PCM Geriatrics.txt

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BostonPhysicianAssist
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PCM Geriatrics.txt
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2011-12-09 18:05:34
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PCM Geriatrics
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  1. Who (male or female) is more likely to have chronic disease with functional impairment and a low perception of their own health
    females
  2. Who (male or female) is more likely to have a catostrophic outcome of a chronic disease?
    Males
  3. Chronic disease is most prevalent in what ethnicity?
    African americans
  4. Rate each ethnicity (african amerian caucaisan and latino in order of functional decline as a function of age)
    AA>Latino>Caucasian
  5. True or false lower socioeconomic status leads to an increase in mortality and disproportionate impairment from major diseases such as CAD, DM, and CA as well as depression
    True
  6. The theraputic goal in geriatric care is
    • A. promote wellness and independence
    • B. maximize function
    • C.Healing their disease
    • A and B
  7. 7.9% of senior living alone have ___
    • A. a puppy
    • B. a chronic medical condidion
    • C.food insecurity
    • D. a steady job
    • C
  8. Why is BMI an important measurement in the elderly?
    Food insecurity can lead to lost weight as can cancer
  9. Which is more common in elderly hypothermia or hyperthermia>?
    Hypothermia
  10. Elderly are more likely to have a (narrowed or widened) pulse pressure.
    Widened (also with systolic HTN and atherosclerosis)
  11. Elderly have a ____ (fast, slow, unchanged) resting heart rate but a ____ (limited, normal, accentuated) maximum heart rate
    Slow, limited
  12. _____ is not a reliable skin sign of hydration status
    Tugor
  13. What are some skin lesions that you really want to watch for in the elderly?
    Squamous cell cardinoma and melanoma, non-blanching ertythema (pressure sores)
  14. Chronic autoimmune subepidermal blistering skin disease that rarely involves mucous membranes and occurs in patients >50 y.o.
    Bullous Pemphigoid
  15. What causes bullous pemphigoid
    IgG protein binding to the basement membrane of the skin
  16. What are the symptoms of bullous pemphigoid?
    Scratchign and itching burning skin with large blisters
  17. What is the treatment for bullous pemphigoid?
    Steriods topical are better than PO in severe cases immunosuppressants (azanthioprine and Imuran)
  18. A common benign skin growth in older adults. A brown black or pale growth on the face chest shoulders or back with a stuck on warty or smooth surface
    Seborrheic Keratosis
  19. What is the treatment for Seborrheic keratosis?
    No intervention is valid, freeze off with liquid nitrogen, shave off, must be distinguished from skin cancers such as melanoma
  20. 4 common places for pressure ulcers
    heel, ankles, hips, buttocks
  21. What is the average sacral pressure on a hospital mattress ?
    100-150mmHg
  22. What two things can make pressure sores progress more rapidly?
    Moisture and friction
  23. Describe the etiology of a pressure sore
    capillary filling pressure is 32mmHg when pressure between support surface and bony prominence is increased there is a decreased blood supply to the skin causing ischemia, acidosis, toxin accummulation hemorrhage into the interstitium and necrosis
  24. A non-blanching erythema or bluish, purple skin lesion that is painful is a stage __ ulcer
    I
  25. A blistering shallow pinkish red ulcer that involves the dermis and the epidermis is a stage __ ulcer
    II
  26. A deeper, crater-like ulcer that may extend beyond the primary wound into the healthy layers of skin below with tissue that sloughts off at the base of the ulcer and leaves subcutaneous tissue exposed is a stage ____ ulcer
    III
  27. A pressure ulcer that has exposed muscle bone and/or tendons, which has dark crusty dead tissue (eschar) at the base and often extends beyond primary wound into the area below layers of healthy skin is a stage ___ ulcer
    IV
  28. you should reposition a bed bound patient every __ hours
    2
  29. True or false you should use a doughnut for a patient with a pressure sore
    False it decreases blood flow to the entire area
  30. Are sheepskin and egg crate mattress covers proven ways to prevent ulcers?
    NO
  31. what should you use besides repositioning to prevent ulcers in bed bound patients?
    • Special mattress
    • float heels
    • use a draw sheet
    • change diapers frequently
  32. Treatment for a Stage I ulcer
    • relieve pressure with foam cusions or pillows
    • avoid further injury or friction to the area
    • optimize clinical conditions
    • Improve nutrition
    • Vitamin C and Zinc Sulfate may improve wound healing
  33. Treatment for Stage II ulcer
    • relieve pressure with foam cusions or pillows
    • avoid further injury or friction to the area
    • optimize clinical conditions
    • Improve nutrition
    • Vitamin C and Zinc Sulfate may improve wound healing
    • Wet to Dry wound packing
    • Keep surrounding area dry
  34. Treatment for Stage III ulcer
    • relieve pressure with foam cusions or pillows
    • avoid further injury or friction to the area
    • optimize clinical conditions
    • Improve nutrition
    • Vitamin C and Zinc Sulfate may improve wound healing
    • Surgical debridement of necrotic tissue
    • enzymatic debridement (santyl or granulex
  35. Treatment for stage IV ulcer
    • relieve pressure with foam cusions or pillows
    • avoid further injury or friction to the area
    • optimize clinical conditions
    • Improve nutrition
    • Vitamin C and Zinc Sulfate may improve wound healing
    • surgical debridement or enzymatic debridement
    • systemic antibiotics for osteomyelitis, cellulitis or sepsis
  36. True or False if you see bone in a pressure ulcer it is osteomyelitis by definition
    True
  37. A gray ring around the eyes of elderly usually composed of lipids
    arcus senilis
  38. Yearly mammograms are recommended until the age of __
    69
  39. Breast cancer incidence is higher until the age of ___
    85
  40. T or F rales are normally heard in the elderly as a normal process of aging
    F rales are abnormal at any age
  41. Rales in the elderly in absence of pathology are most likely due to ____
    atelectasis
  42. S3 is associated with ____
    CHF
  43. ___ is a common heart sound among older persons free of cardiac disease
    S4
  44. Systolic ejection murmur in the elderly is a ____(more or less) reliable sign of hemodynamically significant aortic stenosis
  45. You should screen elderly patients for colon cancer with ___ testing
    fecal occult blood testing
  46. Urinary incontinence in males is usually secondary to what?
    Chronically overfilled and distended bladder make sure to do a prostate exam
  47. prostatic masses on digital rectal exam may also reflect what three processes?
    Granuloma, calcification or hyperplasia
  48. How should you treat Atrophic vaginitis?
    Estrogen therapy for a few weeks
  49. A vaginal condition associated with urinary incontinence or itching, dyspareunia (not UTI)
    Atrophic vaginitis
  50. Is it normal for the ovaries or uterus to be palpable more than 10 years beyond menopause?
    No this usually indicates pathology
  51. what 4 tests should you perform to assess peripheral neuropathy status?
    • Absent achilles tendon reflex
    • reduced vibratory sense
    • impaired position sense at the great toe
    • inability to maintain unipedal stance for 10 seconds in 3 attempts
  52. Primary preventive measures of chronic disease that should be implimented in the elderly (5)
    • Physical activity/initiating exercise
    • Tobacco use
    • alcohol use
    • aspirin for primary prevention
    • tetanus, influenza, pneumococcal, herpes zoster vaccine
  53. What are some secondary preventative measures that should be implemented for elderly patients (5)
    • cancer screening (colorectal, breast, cervical and prostate)
    • BP screening
    • Lipid screening
    • Osteoporosis
    • Abdominal aortic aneurysm
  54. Is dementia a part of normal aging
    no
  55. Dementia is found in ___% of people age 65 + and ___ percent of persons age 85 +
    10, 50
  56. how do you do a mini cognitive assessment
    • 3 item recall
    • clock drawing test, draw a clock and put in all the numbers set the hands to 3o'clock
  57. For home safety the max temp for the water should be set to < ____ degrees
    120 degrees F
  58. Who has the highest risk of serious injury or death per crash incidence other than teens?
    Elderly
  59. Name some risk factors that lead to more accidents in old drivers
    • poor vision and contrast sensitivity
    • dementia
    • impaired neck and trunk rotational
    • limitation of ROM in shoulders hips and angles
    • foot abnormality like neuropathy
    • poor coordination and decreased speed of movement
    • alertness affected by meds or alcohol
  60. 3 things you can encourage old drivers to do to decrease risk of accidents
    • avoid rush hour and congested traffic
    • avoid night driving
    • avoid driving in poor weather
  61. 4 benefits of social integration in older individuals
    • lower functional impairment
    • better immune function
    • reduced depressive symptoms
    • decrease subsequent mortality
  62. Are there more elderly being taken care of by formal care givers or informal care givers?
    Informal
  63. Elder mistreatment includes
    • physical violence
    • verbal abuse
    • financial abuse
    • sexual abuse
    • emotional abuse
    • abandonment
    • intentional neglect
  64. Which is more common abuse by spouse or abuse by adult child
    spouse
  65. 3 greatest risks for inadequate economic well-being
    • women who live alone
    • foreign born
    • ethinic or racial minorities
    • (note low income has been associated with increased mortality)
  66. Does medicare part A cover glasses dentures or long term care?
    No

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