Geriatric Health Maintenance

Question 1

The major targets of prevention should be focused at the major causes of death
With the goals being?
4

Answer 1

1. Reducing premature mortality caused by acute and chronic illness
2. Maintaining function
3. Enhancing quality of life
4. Extending active life expectancy

Question 2

Effectiveness needs to be individualized in terms of what?

5

Answer 2

1. Patients age
2. Functional status
3. Patient preference
4. Culture
5. Socioeconomic status (tend to use preventative services less)

Question 3

It is recommended that for healthy older adults screening can be stopped at ___ years, especially those who have had repeated negative screening in the past, who are frail or demented, or who have a limited quantity and quality of life remaining

Answer 3

85

Question 4

Cardiovascular Disease and Cerebrovascular Disease
Modifiable risk factors?
6

Answer 4

1. Hypertension
2. Smoking
3. Inactivity
4. Cholesterol
5. Obesity
6. Diabetes mellitus

Question 5

What is the single most important activity in reducing morbidity and mortality in the elderly?

Answer 5

Checking BP

Question 6

1. BP measurements should be done at least how often?

2. ______ needs to be evaluated

Answer 6

1. yearly

2. 140/90

Question 7

SERUM CHOLESTEROL
1. Repeated screening is less important in older people because lipid levels are less likely to increase after ___ years of age

2. Those already on lipid lowering meds should be screened at how often?

Answer 7

1. 65

2. yearly

Question 8

Diabetes:
1. Clinicians may choose to screen selected persons who? 3

2. For established diabetic patients, what monitoring should be ongoing? 2

Answer 8

1. -Screen for DM in adults 40-70 with a BMI ≥ 25
   Also screen those with
   -HTN or
   -HLP
2. A1C and glucose

Question 9

Smoking: Repeated urging of the need to quit coupled with self-help materials and what prescriptions can make a difference? 2

Answer 9

nicotine or Bupropion

Question 10

What is the second leading cause of death in the elderly?

Answer 10

cancer

Question 11

Will this patient or group of patients survive long enough to derive benefit from screening:
Providers need to think about?
4

Answer 11

1. the expected time-to-benefit
2. the risk of developing the cancer in the patient’s lifetime
3. the individual’s estimated life expectancy
4. Focus on colorectal, breast, cervical and lung cancer screening

Question 12

What are the potential harms associated with screening for cancer?
3

Answer 12

1. False positive results leading to unnecessary interventions and anxiety
2. Over diagnosis (the risk of finding the treating a cancer that otherwise would not have affected the patient’s life)
3. Cost, discomfort and embarrassment associated with available tests

Question 13

Breast Cancer
1. Physical exam how often?

2. Mammograms are suggested every how often through age ____ and with a life expectancy of at least ______?
3. Beyond this age, may be appropriate for a woman in good health, particularly if she is at higher risk because of family history
   What else is recommended?

Answer 13

1. Yearly
2. 1-2 years, 75, 10 years
3. SBE

Question 14

Cervical Cancer
1. Most recommendations now indicate that screening may be discontinued for women who are what? 2

2. Screening may also be stopped among those who have had a what?

Answer 14

1. • least three normal Pap smears over the preceding 10 years (or 2 consecutive HPV/Pap tests)
   • and are older than 65
2. hysterectomy for a benign indication

Question 15

Prostate cancer

1. Men ages ______ are most likely to benefit from screening
   - Routine screening not recommended
2. Discuss risks and benefits of screening with patient
   If opting to screen, stop when? 2

Answer 15

1. 50-69
2. • after age 69 or
   • when life expectancy is less than 10 years

Question 16

Colorectal Cancer screening
1. USPSTF suggests offering colorectal cancer screening to individuals aged who have at least how long to live?

2. Controversial screening aged what?
3. Depends on what? 3
4. Should not screen over age ___?
5. Invasive test of choice is what?
6. Other screening tests? 4

Answer 16

1. 50-75, five years
2. 76-85
3. • prior screening,
   • risk factors,
   • co-morbidities
4. 86
5. colonoscopy every 10 years
6. • CT colonography,
   • flexible sigmoidoscopy,
   • stool testing for blood or
   • stool DNA testing

Question 17

Lung Cancer screening and health maintanence? 2

Answer 17

1. Health education on smoking cessation
2. Annual low dose spiral CT scan of the chest for high risk individuals ages 55-80 until 15 years out from discontinuing smoking or limited life expectancy

Question 18

Which High risk individuals qualify for low dose spiral CT?

What ages?

Answer 18

= at least 30 pack year history of smoking and are currently smoking or within 15 years of quitting

55-80

Question 19

1. Skin Cancer screening and maintenance? 2
2. Oral Cancer
   - Assess when?
   - Teach about what risks? 2

Answer 19

1.

• Routine skin exam with yearly visit
• Recommendations of sunscreen

2. -Assess with yearly visit
   -Teach about risk
   ETOH
   Smoking

Question 20

Tetanus
1. Adults over the age of ____account for about 60% of tetanus cases

2. Td every___years
   Influenza
3. 90% of influenza-related deaths occur in patients ___ years and older
4. When should they recieve the flu vax?
5. High-dose inactivated influenza vaccine approved for ages what?
6. Pneumococcal
   - What are the types? 2
   - What ages?

Answer 20

1. 60
2. 10
3. 60
4. Annual
5. 65 and older
6. • 13-valent and 23-valent
   • Both should be administered to patients ≥ 65 years old

Question 21

Herpes Zoster
1. Recommended for all immunocompetent persons of what age?

2. Immunocompromised persons may receive what kind of vaccine?

Answer 21

1. ≥ 60 years old

2. inactivated adjuvanted vaccine

Question 22

Osteoporosis
1. No mandate on when to stop what?

2. USPSTF recommends that women aged what be screened routinely for osteoporosis using what?
3. Routine screening begins at age ___ for women at increased risk for osteoporotic fractures

Answer 22

1. DEXA scans
2. 65 and older, bone densitometry
3. 60

Question 23

Sensory loss
Vision
What kind of screening? 5

Hearing
What kind of screening? 3

Answer 23

1. Periodically
   - Snellen chart
   - Amsler grid
   - Optometrist or Ophthalmologist
   - Glaucoma
2. Periodically
   - Screened with questionnaire
   - Whisper test
   - Audiogram

Question 24

1. Fall prevention. How often?
2. Fall risk assessment? 3
3. Function (what are we assessing)? 2
4. Mobility: What test?

Answer 24

1. Annual visit
2. • Go up and go
   • MMSE (Cognitive function)
   • Medication assessment
3. ADL’s and IADL’s
4. Get up and go

Question 25

1. Cognition testing? 2. Depression screening? 3. Medication screening? 4. What else should we screen for?

Answer 25

1. MMSE 2. Depression scale 3. Brown bag test 4. Incontience

Question 26

The two health promotion activities that correlate the strongest with healthy and successful aging are? 2

Answer 26

1. Physical activity | 2. Nutrition

Question 27

Older adults should be counseled on the benefits of aerobic and resistance exercise and life-style modification Long term effects of sedentary lifestyle are numerous: Such as? 4

Answer 27

1. Functional limitations 2. Obesity 3. Diabetes 4. Cardiovascular disease

Question 28

EXERCISE AND THE ELDERLY | Helps with what? 12

Answer 28

1. Older adults are fairly resilient with respect to cardiovascular endurance and strength even after a period of detraining 2. Improves functional limitations 3. Decreases progression to disability 4. Reduces BP and CV disease 5. Reduces abdominal fat and insulin resistance 6. Reduces falls 7. Minimizes or reverses physical frailty 8. Improves overall sense of well-being and self esteem 9. Prevents hip fractures 10. Improves longevity 11. Improves blood lipids 12. Improves osteoarthritis

Question 29

Dynamic aerobic exercise 5

Answer 29

1. Swimming 2. Brisk walking 3. Running 4. Bicycling 5. Muscle strengthening

Question 30

HTN A meta-analysis of multiple BP trials shows that even for patients into their 80’s treatment of hypertension results in significant decreases in all-cause mortality including? 3

Answer 30

1. Stroke 2. Heart failure 3. Major cardiovascular events

Question 31

1. JNC 8 recommends BP goal of less than _____ but SPRINT trial recommends goal of ______? 2. Intensive BP lowering in the elderly caution for what? 4

Answer 31

1. 150/90, 125-130/less than90 2. - Hypotension, - falls, - renal dysfunction and - electrolyte disturbances

Question 32

1. What can aspirin decrease the risk of? 2 2. Increases risk of what? 3. Add what for chronic ASA therapy in pts over 60? 4. Appears to protect men and women from what? 2 5. Dosing? 6. Questionable benefit over what age?

Answer 32

1. May decrease the risk for - CVD and - many cancers 2. Increases the risk of bleeding 3. Add PPI for chronic ASA therapy in patients > 60 4. Appears to provide men with protection from - first MI and women - from first ischemic stroke 5. USPSTF recommends 81mg ASA daily for ages 60-69 6. 70

Question 33

ABDOMINAL AORTIC ANEURYSM: 1. Screening with a one time abdominal ultrasound has been shown to be effective in who? 2. Screening abdominal ultrasound for who then? 2

Answer 33

1. men but not women 2. - men ages 65-75 who have ever smoked or - have a first degree relative with a history of AAA