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98 Cards in this Set
- Front
- Back
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Why is systolic HTN with a widened pulse pressure a common finding in older patients?
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aorta becomes less distensible, stroke volume causes greater rise in systolic BP
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In older adults, heart rate remains ____ but ____ decline.
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unchanged at rest
pacemaker cells decline (less response to physiologic stress) |
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What finding, normal in children and benign up to age 40 should you consider pathologic in those > 60?
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S3 or S4 heart sounds.
S3= CHF S4= impaired vent. filling |
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When assessing a geriatric pt, _____ may be the first indicator of decline in mental or physical health.
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change in how the pt negotiates everyday life activities
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What are the key functional areas of geriatric assessment?
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1. sensory status
2. cognitive and behavioral 3. mobility and function 4. eating and nutrition 5. incontinence/ elimination issues 6. social support & environmental resources 7. domestic violence |
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What is presbyopia?
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impaired near vision due to lack of lens flexibility
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What is presbycussis?
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loss of high frequency hearing (old people hearing!)
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WHat is a significant obstacle in obataining accurate ROS in geriatric patients?
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They may lie to protect independence.
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Elderly people are more likely to have abnormal heart rhythms such as ____
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Atrial or ventricular ectopy
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Abnormal heart rhythms, while often benign, may cause ____
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syncope or temporary LOC
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Elderly patients are (more/less) likely to suffer hypothermia.
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More - changes in temperature regulation mean they are more susceptible
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What is actinic pupura?
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purple patches or macules that fade over time, develop from blood leaking through poorly supported capillaries.
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Describe common changes of the face/eyes in the geriatric pt.
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1. fat that cushions eye will atrophy and eyeball may receed.
2. Skin folds of eyelids wrinkle, may bulge in inner third of upper and entire lower eyelid. 3. Fewer lacrimal secretions - dry eyes 4. corneas less lustrous 5. Pupils smaller and maybe irregularly shaped |
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What eye complications are elderly at high risk for?
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cataracts, glaucoma, macular degeneration (age related)
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What is the prevalence of cataracts in elderly?
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- 1 in 10 people in their 60s
- 1 in 3 people in 80's |
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Why are elderly at increased risk for narrow-angle glaucoma?
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- lens continues to grow and may push the iris forward, narrowing the angle between iris and cornea.
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What is the chief cause of tooth loss in most adults?
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Periodontal disease
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In elderly, the lymph nodes are ____ to feel, and the submandibular glands are ____ to feel.
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1. harder (<50% palpability)
2. easier |
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What are some important respiratory considerations in the elderly?
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1. respiratory muscles weaker, lung recoil decreased
2. residual volume increases, 3. cough less effective |
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Systolic bruits heard in middle or upper carotid arteries of elderly patients suggest what?
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possible partial arterial obstruction from atherosclerosis
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Middle aged and older patients commonly have a ______ due to calcification of the aortic cusps in the heart.
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Systolic aortic murmur
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Calcification of the mitral valve ring may resultin in ____
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systolic murmur of mitral regurgitation.
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Complaints of temporal tenderness, headache, vision changes, and jaw claudication suggest ____, especially in pts older than 70.
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temporal arteritis
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Older patients with back or abdominal pain who smoke, are male, or have coronary disease should be assessed for ____
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abdominal aortic aneurysm
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Nodular, lumpy breasts are (normal/abnormal) in the oler patient.
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normal
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In elderly females, ____ breast tissue is replaced with ____ tissue.
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glandular tissue replaced with fat tissue
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Why do elderly patients often have a soft, protruding abdomen?
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Fat accumulation (normal)
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In what ways may aging mask the manifestations of acute abdominal disease?
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- pain may be less severe
- fever less pronounced - sgns of peritoneal inflammation may be diminished or absent |
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What physiologic changes accompany testosterone decline in elderly males?
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- erections require tactile stimulation
- penis decreases in size - testicles drop lower in scrotum - decreasd testicular size if protracted illness present - common ED |
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What are the most common causes of ED?
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hypogastric-cavernous arterial insufficiency,
venous leakage through subtunical venules |
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Within ____ years of menopause the ovaries are no longer palpable.
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10
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What factors may be to blame for sexual disinterest in women?
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partner issues, partner loss, unusual work or life stress
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Proliferation of prostate epithelial and stromal tissue is called ____
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Benign Prostatic Hyperplasia (BPH)
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Describe "benign forgetfulness".
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difficulty recalling names of people or objects or details of specific events.
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___ is a temporary state of confusion that may be first clue to infection or problems with medications.
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Delirium
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Describe the difference between benign tremors and parkinsonian tremors.
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Unlike parkinsonian tremors, benign tremors are slightly faster and disappear at rest without associated muscle rigidity.
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Describe the effect of aging on reflexes.
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- vibratory sense diminished esp in feet and ankles
- position sense may decrease - gag reflex diminished or absent - abdominal reflexes diminished or absent - plantar reflex less obvoius and difficult to interpret - uncommonly, knee reflexes decrease |
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Describe the common areas of concern when assessing symptoms.
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- ADLs
- IADLs - medications - nutrition - acute/persistent pain - smoking and alcohol - advance directives and palliative care |
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___ consist of self-care abilities such as bathing, dressing, toileting, transferring, continence, feeding, managing money.
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ADLs
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Name 4 IADLs
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1. using the telephone
2. shopping 3. preparing food 4. housekeeping 5. laundry 6. transportation 7. taking medicine |
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Name 4 ADLs
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1. bathing
2. dressing, 3. toileting 4. transferring 5. continence 6. feeding 7. managing money |
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What is the likely cause of >50% adverse drug reactions occuring in older adults?
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polypharmacy, physiologic changes, slower elimination of the drugs
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What does the text suggest may be the best remedy for treating insomnia in the geriatric populatioN?
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increased exercise
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Older adults are less likely to report pain, resulting in ___
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- undue suffering, depression, social isolation, physical disability, and loss of function
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Describe the characteristics of acute pain.
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- distinct onset
- obvious pathology - short duration - common causes: post surgical, trauma, headache |
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Describe the characteristics of persistent pain:
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- >3 months duration
- associated with psychological or functional impairment - fluctuate in character and intensity over time - common causes: arthritis, cancer, claudication, leg cramps, neuropathy, radiculopathy |
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What three factors should be considered when assessing the elderly regarding when to do screening exams?
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1. life expectancy
2. time interval until benefit from screening 3. patient preference. |
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Older adults are advised to perform moderate-intensity aerobic activities for _____ or vigerous activity for _______
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1.at least 30 minutes five days each week
2. 20 minutes 3 days a week |
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Who should receive the influenza vaccine each year?
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- >50 years
- any older adult with chronic heart or lung problems, DM, renal or hepatic dysfunction, immunosuppresion, or AIDS/HIV - residents and healthcare personnel fo nursing homes - caregivers of children - anyone who wants it |
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The pneumococcal vaccine should be given every ____ year(s) to adults ___ years or older
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- every 5 years
- 65 years (with diseases |
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The zoster vaccine should be given at ____ years, regardless of history of zoster or chicken pox.
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60
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What is the recommended frequency for:
a) mammography b) pap smears c) colonoscopy d) lung or ovarian cancer screening |
a) every 1-2 years up to age 75, then every 2-3 years
b) every 1-3 years to age 65 or 70, then stop c) every 10 years beginning at age 50 d) should not be routine |
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Depressed men over 65 are at increased risk for _____
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suicide
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___ is an acquired syndrome of decline in memory and at least one other cognitive domain (language, visuospatial, exacutive function)
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Dementia
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What is "the sixth vital sign"?
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Functional status
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What mneumonic can be used to recall for assessment of incontinence?
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DRIP DRIP - Delerium, restricted mobility, infeciton of urine, polyuria, Drug side effects, Retention of feces, Inflammation, and Psychogenic
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Undernutrition, slowed motor performance, loss of muscle mass, or weakness suggests ___
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frailty
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___ or ___ can impair balance and increase risk of falls.
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Kyphosis or abnormal gait
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Isolated systolic HTN >50 yrs old triples the risk for ____. Who should you be careful about lowering BP in?
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1. coronary heart disease and also increases risk of stroke
2. the "oldest old" >80 |
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____ may indicate lower respiratory infection, CHF or COPD exacerbation
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Resp rate >25
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What is a key indicator of poor nutrition in the geriatric pt?
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Low weight
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What is asteatosis?
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Skin that is dry, flaky, rough, and often itchy
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What depigmented patches, called ___, may be found on the extensor surface ofthe forearms.
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Pseudoscars
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Lesions such as ___ and ___ may mimic ____
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actinic lentigines or actinic keratoses... mimic basal cell carcinoma
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A ____ is initially a translucent nodule that spreads and leaves a depressed center with a firm elevated border.
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basal cell carcinoma
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A ____ is a firm reddis-appearing lesion often emerging in a sun-exposed area.
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Squamous cell carcinoma
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A ____ is a dark raised asymmetric lesion with irregular borders
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Melanoma
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____ are superficial flattened papules covered by a dry scale
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Actinic keratoses
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__ is another term for "liver spots"
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actinic lentigines
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What are comedones?
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Blackheads
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___ are raised yellowish lesions that feel greasy and velvety or warty
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Seborrheic keratoses
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Suspect _____ in painful lesions of dermatomal distrbution.
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herpes zoster
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____ may develop from obliteration of arteriolar and capillary blood flow to the skin in bedridden pts
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Pressure sores
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What is the difference between ectropion and entropion?
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Ectropion- eyelid rolls outward
entropion - eyelid rolls inward. |
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___ are the worlds leading cause of blindness.
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Cataracts
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A patient presents with difficulty seeing clearly. Pt is a long-time smoker and worked outside most of his life. He is also a diabetic. What is a likely diagnosis.
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Cataracts
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Increased cup-to-disc ration suggests ____.
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Open angle glaucoma
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___ are colloid bodies causing alterations in pigmentation
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Drusen
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An elderly patient presents with increased AP diameter of the chest, purse-lipped breathing, and dyspnea with talking. You suspect what?
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COPD
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You should consider AAA if the aorta widthe is _____ or with ____. Who is at increased risk?
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1. >3cm
2. pulsitile mass 3. male smokers with coronary disease |
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Abnormalities of gait and balance, especially widening of base, slowing and lengthenng of stride, and difficult turning are associated with risk for ___
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falls
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Describe the clinical features of delirium.
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- acute onset
- fluctuating course with lucid intervals and worse at night - may last hours to weeks - disrupted sleep/wake cycle - may be due to medical illness or drug toxicity |
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Describe the clinical features of dementia.
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- insidious onset
- slowly progressive - lasts months to years - sleep is fragmented - may not have an associated medical cause or toxicity (esp with Alzheimer's) |
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Describe the following for dementia:
a) LOC b) behavior c) speech d) mood e) thought process f) thought content |
a) usually normal until late in the course of illness
b) normal to slow behavior, may become inappropriate c) difficulty in finding words, aphasia d) mood flat, depressed e) impoverished, speech gives little information f) delusions may occur |
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Desribe the following for dementia:
a) perceptions b) judgement c) orientation d) attention e) memory |
a) hallucinations may occur
b) increasingly impaired judgement over course of illness c) orientation maintained but impaired at late stages d) attention usually unaffected until late e) recent memory and new learning especially impaired |
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Describe the following of delirium:
a) LOC b) behavior c) speech d) mood e) thought process f) thought content |
a) disturbed LOC, less aware of environment and less able to focus
b) activity abnormally decreased or abnormally increased c) hesitatn speech, slow or rapid, incoherent d) labile mood e) disorganized may be incoherent f) delusions common, often transient |
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Decribe the following about delirium:
a) perceptions b) judgment c) orientation d) attention e) memory |
a) illusions, hallucinations, most often visual
b) impaired judgement to varying degree c) usually disoriented, known places may seem unfamiliar d) fluctuates, easily distracted, unable to concentrate e) immediate and recent memory impaired |
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What are some causes of delirium?
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- delirium tremens
- uremia - acute hepatic failure - acute cerebral vasculitis - atropine poisoning |
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What are some causes of dementia?
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- Reversible: b12 deficiency, thyroid disorders
- alzheimers, vascular dementia, head trauma |
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Unexplained bruising in the elderly should raise consideration for what?
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abuse
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Described how you would perform the whispered voice test.
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- eyes closed, clinician 12-18" behind pt.
- whisper 4 numbers or a simple phrase - if pt cannot repeat phrase or at least 2 numbers |
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What is xerostomia?
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Dry Mouth
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What is leukoplakia?
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White patches on the tongue, usually from prolonged irritation.
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Describe how you might test strength, coordination, and walking in the elderly?
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Timed up & go test:
- should take <15 sec to rise from chair without use of arms, walk 10 feet, turn around, walk back and sit back down |
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What is the Romberg 3?
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- stand with eyes open and then closed in each position
-- feet together -- feet semi tandem -- feet tandem |
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What is the chair-rise test? How many attempts are allowed?
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- rise from sitting without using hands
- assess quad strength - 3 attempts allowed |
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What are the 3 steps of the mini-cog?
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- step 1: repeat 3 unrelated words
- step 2: draw clock set to 11:10 - step 3: repeat 3 words from step 1 |
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Describe scoring of the mini-cog test.
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Positive dementia screen
- 0 words recalled with normal or abnormal clock - 1, 2, or 3 words with abnormal clock |
