ANKI Geriatrics Flashcards

Question

What are the changes in respiration in the elderly? - Ventilation and gas exchange reduced - Decreased responsiveness to hypoxia and hypercapnia - Decreased protective reflexes in airways (aspiration pneumonia) What are the clinical implications of these changes in respiration? - Higher risk of developing respiratory failure (Type I and II) from acute illness/ non-pulmonary diseases - 5-10x increa

Answer 1

What are the changes in respiration in the elderly? - Ventilation and gas exchange reduced - Decreased responsiveness to hypoxia and hypercapnia - Decreased protective reflexes in airways (aspiration pneumonia) What are the clinical implications of these changes in respiration? - Higher risk of developing respiratory failure (Type I and II) from acute illness/ non-pulmonary diseases - 5-10x increa

Answer 2

What are the causes for weight loss in the elderly? - Decrease in taste (smoking, medications, xerostomia) - Decrease in smell - Decrease in adaptive compliance of fundus (satiety) - Increased release of CCK (satiety)

Answer 3

what are the causes of syncopes and falls in the elderly? - Age related physiology - Age-related pathology (cardiac and neurodegeneration) - Multiple comorbidities - Medications - TIA (transient cerebral ischaemia) Cardiac degeneration is called sick sinus syndrome.

Answer 4

Ways to maximise lifespan: - Eat very little - Avoid stress - Have good genes - Have enough financial resource - Be a woman/ married man - Live in Singapore - Don't smoke (according to lecturer)

Answer 5

Most common cause of dementia in elderly? Alzheimer's disease!! (other causes can be eg. by subdural hematoma) Gross pathology? Cortical atrophy with widening of cerebral sulci and compensatory ventricular enlargement +/- hippocampal atrophy Microscopy? 1. Beta amyloid plaques 2. Neurofibrillary tangles (tau proteins)

Answer 6

COPD in the elderly is an important cause of morbidity and mortality. Associated with smoking. Components of COPD? - Emphysema - Chronic bronchitis And bronchiolitis

Answer 7

What are the vascular & respiratory changes with age? Cardiovascular changes: Blood vessel walls thicken Circulation of blood impaired Myocardial infarctions Cerebrovascular accidents Poorer respiratory function with age Respiratory capacity decreases 40% from age 20 to age 85 Restricts oxygen to the brain Particularly in smokers

Answer 8

What are the vascular & respiratory changes with age? Cardiovascular changes: Blood vessel walls thicken Circulation of blood impaired Myocardial infarctions Cerebrovascular accidents Poorer respiratory function with age Respiratory capacity decreases 40% from age 20 to age 85 Restricts oxygen to the brain Particularly in smokers

Answer 9

(Summary) What are the important precipitating factors in Dimentia: - Alzheimer's, Parkinson's - Depression - Alcoholism - Other metabolic disorders/infections - Drugs Delirium: - Subdural haemorrhage (common cause of raised ICP in elderly) - Low O2 - Dehydration, malnutrition - Infection - Drugs Depression - Isolation from people - Hx (family or self) - Chronic pain (acute pain acauses anxiety) -

Answer 10

What are the diagnostic methods for Dimentia DSM 4th Edition (Diagnostic and Stastical Manual IV) Amnesia and at least one of - Aphasia - Apraxia - Agnosia - Executive dysfunction Decline from baseline Impact on occupational and/or social functioning Delirium CAM (Confusion Assessment Method) - C: Acute changes in mental status and fluctuating Course - A: In-Attention - M: Disorganized thinking/Al

Answer 11

"Outline the Abbreviated Mental Test (AMT) Start with: - Hi I am HH, a year 2 medical student. How may I address you? - Some of the questions can be easy, and some can be hard, but I need you to do your best - Precondition - Language: Is it ok if I ask in english? - Precondition - Hearing: Can you hear me? 1. Without looking at the clock, roughly what time is it? (within 1 hr) (orientation) 2. Whe

Answer 12

"What are the bias factors we need to exclude in AMT? - Language barrier - Deafness - Aphasia How do we intepret AMT scores? What are the key considerations? - Adjust for confounding factors (e.g education, age) - Ceiling and floor effects (9 may not be considered normal for a university prof) What are the differentials if an ""abnormal"" score was obtained? - Darn! He's normal. - Delirium (includ

Answer 13

"What are the different forms that delirium can take? Hyperactive/agitated delirium - 25% of all cases Mixed Hypoactive delirium - >50% of all cases!! - Misdiagnosed as Dementia or Depression or ""Old Age"" - Poorer prognosis!! Why is delirum often under diagnosed? - Not doing cognitive assessment (e.g AMT) - Not determining baseline status - Not sure of features/how to diagnose/hypoactive form"

Answer 14

"What are the complications from falls? - Minor injuries (bruises, abrasions, sprains) - Serious injuries (fractures, head/brain injuries esp SDH) - Death Post fall behavior changes - Fear of falling (""post fall anxiety syndrome"") - Self imposed reduction in activity - Functional decline"

Answer 15

What are the reasons elderly are prone to falls? Physiological changes associated with aging - Posture - Gait - Vision Pathological changes associated with aging - Stroke - Diabetes - OA Medications - High risk drugs (3pts each): Analgesics, Antipsychotics, Anticonvulsants, BZDs - Medium risk drugs (2pts each): CVS drugs, antidepressants - Low risk drugs (1pt each): Duretics Medication Fall Risk S

Answer 16

What are the things to do before discharging an elderly pt who suffered from a traumatic fall? - Address underlying risk factor causing the fall (physiological, pathological, medications, environment) - Opthalmology review (cataract and refractive errors) - Got caregiver? - Home environment safe? - Need OT do home visit? - Got rehab potential? Step down care services? - Foot wear advice, referral

Answer 17

What are the common public environmental modifications to cater to the aging population? - Armrests on public benches, easier to get up - Wheelchair access in public buses - Lift at pedestrian overhead bridge to improve access

Answer 18

What are some home modifications that can be done for an elderly? - Install removable wooden ramp with non-skid covering at door entrance - Install bed rail to help getting up from bed - Install foldable shower seat - Level toilet flooring - Bright lighting - Wide entryways and doorways - Essential facilities on main accessible floor - Non slip flooring - Anti-scald faucets - Stair threads - Remov

Answer 19

"What are the common treatable causes of undermalnutrition? - Medications - Emotional problems - Anorexia, Alcoholism - Late life psychiatric disorder - Swallowing impairment - Oral disease - No money - Wandering (dementia related behaviour) - Hyper/hypothyroidism, Hyperglycaemia - Enteric problems - Eating disorders - Low fat, low cholesterol diet - Social problems ""MEALS ON WHEELS!"""

Answer 20

List the determinants of active ageing - Personal - Social - Behavioral - Environment - Economic - Health and social services Came out alot also

Answer 21

What are the strategies in prevention of functional decline in an elderly patient? Being mindful of its likelihoodIdentifying and comprehensively assessing both general and body system-specific high risk indicators Implementing preventive management strategies targeting one or more relevant dormains, especially: - Cognition - Emotional health - Mobility - Self-care - Continence - Nutrition - Skin

Answer 22

What are the components of goal setting in rehabilitation? - Ascertain what is important to the patient and family - Explain likely degree of restoration of activity (acknowledge uncertainty) - Explain what is required from the patient - Discharge planning starts early - Review goals in light of progress Came out also

Answer 23

Successful aging means functioning at the highest level possible in the context of the inevitable limitations that growing old places upon an individual. It is getting the best out of what is possible for as long as possible physically, mentally, psychologically and socially What are the 3 components of successful aging? - Maintaining high cognitive and physical function - Avoiding disease & disab

Answer 24

What are the components of optimal physical aging? Exercising - Improve/maintain physical condition through active lifestyle and exercise - 30mins daily, 150min a week - 4 S of exercise (Stamina, strength, suppleness, skill) and Endurance Nutrition - High quality, diverse diet in the company of others - HPB My healthy food plate (1/2 fruit and veggie, 1/4 brown rice and wholemeal bread, 1/4 meat a

Answer 25

What are the components of optimal mental aging? Maximize brain reserves - Anticipating and rehearsing solutions to spatial problems - Setting aside penty of time for complicated tasks. Avoid rushing as haste triggers anxiety which can disrupt attention - Augmenting working memory by working hard, taking plenty of practice tests and working with others - Avoiding doing 2 things at once - Spam the

Answer 26

"What are the components of optimal physiological aging? Life long learning - Listening and asking - Media - books, megazine, television - Enrichment courses/conferences (academic courses, dance, cooking, language, arts) Diversity of experiences - Advocational activities that expand horizons (eg travel) - Volunteer work - Church/religious activities Mindset and philosophy ""I am old, and it's grea

Answer 27

What are the components of optimal social aging? - Begin early to reweave social networks - Choose quality over quantity - Avoid learned dependency

Answer 28

What is the definition of frailty? Increased vulnerability to insult or challenges resulting from impairments in multiple domains that compromise compensatory ability

Answer 29

MOH's 3 beyonds

Answer 30

What are the 4As of Alzheimer's Disease? - Amnesia - Aphasia - Apraxia - Agnosia - Executive dysfunction Same as DSM 4th Edition (Diagnostic and Stastical Manual IV) lol...which is how to diagnose dementia

Answer 31

What are the clinical features (ABCs) of Dementia? - Activities of daily living (ADLs): Loss of independence in accustomed ADLs - Behavioral changes - Cognitive: Memory deficit (recent > remote), disorientation, impaired judgement, impaired problem solving, language, praxis, visuospatial

Answer 32

What are the risk factors for depression in elderly? Biological - Aging changes in neurotransmission Social - Family hx - Past hx of depression - Loss of family and friends (bereavement) - Isolation - Loss of job - Loss of income Physical - Specific diseases (CVA, thyroid disorders, cancer, etc) - Chronic conditions - Chronic pain - Impairment in physical function - Drugs (eg beta blocker blues) -

Answer 33

What are the features (ABCs) of depression? - Affective (mood): Low mood/sadness, loss of interest, feelings of guilt, feelings of worthlessness, suicidal thoughts - Behavioral: Psychomotor slowing or agitation, fatique or loss of energy, poor sleep, altered appetite - Cognitive: Poor memory, poor concentration, poor decision making B and C same as dementia!! yey Dimentia A is loss of independence

Answer 34

"What is late onset depression? First depression after age of 65, distinct from early-onset depression - Less likely to have family hx of mood disorder - Higher risks of developing dementia - Greater association with comorbidities (""vascular depression"" in pts with HTN, IHD & stroke) - Presentation: More behavioral/physical/somatic and cognitive symptoms, fewer affective/mood symptoms Why is lat

Answer 35

Why is it important to treat depression? If untreated, - Over-investigation of somatic symptoms - Increased physician visits and hospitalizations - Decreased quality of life (QoL) - Can aggravate certain conditions (eg. IHD) - Increase caregiver stress - Increase nursing home placement - Risk of suicide We cant treat dementia but we can treat depression!!!

Answer 36

What are the common causes of delirium in the elderly? - Drugs - Eyes, ears - Low O2 states (AMI, Stroke, GI bleed) - Infection - Retention of urine/faeces - Ictal (seizure) - Underhydration, undernutrition - Metabolic - Subdural haemorrhage!!! Disease presentation depends on organ of lowest reserve (“weakest link”) rather than organ of insult (eg. Pneumonia can present as confusion in a dementia

Answer 37

How are healthcare services for the elderly financed in SG? By the Individual - Medisave (mandatory contribution to CPF) - Medishield Life (cover both citizen and PR, cover pre-existing conditions, for life, autoinclusion) - Out-of-Pocket Payment (OOP)(自己还钱) By the Community - Voluntary Welfare Organizations (VWOs) - Community Development Councils (CDCs) By the Government - Medifund (for those no

Answer 38

What are the healthcare programme and policies for the elderly? - Community Health Assistance Scheme (CHAS)(Subsidy for treatment at GP and dental clinics) - Pioneer Generation Package (PGP) (CHAS regardless of socioeconomic status, additional 50% off bill after CHAS discount) - Merdeka Generation Package (MGP) (for those who did not get PGP LOL) - Chronic Disease Management Programme (CDMP)(Medis

Answer 39

What are the social programmes and policies for the elderly? - Children given subsidy and priority when applying for HDB flat to stay near parents - Studio apartments customized with elder-friendly features - Main and Interim HDB Upgrading Programmes (Elder-friendly grab bars in bathrooms and toilets, ramps, lift stopping on every floor) - Revised code on Barrier-Free Accessibility in Buildings (2

Answer 40

Caregivers experience significant stress when caring for dependent elderly. - Mental disability (e.g. dementia, depression) usually causes greater caregiver stress than physical disability. - Caregivers are often ‘hidden patients’.- Stressed caregivers are more likely to admit their care recipient into institutionalized care. - As doctors, it is our responsibility to care for both the patient AND

Answer 41

Outline the differences between Delirium, Dementia and Depression Delirium: Acute onset with fluctuating course, pt often clouded and disoriented with psychosis Dementia: Insidious onset with progressive course Depression: Variable onset and course

Answer 42

The elderly are at increased risk of toxicity from certain drugs. List some of these drugs. CNS drugs: BZD CVS drugs: Digoxin, Nitrates, BB, Furosemide Anticoagulants: Warfarin, Heparin Antibiotics: Aminoglycosides Analgesics: Aspirin, Diclofenac, Coxibs came out also

Answer 43

What is polypharmacy? Use of 3 or more drugs at the same time What are the 2 key concerns with polypharmacy? - Risk of ADR increases exponentially with the number of drugs used - Risk of DDIs increases especially with the use of CYP450 inhibitors What are the consequences of polypharmacy? - Longer length of hospital stay due to higher morbidity - Higher mortality - Higher hospitalization expenses

Answer 44

What are good practices to reduce medication errors? - Computerization (use your COWs) - Good clinical practice of doctors - Nursing assistance - Pharmacist assistance

Answer 45

An elderly man Mr A comes to you and complains of knee pain. You prescribed diclofenac and he happily went home. HE FAINTED AT HOME AND WAS SENT TO A/E 2 WEEKS LATER. WHY???为什么??? Excessive bleeding. What are the questions to ask? - What are the physiological problems? - What are the current problems? - Is he taking any concurrent medication? - What are the ADRs and DDIs of the drug you prescribed

Answer 46

After a successful operation, Mr D was given some Pacofen (paracetamol + codeine) and went home the next day. He presented to A/E 2 days later cuz he cannot pee. Went to drink even more water. Felt lagi worse. A cathether was inserted and he went home with the catheter. Is Pacofen appropriate for this patient? NO!!! ADR!! Common adverse effects of opioids include: - Sedation, addiction, respirator

Answer 47

Mrs T has a past history heart failure and now present with acute pulmonary edema. What drugs are most appropriate for her? Furosemide What is the one test you need to do the next day? Do blood test to check potassium cuz loop diuretics is non K+ sparing

Answer 48

Selection of a safe and suitable drug for elderly patient must be based on? Patient factors: - Physiological functions - Pathology - Social, cultural factors Drug factors - Pharmacology - MoA, Efficacy - Safety (ADRs, DDIs, CYP inhibitors) - Cost

Answer 49

List some barriers to adherence to medication in elderly patients - Polypharmacy (too many drugs to take) - Non-compliance (troublesome) - Language barriers (cannot understand instructions) - Poor hearing (cannot hear instructions properly) - Poor vision - Multiple managing physicians (conflicting instructions) - Poor memory/cognitive impairment (cannot remember)

Answer 50

(exam template) For an elderly patient with multiple comorbidities and polypharmacy, what are the possible causes of acute functional decline? Conditions: Worsening of pre-existing, new medical conditions (stroke, infection, falls, delirium, etc) Medications: Initiation of new medications, poor medication compliance (polypharmacy), drug ADRs (e.g hypotension from glipizide), acute renal injury/deh

ANKI Geriatrics Flashcards

(74 cards)