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Geriatrics > Pirk > Flashcards

Pirk Flashcards

1
Q

What is included in Geriatric ROS?

A
  • Cognitive function
  • Urinary incontinence
  • Functional status (ADLs, IADLS)
  • Mobility
  • Falls
  • Nutrition
  • Vision
  • Hearing
  • Depression
  • Social circumstances
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2
Q

What are the activities of daily living (ADLs)

A
  • Bathing
  • Dressing
  • Transferring
  • Toileting
  • Grooming
  • Feeding
  • Mobility
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3
Q

What are the Instrumental Activities of daily living (IADLs) (8)

A
  • Using telephone
  • Preparing meals
  • Managing finances
  • Taking meds
  • Doing laundry
  • Doing housework
  • Shopping
  • Managing transportation
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4
Q

What is functional loss?

A
  • Impacts quality of life for patient and caregiver
  • May lead to further disability and institutionalization
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5
Q

What are factors of life satisfaction?

A
  • Health
  • Independence
  • Education
  • Optimism
  • Relationships
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6
Q

What are the 5 principles of geriatric care?

A
  • Impact of decreased physiologic reserve
  • Importance of functional and cognitive status
  • The social context of care
  • Using goals of care and prognosis in clinical decision making
  • Impact of multiple conditions, meds, and care setting
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7
Q

What are the major causes of death?

A
  • Heart disease/ Coronary artery disease
  • Cancer
  • Chronic lung disease
  • Accidents
  • Stroke
  • Alzheimer’s disease
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8
Q

What are the MC chronic conditions in the elderly? (5)

A
  • HTN
  • High cholesterol
  • Arthritis
  • Ischemic heart disease
  • diabetes
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9
Q

The co-occurrence of two or more medical or psychiatric conditions, which may or may not directly interact with each other within the same individual.

A

Multicomorbidity

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10
Q

What are the environmental factors that contribute to aging?

A
  • increased caloric intake
  • smoking
  • sedentary lifestyle
  • alcohol use
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11
Q

What causes organs to have reduced ability to respond adaptively to environmental changes and new illnesses?

A
  • Due to loss of tissue cells over time
  • Cellular enzymes may be less active
  • Cellular death
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12
Q

What are the changes of the stratum corneum layer of the epidermis due to aging?

A
  • lower moisture content
  • slower rate of cell renewal
  • decreased cellular cohesion
  • dry, rough, brittle skin
  • Slower rate of wound healing
  • Loss of elasticity
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13
Q

What are the changes of the dermis due to aging?

A
  • decreased thickness
  • decreased vascularity
  • slower wound healing
  • reduced ability to regulate body temperature
  • reduced ability to prevent/respond to infections
  • diminished Vit D synthesis
  • years of oxidative damage increasing skin cancer rates
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14
Q

What are the changes of the eccrine, apocrine, and sebaceous glands due to aging?

A
  • decreased in number
  • diminished sweating with reduced temperature regulation
  • Decreased body odor
  • increased pruritis from dry skin
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15
Q

What are the changes of the hair bulb melanocytes due to aging?

A
  • Decreased in number
  • Graying of hair
  • Genetically determined
  • Some melanocytes enlarge in sun exposed areas (liver-spots or lentigo)
  • Loss of body hair in men
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16
Q

What are the changes of the oral cavity due to aging?

A
  • Diminished mastication strength
  • Diminished mandibular bone density
  • thinning periodontal tissue
  • reduced salivary flow
  • increased risk of dental disease
  • decreased taste sensation
  • increased risk of malnutrition
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17
Q

What are the changes of lung compliance due to aging?

A
  • Decreased lung compliance
  • Ossification of rib-cartilage articulations
  • Loss or damage of elastic fibers reducing recoil of lung tissue which collapses peripheral airways
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18
Q

What are the changes of the air flow rates due to aging?

A
  • air flow rates diminish
  • decreased muscle strength of chest causes decreased FVC and decreased max expiratory flow rate
  • loss of lung volume w/ inspiration from kyphosis and loss of vertebral height from osteoporosis
  • Basilar crackles from opening of collapsed alveoli
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19
Q

What are the changes of the diffusion capacity due to aging?

A
  • Diffusion capacity diminishes
  • Loss of lung parenchyma w/ loss of alveoli and alveolar ducts
  • Decreased total surface area
  • Thickening of alveolar-capillary membrane
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20
Q

What are the changes of the pulmonary immunocompetence due to aging?

A
  • decrease in pulmonary immunocompetence
  • decreased mucociliary transport
  • loss of effective cough reflex
  • diminished cellular immunity
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21
Q

What are the cardiovascular changes due to aging?

A
  • Decline in sinus node function from degenerative fibrosis
  • Increases risk of sick sinus syndrome and atrial dysrhythmia
  • Less increse in HR response to exercise
  • Decreased cardiac reserve
  • LV is less compliant and chamber wall thickens
  • Increased afterload, systolic HTN, LVH
  • Endothelial dysfunction increases risk of atherosclerosis
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22
Q

What are the changes to the esophagus and stomach due to aging?

A

GERD is more common

Peptic ulcer disease is more common

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23
Q

What are the liver changes due to aging?

A

Decreased size

Increased capsular and parenchymal fibrosis

decreased activity of microsomal enzymes

NO CHANGE in LFTs

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24
Q

What are the biliary tract changes due to aging?

A
  • Increased cholesterol concentration w/ supersaturation of bile
  • Increases risk of gallstone development
  • Pre-ampullary bile duct narrowing
  • Stones may cause obstruction
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25
Q

What are the changes to the Colon and rectum due to aging?

A
  • Thinning of colon mucosa and decreased musculature
  • Increases stool transit time through the colon
  • More water absorbed from stool
  • Increased incidence of constipation and diverticular disease
  • decrease in muscle wall elasticity of rectum
  • increases risk of incontinence and fecal impaction
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26
Q

What are the Renal changes due to aging? (6)

A
  • Progressive loss of renal mass w/ basement membrane and mesangium thickening
  • Decrease GFR
  • Increase in ADH from disease (CHF) causes H2O retention
  • Decreased number of functioning nephrons and decreased renal blood flow w/ age
  • Total body water decreases w/ age
  • Thirst mechanisms are blunted (less fluid intake)
  • Inability to excrete large volumes of free water
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27
Q

What is a better estimate of renal function than creatinine alone?

A

Calculated GFR

(Creatinine, age, gender, race)

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28
Q

What are the hematologic changes due to aging?

A
  • Anemia prevalence increases w/ age
  • Progressive decline in hematopoetic tissue in bone
  • Fewer stem cells
  • Diminished tissue sensitivity to EPO
  • Diminished response of WBCs to infection
  • Diminished immune surveillance
  • Diminished response to immunizations
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29
Q

What are the immune function changes due to aging?

A
  • Loss of functional capacity/activity of T-cells
  • Diminished cell-mediated immunity
  • increased risk of infections
  • autoantibodies are found more frequently
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30
Q

What are the physiologic changes that affect lab values?

A

diminished cardiac, pulmonary, and renal function

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31
Q

What are the lab value changes due to aging?

A

Increased - ESR, alk phos, auto antibodies

Decreased - PaO2, albumin, Vit-B12

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32
Q

What are the risk factors for adverse drug reactions (ADRs)?

A
  • Increasing age
  • Women
  • Small body size
  • Duration of therapy
  • Poor compliance
  • Underlying disease
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33
Q

Conditions in older adults that do not fit into distinct categories, often having multifactorial causes and lead to disability and decreased quality of life

A

Geriatric syndromes

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34
Q

What are the 4 key concepts inform/guide the approach?

A
  • Teams and clinical sites of care
  • Prognosis
  • Patient goals
  • Functional status
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35
Q

When is palliative care service considered?

A

<18mo

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36
Q

When is hospice care considered?

A

<6mo

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37
Q

What does functional assessment provide?

A
  • Information that may be used to:
  • Monitor future decline
  • Determine need for support services/placement
  • Determine need for medical/surgical evaluation and intervention
  • Determine need for rehabilitative therapies
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38
Q

What does ADL decline usually indicate?

A
  • worsening disease
  • new illness
  • combined effect of multiple comorbidities
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39
Q

What does new or subtle declines in IADL indicate?

A
  • Presence of disease
  • Loss of vision or hearing
  • Fear of falling
  • Depression and/or dementia
  • Medication side effect
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40
Q

When is early functional impairment suspected w/ highly functioning elders?

A

at onset of depression/dementia if the patient begins to drop their actvity

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41
Q

What is the gait assessment sensitive for detecting?

A
  • Arthritis
  • muscle weakness
  • neurological impairments
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42
Q

What is involved w/ the gait exam?

A
  • Get up from a chair w/o using hands, observe symmetry, stride length, step height, and stance width
  • Test balance
  • Get up from chair, walk 3m and back to sitting in 15 sec
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43
Q

What hearing handicap inventory for the elderly screening (HHIE-S) score recommends a hearing test?

A

>10

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44
Q

What is involved w/ the Mini-Cog exam?

A
  • 3 item recall + clock drawing exercise

Dementia is unlikely if results of both portions of the exam are normal

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45
Q

What are the (PHQ-2) screening questions?

A
  1. Over the past 2 weeks, have you felt down, depressed, or hopeless
  2. Over the past 2 weeks, have you felt little interest or pleasure in doing things
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46
Q

What weight loss is associated with increased morbidity and mortality?

A

>5% of body weight in 1mo

or

>10% of body weight in 6mo

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47
Q

What are the clues that may indicate abuse or neglect?

A
  • Delays between injury and treatment
  • lack of appropriate clothing or hygiene
  • Observing changes in the patient’s behavior when the caregiver is in the room
  • Unfilled prescriptions
  • Caregiver medication seeking (opiods, benzos)
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48
Q

What is the average amount of medications in the elderly?

A

4-5

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49
Q

What are recommended immunizations for elderly?

A

Flu: annually

Pneumococcal: 65yo

Tetanus/Diptheria: every 10 years, add Pertussis once

Herpes zoster: 50yo or older

50
Q

What is the atypical presentation of Urosepsis?

A
  • delerium
  • hypo/normo thermia
  • new incontinence
  • low WBC count
51
Q

What is Amantadine (Symmetrel) for?

A

Influenza A treatment

52
Q

What is Oseltamivir (Tamiflu) for?

A

Prophylaxis or treatment of Flu

53
Q

What is considered an epidemic in a nursing home?

A

Three or more pts w/ fever to 101F and flu like sx w/in 3 days

54
Q

What are the S/S of hypothyroidism?

A
  • insidious onset
  • dry skin, alopecia, diminished reflexes
  • Cold intolerence, decreased max HR
  • Constipation
  • Altered mental status/depression, worsening dementia
  • Fatigue, weakness
  • CHF, HTN, elevated lipids
55
Q

What is the treatment of hypothyroidism?

A

Levothyroxine

56
Q

What is the most common cause of hyperthyroidism?

57
Q

What can hyperthyroidism present as?

A
  • apathetic hyperthyroidism: depressed, withdrawn, unanimated appearance
  • atrial fibrillation
  • dementia
58
Q

What are the S/S of Hyperthyroidism?

A
  • Fatigue
  • Weakness
  • Cognitive changes
  • appetite loss
  • weight loss
59
Q

What is the treatment for hyperthyroidism?

A

I131 ablation or anti-thyroid drugs

60
Q

What is the atypical presentation of Acute coronary artery disease?

A
  • No chest pain
  • Abdominal pain
  • dizziness
  • confusion
  • fatigue
61
Q

What are the common presenting complaints related to acute MI?

A
  • SOB
  • pulmonary edema
  • acute heart failure
  • A-fib
  • myocardial rupture
  • shock
62
Q

What is the MC presenting sx in pts >80yo?

63
Q

What is the management of Acute Coronary Artery Disease?

A

Acute: Aspirin, O2, Nitro, morphine

Reperfusion: PCI, fibrinolysis, CT surgery, CABG

After D/C: daily aspirin/plavix, LMWH, ACEI, B-blocker, lipid lowering med

64
Q

What is the MC cause of hospitalization at >65yo?

65
Q

CHF in elderly is most commonly associated w/ what?

A

prolonged systolic HTN

66
Q

What are the S/S of CHF? (7)

A
  • SOB
  • DOE
  • weight gain
  • lower extremity edema
  • fatigue
  • S3 or S4
  • coarse-wet inspiratory rales in lower lung fields
67
Q

What is class 1 New York Heart Association?

A
  • Mild
  • No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, or dyspnea
68
Q

What is Class 2 New York Heart Association?

A

Mild

Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in fatigue, palpitation, or dyspnea.

69
Q

What is class 3 New York Heart Association

A

Moderate

Marked limitation of physical activity. Comfortable at rest, but less than ordinary activity causes fatigue, palpitation, or dyspnea

70
Q

What is class 4 New York Heart association?

A

Severe

Unable to carry out any physical activity without discomfort. Symptoms of cardiac insufficiency at rest. If any physical activity is undertaken, discomfort is increased.

71
Q

What is the preferred test for evaluation of LV function?

A

Echocardiography

72
Q

What therapy for systolic CHF improves mortality?

A
  • ACEI
  • B-Blockers
  • Spironolactone (advanced systolic HF)
73
Q

What type of murmer is associated w/ mitral regurg?

A

Holosystolic murmer at apex radiating to axilla, back, precordium.

74
Q

What is the MC valvular disorder in the elderly?

A

Mitral regurg

75
Q

What is the treatment for mitral regurg?

A

Repair is preferred over replacement

76
Q

What are the S/S of mitral stenosis?

A
  • Opening snap in early diastole w/ mid diastolic rumble
  • New onset A-fib or CHF symptoms
77
Q

What are the S/S of Aortic insufficiency?

A
  • Dyspnea
  • Fatigue
  • Palpitations
  • Chest Pain
78
Q

What are the S/S of Aortic Stenosis?

A
  • Harsh systolic ejection murmur
  • exertional angina
  • dizziness/ syncope
  • dyspnea
79
Q

What is the treatment for Aortic Stenosis?

A

Valve replacement

80
Q

What is the treatment for A-fib/ flutter?

A

Rate control and anticoagulation

81
Q

What is the treatment for ventricular arrythmias?

A
  • B-blockers FIRST LINE
  • Antiarrhythmics (severe Sx)
  • Ablation
82
Q

What are the S/S of peripheral arterial disease?

A
  • Intermittent claudication
  • Pain in calf, butt, or thigh w/ ambulation that resolves at rest
  • Acute critical limb ischemia
  • Non-Healing LE ulcers or gangrene
  • Skin on the LE is cool to the touch, dry, shiny, and hair loss is common
  • Distal Pulses diminished or absent
  • Ankle-Brachial Index (ABI) <0.91
83
Q

What is the treatment for peripheral arterial disease

A
  • Risk reduction
  • Exercise rehab
  • Foot care
  • Daily ASA or clopidogrel
  • Statin (regardless of cholesterol levels)
  • cilostazol, pentoxiylline
  • Revascularization
84
Q

What are the S/S of Chronic Venous Insufficiency?

A
  • Pitting edema
  • Ache, heaviness, or tightness of LE
  • Worse w/ standing and improves w/ LE elevation
  • Large varicose veins or spider veins
  • Skin is warm, dry, shiny and has bluish-red hue
  • Chronic skin changes (hyperpigmentation)
  • Painless stasis ulcers that usually form just proximal to the medial malleolus
85
Q

What is the treatment for chronic venous insufficiency?

A
  • Compression stockings
  • Skin care
  • Avoid prolonged sitting or standing
  • Leg elevation
  • Radiofrequency and laser ablation
86
Q

What are the risk factors of COPD?

A

Smoking, air pollution

87
Q

What is the treatment for COPD?

A
  • Tobacco cessation
  • Vaccinations
  • Bronchodilators
  • Steroids, Abx, O2
88
Q

S/S of PUD?

A
  • hematemesis
  • early satiety
  • N/V
  • Anemia
  • Melena
89
Q

What medications can cause constipation?

A
  • Opiods
  • Antacids
  • CCB
  • Diuretics
  • Iron supplements
  • Anticholinergics
90
Q

What is the treatment for BPH?

A
  • alpha blockers (first line)- Doxazosin, Terazosin
  • Alpha-1A receptor blockers (first line)- Tamsulosin, alfuzosin
  • 5-alpha reductase inhibitors - Dutasteride, finasteride
  • Surgery
91
Q

What is stress incontinence?

A

increased abd pressure and pelvic floor laxity

92
Q

What is urge incontinence?

A

overactive bladder- need to urinate >7x/day or 2 or more at night

93
Q

What is overflow incontinence?

A

Chronic urinary retention, from outlet obstruction from BPH, neurogenic bladder or urethral strictures

94
Q

What are the transient causes of Urinary incontinence?

A
  • delerium
  • infection
  • atrophic vaginitis/ urethritis
  • Pharmacologic therapy
  • psych (depression, psychosis)
  • Excess fluid output
  • restricted mobility
  • Stool impaction
95
Q

What are the S/S of osteoarthritis?

A
  • Osteophytes
  • Sclerosis
  • bone cysts
  • joint effusions
96
Q

What is the treatment for Gout?

A

Ibuprofen and naproxen

colchicine

corticosteroids (Preferred for renal disease)

97
Q

S/S of Giant cell arteritis?

A

headache, scalp tenderness, jaw claudication, vision loss

Fatigue, weight loss, fever

thickened/tender temporal artery on affected side

elevated CRP/ESR

Elevated CRP and ESR

Confirmed w/ Temporal artery Bx

98
Q

Treatment for Giant cell arteritis?

A

Corticosteroids

99
Q

What is actinic keratosis?

A
  • Precurser to squamous cell cancer
  • Lesions are scaly, rough, and adherent
  • Due to sun exposure
100
Q

What is the treatment for actinic keratosis?

A
  • cryotherapy
  • imiquimod
  • fluorouracil
101
Q

What is the most common skin cancer?

A

Basal cell carcinoma

102
Q

What are the most common sites for pressure ulcers?

A
  • Iliac crest
  • Sacrum
  • Greater trochanter
  • Ischial tuberosity
  • Lateral Malleolus
  • Heels
103
Q

Decreased perfusion of tissue from prolonged pressure on the skin that exceeds the pressure in end-arterioles and capillaries.

Describes the formation of what?

A

Pressure ulcers

104
Q

What is the optimal turning schedule to prevent pressure ulcers?

A

every 2 hours

105
Q

Acute mental status change involving attention and cognitive function

106
Q

What is mild delerium?

A

disturbed sleep and mild tachycardia (sundowner’s syndrome)

107
Q

What is severe delerium?

A
  • disoriented, unable to follow simple requests
  • Lethargic (poor prognosis)
108
Q

What is the diagnostic evaluation tool for delerium?

A

Confusion assessment method (CAM) algorithm

109
Q

What is the most common type of dementia?

A

Alzheimers

110
Q

What medication is used to manage delerious state?

A

Haloperidol

111
Q

What supplementation can be used w/ Delerium?

112
Q

What is the classic triad for Alzheimers?

A
  • Memory impairment
  • Visuospatial impairment
  • Language impairment
113
Q
  • Insidious onset and progressive, fluctuating daily
  • Parkinsonism
  • Fluctuating cognition
  • Hallucinations
  • Sleep disorder

Describe what?

A

Dementia w/ Lewy Bodies

114
Q

What is the treatment for depression w/ dementia?

115
Q

What are the medications for Alzheimers?

A

Cholinesterase inhibitors:

Aricept (donepezil)

Reminyl (galantamine)

Exelon (rivastigmine) inhibits AChE and BuChE

116
Q

What are the 5 stages of death?

A
  • Denial
  • Anger
  • Bargaining
  • Depression
  • Acceptance
117
Q

What are the functions of Hospice?

A
  • Provider: pain and Sx management
  • Nursing: meds, triage, bowel/bladder management, wound care, hygiene
  • Counseling: spiritual, personal
  • Planning: financial, family care
  • Unique: Music/art therapy, massage, diet
118
Q

What are the physical goals and objectives of palliative medical care?

A
  • Advance care planning
  • Nutritional support
  • Incontinence and constipation
  • Pain management
  • Symptom management
  • Can still treat conditions to prolong life
119
Q

What are the first line medications for depressive disorders?

A

SSRIs

  • Sertraline
  • Escitalopram
  • Citalopram
  • Paroxetine
120
Q

What is SIGECAPS?

A
  • Sleep
  • Interest
  • Guilt
  • Energy
  • Concentration
  • Appetite
  • Psychomotor slowing
  • Suicidal ideation

Geriatrics (2 decks)

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