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78 Cards in this Set

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ABRUPT CESSATION OF SMOKING- WHAT CANCER
LUNG
INCIDENCE OF HYPOTHYROIDISM IN RELATION TO AGE
INCREASES WITH AGE
SIGNS AND SYMPTOMS OF HYPOTHYROIDISM
DRY SKIN, ALOPECIA, DIMISHED REFLEXES, COLD INTOLERANCE, DECREASE IN MAXIMAL HEART RATE, ARTHRITIC COMPLAINTS, CONSTIPATION, AMS, DEPRESSION, CHF, HTN, ELEVATED LIPIDS
WHEN DO YOU SCREEN FOR HYPOTHYROIDISM IN ELDERLY
ROUTINELY
DIFFERENCE IN STARTING TREATMENT FOR HYPOTHYROIDISM IN ELDERLY
MUST START AT VERY LOW DOSE AND INCREASE SLOWLY OVER SEVERAL WEEKS
BEFORE INCREASING THE DOSE OF SYNTHROID, WHAT SHOULD BE DONE?
CHECK TSH LEVEL AFTER DOSE IS STABLE AT T5 MCG DAILY FOR 4-5 WEEKS BEFORE INCREASING DOSE
WHAT DOES HYPERTHYROIDISM IN THE ELDERLY USUALLY IMITATE?
DISEASE FROM NON ENDOCRINE ORGANS SUCH AS HEART AND BRAIN
WHAT ARE THE DIFFERENCES IN APPEARANCE OF A HYPERTHYROID ELDERLY PERSON THAN FROM A YOUNGER PERSON/
CLASSIC EYE FINDINGS ARE LESS COMMON; TREMORS MAY BE HARD TO DIFFERENTIATE BETWEEN BENIGN ESSENTIAL TREMOR THAT IS FOUND IN SOME ELDERLY
WHAT TYPE OF HYPERTHYROIDISM OCCURS MOST FREQUENTLY IN THE ELDERLY?
MULTINODULAR GOITER
WHY DOES AMIODARON INDUCE HYPOTHYROIDISM?
IT CONTAINS IODINE AND RESULTS IN IODINE EXCESS
WHICH HYPERTHYROID CONDITION- MN GOITER OR GRAVES- SLOWLY PROGRESSES? WHAT IS THE RESULT?
MULTINODULAR GOITER PROGRESSES SLOWLY AND THE RESULT IS LONGER DURATION OF SYMPTOMS THAT MAY PUT GREATER STRESS ON HEART---INCREASING ARRYHTHMIAS
EVEN WHEN A FIB IS PRESENT, A PATIENT MAY HAVE A HR OF < ______ PER MINUTE
100
DIFFERENT SYMPTOMSOF HYPERTHYROIDISM THAT MAY BE SEEN IN ELDERLY
SWEATING DECREASED IN ELDERLY, INCREASED WEIGHT LOSS, DIARRHEA NOT COMMON
IF A HYPERTHYROIDISM IS ASYMPTOMATIC, WHAT IS IT CALLED?
MASKED HYPERTHYROIDISM
WHAT IS APATHETIC HYPERTHYROIDISM?
USUAL HYPERKINETIC STATE IS REPLACED BY DEPRESSED, WITHDRAWN, AND UNANIMATED APPEARANCE
HYPERTHROIDISM SOMETIMES MAY PRESENT AS THIS (AMS)
DELIRIUM
TREATMENT FOR HYPERTHYROIDISM
RADIOACTIVE IODINE WITH OR WITHOUT ANTITHYROID DRUGS APPROPRIATE FOR GRAVES
GENERAL CORRELATION BETWEEN FEVER AND ELDERLY
MAY BE BLUNTED OR ABSENT IN SMALL, BUT INSIGNIFICANT NUMBER OF ELDERLY PERSONS WITH SYSTEMIC INFECTIONS
EXPLAIN HOW PRESENCE/ABSENCE OF FEVER CORRELATES WITH MORTALITY
BETTWE PROGNOSIS IF FEVER IS PRESENT; WORSE IF HYPOTHERMIC OR AFEBRILE
WHAT MEDICATIONS MAY AFFECT A PT’S TEMP WHO HAS AN INFECTION?
TYLENOL
IMPORTANCE OF NECK STIFFNESS AS A SIGN IN ELDERLY
IT IS AN UNRELIABLE SIGN OF MENINGITIS IN THE ELDERLY B/C ALSO SEEN IN CHRONIC DISEASES INCLUDING CERVICAL ARTHRITIS AND PARKINSON’S
PRESENTATION OF UROSEPSIS IN ELDERLY
DELIRIUM (AMS CHANGES), HYPO OR NORMOTHERMIA, NEW ONSET OF INCONTINENCE, AND LOWWBC COUNT
PRESENTATION OF PNEUMONIA IN ELDERLY
AFEBRILE OFTEN TIMES, MAY BE SEVERE BUT NOT APPEAR ILL (MISSED OFTEN0
PRESENTATION OF INTRAABDOMINAL INFECTIONS IN ELDERLY
HIGHEST MORBIDITY AND MORTALITY FOR APPENDICITIS B/C OF ATYPICAL PRESENTATION AND LESSENED IMMUNITY
HOW ARE SEVERE LIFE THREATENING INFECTIONS TREATED
IN HOSPITAL WITH IV ANTIBIOTICS
REFERENCE FOR ANTIMICROBIAL THERAPY
SANFORD GUIDE TO ANTIMICROBIAL TEHRAPY
HOW HAVE NURSING HOMES INCREASED THEIR ABILITY TO MANAGE COMPLEX PATIENTS?
THEY NOW WILL USE IV ANTIBIOTICS FOR MODERATELY SEVERE INFECTIONS TO CONSERVE RESOURCES AND AVOID HOSPITALIZATION OF RESIDENTS
OCCASIONALLY, SEVERE LIFE THREATENING INFECTIONS ARE NOT TREATED. EXPLAIN.
THEY ARE ALLOWED TO RUN THEIR COURSE AND CAUSE THE DEATH OF A PATIENT (COMPETENT PROVIDER AND FAMILY MEMBERS MAKE DECISION)
WHAT IS FREQUENTLY FOUND AT SURGERY IN APPENDICITIS?
BOWEL PERFORATION (PERITONITIS) AND GANGRENE
WHERE DOES PAIN BEGIN IN ELDERLY WITH APPENDICITIS?
IN THE RIGHT LOWER QUADRANT
DEGREE OF PAIN IN APPENDICITIS
MILD TO MODERATE IN INTENSITY; SEVERE PAIN NOT LIKELY UNTIL PERFORATION
IN SOME CASES, THESE MAY BE THE ONLY SYMPTOMS OF APPENDICITIS IN ELDERLY
LOW GRADE FEVER AND GENERALIZED ABDOMINAL PAIN
TWO CAUSES OF PERITONITIS
DIVERTICULOSIS AND APPENDICITIS
SYMPTOMS IN PERITONITIS
GENERALIZED ABDOMINAL TENDERNESS AND RIGIDITY; BOWEL SOUNDS ABSENT DUE TO ILEUS; HYPOTENSION AND CV COLLAPSE IF UNTREATED
PRESENTATION OF PEPTIC ULCER DISEASE
BLEEDING AND PERFORATION MAY BE PRESENT, BUT CLASSIC EVIDENCE OF PERFORATION (SUDDEN PAIN AND RIGIDITY) MAY NOT OCCUR
DIFFERENT SYMPTOM IN CROHN’S FROM YOUNG
DECREASED PREVALENCE OF A PALPABLE ABDOMINAL MASS; LESS SMALL BOWEL DISEASE
PRESENTATION OF ACUTE CHOLECYSTITIS
ABDOMINAL TENDERNESS AND PERITONEAL INFLAMMATION ABSENT IN 50%, NORMOTHERMIA AND NORMAL WBC IN MANY
THESE ARE OFTEN FOUND AT TIME OF SURGERY FOR ACUTE CHOLECYSTITIS
GANGRENE AND PERFORATION
PRESENTATION OF DIVERTICULOSIS
LEFT LOWER QUADRANT PAIN AND FEVER
PRESENTATION OF MESENTERIC ISCHEMIA
PAIN AFTER EATING, RECTAL PASSAGE OF BLOOD AND MUCOUS, CIRCULATORY COLLAPSE
PRESENTATION OF BOWEL OBSTRUCTION
+/- VOMITING, DIFFUSE ABDOMINAL PAIN, BLOATING, TYMPANY ON PERCUSSION
THIS IS NEVER A NORMAL EVENT IN THE AGING PROCESS
URINARY INCONTINENCE
CAUSES OF URINARY INCONTINENCE
PREGNANCY/CHILDBIRTH, PULM DISEASE WITH COUGH, OBESITY, UTI, NEUROLOGIC D/O, AND COGNITIVE/FUNCTIONAL IMPAIRMENT
WHAT IS TRANSIENT URINARY INCONTINENCE CAUSED BY?
FACTORS OUTSIDE THE URINARY TRACT
WHAT DOES DIAPPERS STAND FOR?
DELIRIUM, INFECTION, ATROPHIC VAGINITIS/URETHRITIS, PHARMACOLOGIC THERAPY, PSYCHOLOGICAL, EXCESS FLUID OUTPUT, RESTRICTED MOBILITY, AND STOOL IMPACTION
4 TYPES OF INCONTINENCE
TRANSIENT, URGE, STRESS, AND OVERFLOW
WHAT IS STRESS INCONTINENCE CAUSED BY?
INCREASED ABDOMINAL PRESSURE
WHAT IS OVERFLOW INCONTINENCE CAUSED BY?
DUE TO BLADDER OUTLET OBSTRUCTION OR IMPAIRED DETRUSOR CONTRACTILITY
WHEN SHOULD THE USE OF ABSORBENT PADS BE CONSIDERED?
ONLY WHEN ALL OTHER TREATMENTS HAVE BEEN TRIED
MEDICATIONS THAT CONTRIBUTE TO ACUTE RENAL FAILURE
AMINOGLYCOSIDE ANTIBIOTICS, NSAIDS, AND ACE INHIBITORS
WHAT TEST SHOULD BE ORDERED SHORTLY AFTER INITIATING ACE I THERAPY IN ELDERLY?
RENAL FUNCTION TESTS
XOMPLICATION OF ACUTE RENAL FAILURE
HYPERKALEMIA
THIS IS THINNING AND FISSURING OF ARTICULAR CARTILAGE THAT OCCURS WITH AGING
OSTEOARTHRITIS
WHAT IS INITIAL THERAPY FOR OA?
TYLENOL 1000 MG OR LESS , 4 TIMES DAILY
WHAT IS THE RISK WHEN NSAIDS ARE USED FOR OA?
GI BLEED
MORE COMMON GOUT INVOLVEMENT IN ELDERLY
POLYARTICULAR AND UPPER EXTREMITY INVOLVEMENT
THIS MEDICATION USED FOR GOUT IS NOT WELL TOLERATED IN ELDERLY? WHAT IS THE ALTERNATIVE?
INDOCIN NOT WELL TOLERATED SO USE ANOTHER NSAID OR PREDNISONE
THIS IS CONSIDERED A SOCIOBIOLOGICAL EVENT MARKING A WOMEN’S ENTRY INTO A NEW LIFE PHASE
MENOPAUSE
AGE WHEN PERIMENOPAUSE STARTS IN MOST WOMEN
45-55
WHAT IS THE CRITERIA TO SAY SOMEONE HAS BEEN THROUGH MENOPAUSE?
CESSATION OF MENSES FOR 12 MONTHS AND LOW SERUM ESTRADIOL LEVEL (OTHER SIGNS OF HOT FLASHES, ETC MAY ALSO BE PRESENT)
THESE ARE CAUSES OF IRRITABILITY, SLEEPLESSNESS, AND DEPRESSION THAT MAY ADVERSELY AFFECT SEXUAL INTEREST IN MENOPAUSAL WOMEN
SEVERE DECREASE IN ESTROGEN AND PROGESTERONE ASSOCIATED WITH CESSATION OF OVARIAN FUNCTION
WHAT CAN INADEQUATE VAGINAL LUBRICATION CAUSE?
DYSPAREUNIA (PAINFUL INTERCOURSE) AND VULVOVAGINITIS (INFLAMMATION OF VULVA AND VAGINA)
TREATMENTS FOR INADEQUATE VAGINAL LUBRICATION
WATER SOLUBLE LUBRICANTS AND SOMETIMES ESTROGEN REPLACEMENT
WHAT MIGHT SOME WOMEN CONSIDER ADVANTAGES TO MENOPAUSE?
CESSATION OF MENSES AND NO FAMILY PLANNING CONCERNS OR UNWANTED PREGNANCIES
WHAT PERCENTAGE OF PEOPLE OVER 65 FALL EACH YEAR?
30%
WHAT PERCENTAGE OF THE ELDERLY WHO SUFFER FALLS, SUFFER MULTIPLE FALLS?
50%
THE LIKELIHOOD OF FALLING INCREASES WITH _____.
AGE
WHAT ELDERLY GROUP FALLS MOST?
FRAIL, ALTHOUGH ACTIVE ELDERS FALL TOO DURING DAILY ACTIVITIES
CONSEQUENCES OF FALLING
DEATH, SERIOUS INJURY, INABILITY TO GET UP, FEAR, LOSS OF CONFIDENCE
ONE OF THE TOP TEN CAUSES OF DEATH IN THE ELDERLY
UNINTENTIONAL INJURY (FALLS)
MOST FEARED MORBID OUTCOME FROM FALLING
HIP FRACTURE
MOST COMMON AGE RELATED FRACTURES
VERTEBRAL, HUMERAL, WRIST, PELVIC, AND HIP FRACTURES
WHAT PERCENTAGE OF FALLS IN ELDERLY PERSONS RESULT IN FRACTURES?
5%
MEN OR WOMEN SUFFER MORE FALLS AND SOFT TISSUE INJURIES?
WOMEN
WHAT GROUP IS AT GREATER RISK PER FALL- FRAIL OR MORE ACTIVE HEALTHY?
MORE HEALTHY
__________________________ OCCURS IN 50% OF FALLS.
INABILITY TO GET UP WITHOUT ASSISTANCE
WHAT ARE THE CLINICAL AND PUBLIC HEALTH IMPLICATIONS RELATED TO FALLS?
PATIENTS HAVE A DECLINE IN ADL’S AND PHYSICAL AND SOCIAL ACTIVITIES; GREATER CHANCE OF INSTITUTIONALIZATION AND UTILIZE MORE HEALTH CARE
MOST CONSISTENT PREDICTOR OF FALLS IN THE ELDERLY
SEDATIVE USE