughing, sneezing, lifting)

-kegels, pessaries, surgery, alpha adrenergic agonists such as pseudoephedrine (have to watch for causing high BP)

68
Q

Overflow incontinence and treatment (2)

A

Loss of detrusor muscle contractility via parasympathetic stimulation or sensation due to urethral blockage (in neuropathies, DM, trauma, or bladder outlet obstruction due to BPH or constricture), bladder can’t empty properly so urine just leaks out

-alpha adrenergic antagonists or cholinergic agonists (bethanechol)

69
Q

Functional incontinence

A

Situations in which physical, functional, or mental disability makes it impossible to void independently even though the urinary tract may be intact (can’t make it to the toilet)**

70
Q

Urodynamic testing

A

Measuring of postvoid residual urine volume (PVR) 50 mL’s normal but over 100mL is a problem or cystometry where the bladder is filled with different capacities and volumes to test for when the sensation and urge is felt by the patient

71
Q

Basic ADL’s (5)

A
  • bathing
  • dressing
  • toileting
  • grooming
  • feeding
72
Q

Intermediate ADL’s (7)

A
  • shopping for groceries
  • technology use
  • housework
  • meal prep
  • laundry
  • taking medications
  • handling finances
73
Q

Advanced ADL’s (1)

A

Vary by individual, include societal, community, family, recreational, and occupational roles

74
Q

Vulnerable elders scale (VES-13)

A

Survey that detects vulnerable group (4x chance of death or functional decline) and does not require direct observation as it can be done over phone, includes age, comparative/self rated health, difficulties with ADL’s, physical activities, etc

75
Q

Get up and go test

A

Monitoring how fast a geriatric can move 20 feet, with 7-10 being mobile, 11-14 being fairly mobile, 15-19 variable mobile, 20-29 severe restriction, and greater than 30 functionally dependent. >12 seconds HIGH risk for falling**

76
Q

__ of seniors die with some form of dementia

A

1 in 3

77
Q

Mini mental state examination (MMSE) advantages (2) and disadvantage (1)

A
  • can track over time
  • highly specific and sensitive

-not quick

78
Q

Mini cog

A

Mental assessment involving clock drawing and registration and recall of 3 words, quick as not limited by language or educaiton

79
Q

MoCA

A

Longer mental assessment than MMSE that involves visuospacial, naming, memory, attention, language, delayed recall, abstraction, and orientation

80
Q

FAST scale

A

Functional assessment staging test for rating dementia that includes mental status as well as ADL’s and motor function to determine hospice eligibility

81
Q

Polypharmacy

A

Tendency for older patients to see many providers and need review of medications AND supplements at each visit to ensure there aren’t any interactions or complications, eased by EMR’s generally

82
Q

Beers criteria

A

List of medications deemed to be generally inappropriate for older patients (mainly nursing home) as they are either ineffective or at high risk for adverse events and had higher risk of hospitalization and death

83
Q

3 categories of drugs/patient type that account for most adverse drug events seen in emergency departments in geriatric populations

A
  • Anticoagulants (heparin, warfarin, xarleto, elequis pradaxa)
  • Antiplatelets (clopidegrol AKA plavix)
  • Hypoglycemics
84
Q

Anticholinergic toxicity symptoms (8)

A
  • flushing
  • dry skin and membranes
  • mydriasis
  • altered mental status
  • sinus tachycardia
  • fever
  • urinary retention
  • hypertension
85
Q

Drug classes that can cause anticholinergic toxicity (3)

A
  • 1st gen antihistamines (benadryl and hydroxyzine)
  • antispasmotics (scopolamine, dicylomine)
  • TCA’s (amitriptyline)
86
Q

Specific drug used for UTI that should be avoided for geriatric populations due to pulmonary toxicity, hepatotoxicity, etc

A

Macrobid (nitrofurantoin)

87
Q

Megestrol (Megace)

A

Appetite stimulant for cachexia that can be used in geriatric populations BUT increases risk for thrombotic events so often not used

88
Q

4 types of elder neglect and abuse

A
  • physical
  • sexual
  • psychological
  • financial exploitation
89
Q

Tobacco use in geriatrics

A

Cessation significantly reduces risk of CAD, cancers, and COPD, within 5 years of cessation relative risk for all cause mortality falls below current smokers, should be promoted at every visit for current smokers regardless of age

90
Q

USPSTF aspirin use policy

A

Discus benefits and harms in patients age 60-69, benefit more likely in those with 10 year cardiovascular risk of >10%, life expectancy of greater than 10 years, PPI reocmmended for all patients >50 y/o on chronic aspirin therapy

91
Q

Oral cancer screening recommendations USPSTF

A

No official recommendations, concludes current evidence is insufficient to assess balance of benefits and harms of screening for oral cancer in asymptomatic adults, some studies show that screening is very simple and potentially capable of preventing many cancer deaths worldwide

92
Q

Length time bias

A

Refers to how the probability of detecting a cancer is proportional to the growth rate of the cancer meaning that detecting a tumor often means its in the later stages

93
Q

Familial adenomatous polyposis (FAP) indicates colonoscopy as early as age…

A

…10

94
Q

2 absolute risk factors for breast cancer development

A
  • sex
  • Age
95
Q

No specific screening for uterine or ovarian cancers exist. Instead, educate patient on reporting any of these 3 symptoms

A
  • unusual vaginal bleeding or discharge
  • bleeding after intercourse
  • persistent abdominal discomfort or bloating
96
Q

Biggest risk factor for testicular cancer and prognosis

A

Cryptorchidism, high survival rate if caught early

97
Q

How does alzheimer’s kill?

A

Typically from a complication as a result, such as aspiration after forgetting muscle memory of swallowing or starvation

98
Q

Hospice care

A

Provides support and care for those in the last phases of life limiting illness, recognizes dying as part of normal process of living, affirms life and neither hastens nor postpones death, focuses on quality of life for individuals and their family caregivers

99
Q

POLST

A

Physician orders for life sustaining treatment, form completed by MD or PA that lists out what a patient wants regarding CPR, medical intervention, antibiotics, hydration and nutrition, can be changed or revoked at any time

100
Q

Healthcare agent and healthcare representative

A

An individual designated in an advanced care directive, if not manually appointed typically goes to spouse then brother then child etc (healthcare representative)

101
Q

Therapeutic nihilism

A

Not believing in the value of treatment and believing treatment is useless so doing nothing is acceptable (very toxic mentality in medicine!!!)

102
Q

Morphine (roxanol) in end of life care

A

-indicated for pain, dyspnea, tachypnea, can be administered sublingually in some cases but contraindicated in renal failure, metabolites are neurotoxic so if build up can cause myoclonus or delerium

103
Q

Oxycodone (oxyfast) in end of life care

A

Indicated for pain, dyspnea, and tachypnea, can be administered sublingually and is more okay to use with renal failure (GFR <30)

104
Q

Lorazepam (ativan) in end of life care

A

Indicated for anxiety, agitation, restlessness, seizure activity, myoclonus, has synergistic effect with opioids, may be effective for palliative sedation

105
Q

Haloperidol (haldol) in end of life care

A

Indicated for acute agitation, psychosis, and delirium, administered PO and IM but unpopular with nursing homes because can increase stroke risk

106
Q

Hyoscyamine (levsin) in end of life care

A

Powerful anticholinergic used mainly for GI symptoms such as spasms and colic and respiratory secretions (death rattle)

107
Q

Flibanserin (addyi) function (geriatric sexual activity)

A

Unknown mech of action to treat premenopausal women with hypoactive sexual desire disorder, black box warning with interactions with alcohol

108
Q

The aging male sexual characteristics (4)

A
  • reduced penile sensitivity
  • reduced volume of ejaculation and force
  • refractory period longer
  • FERTILITY RETAINED**
109
Q

Acute mental status change does not indicate dementia, but rather CNS changes and functional decline can be the first indicator of these 4 things

A
  • UTI
  • pneumonia
  • hydration status
  • constipation
110
Q

Periodic examination of nursing home patients by a provider***

A

At least once every 30 days for the first 90 days after admission, then once every 60 days thereafter, acute as needed

111
Q

Assisted living units

A

Where residents remain independent while receiving assistance as needed with personal care, medications and medically based treatment can happen here***, transportation, housekeeping, meals, and other daily needs, a step down from nursing home (long term care facility) but a step up from an elderly residential community

Professional Development (24 decks)

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