4Cpd6Geriatrics1

Front 1

Aging?

Back 1

process of gradual maturation

Front 2

Senescence?

Back 2

process by which the capacity for cell division and the capacity for growth and function are lost over time, ultimately leading to death.

Front 3

Associated conditions with aging?

Back 3

presbyopia, glucose control, cognitive decline, dementia (considered a dz), Hayflick's limit - limit to cellular replicative capacity

Front 4

theories of aging focus on?

Back 4

1. what controls the degenerative and entropic processes, 2. evelutionary origins of senescence

Front 5

Loose cannon theory?

Back 5

entropy-producing agent - free radicals or glucose -slowly disrupts cellular macromolecular constituents.

Front 6

Rate of living theory?

Back 6

metabolic by-products play a role in senescence

Front 7

Weak link theory?

Back 7

specific physiologic system is vulnerable during senescence which accelerates the degeneration

Front 8

Error catastrope theory?

Back 8

genetic errors promoting senescence

Front 9

Mastor clock theory?

Back 9

oldest least credible, direct genetic control for the good of the species

Front 10

Disorders of accelerated aging in children?

Back 10

Progeria: normal elderly characteristics (bald, wrinkled), no gonadal activity, short, NOT a model of accelerated aging
Werner's syndrome: sclerodermal skin changes and baldness, cataracts, muscular atrophy, glc intolerance, CA, death dt atherosclerosis
Wiedemann-Rautenstrauch syndrome and Hutchinson-Gilford syndrome: premature scleroderma, baldness.
Down syndrome: glc intolerance, vascular disorders, CA, hair loss, degenerative bones, death, impairs CNS

Front 11

Longetivit is due to?
Is influenced by?

Back 11

decreasing childhood mortality
heredity, hypercholesterolemia versus genes protecting vs DAD, medical tx, lifestyle

Front 12

Keep in mind while taking geriatric history:

Back 12

hearing deficits, drugs, include caregiver, interdisciplinary team, take more time, many nonspecific sx, underreported sx, clinical features differ from younger pts, ask about duration of functional decline (ADLs - activities of daily living), ask them to describe a typical day, build a rapport, notice physical changes and hygiene, speak clearly, mental status exam,

Front 13

Medical hx:
drug hx:

Back 13

older disorders and tx
bring them in, count btwn visits

Front 14

alcohol/tobacco/drug hx:
nutrition hx:

Back 14

smoking in bed, CAGE
type, quantity, frequency of food eaten, special diets, wieght loss, access to food, physical ability to eat, decreased taste/smell, fluid intake

Front 15

mental health hx:
functional status:

Back 15

harder to detect
ADLs

Front 16

Social hx:

Back 16

housing, safety, social life, safe sex, education, job, finances, surrogate decision maker

Front 17

Physical exam:
Vital signs:

Back 17

movement, hygiene
weight and height each visit, temp, pulses and BP both arms, orthostatic hypotension common

Front 18

Skin:

Back 18

lesions, ischemia, ulcers, bruises, ecchymoses, nails

Front 19

Head and Neck:

Back 19

palpate temporal arteries, enophthalmos is common, pseudoptosis, entropia, ectropia, arcus senilis, tophi, hearing test, xerostomia, smooth painful tongue (B12 def)

Front 20

Temporomandibular joint:
Neck:

Back 20

from osteoarthrosis
thyroid, carotid bruits, flexibility

Front 21

Chest, back, breasts:

Back 21

percussion, auscultation, mammogram

Front 22

Heart:

Back 22

size, kyphoscoliosis moves the heart, auscultation, aortic valve stenosis will be softer, fourth heart sounds, asx bradycardia, pacemaker

Front 23

GI:

Back 23

palpate for hernias, aneurysms, liver, spleen, bowel sounds, anorectal exam, DRE, prostate gland

Front 24

Female Reprod:

Back 24

Pelvic exam with Pap until age 70

Front 25

Musculoskel:

Back 25

Heberden's nodes (bony distal interphalangeal joints), Bouchard's nodes (bony proximal) in OA. subluxations, ulnar deviations in RA.

Front 26

Hyperextension of the proximal interphalangeal joint and flexion of the distal interphalangeal joint (swan-neck deformity) and hyperextension of the distal interphalangeal joint and flexion of the proximal interphalangeal joint (boutonnière deformity) suggests?

Back 26

RA

Front 27

Feet:

Back 27

hallux valgus, medial prominence of the 1st metatarsal head with lateral deviation and rotation of the big toe, and lateral deviation of the 5th metatarsal head; hammertoe with RA; claw toe

Front 28

Neuro:

Back 28

may be impeded by other deficits, note symmetric findings without fx loss,

Front 29

Cranial nerves:

Back 29

may have small pupils, sluggish pupillary light reflex, pupillary mitotic response to near vision diminished, limited gaze, irregular eye mvmt, Bell's phenomenon (eyes move up when closed) maybe absent, decreased senses

Front 30

Motor fx:

Back 30

weak, increased muscle tone, jerky mvmts abnormal, tremor (ddx parkinsons by having them draw circle), decrease muscle mass (sarcopenia), increased rxn time, ddecrease coordination, deep tendon reflex maybe absent, asymmetric achilles tendon reflex = sciatica, Romberg test, Babinski's = UMN lesion, cortical release reflexes

Front 31

Sensation:

Back 31

touch, cortical sensory fx, temp sense, proprioception, vibration: maybe decreased, numbness maybe neuropathy, vibratory sensation loss below knees

Front 32

Unusual illnesses may present with nonspecific/different or diminished signs/sx:

Back 32

hyperthyroidism (apathitic not hyperkinetic), hypothyroidism (maybe no prolonged relaxation time post contraction), hyperparathyroidism (sx absent), sarcoidosis, bacteremia (maybe no fever), UTIs (no asx), meningitis (asx), pneumonia, TB, apppendicitis (RLQ pain), biliary disorders, acute bowel infarction, peptic ulcer dz, MI(delay longer), heart failure