IRAT 4 GERIATRICS/PEDIATRICS Flashcards
(92 cards)
1
Q
Geriatric
A
Over 65
2
Q
__ of most DC practices are geriatrics
A
12-15%
3
Q
Population over 65 purchases ___ of Rx drugs
A
1/3
4
Q
Represents 3M and is fastest growing segment of the population
A
Greater than 85
5
Q
Average age of death is ___ in the US
A
75
6
Q
Only ___ of geriatrics utilize DC services
A
4.6%
7
Q
Goal of treatment of geriatrics
A
Prevent or delay functional decline and restore or maintain function to allow as much independent living as possible
8
Q
3 categories of geriatrics
A
Young-old
Middle-old
Old-odl
9
Q
Maintained a level of fitness that allows participation in recreational activities
A
Young-old
10
Q
Independent with daily activities but need assistance with demanding needs
A
Middle-old
11
Q
Require nursing care
A
Old-old
12
Q
10 most common chronic conditions in primary care
A
OA Hypertension Hearing Cardiac Ortho impairment Chronic sinusitis Vision Diabetes Varicose veins Abdominal hernia
13
Q
Cardiac disease, cancer, and stroke account for __ of deaths in geriatrics
A
75%
14
Q
Suicide in geriatrics is ___ the national average
A
5x
15
Q
Death from complications of hip fracture is ___
A
15%
16
Q
Abrupt onset of signs and symptoms will usually represent a disease rather than
A
Normal again
17
Q
Geriatrics often suffer side effects of
A
Multi-drug Rxs
18
Q
Seniors have less reserve to deal with
A
Infections
19
Q
Geriatrics are prone to
A
Depression and alcoholism
20
Q
Often geriatrics are victims of
A
Verbal or physical abuse
21
Q
Common musculoskeletal conditions in geriatrics
A
OA, RA, DISH, gout
Osteoporosis
Paget’s
22
Q
Common neuro conditions geriatrics
A
Alzheimers
Parkinsons
Depression
23
Q
Common EENT conditions geriatrics
A
Vision loss
Presbycusis
Tinnitus
Chornic sinusitis
24
Q
Common endocrine conditions geriatrics
A
Diabetes
Hyperparathyroidism
25
Cardio/renal common conditions geriatrics
```
CHF
MI
Hypertension
Stroke
Aneurism
Temporal arteritis
Renal failure
Incontinence
```
26
Common reproductive condtions geriatrics
Breast CA
Ovarian CA
Prostatic CA
27
Common GI conditions geriatrics
```
Hiatal hernia
GERD
Constipation
Diverticulitis
Colorectal CA
```
28
Strategy for symptomatic patient evaluation
Most common conditions in elderly
Atypical presentations
Drug side effects or interactions
Cancer
29
Geriatrics management
Establish an annual physical
Provide info with regard to reducing risk of disease
Provide info with regard to falling
Provide info regarding support groups if applicable
30
For patients with a diagnosed condition managment
Refer to presecriber if drug related
Refer for further evaluation if necessary
Manage or comanage hypertension, obesity, diabetes, musculoskeletal conditions, pain
31
Adjusting recommendations geriatrics
Light force for osteoporosis
Avoid excessive rotational techniques
Avoid extreme spinal flexion with osteoporosis
Adjust headpiece for comfort
Distract joint when adjusting extremities
32
Geriatrics normal aging spine
Spinal canal - cord compression likely
33
Geriatrics normal aging cardio
```
Blood vessels inc atherosclerosis/HBP
Heart - stroke volume
Resp - difficulty breathing
GI - GERD, B12
Colon - constipation
Kidney - excretion
Bladder - nocturia/incontinence
Endocrine - BPH/CA
Blood glucose - 5 mg/dL per decade after age 50
Bone - osteopenia/osteoporosis
Muscle - strength
Brain - dementia
Peripheral nerves - reaction time
Eyes/ears - acuity
```
34
Geriatrics normal aging eyes/ears
8% visually impaired
Visual impairment places pt at risk for falls, MVAs, etc
60% of patients 70+ have hearing deficit
Most common condiiton is presbycusis
35
Geriatrics radiograph
Value is high
Must correlate findings with complaints
Bone scans useful for primary CA or mets
36
May be the decision point for a nursing home
Falls
37
Leads to dependence
Falls
38
1/3 of pts greater than 65 report __ falls per year
1+
39
Women fall more than men. T/F
Ture
40
Major causes of falling
```
Accidents
Gait disturbance
Vertigo
Confusion
Postural hypotension
Visual impairment
Syncope
```
41
Ddx requires
Breast and pelvic exam
42
For many complaints a clinical impression may still be gained through appropriate questioning resulting in either a limited trial of treatment or
A referral for further testing or managment
43
Public health task force on women’s health issues established
1983
44
National institute of health (NIH) established the office of research on women’s health
1990
45
Women’s helath initiative (WHI) was developed - this is a prevention based study
1991
46
Women live longer than men. T/F
True
47
On average women develop cardiac disease ___ than men
10 years later
48
Women have a higher incidence of some sports injuries at the
Knee
49
Women have a higher incidence of
```
Migraine HA
Depression
Eating disorders
Urinary incontinence
Obesity
Progressive scoliosis
Osteoporosis
```
50
Leading cause of death for women 24-34
Accidents
Homicide
Suicide
51
Leading cause of death for women 45-54
Heart disease
| Lung CA
52
Leading cause of death in women age 65-74
Heart disease
Lung CA
Cerebrovascular disease
Breast CA
53
Leading cause of death in women with mortality rate 5-6x higher than lung or breast CA
Heart disease
54
Top ten CA’s in women
```
Breast
Lung
Colorectal
Cervical
Urinary tract
Lymphoma
Melanoma
Thyroid
Ovarian
Leukemia
```
55
Study at Creighton medical school showed vitamin D could cut the risk of CA by
60%
56
Vitmain D3 recommended
Female patients
57
Female patient evaluation
| Screen for family hx of
```
CA
Heart disease
Hypertension
Osteoporosis
Depression
Rheumatic disease
HA
Obesity/diabetes
```
58
BP done every
2 years if normal
59
Breast exam every
3 years for 20-39 then annually
60
Mammogram every
1-2 years for 40-49 then annually til 69
61
Pelvic exam
Annually
62
Papanicolaou smear from 18 to sexually active then
Annually until 3 negative results then dr’s discretion, discontinue at 65
63
Eye exam
1x between puberty and 40 then every 2-4 years til 64 then annually
64
Fasting blood glucose every
3 years
65
Cholesterol every
5 years
66
Colonoscopy ever
5-10 years after age 50
67
Skin exam by dermatologist every
3 years after age 40
68
Female patient evaluation for the symptomatic patient
Consider most common conditions that are seen in females
Consider cardiac dz
Be vigilant for symptoms of abuse
69
Female patient evaluation for athletic patient
Screen for regional weakness
Screen for joint instability
Screen for patellar tracking abnormalities
Watch for indicators of female athelte triad
Examine for nutritional deficiencies
Watch for signs of stress fx
70
Female athlete triad
Eating disorder
Amenorrhea
Osteoporosis
71
Female patient evaluation for pregnant patient
Reinforce need for regular prenatal chekc-ups
Counsel on avoidance of alcohol, smoking, control of diabetes, safe exercise
Monitor patient’s blood pressure
Be alert to post partum depression
72
Female patient evaluation for the postmenopausal patinet
Pay attention to signs of osteoporosis
Screen for indicators of diminishing cognitive function
Reinforce breast CA screenings
Reinforce colon CA screenings
73
For all femal patients management
Stress importance of monthly breast exams
Provide counseling on age-related concerns
Advice regarding exercise, nurtition, heart dz
Advise regarding osteoporosis
Modify adjusting procedures with regard to age and pregnancy
74
Natual menopause represents an age-related
Ovarian failure
75
A progressive FSH results in
Shorter menstrual cycles and fewer ovulations and a decrease in progesterone
76
During transitional phase, referred to as the climactic or premenopausal period, frequency of bleeding is
Irregular and less frequent
77
When menses has not occurred for one year
Female has reached menopause
78
In USA menopause occurs on average of
50-51 years old
79
Majority of problems occur in female athletes or with women in occupations where a thin appearnce is required
Eating disorders
80
The 2 priamry disorders in females
Anorexia nervosa
| Bulimia nervosea
81
A disorder associated with self-imposed weight loss due to a distorted body image and other psychologically related problems
Anorexia nervose
82
85% anorexia nervosa are
Young affluent white females
83
Often a perfectionist
Anorexia nervosa
84
Weight is maintainted at least 15% below that expected as normal based on height and gender
Anorexia nervosa
85
Intense fear of gaining weight even though obviously underweight
Anorexia nervosa
86
Distorted sense of self
Anorexia nervosa
87
Absence of at least 3 consecutive menstrual cycles without any other known cause
Anorexia nervosa
88
Characterized by a binge-purge cycle in order to avoid weight gain
Bulimia nervosa
89
Seen in about 50% of AN patients
Bulimia nervosa
90
Usually cocurs when the pt is depressed bored or lonely
Bulimia nervosa
91
Seen in 20% of college sutdents
Bulimia nervosa
92
4% report weekly events
Bulimia nervosa
