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Clin Med IV Exam II > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

2 types of sleep states

A
  • nonrapid eye movement

- rapid eye movement

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2
Q

sleep stages

A

1 and 2–> light sleep

3 and 4–> deep sleep

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3
Q

Normal night

A

NREM–> REM after 80 minutes–> cycle continued between NREM and REM w/ REM getting longer

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4
Q

Four common types of insomnia

A
  • difficulty falling asleep
  • mid sleep awakening
  • early morning awakening
  • nonrestorative sleep
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5
Q

Categories of insomnia

A

Transient/acute- <1 week
Short term/subacute- 1 week to 3 months
Chronic- >3 months

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6
Q

Sleep disorder NREM non-pharmacologic tx

A
  • sleep hygiene
  • behavioral therapy
  • bright light therapy
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7
Q

Sleep disorder NREM pharmacologic tx

A
  • benzos (caution with short acting–> increased rebound insomnia, falls, hallucinations)
  • trazadone
  • zolpidem

OTC–> melatonin, APAP
NO BENADRYL

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8
Q

Who gets sleep apnea

A

obese males over 65

high prevalence in pts with dementia

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9
Q

What type of sleep apnea is most common in the elderly

A

obstructive

d/t anatomy or obesity

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10
Q

What is the other type of sleep apnea that the elderly doesn’t tend to get as much

A

Central–> rain fails to transmit signals to your breathing muscles (parkinsons, stroke, CHF)

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11
Q

Presentation of sleep apnea

A
  • daytime sleepiness is most common
  • morning HA or lethargy/confusion
  • HTN
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12
Q

What would the bed partner of a patient with sleep apnea report

A
  • loud snoring
  • apnea
  • choking
  • gasping sounds
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13
Q

How do you diagnose sleep apnea

A

polysomongraphy

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14
Q

Treatment of sleep apnea

A
  • weight loss
  • avoid alcohol
  • avoid sedatives
  • avoid sleeping supine
  • oral dental devices that reposition the jaw or tongue
  • mandibular maxillary advancement
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15
Q

Risk factors for periodic limb movement disorder/restless leg syndrome

A
  • family history
  • uremia
  • low iron stores
  • increased age
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16
Q

Signs and symptoms of PMLD

A

recurring episodes of stereotypic rhythmic movements during sleep, generally incolving the legs

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17
Q

Signs and symptoms of RLS

A

uncomfortably irresistible urge to move legs, motor restlessness

-UE not commonly involved’-occurs just before the onset of sleep

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18
Q

Diagnosis of PMLD? RLS?

A

PMLD: polysomnography

RLS: based on pts symtpoms

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19
Q

Treatment of RLS/PMLD

A
  • depends on the severity of sx*
  • RLS–> stretching and massage
  • dopaminergic agents (pramipexole, ropinirole)
  • oxycodone and clonazepam (caution of bad side effects)
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20
Q

What is failure to thrive

A

deteriorating state characterized by

  • weight loss
  • decreased appetite, poor nutrition
  • inactivity
  • often accompanied by dehydration, depression, impaired immune function and low cholesterol
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21
Q

What is the etiology of failure to thrive

A

interaction of 3 things

  • physical frailty
  • disability
  • impaired neuropsychiatric function
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22
Q

Risk factors for failure to thrive

A
  • medication side effects
  • comorbidities
  • psychosocial factors
  • weight loss of 5% of body weight over 6 to 12 months
  • poor food intake
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23
Q

Cardiovascular health study criteria for frailty

A
  • weight loss (>5% of body weight in one year)
  • exhaustion
  • weakness
  • slow walking speed
  • decreased physical activity

*must have 3 of 5

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24
Q

Risk factor measurements for failure to thrive

A
  • mini mutritional assessment

- subjective global assessment

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25
Q

What are important parts of the history you need to obtain if your patient is failure to thrive

A
  • identifying medical and psych disorders
  • medications (OTC and RX)
  • use of alcohol or illicit drugs
  • need to do complete ROS
  • assess contributors to poor mobility/disability and difficulty in feeding
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26
Q

What should you consider if your patient has failure to thrive

A

elder abuse or neglect

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27
Q

PE for failure to thrive

A
  • assess physical and cognitive impairment
  • look for signs of disease that cna lead to impairment
  • vitals (orthostatic hypotension
  • evaluate for dementia with MMSE
  • “get up and go test”
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28
Q

Things you should assess for in each section of physical exam if you suspect your patient is failure to thrive

A

HEENT–> dental caries, poor dentition

Neck–> thyroid mass, LAD

Breast–> masses and LAD

Rectal–> abscess, fecal impaction, occult blood

Vision and Hearing

Neuro–> reflexes, muscle strength, test propioception and sensation

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29
Q

Labs that aid in diagnoses of failure to thrive

A
  • screen for infection (WBC, UA, blood cx)
  • check for organ failure (CMP–> lft, cr)
  • calcium phosphate
  • TSH
  • B12 folate
  • albumin, prealbumin
  • total cholesterol
  • vitamin D
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30
Q

Imagine for diagnosis of FTT

A

only based on clinical suspicion for malignancy, TB, Infection

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31
Q

Goal of FTT treatment

A

improve quality of life

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32
Q

Consults for a FTT patient

A
  • dietitian
  • psychiatrist
  • social worker
  • physical therapy
  • speech therapist
  • dentist
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33
Q

Treatment of FTT

A
  • stop non essential medications
  • offer ensure
  • vitamin supplements if needed
  • appetite stimulants (megestrol, dronabinol)
  • physical therapy
  • anabolic agents
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34
Q

Preferred agent for treatment of depression in FTT

A

mirtazapine

can also do methylphenidate

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35
Q

Criteria for hospice

A
  • weightloss not due to reversible cause
  • chronic or intractable infection
  • recurrent aspiration and/or inadequate intake 2/2 pain with swallowing or weakness
  • progressive dementia
  • progressive pressure ulcers even with extreme care
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36
Q

Definition of visual acuity

A

best corrected visual acuity worse than 20/40 and better than 20/200 in better seeing eye

37
Q

What is considered blindness

A

visual acuity less than 20/200

38
Q

Common diseases that cause visual impairment

A
  • cataracts
  • age related macular degeneration
  • glaucoma
  • diabetes
39
Q

Cataracts

A

lens opacity which causes glare, blurred vision, alterations of color

40
Q

Risk factors for cataracts

A
  • age >60
  • excessive sunlight exposure
  • smoking
  • eye trauma
  • steroids
  • systemic diseases
41
Q

Signs and symptoms of cataracts

A
  • glare related vision loss
  • difficulty w/ contrast sensitivity
  • reduction of visual acuity
  • color perception altered
  • yellow discoloration of lens
  • peripheral dark opacity
  • alterations in red reflex
42
Q

Treatment of cataracts

A

surgery if 20/50 or worse

43
Q

Macular degeneration

A

degeneration of the macular retina leading to central vision loss

44
Q

What is the first sign of macular degeneration

A

appearance of yellow-white deposits under the retina in a dilated exam

45
Q

What are the two groups of macular degeneration

A
  • atrophic, “dry”

- neovascular, “wet”

46
Q

What will atrophic macular degeneration have

A

yellow drusen bodies

47
Q

What will neovascular macular degeneration have

A
  • growth of abnormal blood vessels

- can sometimes see bleeding

48
Q

Signs and symptoms of mascular degeneration

A
  • inability to read, drive, identify faces or perceive details
  • loss of central vision, spares peripheral vision
  • bilateral
  • impaired color vision
  • scotomas
  • distortion of straight lines
49
Q

What needs to be done to diagnose neovascular macular degeneration

A

fluorescence angiography

50
Q

Treatment of macular degeneration

A

NONE

  • neovascular may benefit from focal photocoagulation or photodynamic therapy
  • laser surgery for neovascular
  • low vision rehab if central loss in both eyes
51
Q

Triad of signs for glaucoma

A
  • elevated intraocular pressure
  • optic disc cupping
  • visual field loss
52
Q

Most prevalent type of glaucoma in the elderly

A

primary open angle

53
Q

Who is at the highest risk for developing glaucoma

A
  • black and hispanics

- pts with a family history

54
Q

Signs and symptoms of primary open angle glaucoma

A
  • blurred vision
  • halos around lights
  • impaired dark adaption
  • visual loss starting in nasal field
55
Q

Signs and symptoms of primary closed angle glaucoma

A
  • blurred vision
  • HA
  • N/V
  • corneal edema
  • mid dilated pupil
56
Q

Diagnosing glaucoma

A
  • tonometry
  • optic disc assessment and gonioscopy (distinguish open vs closed)
  • visual field examination
57
Q

Normal eye pressure

A

10-21 mmHg

58
Q

Which type of glaucoma might have normal pressure

A

primary open angle

59
Q

What is the goal of glaucoma treatment

A
  • lower IOP

- stabilize visual field loss and optic nerve damage

60
Q

Medical treatment for glaucoma

A
  • beta adrenergic agonists
  • alpha adrenergic agonists
  • muscarinic agonist
  • carbonic anhydrase inhibitors
61
Q

Surgical treatment for glaucoma. When?

A

laser trabeculoplasty when refractory to medications

62
Q

Nost common hearing loss

A

presbycusis: bilateral high frequency sensorineural hearing loss in inner ear

63
Q

What is the most common cause of conductive hearing loss

A
  • infection
  • tumor
  • wax

usually an external or middle ear problem

64
Q

Gradual changes in the inner ear due to cumulative effects of repeated exposures to loud noise lead to what type of hearing loss

A

sensorineural

65
Q

Causes of sensorineural hearing loss

A
  • presbycusis
  • loud noise
  • infection
  • Meniere’s
  • trauma
  • tumors
  • systemic/endocrine disorders
  • iatrogenic (medications)
  • neurogenic
66
Q

Causes of conductive hearing loss

A
  • external otitis
  • trauma
  • wax
  • tympanic membrane -perforation
  • cholestoma
  • otosclerosis
  • Paget’s disease
  • otitis media
  • tumors
67
Q

What parts of the ear can be affected in prebycusis

A
  • cochlear hair cells

- spiral ganglion cells in the vestibulocochlear nerve

68
Q

What are the three main areas affected by presbycusis? What is affected in these areas?

A

sensory: loss of hair cells and a high frequency hearing deficit
metabolic: loss of stria vascularis and a low frequency hearing deficit
neural: loss of ganglion cells and a variable pattern of hearing loss

69
Q

Risk factors for presbycusis

A
  • low socioeconomic status
  • noise exposure
  • ototoxins
  • infections
  • smoking
  • HTN
  • DM
  • vascular disease
  • immunologic disorders
70
Q

Presentation of presbycusis

A
  • halmark: progessive, symmetric loss of high frequency hearing
  • bilateral
  • tinnitus in both ears
  • dizziness from loss of vestibular end organ function
71
Q

Treatment of presbycusis

A
  • hearing aid
  • cochlear implant if hearing aid fails
  • assisted listening devices
  • auditory rehab
72
Q

Why does syncope happen more often in elderly?

A
  • decreased baroreceptor reflex sensitivity (cannot maintain cerebral blood flow)
  • more sensitive to effects of vasodilators and other hypotensive drugs
  • sensitive to volume loss, GI bleeding, standing up from sitting
73
Q

Top 3 etiologies of syncope in elderly

A
  • reflex (neurogenic including vasovagal)
  • cardiac (brady arrhythmia or tachyarrhythmia)
  • unknown
74
Q

4 subtypes of reflex syncope

A
  • vasovagal
  • orthostatic
  • carotid sinus hypersensitivity
  • situational
75
Q

What is a vasovagal response

A

development of inappropiate cardiac slowing and arteriolar dilation from a decrease in the sympathetic response

76
Q

Where does the vasovagal response originate

A

in the hears

77
Q

Prodrome associated with vasovagal syncope

A
  • nausea
  • pallor
  • sweatingsecondary to increased vagal tone
78
Q

What is orthostatic hypotension

A

postural decrease in systolic blood pressure of at least 20 mmHg

79
Q

What things can cause orthostatic hypotension

A
  • decreased intravascular volume d/t infection or diuretics
  • medications
  • Parkinsons
  • DM, ETOH
80
Q

Risk factors for syncope

A
  • cardiac disease
  • stroke/ TIA
  • DM
  • hyperglycemia
  • increased ETOH
81
Q

What should you check in you PE for a patient that has a syncopal

A
  • orthostatics
  • skin turgor
  • heart–> murmur or arrhythmia
  • lungs–> ?infection
  • neuro–> focal neuologic deficit
  • Guaiac–> ?GIB
82
Q

Every person presenting with syncope gets what

A

EKG!

83
Q

When is a til table diagnostic

A

if syncope is due to bradycardia and hypotension

84
Q

When is exercise testing used for pts presenting with syncope

A

if syncope was experienced with exertion or stress

85
Q

What types of patients are at highest risk for pressure ulcers

A

those with comorbid conditions, immobility and reduced tissue perfusion

86
Q

Stages of pressure ulcers

A

Stage 1–> non blanchable erythema of intact skin

Stage 2–> partial thickness skin loss with exposed dermis

Stage 3–> full thickness skin loss

Stage 4–> full thickness skin and tissue loss

87
Q

Prevention of pressure ulcers

A
  • improve mobility and reduce friction/pressure
  • frequent turning and position
  • air mattresses/ foam mattresses
  • air suspension devices
  • optimum protein intake
  • vit C and zinc supplementation
88
Q

Treatment of pressure ulcers

A
  • maintain a moist wound healing environment
  • topical dressings (hydrogels, hydrocolloid, alginates)
  • growth factors
  • debridement

Clin Med IV Exam II (8 decks)

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