Week 1 Flashcards
Age changes: prostate Heart function Weight Bone density Renal perfusion
Prostate- increase 100%
Max heart rate Decreases from 195 to 155 bpm
Weight decreases by 7%
Bone mineral content decreases by 10 to 30%
Renal perfusion decreases by 50%
Causes of age related nocturia
Changes in bladder physiology include decreased capacity and increased residual volume
Altered control of fluid excretion related to low nighttime ADH levels and increased nighttime natriuretic polypeptide levels
Frailty occurs when? 3/5
Unintentional weight loss self-reported exhaustion weakness slow walking speed and low physical activity
Icebergs
Frequently and reported symptoms that are not normal response to ageing
Most common iatrogenic problems in geriatrics
Adverse drug affects, acute kidney injury, adverse surgical outcomes
Pneumonia vaccine schedule BC
Eligibility?
Conjugate 1st (ie Prevnar 13) then 8 weeks later = ppv23
ppv23 1st-wait 1 year then conjugate
Older than 65 years or high risk
4 As of smoking cessation approach
Ask, advise, assist, arrange follow-up
Type of physical activity to improve: Cardiovascular Body comp Metabolism Bone health Psychological wellbeing
Aerobic activity Aerobic activity Aerobic activity Weight bearing exercise Aerobic
Indication of poor nutritional intake: BMI ? Weight loss
BMI ≤20
Weight loss ≥ 10 lbs in 6 months
Fat Dietary recommendations: sat fat? Dietary cholesterol?
Sat fats- 10% caloric intake?
<300mg diet cholesterol
Eg. Monounsaturated fat
Benefit?
Olive oil
Lower LDL and leave HDL intact
Sunflower, corn, soy beans, are examples of what fats?
What’s their impact on lipoproteins?
Polyunsaturated fats
Lower HDL and LDL
Recommended fibre intake
14g. per 1000 cal
% Of diet that should be made up of proteins
12-20% total cal
Four domains of assessment
Physical, functional, emotional, socioeconomic
Five I’s of subjective assessment
Immobility Instability incontinence intellectual impairment iatrogenic complications
Name three geriatric Giants
Dementia, depression, delirium, incontinence, orthostatic hypotension, falls in dizziness, osteoporosis, polypharmacy, pain in the elderly, failure to thrive/frailty
Ultrasonography is helpful in evaluating the biliary tree, looking for urethral obstruction, evaluating vascular structures, but has limited utility in _______ patients.
Obese
Best imaging method of the brain parenchyma when used with gallium contrast
MRI- MR angiography
** Gallium is not nephrotoxic
Uses ultrasound to delineate the cardiac size, function, ejection fraction and presence of valvular disease
Echocardiography
Radio pig die injected into the various vessels and radiographs or fluoroscopic images are used to determine vascular structure, occlusion, cardiac function, or valvular integrity
Angiography
Test used to test individuals at risk for coronary heart disease, monitor blood pressure, heart rate, chest pain, and ECG while increasing oxygen demands
Treadmill stress test
Normal TSH level
0.5-5mIU/L
New York Heart Ass functional classes
1- no
2- slight
3- marked
4- inability
Normal Na and K serum levels
K- 3.5-5.5
Na- 135-145
CKD - ‘normal to mild increase’ ACR level
<3 mg/mmol
CKD- ‘moderately increased’ ACR
3-30 mg/mmol
CKD ‘severely increased’ ACR
> 30 mg/mmol
HF likely with level greater than - (>55yrs)
Nt-proBNP
BNP
Nt-proBNP- >300pg/ml = likely
BNP- <100pg/ml = unlikely >400pg/ml = likely
Levothyroxine wt based dosing and follow-uptime?
1.6 mg/kg/d
FU- 6 weeks
Polypharmacy is how many meds
≥5
Age when stamina reduction begins
20 yrs
Woman with normal paps x3 can stop @ what age
69yrs
Follow up interval For men with normal PSA tests (age specific).
Less than two year intervals not recommended
Mini mental status exam score of 10 to 20 means?
Moderate impairment
Mini mental status exam results 20 to 25 means?
Mild impairment
Mini mental status exam result 0 to 10 means?
Severe impairment
Iatrogenic disease is?
Caused by medical intervention
ADL mnemonic & common assessment tool
D-dressing E- eating A- ambulating T-toileting H-hygiene
Katz index of independence
IADL mnemonic and tool
S- shopping H-housework A-accounting F-food prep T-transport T-telephoning T-taking meds
Lawton IADL tool
Pneumovax 23- who?
Booster?
All over 65- covered
Or <65 and high risk
Booster after 5 years if high risk
Prevnar13- vaccine type?
Who?
When?
Conjugate vaccine
High risk people often >65y
Give 8 weeks BEFORE pneumo23
Give 1 year AFTER pneumo23
Who should get the shingles vaccine?
Coverage?
Doses?
> 50 at risk of shingles
2 doses, 2-6 months apart
No coverage
When can shingrix be given IF pt had shingles or has had zostavax?
Who should get zostavax?
1 year after both shingles and shingrix vaccine
Those who can’t get shingrix
MMR vaccine in olde adults?
Born pre 1970 considered immune- maybe get one time dose
Breast cancer screening for average risk-
50 to 74?
>74?
50-74= q2y >74= q2-3y
BC Cancer higher than average risk = ?
breast cancer screening- 40-74 years
1st degree relative with BCa
Q1year
BC Cancer high risk?
Screening for 30-74y?
High risk- BCa in 1st deg relative, strong fam hx, previous chest radiation
Q1year
Who is not eligible for mammogram? (5)
- Breast implants
- Pregnant/ breast feeding
- Previous history of breast cancer
- New breast complaints ie. lump/ discharged
- Has had mammogram on both breasts in last 12 months
When does cervical cancer screening begin?
And what interval?
When can it stop if 3 normal results in 10 years?
25 y/o
Q3 years
69 y/o
Colon cancer screening- Average risk, asymptomatic, 50 to 74 years old
FIT q2y
Or- colonoscopy q10y
