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Flashcards in geriatrics Deck (45):
1

temporal arteritis (giant cell arteritis)
s/s, what to check

scalp tenderness, sudden vision loss in one eye (amaurasis fugax), one side temporal headache

check sedimentation rate, medical emergency dt risk of blinds

2

severe bacterial infection presentation

NOT FEVER

3

acute closure glaucoma

sudden onset of severe eye PAIN, headache, n/v
eye is RED with profuse TEARING, blurred vision

call 911
tonometry done in ER to measure IOP

4

CVA versus TIA

CVA blurry vision, weakness, slurred speech
TIA: temporary episode lasts

5

actinic keratosis

precursor for squamous cell carcinoma
rough pink lesions that DO NOT heal.
biopsy to dsg, small lesions can be treated with cryo
large amount- use 5fu

6

fractures of the hip

acute onset of limping
major cause of mortality (20% die from complications such as pneumonia)

7

3 questions to ask elders for abuse:

do you feel safe where you live
who handles your finances
who prepares your meals

8

top 3 leading cause of death >65 yo

3 c's ( Cardiac, cancer, copd)

heart disease ( MI, heart failure)
cancers ( lung, colorectal)
respiratory disease ( COPD)

9

cancer with highest mortality

lung

10

screening test for lung cancer

none

if s/s present ( sob, dull achy chest pain, recurrent pneumonia) order chest radiograph ( to look at nodules), next is CT, gold standard biopsy.

11

colon cancer screening

2nd most common cancer related to death
screening:
start at age 50 with baseline colonoscopy q 10 years, signmoidscopty every 5 years, high sensitive Fecal occult blood annually

12

multiple myeloma s/s

bone pain located on the chest or back
majority have anemia
2-3x more in AA
refer

13

any patient with unexplained iron def anemia, older male, post menopausal should be reffered for what?

colposcopy

14

chemistry showing > serum calcium and/or alkaline phosphates suspicious of what?

cancerous metastasis of the bone

15

adl versus instrumental adl

adl: grooming, feed, bathing
instrumental: driving, grocery shopping, laundry, cookingg

16

medications with high adverse effects ( AVOID with elderly)

diphenhydramine ( benadryl) dt drowsiness ( claritin better option)
TCA: amitriptyline (elavil) most sedating
ALL TCA give at night
hypnotics: avoid long acting ( Halcion), prefer ambient
BB: propranolol
Digoxin (warfarin sodium)
muscle relaxers (soma, skelaxin, norflex)
high ANTICHOLINGERGIC EFFECT: antihistamines, atipsychotics, atropine,
** BLack box for ATYPICAL antipsyhotics: high risk of mortality with eldery. ( i.e.: seroqueL)

17

black box with atypical antipsychotics
give ex of rx.

** BLack box for ATYPICAL antipsyhotics: high risk of mortality with eldery. ( i.e.: seroqueL, risperidol, ambilify)

Atypical antipsychotics are typically used to treat schizophrenia or bipolar disorder, dementia

18

common s/e of digoxin early vs late

early: GI, abdominal discomfort
late: halos around light

19

screening for dementia

folstein mini mental examl


max score of 30
low score: dementia, delirium, schizophrenia
6 subject areas; orientation, attention, recall, sentence, command, copy a design

20

dementia vs delirium

dementia: IRREVERSABLE (alzheimers, cva, b12 def, parkinson)
delirium: reversable (high fever, infection, drugs, dehydration

21

mini mental

orientation (date, day, week state, country, etc)
attention & calculation ( subtract 100-7 5x's, spell "world" backwards
recall ( name 3 objects, repeat in 5 minutes)
write a sentence
3 stage command
copy a design

22

immunizations

pneumococcal >65 yo- one per lifetime if healthy ( if 50 should receive 1 dose tdap regardless of time since last immunization)

zoster (>60)
** MUST have hx of chicken pox of varicella titer before giving vaccine

23

most common cause of hearing loss

presbycusis- sensorineural ( inner ear- cochlear hair cells and vestibulocochlear nerve)
progressive, symmetric, human loss first

24

ototoxic medications

aminoglycosides ( gentamycin, vancomycin), asa

25

which side can "hear" with cerumen

the side that can hear has the cerumen ( bad side)

26

eye s/s that are emergency

acute onset of floaters with blurred vision (s/s retinal detachment)

yellow/green tint to everything ( digoxin toxicity)

acute onset of severe eye pain, tearing, redness, n/v (acute glaucoma)

27

glaucoma s/s

excessive glare of lights and interfere with driving

28

hemianopsia s/s

wall edges or light poles seem bent/crooked, leaves food untouched consistently on one side of tray

29

drugs that adversely affect vision

viagra ( BLUISH tint)/ishemic optic neuropathy
anticholinergics (decongestants, antihistamine)- can precipitate acute angle glaucoma

30

stages of ulcer

1-4
1- superficial
2- damage to epidermis
3- damage to epi/dermis
4- depp ulcers with visable muscle/tendon, fascia

31

dementia etiology

neurofibrillary plaques and tangles

"dementia with lewy bodies" is caused by lewy body brain deposits, this pt will have hallucinations

32

differenial dsg for dementia

b12 deficiency, hypothyroid, depression, infection, drugs, metal poisoning

33

dementia rx

aricept, namenda, exelon, cerefolin (folate, b12, acetylcysteine). NO SURE

34

2 most common infections

uti and pneumonia

35

sundowning

seen in BOTH delirium and dementia
starts at dusk/sundown
pt becomes combative, confused, agitated
resolves in the morning

tx: avoid quiet and dark rooms
well lit room with radio/tv/clock
familiar surroundings
avoid drugs that affect cognition (antihistamine, sedatives, narcotics)

36

3 A's with alzheimers

aphasia ( difficulty verbalizing)
apraxia ( difficulty with gross motor mvmt, i.e. walking)
agnosia (difficutly to recognize people/objects)

37

death from alzheimers

usually due to penumonia/sepsit, hip fracture complication

38

parkinson's s/s and rx

tremor, rigidity, bradykinesia (depression, dt

39


essential tremor

"action" tremor (not a resting tremor)
rx: BB ( propranolol)

40

immunizations for healthy 65 yo

flu
pneumovax

if >65, only needs flu vaccine

41

eldepryl is a specialized mao inhibitor, which meds to avoid

SSRI
triptans ( triptilyne)
TCA

dt seotonin syndrome

42

TIA

neuro dysfunction cause by focal ishemia without acute infarction of the brain ( like stroke)

"mini stroke", increase risk of stroke

43

stoke

most common cause HTN
emboli or bleeding, permanent neurologic damage

"worst headache of my life"

44

broca vs wernicke's aphasia

broca- can understand, but difficulty with motor aspect (

45

drugs to avoid in elderly

Sulfonylureas: glyburide (diabeta), chlorpropamide ( Diabenase)

benadryl, seroquel, zyprexa, elavil, tofranil,