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32 Cards in this Set

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Aging?
process of gradual maturation
Senescence?
process by which the capacity for cell division and the capacity for growth and function are lost over time, ultimately leading to death.
Associated conditions with aging?
presbyopia, glucose control, cognitive decline, dementia (considered a dz), Hayflick's limit - limit to cellular replicative capacity
theories of aging focus on?
1. what controls the degenerative and entropic processes, 2. evelutionary origins of senescence
Loose cannon theory?
entropy-producing agent - free radicals or glucose -slowly disrupts cellular macromolecular constituents.
Rate of living theory?
metabolic by-products play a role in senescence
Weak link theory?
specific physiologic system is vulnerable during senescence which accelerates the degeneration
Error catastrope theory?
genetic errors promoting senescence
Mastor clock theory?
oldest least credible, direct genetic control for the good of the species
Disorders of accelerated aging in children?
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
Longetivit is due to?
Is influenced by?
decreasing childhood mortality
heredity, hypercholesterolemia versus genes protecting vs DAD, medical tx, lifestyle
Keep in mind while taking geriatric history:
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,
Medical hx:
drug hx:
older disorders and tx
bring them in, count btwn visits
alcohol/tobacco/drug hx:
nutrition hx:
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
mental health hx:
functional status:
harder to detect
ADLs
Social hx:
housing, safety, social life, safe sex, education, job, finances, surrogate decision maker
Physical exam:
Vital signs:
movement, hygiene
weight and height each visit, temp, pulses and BP both arms, orthostatic hypotension common
Skin:
lesions, ischemia, ulcers, bruises, ecchymoses, nails
Head and Neck:
palpate temporal arteries, enophthalmos is common, pseudoptosis, entropia, ectropia, arcus senilis, tophi, hearing test, xerostomia, smooth painful tongue (B12 def)
Temporomandibular joint:
Neck:
from osteoarthrosis
thyroid, carotid bruits, flexibility
Chest, back, breasts:
percussion, auscultation, mammogram
Heart:
size, kyphoscoliosis moves the heart, auscultation, aortic valve stenosis will be softer, fourth heart sounds, asx bradycardia, pacemaker
GI:
palpate for hernias, aneurysms, liver, spleen, bowel sounds, anorectal exam, DRE, prostate gland
Female Reprod:
Pelvic exam with Pap until age 70
Musculoskel:
Heberden's nodes (bony distal interphalangeal joints), Bouchard's nodes (bony proximal) in OA. subluxations, ulnar deviations in RA.
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?
RA
Feet:
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
Neuro:
may be impeded by other deficits, note symmetric findings without fx loss,
Cranial nerves:
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
Motor fx:
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
Sensation:
touch, cortical sensory fx, temp sense, proprioception, vibration: maybe decreased, numbness maybe neuropathy, vibratory sensation loss below knees
Unusual illnesses may present with nonspecific/different or diminished signs/sx:
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