Geriatrics

Question 1

What is the “oldest old” segment of the population?

Answer 1

85+

Question 2

What happens to cerebral blood flow with aging?

Answer 2

Decreases

Question 3

What happens to the transport across the BBB with aging?

Answer 3

Increases

Question 4

What is the major concern with increased fat with aging in terms of drug prescriptions?

Answer 4

More lipophilic drugs stay around longer–lower doses needed

Question 5

IQ is stable until what age?

Answer 5

80

Question 6

True or false: the verbal abilities of the elderly generally decline with age

Answer 6

False

Question 7

True or false: simple recall declines with older age

Answer 7

True

Question 8

True or false: Recognition is generally intact in the elderly

Answer 8

True

Question 9

Does personality change much with age?

Answer 9

Thinking is no

Question 10

What is the role of social activity in the elderly?

Answer 10

Socially active seniors are generally healthier, both physically and emotionally

Question 11

What is the major issue with retirement in some older folk?

Answer 11

Loss of identity and self esteem

Question 12

True or false: most people who retire voluntarily will not re-enter the workforce

Answer 12

False–will reenter the workforce in 2 years

Question 13

What happens to sexuality with geriatrics?

Answer 13

• Frequency of orgasms declines

- social/culture factors prevent them to realize their full sexual potential

Question 14

The level of sexual activity in the elderly depends largely on what?

Answer 14

The presence of and health of the spouse

Question 15

Who are the usual caregivers with the elderly?

Answer 15

Wives, daughters, and daughters-in-law

Question 16

Do caregivers to the elderly usually have jobs outside the home?

Answer 16

Yes–more than 50%

Question 17

What are the levels of care for the elderly?

Answer 17

• Home care services
• Assisted living
• Nursing homes
• Memory care units

Question 18

True or false: there is a good correlation between physical health, and mental health in older patients

Answer 18

True

Question 19

What is the major challenge with family dynamics in the elderly?

Answer 19

Maintaining appropriate boundaries, and ensuring that information is released appropriately

Question 20

How hard is it to get durable power of attorney for healthcare?

Answer 20

Tough-ish (legal document must be signed)

Question 21

What is the difference between a guardianship vs a conservatorship?

Answer 21

Conservatorship = Court ordered person to look over a specific aspect of a pt’s life (financial)

Guardianship = Personal and property interests of a person is given to another

Question 22

True or false: a civil commitment can be filed by anyone

Answer 22

True–but need two

Question 23

True or false: mental decline falls under the jurisdiction of civil commitment

Answer 23

True

Question 24

Which is judge determined: competency vs capacity

Answer 24

Competency

Question 25

Does self-abuse (e.g. no eating/drink etc) fall under the category of dependent adult abuse?

Answer 25

Yes

Question 26

True or false: if it's not your patient, then you do not have a legal requirement to report abuse

Answer 26

True

Question 27

What is the major issue with interviewing the a patient with their caretaker?

Answer 27

May not see abuse, or interfere with examination

Question 28

True or false: if you are determining capacity, you should not tell the patient that you are assessing them for it

Answer 28

False--should inform them

Question 29

What are the two major things that should be done with elderly patients on a regular basis?

Answer 29

- Updated medication list | - Cognitive screening

Question 30

Personality changes in the elderly should be suspicious for what?

Answer 30

Neurocognitive disorder or dementia

Question 31

New onset psychosis in the elderly should be suspicious for what?

Answer 31

Dementia or neurocognitive disorder

Question 32

When is dividing doses appropriate in the elderly?

Answer 32

If they are in a nursing home, or have help with their medications

Question 33

What is the general rule of thumb for prescribing medication in the elderly?

Answer 33

Start low, go slow, sometimes say no

Question 34

True or false: prevalence of depressive disorders in the geriatric population is actually lower than younger people if they are in good health

Answer 34

True

Question 35

True or false: suicide rates are higher in elderly

Answer 35

True

Question 36

What is the common theme with depressive disorders in the elderly

Answer 36

Loss

Question 37

True or false: elderly patients may have quasi-psychotic experiences where they sense the presence of the deceased

Answer 37

True

Question 38

What type of drugs should be avoided with bereavement in the elderly?

Answer 38

Sedative hypnotics

Question 39

When do the psych symptoms of bereavement subside, usually?

Answer 39

Within a year

Question 40

What is the most common presentation of late life major depression?

Answer 40

Somatic complaints

Question 41

True or false; relapse rates of MDD in the elderly are generally low

Answer 41

False-- high

Question 42

What happens to cognition with MDD later in life?

Answer 42

Blunted--pseudodementia

Question 43

Venlafaxine side effect = ?

Answer 43

HTN

Question 44

What is the major side effect of citalopram?

Answer 44

QT prolongation

Question 45

What is the major side effect of paroxetine?

Answer 45

anticholinergic effects

Question 46

What is the major side effect of duloxetine?

Answer 46

Bleeding risk

Question 47

What is the major side effect of mirtazapine?

Answer 47

Promotes sleep, increases appetite

Question 48

What is the major side effect of doxepin?

Answer 48

QT prolongation, sleep

Question 49

What is the major issues with Li in the elderly?

Answer 49

New neurological symptoms

Question 50

Should you discontinue treatment of Li in the elderly if they are responding well w/o side effects?

Answer 50

No

Question 51

How common are late life schizophrenia?

Answer 51

Very Rare

Question 52

What happens to late life schizophrenia, in terms of residual s/sx?

Answer 52

30% will enter a residual phase where negative symptoms are more prominent and positive symptoms fade

Question 53

What is the usual onset of late life delusional disorders?

Answer 53

40-55

Question 54

What should always be suspected with late life delusional disorder?

Answer 54

Neurocognitive disorders

Question 55

What is the most common type of anxiety disorder late in life? How do the s/sx of this compare to the same disorder earlier in life?

Answer 55

Phobias--less severe

Question 56

What specific treatment for late anxiety disorders might you not be able to use if the patient is cognitively impaired?

Answer 56

Psychotherapy--will not remember

Question 57

What are the major side effects of benzos in the elderly?

Answer 57

- Impair gait | - Paradoxical excitation

Question 58

How does the pharmacological treatment for anxiety disorders in the elderly compare to the younger population?

Answer 58

Same meds, but more avoidance of benzos

Question 59

What are the issues with later life substance abuse? (2)

Answer 59

- related injuries can be devastating | - new onset neurocognitive disorders

Question 60

What are the common approaches to late life sleep disorder?

Answer 60

Sleep hygiene: - Avoid EtOH and caffeine - Avoid hypnotics - CPAP PRN

Question 61

What is the major side effect of clozapine?

Answer 61

Agranulocytosis

Question 62

What is the antidepressant of choice for anorexic patients, or those with insomnia? Why?

Answer 62

Mirtazapine--promotes sleep and increases appetite

Question 63

How common are late life somatic symptoms disorders (e.g. hypochondriasis etc)?

Answer 63

Common