Test #1 Flashcards
The process or condition of growing old, & ultimately leads to an incompatibility w/ life & terminates in death
Senescence
A PCP who is board-certified in either family practice or internal medicine & who has acquired the additional training necessary to obtain the Certificate of Added Qualification in Geriatric Medicine
Geritrician
The scientific study of the problems of aging
Gerontology
A process of gradual & spontaneous change, resulting in maturation through childhood, puberty, young adulthood & then decline through middle & late life
Aging
The preferred term to describe people aged 65 years or above
Older adults
Term used to describe the average life span
Longevity
The length of time an average particular individual can expect to live, depending on his/her current age
Life Expectancy
What are the 3 subgroups of “older adults” according to the WHO & the age ranges assoc. w/ them?
Elderly (young-old) - 65-75 yoa
Old - 76-90 yoa
Very Old (old, old) - >90yoa
The loss of skeletal muscle mass & function d/t aging
Sarcopenia
Cells lose their ability to divide over time. This limit to cellular replicative capacity is known as what?
Hayflick’s Limit/Phenomenon (appears to be 50 cell divisions)
The 1/3rd rule describes what?
Functional losses of the aged:
1/3rd d/t to disease
1/3rd d/t disuse
1/3rd d/t normal aging
What is the average life expectancy today?
78 yoa
Baby-boomers describes people that where born during what time period?
1945-1964
The fastest growing segment of the population are those over what age?
85
What are some reasons women live longer than men?
Handle stress better
Have more social support systems
More sensitive to changes in their body
Seek out medical care earlier
What minority group has the shortest life expectancy?
Native Americans (45-60yoa)
What are the major concerns of the elderly?
Financial Issues Health care & costs Retirement Housing Crime Transportation Sex
What was the original & intended purpose of social security?
Serve as a supplemental source of retirement income
What is the goal of the physician when it comes to the elderly?
Keep the older adult functioning independently, preserving their lifestyles, & self-respect as long as possible
What is the most important thing to slow down aging & frailty?
Movement (exercise)
What 2 things causes 75% of all deaths, 20% of all dr visits, 30% of all hospital stays, & 50% of all bed ridden days?
Heart disease & malignancies
What are the major sources of funding for older adult health care services?
Medicare Medicaid Other federal plans (VA) Private insurance Out-of-pocket payments
Medicare does not cover what type of healthcare service(s)?
Preventative care (for symptom relief only)
What are the 4 parts of medicare?
Part A: Hospital insurance
Part B: Medical insurance
Part C: Medicare Advantage plans
part D: Prescription Drug Plan
Part A of medicare covers what % of in-pt hospital care?
80% (if medically prescribed)
Part B of medicare covers what % of physician services?
80%
What does Part C of medicare give patients the ability to do?
Choose a private insurance company to pay for Medicare A & B
Give the option to choose prescription coverage (Part D)
This is used in conjunction w/ the original medicare. It pays some or all of what is not covered under the original medicare
Medicare supplemental insurance (medigap)
How many medigap plans are there?
11
For any pain noted in a SOAP note for medicare you must show what?
Provokes Quality Radiates Severity Time
This pays for health services for certain categories of the poor including the aged poor, those who are blind or disabled & low-income families with dependent children
Medicaid
What is the most important part of good dr/pt communication?
Good listening
Interviewing older pts presents some unique challenges b/c they tend to do what?
Under-report problems Overestimate their cognitive abilities Symptoms may overlap Perception of pain is diminished Atypical presentation of many illnesses
The mnemonic LO DR FICARA is used to record info about pain. What does it stand for?
Location Onset Duration Radiations Frequency Intensity Character of pain Assoc symptoms Relieving factors Aggravating factors
What are 7 important ADL’s for the elderly?
Ambulation Bathing one self Continence Dressing self Feeding self Using the toilet Transferring from one surface to another
What are 5 instrumental ADL’s (IADL)?
Money management Shopping/Cooking Cleaning Using the telephone Doing laundry
Obese men have a waist size over what? Women?
Men = >40" Women = >35"
What should the hip/waist ratio be below for men? Women?
Men < 0.9
Women < 0.85
What 3 conditions are assoc. w/ unexplained weight loss?
Depression
Alzheimer’s
Cancer
What 2 conditions are assoc. w/ unexplained weight gain?
Heart problems
Kidney problems
Who are the M/C victims of elder abuse?
Mentally incompetent
Isolated older females
Who is most commonly the abuser in elder abuse?
A family member (Most often spouse, daughter)
What are the different types of elder abuse (from M/C to least common)?
Self-neglect Physical neglect Financial Exploitation Emotional Abuse Physical Abuse
What are the 5 M/C geriatric problems (Five I’s)?
Intellectual Impairment Incontinence Instability Immobility Iatrogenic drug reactions
What are the 3 D’s of intellectual impairment?
Dementia
Delirium
Depression
The avg. older pt is taking how many prescription drugs, OTC meds, & self-selected supplements per day?
12-15 per day
Drug side effects are one of the primary causes of what?
Falls
After 60, how long does it take for a skin cell to be replaced?
42 days (instead of normal 28 days)
The mnemonic SHARP is assoc. w/ signs of inflammation. What does it stand for?
Swelling Heat Altered function Redness Pain
What are general charac.of squamous cell?
Irregular
Flaky
Bleeds
What are the general charac. of basal cell?
Raised borders
Waxy, indurated
Grows downward
What are the general charac. of Melanoma?
Pigmented
Multicolor
Invasive
Spots on the nails indicate what?
Zinc deficiency
Pitted nails indicates what?
Psoriasis
Spoon nails (koilonychia) indicated what?
Iron deficiency, fungus
Clubbing of the nails indicates what?
COPD
Yellow nail syndrome is assoc. w/ what ds?
Diabetes
Terry’s half & half nails is assoc. w/ what type of diseases?
Renal or liver disease
Loss of height is a late sign of what?
Osteoporosis
Possible vertebral compression fx’s
A temp rise of 3 deg F over baseline is a possible sign of what?
Infection
In the elderly, fever is defined as an oral temp greater than what?
100F
Lucatello’s sign is a higher axillary temp than oral temp that suggests what?
Hyperthyroidism
Barnes Temp. Test (checking axillary temp before getting out of bed) tests for what?
Hypothyroidism
What Liebermeister’s rule?
Fever is usually assoc. w/ an increase in pulse of 8-10 bpm for each Centigrade degree increase
Hypothermia is defined as an oral temp that is less than what?
95F
What should the pulse pressure (difference b/w systolic & diastolic) in an older adult be?
40
Hypertension may be distinguished from pseudohypertension by performing what maneuver?
Osler’s Maneuver (inflate the BP cuff above the systolic pressure. Check the radial pulse. The pulse should be absent. If the pulse can still be felt, the intra-arterial pressure may be lower than the BP which may indicate that there is sufficient arteriosclerosis to produce some degree of pseudohypertension)
Presbyopia is AKA what?
Farsighted
A grey, opaque ring around the cornea bilaterally. This is considered a normal part of aging.
Arcus Senilis
Bulging or prominence of the eye. May be uni- or bilateral.
Proptosis
Hearing loss that is gradual & progressive assoc. w/ aging. It’s the M/C form of neurosensory hearing loss in adults. Affects men more than women.
Presbycusis
Hyposmia is what?
Decrease in smell
Aging causes stiffening of the chest walls & weakness of the muscle in the chests. This causes a decrease in chest expansion which leaves the pt more susceptible to what?
Pneumonia
LUQ pain should make you think?
Pancreatitis
AAA
RUQ pain should make you think?
Cholecystitis
Hepatitis
Duodenal ulcer
RLQ pain should make you think?
Appendicitis
LLQ pain should make you think?
Constipation
Diverticulitis
Colon CA
Epigastric pain should make you think?
Peptic ulcers
Pancreatitis
AAA
Hypogastric pain should make you think?
Cystitis
Diverticulitis
Pain in the RLQ when palpating RUQ is what sign?
Soresi’s Sign
Urine loss when coughing, sneezing, or laughing. Affects one in three women in their 60’s.
Stress incontinence
What is the primary complaint in pts w/ musculoskeletal problems?
Pain
R shoulder pain/scapular pain could indicate what visceral disorders?
- Gallstones (Female, fat, forty, fair complexion, flatulence)
- Peptic Ulcers
- Liver or hepatic problems
L shoulder pain could indicate what visceral disorders?
Heart problems (MI)
Spleen problems
Pancreatic problems
Much of the medications that older adults take is linked to problems assoc. w/ what condition?
Obesity
Pharmacokinetics is what?
How the body handles a medication
Pharmacodynamics is what?
How the medication affects the pt.
The use of multiple prescriptions & OTC meds is called what?
Polypharmacy
Adverse drug events are how many times more common in older adults?
3x
Adverse drug events manifest as nonspecifc symptoms such as?
Dizziness
Weakness
Confusion
Instability
What are 2 non-drug strategies to help with sleep?
Glass of warm milk
Valarian Root
What does the mnemonic FRAIL stand for?
Fatigue
Resistance (can you walk up a flight of stairs?)
Aerobic (Can you walk a block?)
Illness (Do you have more than 5 illnesses?)
Loss of weight (have you lost >5% of your body weight in the past year?)
Dizziness is divided by history of sensation into what five categories?
- Vertigo (subjective & objective)
- Disequilibrium -feeling a fall is imminent
- Presyncope - feeling loss of consciousness is imminent
- Mixed dizziness
- Non-specific dizziness - sensation of instability
The mnemonic MEOW is assoc. w/ falls. What does it stand for?
Multifactorial, medical, medicines, mental status
Environmental, eyes, ears, ethanol
Orthostatic hypotension
Weakness of lower extremities
The best predictor of future behavior relating to falls is what?
Past behavior (previous falls)
Fall rates are higher in those individuals who found it difficult to do what?
Walk 1/4 mile
Stand for 2 hours
Stoop
Climb 10 steps
What should always be considered in the older adult w/ unexplained falls?
Syncope
What are intrinsic risk factors related to falls?
Age Illness Visual Impairments Depression/Dementia Lower extremity weakness/disability Abnormal gait or balance
What are some examples of extrinsic risk factors related to falls?
Height of bed Low toilet seats Poor lighting Upturned carpets, loose rugs Uneven curbs/sidewalks, uncleared walkways Wet or slick floors
What is the most dreaded fall related injury?
Hip fractures
90% of all hip fxs occur where?
At femoral neck
What is the M/C upper extremity fx?
Distal radius
A majority of wrist fx’s result from what?
Fall while walking
Pts that presnet w/ acute pain that is exacerbated by sitting or standing and have a progressive kyphosis & loss of height probably have what?
Vertebral fx
A complex, subjective & unpleasant sensation derived from sensory stimuli & modified by memory, expectations & emotions
Pain
What are the common presenting pain complaints in the geriatric pt population?
HA Back/neck pain Extremity pain Abdominal pain Chest pain
The mnemonic OLD CART is assoc. w/ pain. What does it stand for?
Onset Location Duration Characteristics Aggravating factors Relieving factors Treatments previously tried
Describe the functional pain scale (0-5)
0 - no pain
1 - tolerable & doesn’t prevent any activities
2 - tolerable but does prevent some activities
3 - intolerable but can use telephone, watch TV, or read
4 - intolerable but can’t use telephone, watch TV, or read
5 - intolerable & unable to verbally communicate b/c of pain
This is the M/C significant source of morbidity (problem) in the older adult
Back pain
What is the M/C cause for LBP in older adults?
Mechanical (pain secondary to overuse of a normal anatomical structure or pain secondary to trauma)
Pain that persists beyond the expected time or after healing or more than 3-6 months
Chronic
Any painful disorder affecting the loco-motor system including joints, muscles, connective tissues, soft tissues around the joints & bones.
Rheumatism
What is the M/C form of arthritis?
OA (degenerative arthritis)
Where is the primary site of OA (think tissue)?
articular cartilage
What are 2 primary causes of OA in older adults?
repetitive joint injury
obesity
What is one of the most effective tx’s for OA?
Activity/exercise
What are clinical features of OA?
Joint pain following activity
Transient stiffness in AM & after rest
reduced ranges of motion
Joint crepitus &/or periarticular swelling
Pain described as aching or throbbing, episodes of sharp shooting pain
Generally insidious in onset
What is the diff. dx for hip pain?
OA
Osteonecrosis
Fx
Bursitis
What are some systemic causes of hip pain?
Bone tumor Crohn's Ds IBS PID Ankylosing spondylitis Sickle cell Testicular CA (men 18-24 w/ unknown etiology)
Knee pain involves which joint first?
Patellofemoral joint (pain on descending an incline or stairs)
These conditions will produce pain upone weight bearing especially climbing stairs. There will also be weak quadriceps
Medial or lat. compartment syndromes
What is the goal for OA tx?
Control the pain & minimize functional disability
This is a common cause of LBP & the leading indication for lumbar surgery in the US for persons over the age of 65
Lumbar spinal stenosis
What is the key presentation for lumbar spinal stenosis?
Sitting gives relief
What is the medical tx for spinal stenosis?
Total laminectomy at one or more levels
Leg pain, paraesthesia or weakness develops w/ prolonged standing or walking & relieved by leaning forward &/or resting for a few minutes. Pt can ride a bicycle by leaning forward w/ no pain.
Pseudo-claudication (spinal)
Type of claudication that is not precipitated by long standing. Acute exacerbations can occur following lifting or twisting motions. Often there are few neurological findings. There may be limited movement of the spine w/ reproduction of symptoms w/ extension. Pt can ride a bicycle but leaning forward doesn’t relieve the pain.
Ischemic Claudication
What are red flags for malignancy?
Fever
Night sweats
Weight loss
Bone is a common site for metastasis from what organs?
Prostate Breast Lungs Kidney Bladder Thyroid
Vertebral body compression fx are common in what time period after menopause?
1st 10 years
Research conducted at the Mayo clinic has demonstrated that what type of exercise performed regularly had significantly reduced the number of compression fx’s in the group exercising
Extension exercises
50% of pt’s w/ this ds have warm swelling, cutaneous erythema & severe pain in the MTP joint. There also may be fever, chills, & malaise
Gout
Gout in women occurs exclusively after what?
Menopause
What are some factors assoc. w/ predisposing a person to gout?
Obesity
High purine diets
Habitual alcohol ingestion
Use of diuretics
Extra-articular problems w/ the shoulder tend to interfere more w/ what type of ROM?
Active
A pt that presents w/ no history of prior trauma or repetitive activity in the shoulder, but w/ a gradual history of increasing shoulder discomfort & pain w/ movement could indicate what?
Rotator cuff tendonitis
Ds found in adults >50yoa. Periarticular condition in which there is pain & stiffness in AM longer than 30 mins, primarily in the neck, shoulders, LB, hips & pelvic girdle. Pts complain that “they can’t brush/comb their hair.” Up to 30% have temporal arteritis
Polymyalgia Rheumatica
What is the laboratory hallmark for polymyalgia rheumatica?
Elevated ESR
Immune-mediated inflammatory ds that affects women 3x more than men. Causes hypertrophy in the synovial lining, resulting in excess fluid production, cartilage degradation, bone erosion, & damage to tendons & ligs.
Rheumatoid Arthritis
Hard, bony swelling of the DIP joint
Heberden Node
Hard, bony swelling of the PIP joint
Bouchard Nodes
Erythematous rashes over the back of the shoulders “Shawl sign”. Causes fatigue, progressive weakness, & sometimes constitutional symptoms may be present. Typically no stiffness & aching.
Dermatomyositis
A form of non-articular rheumatism of unknown etiology that affects up to 4% of the pop., mainly Caucasian females b/w 40-60
Fibromyalgia
What criteria must be met for a dx of fibromyalgia?
- Diffuse musculoskeletal pain of at least 3 months duration
- Stiffness that is worse in the morning
- tenderness to digital palpation of at least 11 or 18 specific points
What 2 GI ds’s are common in people w/ fibromyalgia?
IBS & Crohn’s
People w/ fibromyalgia have abnormal levels of what in their spinal fluid?
Substance P
What is one of the main differences b/w fibromyalgia & myofascial pain syndrome (MPS)?
Fibromyalgia tends to be bilateral & widespread whereas MPS tends to have a regional & specific pain pattern
