Geriatrics Exam

Question 1

Exercise Dosage for Geriatrics

Answer 1

50 + hours, 2x/wk for 6 months minimum

Question 2

A one day hospital stay where the patient is immobile = a _____% decline in function

Answer 2

30%

Question 3

Sx of older pt with PNA, UTI, peritonitis, abscess

Answer 3

Absence of fever

Falls, decreased appetite or fluid intake, confusion, change in functional status

Question 4

Sx of older patient with silent acute abdomen

Answer 4

Silent presentation
Mild discomfort and constipation
Some tachypnea and possibly vague respiratory sx

Question 5

Sx of older patient with MI

Answer 5

Fatigue, N and decline in functional status

Classic presentation: SOB

Question 6

Sx of older patient with silent malignancy

Answer 6

Back pain secondary to metastases from slow growing breast masses
Silent masses of the bowel

Question 7

Sx of older patient with pulmonary edema

Answer 7

Insidious w/ change in function, food or fluid intake, or confusion

Question 8

Sx of older patient with hyperthyroidism

Answer 8

Apathetic thyrotoxicosis

Fatigue and a slowing down

Question 9

Sx of older patient with hypothyroidism

Answer 9

Confusion and agitation

Question 10

Sx of older patient with depression

Answer 10

Somatic complaints (appetite changes, vague GI sx, constipation, sleep disturbances)
Hyperactivity

Question 11

Medical illness that presents as depression

Answer 11

Hypo and hyperthyroid dz that presents as low energy and apathy

Question 12

Mild Cognitive Impairment Definition

Answer 12

Memory loss noted by pt or family
Detailed testing shows abnormal memory
Pts have no functional impairment
Do not meet criteria for dementia
Not neurologically normal; memory is worse than age-matched controls
Increased rate of progression to dementia

Question 13

Short term memory loss with other cortical deficits
Problems with language and praxis
Relative preservation of social graces early in dz

Answer 13

Alzheimer’s

Question 14

Stepwise progression and/or evidence of focal neurological deficits on exam

Answer 14

Vascular Dementia

Question 15

Prominent behavioral and personality change early in the course of cognitive impairment
Inhibition, trouble with the law, impulse control, reactivation of primal reflexes

Answer 15

Frontotemporal Dementia

Question 16

Frontal release signs of frontotemporal dementia

Answer 16

Snout, grasp, palmomental reflexes

Question 17

Trouble with stiffness and slowness starting insidiously around same time as cognitive loss.
First symptom is often hallucinations

Answer 17

Lewy Body Dementia

Question 18

> 1 area of progressive cognitive impairment that persists after a patient with a history of chronic EtOH abuse stops drinking

Answer 18

Wernicke-Korsakoff Dementia

Question 19

Triad of normal pressure hydrocephalus

Answer 19

Cognitive Decline
Falls
Incontinence

Question 20

Delerium

Answer 20

Symptom, not a dz
Acute mental status d/o characterized by abnormal and fluctuating attention
Disturbance in level of awareness
Decreased ability to direct, focus, sustain, and shift attention

Question 21

Pressure sores - blanchable hyperemia

Answer 21

Stage 1

Question 22

Pressure sores - extension through the epidermis

Answer 22

Stage 2

Question 23

Pressure sores - full thickness skin loss

Answer 23

Stage 3

Question 24

Pressure sores - full thickness with extension into muscle bone or supporting structures

Answer 24

Stage 4

Question 25

Pressure sores - eschar/slough overlies the wound

Answer 25

Unstageable

Question 26

Suspected deep tissue injury

Answer 26

Area of blistered skin or area which is discolored

Question 27

Risk factors for elder abuse

Answer 27

Frail Female White

Question 28

____% of abusers are the adult child living in the same home, usually financially dependent

Answer 28

50%

Question 29

Different types of incontinence

Answer 29

Stress - cough Overflow - bladder is not emptying Urge - inability to delay Functional - cannot get there in time

Question 30

____% of people >65 y/o drink daily | _____% may experience health risks due to alcohol

Answer 30

50% | 15-20%

Question 31

Legal document that delineates kinds of tx wanted under various circumstances

Answer 31

Advanced Directive

Question 32

Medicare A Coverage

Answer 32

3 night inpatient hospital stay required within 30 days admission into skilled nursing facility Days 1-20 medicare A covers 100% Days 21-100 medicare A covers all but $157.50/day

Question 33

Medicare B Coverage

Answer 33

Covers outpatient rehab serves (PT/OT, home health) | Yearly cap of $1900

Question 34

The quality or state of being healthy in body and mind, especially as the result of deliberate effort

Answer 34

Wellness

Question 35

Mini cognitive exam

Answer 35

Apple Table Penny

Question 36

How long to complete clock drawing test

Answer 36

3 min

Question 37

What percentage of elderly patients suffer from depression?

Answer 37

25%

Question 38

Bacteria in urine does not always have to be treated in _________, but it does always have to be treated in ________

Answer 38

Females | Males

Question 39

1st line in elderly for sleep

Answer 39

Trazodone and Remeron

Question 40

______% of people > 65 fall yearly ______% of people > 80 fall yearly ______% of older adults that fall, fall repeatedly

Answer 40

30% 50% 50%

Question 41

______% of older fallers are injured ______% of older fallers are admitted to the hospital ______% of fractures in older adults result from falls

Answer 41

20% 15% 87%

Question 42

_____ of patients die within 12 mo of hip fracture | _____% of patients with hip fracture have limited functional recovery

Answer 42

1/3 | 50%

Question 43

No risk factors = _____% chance of fall | >4 risk factors = _____% chance of fall

Answer 43

8% | 78%

Question 44

_____% of women > 80 y/o with depression taking an SSRI fell in the last year

Answer 44

60%

Question 45

_____-_____% of people fall in the first year post-stroke

Answer 45

40-70%

Question 46

After hospital discharge, pts should be evaluated for fall risk within _______

Answer 46

2 weeks

Question 47

8 dimensions of wellness

Answer 47

``` Nutritional Intellectual Environmental Emotional Physical Social Community Spiritual ```

Question 48

Most frequent dz present in the elderly

Answer 48

``` Hypertension Arthritis Heart Dz Cancer Diabetes ```

Question 49

Pharmacokinetics of the elderly

Answer 49

Decreased kidney function Decreased gastric emptying Decreased total body water Increased body fat

Question 50

Medications to be careful with the elderly

Answer 50

``` NSAIDs Diltiazem Benzos Morphine Warfarin ACEI Albuterol Diphenhydramine Loop Diuretics ```

Question 51

START Initiation

Answer 51

58% of pts missing meds for appropriate indication. Statins Warfarin for AFib Antiplatelet drugs for arterial dz Calcium/Vitamin D ACEI, SSRI, SNRI, BPH meds, topical estrogen, opioids, laxatives, flu and pneumococcal vaccinations

Question 52

STOPP Criteria

Answer 52

``` Warfarin, digoxin, insulin Don't use antipsychotics first line for dementia Don't add meds to push A1c below 7.5% Don't use BZDs or other sedative-hypnotics Verapamil/Diltiazem BB with CCB Loop Diuretics ASA > 160 mg Ticlopidine TCAs BZDs 1st gen antihistamines ```

Question 53

Beers Man

Answer 53

``` TCAs (anticholinergics) Alpha Agonists (Clonidine) Xanax Benadryl ZZZ Antiarrhythmics NSAIDs Metoclopramide (tardive dyskinesia) Nitrofurantoin Skeletal Muscle Relaxants Prostate Alpha Blockers (Just don't use for HTN) ```