Geriatric Health Maintenance

Question 1

Typical presentation of presbyacusis

Answer 1

elderly person complains of difficulty understanding speech and conversation in noisy areas (loss of high frequency and speech discrimination)

age-related SENSORINEURAL hearing loss

Question 2

Examples of IADL

Answer 2

cooking, driving, shopping, housecleaning, laundry, using the phone, money management

Question 3

Examples of ADL

Answer 3

bathing, dressing, eating, continence, toilet, grooming

Question 4

What kinds of conditions lead to vision loss in elderly

Answer 4

presbyopia, cataracts, glaucoma, macular degeneration, diabetic retinopathy

Question 5

What is the leading cause of severe vision loss in elderly

Answer 5

age-related macular degeneration AMD

Question 6

What happens to vision in presbyopia

Answer 6

difficulty focusing on nearby objects while distant vision remains intact

Question 7

Pathophysiology of AMD

Answer 7

atrophy of cells in central macular region of retinal pigment epithelium resulting in loss of central vision

Question 8

How to treat AMD

Answer 8

laser photocoagulation and intravitreal injections of vascular endothelial growth factor (VEGF)

Question 9

Increased intraocular pressure leading to optic nerve neuropathy

Answer 9

glaucoma

Question 10

risk factors for glaucoma

Answer 10

increased intraocular pressure, family history, vision changes, AA race…if have risk factors, do routine screening

Question 11

Most common cause of blindness worldwide

Answer 11

cataracts…definitive treatment is surgery

Question 12

Leading cause of blindness in working age adults in US

Answer 12

diabetic retinopathy

Question 13

Common causes of geriatric hearing impairent

Answer 13

presbycusis, noise-induced hearing loss, cerumen impaction, otosclerosis, central auditory processing disorder

Question 14

otosclerosis

Answer 14

autosomal dominant disorder of bones in the inner ear that results in progressive conductive hearing loss with onset late 20s-early 40s

Question 15

central auditory processing disorder

Answer 15

conditions that reult from CNS dysfunction; can hear sounds fine just has difficulty understanding spoken language

Question 16

Evidence for routine screening of vision and hearing in elderly

Answer 16

INSUFFICIENT

Question 17

Leading cause of nonfatal injuries in elderly

Answer 17

falls

Question 18

how to prevent falls

Answer 18

incorporation of exercise and physical therapy, as well as vitD supplementation

Question 19

How to screen for dementia

Answer 19

MMSE; clock draw; three item recall

Question 20

Easy screen for depression

Answer 20

have you felt down/depresed/hopeless in last two weeks? have you felt little interest or pleasure in doing things?

Question 21

How to assess nutritional status in elderly

Answer 21

serial weight measurements and inquiry about changing appetite

Question 22

What can protein undernutrition look like?

Answer 22

increased risk of infections, anemia, orthostatic hypotension, decubitis ulcers

Question 23

2 greatest risk factors for stroke

Answer 23

1. HTN

2. afib

Question 24

How to reduce risk of strokes in patients with afib

Answer 24

anticoagulation!

warfarin, dabigatran, apixaban

Question 25

When to stop mammograms?

Answer 25

until life expectancy falls below 5 to 10 years; insufficient evidence for or against screening in women over 75

Question 26

When to stop colon cancer screening

Answer 26

75-85

Question 27

When to stop cervical cancer screening

Answer 27

65; only if you've had adequate prior screening and aren't at high risk for cervical cancer

Question 28

What vaccines should someone over 65 get?

Answer 28

influenza annually, at least one pneumococcal and single booster Tdap one dose of herpes zoster at 60 older

Question 29

advance directive

Answer 29

oral/written statements made by patients when they are competent that are intended to guide care should they become incompetent

Question 30

What proportion of patients who undergo CPR in the hospital actually survive to discharge?

Answer 30

15% :(