Dr. Cumming's Notes Flashcards
(20 cards)
which tumors peak in older populations?
- -multiple myeloma (50-70)
- -osteosarcoma (>74)
- -chondrosarcoma (40-70)
- -chordoma (40-70)
- -fibrous dysplasia
- -paget’s (>40)
- -hemangioma
- -osteoma
what are the top 5 locations of cancer in the aged
- -breast
- -prostate
- -kidney
- -thyroid
- -lung
- -bronchus
which cancers are known for returning after an extended number of years?
- -breast
- -hodgkin’s
- -lymphoma
- -leukemias
what would be the top 2 immediate differentials in the patient with LBP & recurrent infections
–multiple myeloma
what are the common sites for metastasis?
from where?
–Liver, lung & spine
FROM: prostate, lung, breast
because of the increased risk of pathology what steps are expected in an elderly treatment plan?
– >65 = red flag, radiographs are often indicated at the time of initial presentation, especially if the patient has at least 1 additional red flag
what are some of the factors that make the geriatric exam more challenging?
- -altered response to pain during the exam
- -decrease the correcting reflex d/t loss of nerve fibers & slower dendritic connections
- -changes in ROM, joint flexibility, osteoporosis & soft tissue fragility reduce resiliency
- -the physician must be cautious when performing the physical exam
how does the nervous system change with aging?
- -atrophy of neurons
- -nerve fibers decrease and change in structure
- -slowing of motor neuron conduction, contributing to alterations in the autonomic systems (HR, BP, T, syncope)
- -overal slowed reaction time
what are the physiologic, autonomic changes in the nervous system?
–impairement in:
m strength, DTR’s, nerve conduction velocity
–slow motor skills
–potential deficits in balance & coordiation
–increased fall risk
–decreased pain perception & temp sensitivity
–reduced vibration, touch, pressure sense
as the nervous system ages, what is impaired?
Same as physiologic autonomic changes AS WELL AS:
- -increased risk of sleep disorders, depression, delirium, neurodegenerative diseases & parkinson’s
- -slowed speed of cognitive processing = ~cognitive decline
- -difficulty in raising their eyes upward
what should be emphasized in geriatric neurologic examination?
- -sensory function
- -especially eyesight & hearing
what disease process might be detected by testing the gag reflex?
stroke
swallowing function difficulties may indicate what disease process?
–dysphagia with ant long leg ossification
what 3 D’s can contribute to atrophy?
- -orthopedic deformity
- -neural disease
- -disuse
considering the changes with aging, should muscle strength testing still be rated as a 5.5
yes, muscle does atrophy BUT testing of strength should be a normal 5/5 in healthy older patients
what might the finding of poor or declining grip strength indicate?
- -associated with poor survival and may be used as a tool to assess mortality
- -low handgrip strength has been consistently linked to premature mortality, disability & other health complications in middle-aged & older people
how might the sense of touch change with aging? reflexes? vibration?
- -touch = intact, but may be decreased to pin prick
- -DTR’s absent at ankle in a significant minority of the elderly
- -vibration = lost sensation is frequent in older people at distal lower extremities
which measurements best test for change in the large myelinated fibers?
- -vibration
- -2 pt discrimination
- -proprioception in LE
what is likely responsible for loss of ankle reflexes & reduced proprioception?
–peripheral sensory nerve function decline probably accounts for the loss of ankle jerk and the diminished proprioception
what skills can you ask your patient to perform to brief evaluate fine & gross motor function?
- -raise the arms over the head & undress or dress
- -button or zip without assistance
