Final Flashcards
(178 cards)
1
Q
Wheezing (high pitch, whistling) in the lungs indicates what?
A
Obstruction
2
Q
Rhonchi (low pitch, snoring) in the lungs indicates what?
A
Secretions
3
Q
Fine (high pitch, “rubbing hair”) or Coarse Crackles (low pitch, “velcro-like”) in the lungs indicates what?
A
Infection in the bronchi, alveoli. (will disappear after several breaths if not pathological)
4
Q
Type of lung sound that is common w/o pathology?
A
Rales
5
Q
What are signs of possible pulmonary pathology?
A
- Neck pain, shoulder pain, mid-thoracic pain
- Cough
- Fever
- Shallow breathing
- Increased respiratory rate
- Increased pulse
6
Q
An inflammatory reaction to microbes or to microbial products involving the pulmonary parenchyma. One of the M/C & significant health problems in the elderly. Been called “Old man’s friend”
A
Pneumonia
7
Q
What are predisposing factors to pneumonia?
A
- Poor oral hygiene
- Debility from cardiac/respiratory ds
- Cancers
- Decreased ambulation
- Exposure to broad-spectrum antibiotics (Big factor)
8
Q
What are s/s of pneumonia?
A
- High fever
- Cough
- Sputum production
- Tachypenia (increased resp. rate over 16bpm)
- Tachycardia
9
Q
What clinical findings are unique to viral pneumonia?
A
- Decreased neutrophils, increased lymphocytes
- low-grade fever
- Normal auscultation
10
Q
What clinical findings are unique to bacterial pneumonia?
A
- Increased neutrophils
- Night sweats
- Rales, wheezes, bronchial breath sounds
11
Q
How is TB primarily acquired in the elderly?
A
Through inhaling droplets
12
Q
What causes TB to remain dormant?
A
Host’s immune system remains intact
13
Q
What conditions have to met for a person to be considered to have a TB INFECTION?
A
- They’ve been exposed to the infection
- Remain asymptomatic w/ a (+) tuberculin skin test
14
Q
What conditions have to met for a person to be considered to have TB DISEASE?
A
- They’ve been exposed to the infection
- Have symptoms
15
Q
What are symptoms of TB?
A
- HA
- Fever
- Cough
- Excessive sputum production*
- Hemoptysis*
- Fatigue
- Anorexia*
- Weight loss*
- Night sweats ***
- Muscle weakness
16
Q
What are the 2 tests for TB?
A
- Mantoux method: PPD (Polysorbate-Stabilized Purified Protein Derivative Antigen)
- Chest X-ray
17
Q
What does a (+) PPD test indicate?
A
Person harbors viable organisms (has been exposed, not that they are active)
18
Q
Flu season typically occurs during what months (in the northern hemisphere)?
A
December through April
19
Q
What are s/s of influenza?
A
- Abrupt fever (w/i 1st 12 hours)*
- Nasal obstruction w/ clear nasal discharge *
- Non-productive (dry) cough (bronchitis) *
- Chills
- Rigors (shaking during high fever)
- HA
- Myalgias
- Malaise
- Anorexia
- dry/sore throat causing cough to get worse on 2nd/3rd day
20
Q
Medical profession recommends that all elderly people over what age receive a flu vaccine annually?
A
65 & older
21
Q
What is the efficacy of the flu vaccine at preventing major symptoms? hospitalizations? Reducing deaths?
A
30-70% for preventing major symptoms
50-60% for preventing hospitalizations
75% in reducing deaths
22
Q
Why do pt’s usually get the flu after getting the vaccine?
A
Usually b/c they got the shot too late & they already had the ds in them
23
Q
What is the mortality rate assoc, w/ the flu?
A
High (primarily d/t pneumonia)
24
Q
An obstruction of the pulmonary arts. caused by a blood clot (thrombus) or other material carried to the pulmonary vasculature by the circulatory system (embolus)
A
Pumonary embolism
25
What 2 things pose the greatest risk for developing a DVT?
Bed rest
| Inactivity
26
What are s/s of a pulmonary embolism?
- Tachypenia
- Shortness of breath
- Chest pain
- Syncope
- Wheezing
- Hemoptysis
- Low grade fever
- Leg pain or swelling
- Anxiety
27
What are s/s of a DVT?
- Leg swelling
- Tenderness
- Increased warmth
28
This is a group of diseases that includes chronic bronchitis & emphysema, that block airflow in & out of the lungs
COPD
29
This is charac. by a productive cough occurring most days of the month for at least 3 months of the year for 2 consecutive years
Chronic bronchitis (Ain't nobody got time for that)
30
This is charac. by enlarged alveolar spaces that reduce the surface area for gas exchange.
Emphysema
31
What is the M/C environmental risk factor for COPD?
Cigarette smoking (contributes to 80% of cases)
32
What are s/s of COPD?
- Productive cough
- Increased sputum production
- dyspnea
- Wheezing
- Opalescent sputum (milky in color, able to see through)
33
What is the most disabling symptom of COPD?
Dyspnea
34
When wheezing is present in a pt w/ COPD, it's usually first noted when the pt is in what position?
Supine (later occurs in any position, d/t bronchospasms)
35
What are signs of severe airway obstruction seen in people w/ COPD?
- Pursed-lip breathing
| - Breathing in sitting position w/ elbows on thighs/table
36
What are the 2 stereotypical COPD pts & charac. of each?
Pink puffer - barrel-chested emphysemic, pursed-lip breathing, no cyanosis or edema
Blue Bloater - overweight, cyanotic, & chronic productive cough
37
Hospitalization for COPD is assoc. w/ an avg survival time of?
about 5 years
38
Type of cancer that is the M/C cause of cancer-linked deaths among both males & females in the U.S.
Lung cancer
39
90% of lung cancer in men & 80% of lung cancer in women is attributable to what?
Cigarette smoking (duh)
40
M/C type of lung cancer (50%). Tends to grow slowly & arises in the central airways
Squamous cell carcinoma
41
2nd M/C type of lung cancer (35%). Arises from the bronchial & mucosal glands & has a worse prognosis than squamous cell carcinoma
Adenocarcinoma
42
Most rapidly growing of the lung carcinomas but is the most chemoresponsive of all the lung cancers
Small Cell Carcinoma (Oat cell)
43
What % of pts w/ lung CA have no symptoms?
25%
44
What is the 1st symptom usually assoc. w/ lung CA?
Cough that won't go away or gets worse over a period of time
45
What are s/s of lung CA?
- Productive cough (may b/co bloody)
- Dyspnea
- Chest pain (25% - dull, persistent, aching)
- Hemoptysis (one of M/C symptoms)
- Wheezing
- Fever
- Hoarseness
- Dysphagia
- Pancoast syndrome (shoulder pain that radiates down outside of arm)
46
Are most HA's primary or secondary in the elderly?
Secondary
47
What is the M/C type of HA experienced by the elderly?
Tension HA
48
What are charac. of hypnic HA's?
- Induced by sleep
- Common b/w ages of 65-84
- Diffuse & throbbing
- Awake pt at same time every night (b/w 1-3am)
- Tx is lithium at bedtime
49
Type of HA rarely encountered in the elderly
Migraine
50
Thunderclap HA should make you think what?
Stroke
51
HA assoc. w/ visual loss should make you think what?
Giant Cell Arteritis & stroke
52
HA w/ positional exacerbation or increase w/ valsalva should make you think?
HTN
53
HA's after trauma should make you think what?
Subarachnoid hemorrhage (may present as a relatively mild unremitting HA)
54
What are some substances that can cause a HA?
- Medications
- Alcohol
- Nitroglycerine
- Hormones (estrogen replacement)
- Caffeine
55
Type of muscle contraction HA assoc. w/ ant. head carriage
Tension/Stress HA
56
Type of HA assoc. w/ sustained muscular contraction d/t loss of the cervical lordosis. Often there is hypermobility of the upper cervicals as a compensatory mechanism to lower cervical/ upper thoracic subluxation
Suboccipital HA
57
The ability to carry out purposeful motor actions
Praxis
58
Decreased ability to plan &/or execute purposeful movements
Dyspraxia
59
Total inability to carry out purposeful movements
Apraxia
60
A group of vascular disorders that result in brain injury
Cerebrovascular Ds
61
M/C type of stroke?
Ischemic (90%)
62
What are some strategies to prevent stroke in the elderly?
- Control HTN
- Measure & tx hyperlipidemia
- Recommend to stop smoking, illicit drug use, alcohol only in moderation
- Exercise regularly
- Don't overeat
63
If tx is necessary for a stroke it should be started w/i what timeframe?
3 hours
64
Deterioration of the CNS myelin. Manifests as impaired motor, sensory, cerebellar, visual or other system dysfunctions. 60% begins b/w 20-40 & then again b/w 50-70
Multiple Sclerosis
65
One of the most prevalent neurodegenerative ds encountered in older adult b/w ages of 50-79. Charac. by tremor, muscular rigidity, bradykinesia, loss of postural reflexes, dementia, sleep abnormalities
Parkinsonism (paralysis agitans)
66
What are the 2 types of Parkinson's?
1. Primary Idiopathic (loss of substantia nigra)
| 2. Secondary/Acquired (result of infection, meds, toxins, hypothyroidism*, etc)
67
What are usually the 1st signs of Parkinson's?
Stiffness/soreness of the axial girdle musculature
| Unexplained tiredness or fatigability
68
What's the difference b/w resting tremor & action tremors?
```
Resting = hands shake when resting, stop w/ moving
Action = hands shake when moving, stop w/ relaxation
```
69
Type of tremor that predominantly affects the upper extremities, may also affect the head. Cause is unknown; Chronic; Action tremor
Essential tremor (AKA senile tremor)
70
Type of tremor that is coarse, irregular & is present during finger-to-nose maneuver. Result of cerebellar pathology.
Cerebellar Tremor (AKA Intention tremor)
71
What's the difference b/w the way a pt misses their target w/ an essential tremor vs. a cerebellar tremor?
```
Essential = miss target b/w right & left sides of target
Cerebellar = miss target b/w forward & backward
```
72
What is the leading cause of blindness in adults & most frequent cause of end-stage renal ds & leading cause of lower limb amputation?
Diabeetus
73
According to the journal Diabetes, about 61% of people w/ type 2 diabetes suffer from what vitamin deficiency?
Vit. D
74
What are the 3 main types of neuropathy affecting diabetics?
Peripheral neuropathy (M/C)
Focal neuropathy
Autonomic neuropathy
75
Type of neuropathy that may come on rapidly & is caused by diabetes-related damage to a particular nerve or group of nerves. Usually clears up over a period of months
Focal Neuropathy
76
Type of neuropathy that affects the digestive system, sexual function, bladder as well as other organs. Ex: gastroparesis
Autonomic Neuropathy
77
This is the confluence of Type II diabetes, HTN, & obesity.
Metabolic Syndrome X
78
The conditions comprising Metabolic Syndrome X all have what 3 common cause?
1. Diets of highly refined CHOs
2. Diets high in fat content
3. A sedentary lifestyle
79
Older adults need how many hours of sleep a night?
8 hours
80
Why is getting enough sleep more difficult for older adults?
Decrease in deep sleep leading to more time spent in lighter stages of sleep which are easily disrupted.
81
What are common sleep complaints in older adults?
- Difficulty falling asleep
- Early waking
- Disturbed sleep
- Increased wakefulness at night
- Decreased sleep time
- Daytime sleepiness
82
What are some causes of insomnia in the elderly?
- Various diseases (parkinson's)
- Polypharmacy or meds
- Chronic pain
83
This is present in 90% of men & 70% of women over age of 80. Major cause of sleep disturbance, daytime fatigue, an falls. Assoc. w/ smaller bladder capacity, increased urge to urinate., diabetes, hypercalcemia, renal failure, prostate hypertrophy, constipation, & meds
Nocturia
84
This condition is most often seen in obese pts w/ a short neck. Commonly assoc. w/ snoring., excessive daytime sleepiness, night time sweating, & morning HA's.
Sleep apnea
85
What are some tx's for apnea?
- Weight loss
- Discontinuation of certain meds
- Use of nasal CPAP (continuous positive airway pressure)
- Certain dental devices
- Surgery
86
What are some ways to improve sleep?
- Regular sleep schedule
- Bedtime routine
- Sleep-conductive environment
- Only use bedroom for sleep
- Melatonin, Kava Kava, Valerian Root, L-trytophan
- Avoid substances that interfere w/ sleep
- Pillow b/w knees or under waist
- Regular exercise
- Relaxation
87
An uncomfortable sensation in one or both legs that is relieved by moving or rubbing the affected limb. No cramps. Usually occurs immediately before bedtime or while the pt is awake in bed.
Restless legs syndrome
88
What changes occur in the heart & blood vessels w/ age?
- Arteries stiffen
- Myocardium b/co less able to relax
- Heart enlarges
89
What are 9 signs of possible cardiac problems?
- Neck, jaw, or L arm pain
- Sharp ant. chest pain or shoulder pain
- Increased temp
- Increased HR
- Increased pulse rate
- Increased BP
- Shortness of breath
- Palpitations
- Syncope
90
A term that applies to a full spectrum of pathological syndromes. This ranges from early plaque formation in the wall of arts. causing no symptoms through partially blocked arts. that don't significantly obstruct blood flow to totally occluded vessels
Ischemic heart disaese
91
Major stenosis (>70% narrowed) is likely to be assoc. w/ what?
Angina pectoris
92
Lesions of less than what % stenosed do not usually cause symptoms
50%
93
This ds causes myocardial ischemia & is charac. by dyspnea, precordial discomfort, pressure, or pain that last 1-15 mins & is typically precipitated by exertion & relieved by rest w/i 3-5 mins or sublingiual nitroglycerin
Coronary Artery Disease
94
In the older pt, what is a more common manifestation of myocardial ischemia that chest pain?
Dyspnea on exertion
95
This type of angina displays charac. of angina that are usuall constant. Brought on by exertion & relieved by rest w/i a few mins.
Stable angina
96
Type of angina that refers to any worsening in the pattern of symptoms: Increased freq., intensity, or duration of episodes, or the occurrence when the pt is sedentary or awakening from sleep
Unstable angina
97
This is defined as at least 140/90 (resting) regardless of age.
Systemic HTN
98
How is someone diagnosed with HTN?
High BP has to be documented on at least 3 separate occasions, & w/ at least 2 separate measurements (resting & standing/sitting) on each occasion.
99
What is a more accurate predictor of CV complications, high systolic pressure or high diastolic pressure?
High systolic pressure
100
What is the true measurement of how bad arteries are?
Pulse pressure
101
Pulse pressure should be lower than what?
40
102
Elevation of BP over what increases heart attack mortality risk by up to 5x & a stroke by 2.5x?
160/90
103
What is the M/C type (cause) of HTN?
Uncomplicated Primary Essential HTN (Idiopathic)
104
Pts w/ HTN will experience what type of HAs?
Suboccipital or top of head & most often in a.m.
105
Any pt w/ a BP over what should be sent immediately to the ER?
210/120
106
What drugs are most commonly assoc. w/ orthostatic hypotension?
Nitrates
| Diuretics
107
A decline in arterial BP that occurs after a meal is called what? May drop 20mmHg w/i 75 mins of eating a meal.
Postprandial Hypotension
108
What is the M/C cause of death (80%) in persons over the age of 65?
CAD
109
What is the gold standard for detecting the presence of CAD?
Coronary angiography
110
The classical description of the location of pain assoc. w/ CAD is a clinched fist placed over the center of the chest. This is known as what sign?
Levine sign
111
What are s/s of a MI in women?
- Sudden discomfort or pain in back, neck, lower jaw
- Sudden pain in arms & legs especially one side
- Sudden feeling of nausea then vomiting.
- Breaking out in cold sweat
- Sudden shortness of breath
- Persistent hiccups
- Sudden fatigue & feeling like you need to lay down
112
Drinking what increases risk of stroke by 83%
Sugary drinks
113
Most MI's occur during what time of the day?
6am-noon
114
MI's at night are most often assoc. w/ what?
Sleep apnea
115
A condition in which cardiac output id insufficient to meet physiologic demands. The M/C diagnosis among hospitalized elderly pts
Heart failure
116
In the elderly, heart failure usually results from what?
Systemic arterial HTN
117
What are the s/s of heart failure?
- Dyspnea & fatigue
- Peripheral edema
- Tachycardia
118
The occlusion of blood supply to the extremities by athersclerotic plaques is called what?
Peripheral Arterial disease
119
What are the M/C exacerbating factors of PAD?
Cigarette smoking
| Diabetes
120
What is the M/C symptom of PAD?
Intermittent claudication (occurs during walking a relatively short distance; M/C in calf)
121
DVT's are usually assoc. w/ (caused by) what?
- Recent surgery
- Trauma
- Immobilization
122
What is the hallmark symptom of DVT?
Rapid onset of unilateral leg swelling (Edema)
123
Inflammation assoc. w/ a thrombosed superficial veins. Usually a self-limited process & the signs of inflammation fade w/i 5-10 days. Rarely leads to pulmonary embolus.
Superficial Thrombophlebitis
124
Dilated, tortuous superficial veins w/ incompetent venous valves. May be hereditary. Common sites are the medial thigh & leg & the area behind the knee.
Varicose veins
125
Local dilation & weakening of an artery secondary to a loss of smooth muscle & elastic tissue. Most likely occur at branching points or areas of stress. HTN is a major risk factor. M/C in males (2:1)
Aneurysm
126
What is the M/C cause of a AAA?
Atherosclerosis
127
Any aneurysm less than ___ cm rarely rupture but those that are ____cm often do
5cm; 10cm
128
What is the method of choice in confirming the diagnosis of a AAA?
Ultrasound
129
The likelihood that an aneurysm will elad to death is directly related to what?
Its size
130
Gastric cancer is M/C found in pts older than what age?
60
131
What is the M/C symptom of GERD?
Substernal burning (most often after meals or on reclining)
132
Peptic Ulcer Ds is caused by what bacteria?
H. pylori (increases d/t lowered gastric acid
133
What are the 2 type of peptic ulcers?
1. Gastric ulcers (large; heal slowly; tend to recur; pain exacerbated by eating)
2. Duodenal ulcers (M/C type; occur 2-3 hours after meals; relieved by food or antacids
134
Ischemic colitis occurs almost exclusively in the elderly d/t what?
Atherosclerosis
135
What is the M/C condition affecting the intestines?
Diverticular ds
136
Diverticular ds is assoc. w/ what type of diet?
Low-fiber & high fat diets
137
What are s/s of diverticulitis?
- Intermittent cramping pain & tenderness in LLQ
- Constipation is usually present
- Possible diarrhea or alternating b/w diarrhea & constipation
- Possible nausea/vomiting
- Fever (?)
- Occasional blood in stool
138
What is a difference in stool b/w Crohn's & UC?
Crohn's causes watery diarrhea w/ or w/o blood
| UC causes bloody diarrhea w/ mucus
139
A motility disorder of unknown cause charac. by abdominal pain, & alternating periods of diarrhea & constipation
IBS (new onset is uncommon in elderly)
140
What are some s/s of IBS?
- Variable degrees of ab pain (LLQ/paraumbilical area)
- Pencil thin stools
- Ab pain relieved by defecation
- No blood in stools
141
What should you always suspect in middle-aged (>40) pts w/ occult blood in the stool
Colon cancer
142
What are typical colon cancer screenings?
Stool guaiac test (annual)
Sigmoidoscopy (every 3-5 yrs)
Colonoscopy (every 10 yrs)
143
Bruising of the flanks caused by retroperitoneal hemorrhage. Appears as a blue discoloration. Takes 24-48 hours to show up. Can predict a severe attack of acute pancreatitis.
Gray Turner Sign
144
Superficial edema & bruising around the umbilicus is what sign? Usually accompanies Gray Turner Sign
Cullen's Sign
145
A palpable, non-tender gallbladder is what sign? Assoc. w/ Pancreatic cancer
Courvoisier's sign
146
Migratory thrombophlebitis is what sign? Assoc. w/ pancreatic cancer
Trousseau's sign
147
What lab test is best to measure for long term inflammation?
ESR
148
What lab test is best to measure for acute inflammation?
CRP
149
Acute, intermittent, ab pain should make you think what?
Ulcers
150
Diffuse, cramp, acute ab pain should make you think what?
```
Bowel Ischemia (obstruction)
Cancer (pain out of proportion to physical findings)
```
151
Constant, acute ab pain should make you think what?
Biliary colic
Peritoneal inflammation
Neoplasms
152
Sudden, intense, acute ab pain should make you think what?
Ab aneurysm
Infarct
Intestinal perforation
153
What is the M/C gastrointestinal complaint in the elderly?
Constipation
154
A non-malignant enlargement of the prostate gland w/ age
Benign Prostatic Hyperplasia
155
Urinary urgency, hesitancy, weakness of the urinary stream, feeling of incomplete bladder emptying, dribbling afterwards, & nocturia are symptoms of what?
Bladder outlet obstruction
156
2nd leading cause of cancer death in men after lung cancer?
Prostate cancer (most die w/ prostate CA, not of prostate CA)
157
PSA levels of what may reflect early ds confined to the prostate? what levels suggest local spread? What levels suggest widespread CA?
4-10; 10-20; above 50
158
If a mass on the prostate is dectect, a needle biopsy is performed & the tissue is assessed by what score?
Gleason Score
159
Suprapubic, perineal, pelvic, scrotal, testicular, penile or upper thigh pain and urinary symptoms of urgency, frequency, nocturia, & dysuria are all symptoms of what?
Prostatitis
160
What's the difference b/w ED & impotence?
ED is inability to get/maintain an erection. Impotence is lack of sexual desire, inability to ejaculate, & problems w/ orgasm (AKA the Terrible Triad...not really)
161
Menopause usually occurs around what age?
51
162
What is one non-medical intervention that helped pre- & postmenopausal women physically & mentally?
Walking 45 mins a day, 3x per week
163
Impaired concentration, forgetfulness, decreased attention span, loss of computational skills, problems maintaining personal hygiene, & changes in personality are all symptoms of what mental problem?
Dementia
164
Pts w/ dementia always demonstrate what symptom?
Memory impairment
165
What is a quick way to test for dementia?
Ask pt 3 quick questions, have them answer.
| 5 mins later, ask same questions again
166
What is the M/C form of dementia?
Alzheimer's
167
What does A & O x3 mean?
Pt is alert & oriented to self, place, & time (considered normal)
168
What is the single greatest risk factor for Alzheimer's?
Age (peak age b/w 60-80)
169
What gene is potentially the cause of the amyloid production assoc. w/ Alzheimer's?
Apolipoprotein E (ApoE)
170
What are behavioral symptoms of Alzheimer's?
- Wandering & aggression
- Delusions
- Hallucinations
- Depression
171
What are the different stages of Alzheimer's?
- Stage I Mild: difficulty functioning but can survive on own, changes in personality/mood
- Stage II Moderate: Can't survive on own, b/co "someone else", forgets personal history, difficulty w/ face/speech
- Stage III Severe: Require continuous supervision, bed-ridden, M/C cause of death is pneumonia, UTI's & infected bedsores
172
What are the 10 warning signs of Alzheimer's Ds?
1. Memory changes that disrupt daily life
2. Challenges in planning or solving problems
3. Difficulty completing familiar task at home, at work, or at leisure
4. Confusion w/ time or place
5. Trouble understanding visual images & spatial relationships
6. New problems w/ words in speaking or writing
7. Misplacing things & losing the ability to retrace steps
8. Decreased or poor judgement
9. Withdrawal from social, family, & work activities
10. Changes in mood & personality **
173
What are environmental factors that have been assoc w/ Alzheimer's ?
Increased levels of aluminum, copper, zinc, & iron
174
What is the 2nd M/C cause of dementia?
Vascular dementia
175
Condition where the pt is unable to initiate or experience pleasure or sustain hope. Thoughts of despair & suicide (highest rate of suicide occurs in >70yoa)
Depression
176
The M/C used medications for depression?
SSRIs
177
What are some effects of depression?
- Weaken the immune system
- Trigger weight gain
- Lead to more depression
- Weaken collagen & bone growth
- Alter heart rhythms & increase blood pressure
- Make chronic conditions worse
- Has a negative effect on the brain
- Often leads to alcohol problems
- Can cause insomnia
178
The most important proprioceptive information needed for the maintenance of equilibrium is that derived from where?
Joint receptors of the neck
