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Geriatrics > Geriatrics Exam 2 > Flashcards

Geriatrics Exam 2 Flashcards

1
Q

Ependymal cells

A

CSF cells

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2
Q

Astrocytes

A

Bring blood to neurons

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3
Q

Oligodendrocytes

A

Myelinate the neurons

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4
Q

Microglial cells

A

CNS macrophages - remove waste and heal neurons

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5
Q

Nonfunctioning microglia

A

Chronic pain

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6
Q

Malfunctioning neurons

A

ALS
Parkinsons
Stroke
Alzheaimer

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7
Q

Malfunctioning oligodendrocytes

A

Leukodystrophy
Multiple sclerosis
Neuromyelitis optica

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8
Q

Malfunctioning cerebral blood vessels

A

Infection
Hepatic encephalopathy
Migraine
Brain edema

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9
Q

Generalized cerebral atrophy

A

Affects a limited area of the brain - cerebral palsy, Picks disease

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10
Q

Generalized cerebral atrophy

A

Brain shrinks

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11
Q

3 symptoms of cerebral atrophy

A

Dementia, Seizures, Aphasia

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12
Q

Leptomeninges

A

Insulation - Pia, Dura

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13
Q

Key historical information for a cognitive assessment

A

Duration
Memory
Language
Visuospatial
Executive function
Apraxia

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14
Q

Alzheimer disease

A

Amyloid plaques and neurofibrillary/tau tangles
Neurons can’t communicate and brain atrophies

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15
Q

Risk factors for alzheimers

A

Age
Female
Ape e4 gene
Hx of head trauma
Lower educational level
Diabetes
Down syndrome

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16
Q

Classic triad of alzheimers disease

A

Difficulty learning and recalling information
Visuospatial problems
Language impairment

Usually noticed by friends and family first

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17
Q

Moderate alzheimers

A

Recalling demographics
Short attention span
Repetitive statements
Trouble reading/writing
Easily lost

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18
Q

Signs of severe alzheimers disease

A

Weight loss
Incontinence
Increased infections
Absent recognition of familiar individuals
Unable to communicate effectively

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19
Q

Difference between dementia and delerium

A

Acute - Delerium
Chronic - Dementia

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20
Q

Diagnostics for Alzheimers disease

A

Clinical diagnosis
Use imaging to rule out other etiologies
Progressive atrophy of brain tissue

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21
Q

First Line Treatment for AD

A

Acetylcholine esterase inhibitors
Donepezil
Rivastigmine - Transdermal
Galantamine

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22
Q

SE of acetylcholinesterase inhibitors

A

Nausea, Anorexia, Sleep disturbance, diarrhea
Serious - Bradycardia, AV block, SYncope

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23
Q

NMDA receptor antagonists

A

Also for alzheimers mod to severe or non-responsive to acetylcholinesterase inhibitors
Reduces destruction of cholinergic neurons
Memantine (Namenda)

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24
Q

SEs of NMDA receptor antagoinists

A

Dizziness, HA, Confusion , Constipation

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25
Q

Namzaric

A

Combines acetylcholinesterase inhibitors and NMDA antagonist (donepezil and Namenda)

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26
Q

Non-pharm interventions for alzheimers disease

A

Physical, Mental and social activity
Music therapy

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27
Q

Additional adjunct meds for alzheimers

A

SSRI for depression
trazodone for sleep wake

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28
Q

4 complications of alzheimers

A

Poor nutritional intake
Urinary incontinence
Skin breakdown
Infections

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29
Q

When to d/c alzheimers meds

A

When patient can no longer express needs

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30
Q

Vascular dementia presentation

A

Less severe memory impairment than AD
Difficulty with timed activities/executive function - one minute test
Behavior and psych similar to AD
Depression MORE severe than AD
Few focal deficits

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31
Q

Imaging and treatment for vascular dementia

A

MRI may show infarcts/white matter lesions
Same tx as AD

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32
Q

Risks for vascular dementia

A

HTN
Smoking
DM
Statins
Antiplatelets

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33
Q

Lewy body dementia etiology

A

Deposits of alpha synuclein at presynaptic terminals
Unknown pathophys
Average age of onset at 75

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34
Q

Clinical presentation of lewy body dementia

A

Spontaneous parkinsonism
Fluctuating cognitive impairment
More severe visuospatial, problems solving and processing difficulties
Visual hallucinations, delusional misidentification
No tremors or response to levadopa

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35
Q

Diagnostics for Lewy Body dementia

A

Greater atrophy of the basal ganglia structures and dorsal midbrain - seen on MRI

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36
Q

Areas of atrophy more characteristic of alzheimers

A

Medial temporal lobe and hippocampus

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37
Q

McKeith criteria for Lewy Body diagnosis

A

Probable
Two core clinical features w/o biomarkers OR One clinical feature w/ biomarkers
Possible
One core clinical feature only or biomarkers only

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38
Q

Biomarkers for lewy body dementia

A

Preservation of medial/temporal lobe structures
Low SPECT/PET dopamine uptake with reduced occipital activity
Prominent posterior slow wave activity on EEG with periodic fluctuations

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39
Q

Core clinical features for Lewy Body dementia

A

Fluctuating cognition
Well-formed, detailed, recurrent visual hallucinations
REM sleep disorder
Brakinesia, rest tremor, rigidity (Parkinsonian signs)

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40
Q

Diagnosis of Lewy Body

A

Only definitive via autopsy
More pronounced cortical atrophy than PD

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41
Q

Tx for Lewy body dementia

A

Cholinesterase inhibitors
Mixed evidence for memantine
Atypical antipsychotics ONLY if severe psychosis
SSRI
Melatonin
Fludrocortisone for orthostatic hypotension

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42
Q

Clinical course of Lewy body

A

10 year survival
Decrease of MMSE 4-5 points per year

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43
Q

Frontotemporal dementia presentation

A

Focal atrophy of frontotemporal cortex
Behavioral variance
Semantic progressive aphasia - decoding
Primary progressive aphasia - Inability to produce words

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44
Q

Management of frontotemporal dementia

A

Safety - driving
Exercise
Speech therapy
Pharm only if behavior modification fails - SSRI or Trazodone

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45
Q

Presentationof Normal pressure hydrocephalus (3)

A

Dementia, incontinence and gait problems

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46
Q

Management of normal pressure hydrocephalus

A

Ventricular shunting abdomen - MC or heart - LC

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47
Q

Diagnostics for normal pressure hyrdrocephalus

A

MRI of brain showing ventriculomegaly out of proportion to sulcal enlargement

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48
Q

LP for normal pressure hydrocephalus

A

Normal opening pressure
Remove 30-50cc of CSF
If gait improves after LP there is a good prognosis for ventricular shunt placement

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49
Q

Clinical presentation of delerium

A

Acute with fluctuating symptoms
Attention deficits
Cognitive impairment

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50
Q

3 approaches to the treatment of delerium

A

Identification and treatment of the underlying cause
Eradication or minimization of contributing factors
Management of delerium symptoms

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51
Q

Non-pharm delerium management

A

Frequent reorientation
Environment optimization
Sensory deficit correction
Restraint avoidance
Self care
Sleep hygeine

52
Q

Pharm indications for delerium

A

Reserved for those with severely agitated behavior - threatens medically necessary care or poses a safety hazard
Sedate as LITTLE AS POSSIBLE

53
Q

Typical antipsychotic for delerium

A

Haldol

54
Q

Atypical antipsychotics for delerium

A

Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Risperidone (Risperdal)

55
Q

Benzo for delerium

A

Lorazepam if the benzo of choice (Ativan)

56
Q

Mini Cog Assessment

A

3 word recall (3 points)
Clock draw for executive function (2 points)
Less than 3/5 is abnormal

57
Q

1 minute semantic fluency assessment

A

Name as many items as possible from a category (ie. Fruits) in a minute each unique item= 1 point

58
Q

Cut off scores for one minute semantic fluency assessment

A

65-74 = 15
75-79 = 14
80-84 = 13
85+ = 11
Further screening for pts below cutoff score

59
Q

Mini mental status examination

A

Orientation to Place
Oritentation to time
Name three objects
Serial sevens
Recall of three objects
Name two simple objects
Repeat a phrase
Fold paper
Read instructions and follow
Make up a sentence with noun and verb
Copy picture

60
Q

SIngle cutoff for MMSE

A

Below 24

61
Q

Increased risk for dementia MMSE

A

Under 21

62
Q

Education level MMSE scores

A

21 - abnormal for 8th grade
Under 23 abnormal for HS
Under 24 abnormal for college

63
Q

Mild and severe cognitive impairment MMSE

A

18-23 = Mild
0-17 = Severe

64
Q

SLUMS

A

Saint Louis University Mental Status Exam
Utilized to screen for mild cognitive dementia
More sensitive than other assessments but longer
Used if poor MMSE score

65
Q

Questions on the SLUMS assessment

A

Q1-3 = Attention, immediate recall, Orientation
Q4 and 7 = Delayed recall
Q5 = Calculation
Q6 = Memory using semantic fluency
Q8 = Digit span
Q9 = Visual spatial
Q10 = Executive function
Q11 = Exec. func. with extrapolation

66
Q

HS+ scoring for SLUMS

A

27-30 = Normal
21-26 = Mild neurocognitive disorder (MNCD)
1-20 = Dementia

67
Q

Less than HS scoring for SLUMS

A

25-30 = Normal
20-24 = MNCD
1-19 = Dementia

68
Q

Montreal Cognitive assessment

A

For mild cognitive impairment
More detailed, time intensive, and sensitive
Versions for different languages and audiovisual impairment
Measures the same things as SLUMS

69
Q

Percent of falls with injury

A

50%

70
Q

Most commonly missed fall injury

A

C-spine activity

71
Q

4 strongest risk factors for falls

A

Previous falls
Decreased muscle strength
Gait/Balance impairment
Specific medication use

72
Q

4 common fractures from falls

A

Hip, wrist, humerus (head), ribs

73
Q

Hip fracture patients who will die within the first year

A

1/3
Usually from a fall sideways

74
Q

Hx taking for Falls

A

WHY did you fall - usually accidental and precipitated by an environmental hazard (can be prevented)
Expected/Unexpected
What they were doing (micturation syncope)
Lightheaded, aura, etc.
LOC

75
Q

Medications that may cause falls

A

Psycotropic drugs
Benzos
BP drugs
ANticholinergic

76
Q

Functional reach test

A

Stand perpendicular to the wall - reach out and see how far you can go without taking heels off the ground
Under 6 inches is concerning for fall risk

77
Q

Tests for balance

A

Heel to toe and romberg

78
Q

Differentials to consider for falls

A

Anemia
B12 deficiency
UTI Thyroid
Electrolyte disorders
Pneumonia

Always check neuro

79
Q

Goal for immobility

A

Optimize mobility in the patient and promote small movements

80
Q

Stage I pressure ulcer

A

Inflamed and red on the outside, may be boggy

81
Q

Stage II pressure ulcer

A

Extension of inflammatory response through the dermis and intosubcutaneous fat junction
May look like an abrasion or ulcer with distinct edges

82
Q

Stage III Ulcer

A

Full thickness skin ucer extending through SQ fat but not through underlying fascia
Infection and nectrosis - crater like

83
Q

Stage IV ulcer

A

Extension of ulcer through deep fascia to the bone, osteomyelitis and septic arthritis

84
Q

Treatment for Stage I and II ulcers

A

Clean wounds with warm normal saline
Avoid pressure and moisture
Cover open wounds with dressing
Abx if needed for II

85
Q

Treatment for Stage III ulcer

A

Debride
Cleanse and dress
Culture

86
Q

Treatment for stage IV ulcer

A

Tussue biopsy for culture
IV ABX - Bactrim, Vanc maybe
Cleanse and dress
Surgical consult

87
Q

Visual impairment

A

Over 20/40

88
Q

Legal blindness

A

20/200

89
Q

Age related visualchanges

A

Cataracts
Glaucoma
Macular degeneration
Diabetic retinopathy

90
Q

Common hearing loss in the elderly

A

High frequency loss
Check for cerumen impaction
Can lead to false diagnosis of dementia

91
Q

Hearing loss and medicare

A

Required for annual medicare wellness visit
Hearing aids not paid for

92
Q

Incontinence for which diapers should not be used

A

Bowel incontinence to avoid UTIs

93
Q

Length of coverage for rehab facilities with medicare

A

14 days post hospital discharge

94
Q

HELP

A

Hospital Elder Life Program
Goal to prevent delerium in older hospitalized adults
Implementation of mobility, cognitive, sleep, and medication protocols
33% reduction in delerium

95
Q

6 Aspects of HELP

A

Quiet environment
Nonpharmalogical sleep
Improve cognition
Hydration and Nutrition
Early Mobility
Hearing/Vision adaptations

96
Q

ACE model

A

Acute Care for Elders
Goal to prevent functional decline and improve quality of care for older adults during hospitalization
Uses comprehensive geriatric assessment and interprofessional team-based care

97
Q

8 Aspects of the ACE model

A

Mobility
Good Nutrition
Continence
Orientation
Healthy Sleep
Inclusion of patient in care plan
Frequent review of care plan
Skin integrity

98
Q

Indications for Urinary Catheterization

A

Urinary retention
Urinary incontinence resistant to ALL OTHER treatments
I/O monitoring
End of life
Bladder pharm
Surgery
Immobilization

99
Q

2 inappropriate indications for catheter

A

Incontinence that has NOT failed other managements
Urine specimen in a patient who can void spontaneously

100
Q

Absolute CI to a foley catheter

A

Urethral injury

101
Q

Relative CIs for foley catheter

A

Urethral stricture
Recent urinary tract surgery
Presence of artificial sphincter

Consult Urology

102
Q

Risks of indwelling catheters

A

Infection
Limits mobility
Stones
Bladder cancer

103
Q

Alternatives to catheter placement

A

Bladder training (Kagel exercise, diary)
Scheduled toileting
Adjunct stimulation techniques (tap water, thigh stroke, suprapubic tapping)
Adjunct to facilitate complete emptying of the bladder (prostate, bend forward)

104
Q

Pharm alternatives for urinary catheterization

A

Antimuscarinics (Oxybutynin, Tolterodine, Darifenacin)
Beta-3 Agonist (Mirabegron)
Alpha adrenergic blockers for BPH (Tamsulosin(Flomax))

105
Q

Surgical alternatives to folwy catheter placement

A

Sling or bladder neck suspension in women
Anatomic repair or prostatic resection

106
Q

SE of antimuscarinics

A

Anticholinergic

107
Q

SE of Tamsulosin

A

Orthostasis and dizziness

108
Q

Eligibility for short stay rehabilitation

A

Skilled needs following hospitalization - Medicare part A

109
Q

Eligibility for Long-term institutional care

A

24/7 assistance needed for safety or due to functional impairment

110
Q

Conditions commonly treated in rehab

A

Pulm rehab - COPD
Cardiac rehab - Post MI/CHF
PAD Rehab - Exercise and walking
Stroke rehab
Arthritis rehab - Fall prevention etc.

111
Q

Indications for transfer from SNF to ER

A

Uncontrollable pain
Acute exacerbation
Infection and IV abx need
Falls, AMS, Behavior change
Family request

112
Q

Reasons NOT to transport to hospital

A

End of life - staff don’t want patient to die there
Vague symptoms
Family request

113
Q

Medicare Part A coverage

A

Inpatient hospital care
SNF care
Hospice care
Home health care

114
Q

Medicare Part B coverage

A

Medically necessary services
Preventive services
Mental health
Equipment & Supplies
Limited outpatient drugs

115
Q

Part D coverage

A

DRUGS
Each plan has its own formulary

116
Q

Medicare Part C

A

Advantage plans - Offered by approved companies
Limit on what you have to pay of pocketper year
Mustt have A and B to enroll

117
Q

4 Principles of medical ethics

A

Autonomy
Nonmalifesensce
Benefisence
Justice

118
Q

Capacity

A

Determined by a clinician - make sure patient has decision making capacity
Clock draw/consult psychiatry

119
Q

Competence

A

Ability to act reasonably
Determined by court

120
Q

5 Elements of a patient’s decision making capacity

A

Patient must make a decision
Patient must explain reason behind decision
Decision cannot result from delusions or hallicinations
Decision must be consistent with patient values and preferences over time

121
Q

4 parts of informed decisionmaking

A

Nature of proposed intervention
Potential risks and benefits
Alternatives
Risks of not going through with it

Avoid medical jargon and understand what patient knows, wants to know, and understands

122
Q

MPOA hierarchy

A

Spouse
Adult children
Siblings
Parents
Health Care Team

123
Q

1st line palliative care pain management

A

Acetominophen for mild pain

Give lowest possible dose that is effective for all meds

124
Q

Drug for “death rattle”

A

Scopalamine patch

125
Q

When not to screen for breast cancer

A

Life expectancy under 5 years - personal values

Geriatrics (1 decks)

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