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1

The process or condition of growing old, & ultimately leads to an incompatibility w/ life & terminates in death

Senescence

2

A PCP who is board-certified in either family practice or internal medicine & who has acquired the additional training necessary to obtain the Certificate of Added Qualification in Geriatric Medicine

Geritrician

3

The scientific study of the problems of aging

Gerontology

4

A process of gradual & spontaneous change, resulting in maturation through childhood, puberty, young adulthood & then decline through middle & late life

Aging

5

The preferred term to describe people aged 65 years or above

Older adults

6

Term used to describe the average life span

Longevity

7

The length of time an average particular individual can expect to live, depending on his/her current age

Life Expectancy

8

What are the 3 subgroups of "older adults" according to the WHO & the age ranges assoc. w/ them?

Elderly (young-old) - 65-75 yoa
Old - 76-90 yoa
Very Old (old, old) - >90yoa

9

The loss of skeletal muscle mass & function d/t aging

Sarcopenia

10

Cells lose their ability to divide over time. This limit to cellular replicative capacity is known as what?

Hayflick's Limit/Phenomenon (appears to be 50 cell divisions)

11

The 1/3rd rule describes what?

Functional losses of the aged:
1/3rd d/t to disease
1/3rd d/t disuse
1/3rd d/t normal aging

12

What is the average life expectancy today?

78 yoa

13

Baby-boomers describes people that where born during what time period?

1945-1964

14

The fastest growing segment of the population are those over what age?

85

15

What are some reasons women live longer than men?

Handle stress better
Have more social support systems
More sensitive to changes in their body
Seek out medical care earlier

16

What minority group has the shortest life expectancy?

Native Americans (45-60yoa)

17

What are the major concerns of the elderly?

Financial Issues
Health care & costs
Retirement
Housing
Crime
Transportation
Sex

18

What was the original & intended purpose of social security?

Serve as a supplemental source of retirement income

19

What is the goal of the physician when it comes to the elderly?

Keep the older adult functioning independently, preserving their lifestyles, & self-respect as long as possible

20

What is the most important thing to slow down aging & frailty?

Movement (exercise)

21

What 2 things causes 75% of all deaths, 20% of all dr visits, 30% of all hospital stays, & 50% of all bed ridden days?

Heart disease & malignancies

22

What are the major sources of funding for older adult health care services?

Medicare
Medicaid
Other federal plans (VA)
Private insurance
Out-of-pocket payments

23

Medicare does not cover what type of healthcare service(s)?

Preventative care (for symptom relief only)

24

What are the 4 parts of medicare?

Part A: Hospital insurance
Part B: Medical insurance
Part C: Medicare Advantage plans
part D: Prescription Drug Plan

25

Part A of medicare covers what % of in-pt hospital care?

80% (if medically prescribed)

26

Part B of medicare covers what % of physician services?

80%

27

What does Part C of medicare give patients the ability to do?

Choose a private insurance company to pay for Medicare A & B
Give the option to choose prescription coverage (Part D)

28

This is used in conjunction w/ the original medicare. It pays some or all of what is not covered under the original medicare

Medicare supplemental insurance (medigap)

29

How many medigap plans are there?

11

30

For any pain noted in a SOAP note for medicare you must show what?

Provokes
Quality
Radiates
Severity
Time

31

This pays for health services for certain categories of the poor including the aged poor, those who are blind or disabled & low-income families with dependent children

Medicaid

32

What is the most important part of good dr/pt communication?

Good listening

33

Interviewing older pts presents some unique challenges b/c they tend to do what?

Under-report problems
Overestimate their cognitive abilities
Symptoms may overlap
Perception of pain is diminished
Atypical presentation of many illnesses

34

The mnemonic LO DR FICARA is used to record info about pain. What does it stand for?

Location
Onset
Duration
Radiations
Frequency
Intensity
Character of pain
Assoc symptoms
Relieving factors
Aggravating factors

35

What are 7 important ADL's for the elderly?

Ambulation
Bathing one self
Continence
Dressing self
Feeding self
Using the toilet
Transferring from one surface to another

36

What are 5 instrumental ADL's (IADL)?

Money management
Shopping/Cooking
Cleaning
Using the telephone
Doing laundry

37

Obese men have a waist size over what? Women?

Men = >40"
Women = >35"

38

What should the hip/waist ratio be below for men? Women?

Men < 0.9
Women < 0.85

39

What 3 conditions are assoc. w/ unexplained weight loss?

Depression
Alzheimer's
Cancer

40

What 2 conditions are assoc. w/ unexplained weight gain?

Heart problems
Kidney problems

41

Who are the M/C victims of elder abuse?

Mentally incompetent
Isolated older females

42

Who is most commonly the abuser in elder abuse?

A family member (Most often spouse, daughter)

43

What are the different types of elder abuse (from M/C to least common)?

Self-neglect
Physical neglect
Financial Exploitation
Emotional Abuse
Physical Abuse

44

What are the 5 M/C geriatric problems (Five I's)?

Intellectual Impairment
Incontinence
Instability
Immobility
Iatrogenic drug reactions

45

What are the 3 D's of intellectual impairment?

Dementia
Delirium
Depression

46

The avg. older pt is taking how many prescription drugs, OTC meds, & self-selected supplements per day?

12-15 per day

47

Drug side effects are one of the primary causes of what?

Falls

48

After 60, how long does it take for a skin cell to be replaced?

42 days (instead of normal 28 days)

49

The mnemonic SHARP is assoc. w/ signs of inflammation. What does it stand for?

Swelling
Heat
Altered function
Redness
Pain

50

What are general charac.of squamous cell?

Irregular
Flaky
Bleeds

51

What are the general charac. of basal cell?

Raised borders
Waxy, indurated
Grows downward

52

What are the general charac. of Melanoma?

Pigmented
Multicolor
Invasive

53

Spots on the nails indicate what?

Zinc deficiency

54

Pitted nails indicates what?

Psoriasis

55

Spoon nails (koilonychia) indicated what?

Iron deficiency, fungus

56

Clubbing of the nails indicates what?

COPD

57

Yellow nail syndrome is assoc. w/ what ds?

Diabetes

58

Terry's half & half nails is assoc. w/ what type of diseases?

Renal or liver disease

59

Loss of height is a late sign of what?

Osteoporosis
Possible vertebral compression fx's

60

A temp rise of 3 deg F over baseline is a possible sign of what?

Infection

61

In the elderly, fever is defined as an oral temp greater than what?

100F

62

Lucatello's sign is a higher axillary temp than oral temp that suggests what?

Hyperthyroidism

63

Barnes Temp. Test (checking axillary temp before getting out of bed) tests for what?

Hypothyroidism

64

What Liebermeister's rule?

Fever is usually assoc. w/ an increase in pulse of 8-10 bpm for each Centigrade degree increase

65

Hypothermia is defined as an oral temp that is less than what?

95F

66

What should the pulse pressure (difference b/w systolic & diastolic) in an older adult be?

40

67

Hypertension may be distinguished from pseudohypertension by performing what maneuver?

Osler's Maneuver (inflate the BP cuff above the systolic pressure. Check the radial pulse. The pulse should be absent. If the pulse can still be felt, the intra-arterial pressure may be lower than the BP which may indicate that there is sufficient arteriosclerosis to produce some degree of pseudohypertension)

68

Presbyopia is AKA what?

Farsighted

69

A grey, opaque ring around the cornea bilaterally. This is considered a normal part of aging.

Arcus Senilis

70

Bulging or prominence of the eye. May be uni- or bilateral.

Proptosis

71

Hearing loss that is gradual & progressive assoc. w/ aging. It's the M/C form of neurosensory hearing loss in adults. Affects men more than women.

Presbycusis

72

Hyposmia is what?

Decrease in smell

73

Aging causes stiffening of the chest walls & weakness of the muscle in the chests. This causes a decrease in chest expansion which leaves the pt more susceptible to what?

Pneumonia

74

LUQ pain should make you think?

Pancreatitis
AAA

75

RUQ pain should make you think?

Cholecystitis
Hepatitis
Duodenal ulcer

76

RLQ pain should make you think?

Appendicitis

77

LLQ pain should make you think?

Constipation
Diverticulitis
Colon CA

78

Epigastric pain should make you think?

Peptic ulcers
Pancreatitis
AAA

79

Hypogastric pain should make you think?

Cystitis
Diverticulitis

80

Pain in the RLQ when palpating RUQ is what sign?

Soresi's Sign

81

Urine loss when coughing, sneezing, or laughing. Affects one in three women in their 60's.

Stress incontinence

82

What is the primary complaint in pts w/ musculoskeletal problems?

Pain

83

R shoulder pain/scapular pain could indicate what visceral disorders?

-Gallstones (Female, fat, forty, fair complexion, flatulence)
- Peptic Ulcers
- Liver or hepatic problems

84

L shoulder pain could indicate what visceral disorders?

Heart problems (MI)
Spleen problems
Pancreatic problems

85

Much of the medications that older adults take is linked to problems assoc. w/ what condition?

Obesity

86

Pharmacokinetics is what?

How the body handles a medication

87

Pharmacodynamics is what?

How the medication affects the pt.

88

The use of multiple prescriptions & OTC meds is called what?

Polypharmacy

89

Adverse drug events are how many times more common in older adults?

3x

90

Adverse drug events manifest as nonspecifc symptoms such as?

Dizziness
Weakness
Confusion
Instability

91

What are 2 non-drug strategies to help with sleep?

Glass of warm milk
Valarian Root

92

What does the mnemonic FRAIL stand for?

Fatigue
Resistance (can you walk up a flight of stairs?)
Aerobic (Can you walk a block?)
Illness (Do you have more than 5 illnesses?)
Loss of weight (have you lost >5% of your body weight in the past year?)

93

Dizziness is divided by history of sensation into what five categories?

1. Vertigo (subjective & objective)
2. Disequilibrium -feeling a fall is imminent
3. Presyncope - feeling loss of consciousness is imminent
4. Mixed dizziness
5. Non-specific dizziness - sensation of instability

94

The mnemonic MEOW is assoc. w/ falls. What does it stand for?

Multifactorial, medical, medicines, mental status
Environmental, eyes, ears, ethanol
Orthostatic hypotension
Weakness of lower extremities

95

The best predictor of future behavior relating to falls is what?

Past behavior (previous falls)

96

Fall rates are higher in those individuals who found it difficult to do what?

Walk 1/4 mile
Stand for 2 hours
Stoop
Climb 10 steps

97

What should always be considered in the older adult w/ unexplained falls?

Syncope

98

What are intrinsic risk factors related to falls?

Age
Illness
Visual Impairments
Depression/Dementia
Lower extremity weakness/disability
Abnormal gait or balance

99

What are some examples of extrinsic risk factors related to falls?

Height of bed
Low toilet seats
Poor lighting
Upturned carpets, loose rugs
Uneven curbs/sidewalks, uncleared walkways
Wet or slick floors

100

What is the most dreaded fall related injury?

Hip fractures

101

90% of all hip fxs occur where?

At femoral neck

102

What is the M/C upper extremity fx?

Distal radius

103

A majority of wrist fx's result from what?

Fall while walking

104

Pts that presnet w/ acute pain that is exacerbated by sitting or standing and have a progressive kyphosis & loss of height probably have what?

Vertebral fx

105

A complex, subjective & unpleasant sensation derived from sensory stimuli & modified by memory, expectations & emotions

Pain

106

What are the common presenting pain complaints in the geriatric pt population?

HA
Back/neck pain
Extremity pain
Abdominal pain
Chest pain

107

The mnemonic OLD CART is assoc. w/ pain. What does it stand for?

Onset
Location
Duration
Characteristics
Aggravating factors
Relieving factors
Treatments previously tried

108

Describe the functional pain scale (0-5)

0 - no pain
1 - tolerable & doesn't prevent any activities
2 - tolerable but does prevent some activities
3 - intolerable but can use telephone, watch TV, or read
4 - intolerable but can't use telephone, watch TV, or read
5 - intolerable & unable to verbally communicate b/c of pain

109

This is the M/C significant source of morbidity (problem) in the older adult

Back pain

110

What is the M/C cause for LBP in older adults?

Mechanical (pain secondary to overuse of a normal anatomical structure or pain secondary to trauma)

111

Pain that persists beyond the expected time or after healing or more than 3-6 months

Chronic

112

Any painful disorder affecting the loco-motor system including joints, muscles, connective tissues, soft tissues around the joints & bones.

Rheumatism

113

What is the M/C form of arthritis?

OA (degenerative arthritis)

114

Where is the primary site of OA (think tissue)?

articular cartilage

115

What are 2 primary causes of OA in older adults?

repetitive joint injury
obesity

116

What is one of the most effective tx's for OA?

Activity/exercise

117

What are clinical features of OA?

Joint pain following activity
Transient stiffness in AM & after rest
reduced ranges of motion
Joint crepitus &/or periarticular swelling
Pain described as aching or throbbing, episodes of sharp shooting pain
Generally insidious in onset

118

What is the diff. dx for hip pain?

OA
Osteonecrosis
Fx
Bursitis

119

What are some systemic causes of hip pain?

Bone tumor
Crohn's Ds
IBS
PID
Ankylosing spondylitis
Sickle cell
Testicular CA (men 18-24 w/ unknown etiology)

120

Knee pain involves which joint first?

Patellofemoral joint (pain on descending an incline or stairs)

121

These conditions will produce pain upone weight bearing especially climbing stairs. There will also be weak quadriceps

Medial or lat. compartment syndromes

122

What is the goal for OA tx?

Control the pain & minimize functional disability

123

This is a common cause of LBP & the leading indication for lumbar surgery in the US for persons over the age of 65

Lumbar spinal stenosis

124

What is the key presentation for lumbar spinal stenosis?

Sitting gives relief

125

What is the medical tx for spinal stenosis?

Total laminectomy at one or more levels

126

Leg pain, paraesthesia or weakness develops w/ prolonged standing or walking & relieved by leaning forward &/or resting for a few minutes. Pt can ride a bicycle by leaning forward w/ no pain.

Pseudo-claudication (spinal)

127

Type of claudication that is not precipitated by long standing. Acute exacerbations can occur following lifting or twisting motions. Often there are few neurological findings. There may be limited movement of the spine w/ reproduction of symptoms w/ extension. Pt can ride a bicycle but leaning forward doesn't relieve the pain.

Ischemic Claudication

128

What are red flags for malignancy?

Fever
Night sweats
Weight loss

129

Bone is a common site for metastasis from what organs?

Prostate
Breast
Lungs
Kidney
Bladder
Thyroid

130

Vertebral body compression fx are common in what time period after menopause?

1st 10 years

131

Research conducted at the Mayo clinic has demonstrated that what type of exercise performed regularly had significantly reduced the number of compression fx's in the group exercising

Extension exercises

132

50% of pt's w/ this ds have warm swelling, cutaneous erythema & severe pain in the MTP joint. There also may be fever, chills, & malaise

Gout

133

Gout in women occurs exclusively after what?

Menopause

134

What are some factors assoc. w/ predisposing a person to gout?

Obesity
High purine diets
Habitual alcohol ingestion
Use of diuretics

135

Extra-articular problems w/ the shoulder tend to interfere more w/ what type of ROM?

Active

136

A pt that presents w/ no history of prior trauma or repetitive activity in the shoulder, but w/ a gradual history of increasing shoulder discomfort & pain w/ movement could indicate what?

Rotator cuff tendonitis

137

Ds found in adults >50yoa. Periarticular condition in which there is pain & stiffness in AM longer than 30 mins, primarily in the neck, shoulders, LB, hips & pelvic girdle. Pts complain that "they can't brush/comb their hair." Up to 30% have temporal arteritis

Polymyalgia Rheumatica

138

What is the laboratory hallmark for polymyalgia rheumatica?

Elevated ESR

139

Immune-mediated inflammatory ds that affects women 3x more than men. Causes hypertrophy in the synovial lining, resulting in excess fluid production, cartilage degradation, bone erosion, & damage to tendons & ligs.

Rheumatoid Arthritis

140

Hard, bony swelling of the DIP joint

Heberden Node

141

Hard, bony swelling of the PIP joint

Bouchard Nodes

142

Erythematous rashes over the back of the shoulders "Shawl sign". Causes fatigue, progressive weakness, & sometimes constitutional symptoms may be present. Typically no stiffness & aching.

Dermatomyositis

143

A form of non-articular rheumatism of unknown etiology that affects up to 4% of the pop., mainly Caucasian females b/w 40-60

Fibromyalgia

144

What criteria must be met for a dx of fibromyalgia?

1. Diffuse musculoskeletal pain of at least 3 months duration
2. Stiffness that is worse in the morning
3. tenderness to digital palpation of at least 11 or 18 specific points

145

What 2 GI ds's are common in people w/ fibromyalgia?

IBS & Crohn's

146

People w/ fibromyalgia have abnormal levels of what in their spinal fluid?

Substance P

147

What is one of the main differences b/w fibromyalgia & myofascial pain syndrome (MPS)?

Fibromyalgia tends to be bilateral & widespread whereas MPS tends to have a regional & specific pain pattern