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137 Cards in this Set

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  • Back
  • 3rd side (hint)
In 1999 what percent of the US population was 65 or older?
13% or 34.5 mllion
What age group will increase the fastest?
A. 50 and over
B. 65 and over
C. 75 and over
D. 85 and over
D. 85 and over
Increased Mortality of older adults is due to
A. Widowhood
B. Death of family, especially siblings.
C. Recognizing declining function.
D. None of the above
E. All the above.
E. All the above.
What percentage of elderly live in poverty? Consider an apartment complex with six apartments. How many of the residents are poor who live there?
17% or 1/6
Atchley has identified 5 stages of retirement. What are they?
Remote phase - anticipation but no preparation.
Near phase - Reality is evident, beginning to prepare.
Honeymoon phase - immed after retirement. Epheuoria. Trying to do all they didn't do while working Financial limitations.
Disenchantment phase - "let-down"
Reorientation - more realstic choices and alternate souces of satisfaction
In what culture is old age a triumph. HTN is their major issue.
African Amercans
What culture expects their family to care for the elderly. Old age is considered a blessing.
Asian
In what culture is youth valued and elderly are instutionalized?
Caucasian
What culture believe their states of health and illness are actions of God. Older relatives are held in high esteem.
Hispanics
The people of this culture have a strong sense of identity and shared beliefs. Their religious traditions are of great importance.
Jewish American
HTN Pharm Choice for Heart Failure.
No CCB See Hint card
Give Thiazide, BB, ACEI, ARB, Aldosterone Antagonist
HTN Pharm choice for Post MI
No thiazide, no ARB, no CCB
Give BB, ACEI, aldosterone antagonist
HTN Pharm Choice for high CVD risk. See hint card.
No aldosterone antagoinst
Give thiazide, BB, ACEI, CCB
HTN Pharm Choice for Chronic Kidney disease
No thiazide, beta blocker, CCB. See hint card.
Give ACEI and ARB
HTN Pharm Choice for Diabetes
No aldosterone antagonist, See hint card.
Give thiazide, BB, ACEI, ARB, CCB
HTN for stroke prevention
No ARB, CCB, BB, Aldosterone antagonist. See hint card.
Give Thiazide, ACEI
What condtion do you not give ARB?
Stroke preventon and Heart Failure
What condition do you not give a thiazide?
Kidney disease and post MI
What condition do you not give ACEI?
It is OK for all conditions
What condition do you not give CCB?
Heart Failure, Post MI, Chronic kidney disease, recurrent stroke prevention
What condition do you not give a BB? Can't PP, then no BB.
Chronic kidney disease, Recurrent kidney disease
What condion do you not give Aldosterone Antagonist?
Diabetes, Chronic kidney disease, Recurrent stroke prevention.
A list of Loop Diuretics
Furosemde, Bumetanide (Bumex), Torsemide (demedex)
A list of Potassium-sparing diuretics
Amiloride, spironolactone, triamterene
A list of Beta Blockers
Propanolol, nadolol (corgard), penbutolol, atenolol (tenormin), metoprolol (lopressor), among many others
Name some beta-blockers with some alpha-1 blocking activity
labetolol (trandate), carvediol (coreg)
A list of ACEI
Benzapril (lotensin), Catopril (capoten), Enalapril (vasotec), lisinopril (zestril), Ramipril (altace). Notice the ****Pril's
A list of ARBs
You can get a tan on ARB beach.
Notice the "tans." Losartan (cozaar), valsartan (diovan), irbesartan (avapro), Olmesartan (benicar), among others
A list of Calcium Channel Blockers
Diltiazem (cardizem), amlodipine (norvasc), verapamil (calan), amont others. Note the "pines."
A list of Alpha 1 antagonists
Doxazosn (cardura), Prazosin (minipress), Terazosin (hytrin)
A list of centrally acting alpha agonists. Consider the Child psychiatric CENTER.
Clonidine, Gunafacine (tenex), methydopa (aldomet).
A list of vasodilators. That means you get more blood to places, like your scalp.
Minoxidil (loniten), Hydralazine (apresoline).
Skin: Morphology

Abscess
Localized collection of purulent fluid in a cavity formed by disintegration or necrosis of tissues >1cm
Skin: Morphology

Bulla (blister)
Circumscrised elevation of skin >=1 cm in diam. containing liquid membranous lining and containing fluid or semisolid material. Blister on the foot.
Skin: Morphology

Cyst
Closed cavity or sac (norm or abnorm) with an epithelial, endothelial or membranous lining and containing fluid or semisolid material.
Skin: Morphology

Macule
Circumscribed flat area of skin, different in color or texture from its surrounding tissue <1cm diam. with a patch being larger
Skin: Morphology

Nodule
Solid mass of the skin with can be observed as an elevation or can be palpated, usually 1 cm in diam or more
Skin: Morphology

Papule
Small solid elevation of the skin, <1cm in diam.
Skin: Morphology

Patch
Large macule >1 cm in diam

Skin: Morphology

Plaque
Elevated area of skin >1cm with relatively broad flat surface which appears like a plateau in cross-section; may have the same subdivision as mentioned under papule: Classic is psoriasis
Skin: Morphology

Pustule
A visiblue accumulation of purulent fluid in the skin <1cm
Skin: Morphology

Tumor
Enlargement of the tissues by normal or pathological material or cells that form a mass; may be inflammatory or a begign or a malignant new growth of cells or tissue.
Skin: Morphology

Vesicle
A curcumstribed elevation of the skin <1cm in diameter and containing a serous fluid.
Skin: Morphology

Wheal
Elevated white or pink compressible, evanescent papule or plaque produced by dermal edema; a red, axon-mediated flare often surrounds it: associated commonly with allergic reactions.
Skin: Configuration

Annular
Circular, begins in center and spreads to periphery
Skin: Morphology

Confluent
Lesions run together
Skin: Morphology

Grouped
lesion cluster
Skin: Morphology

Gyrate
twisted, streak, line, stripe
Skin: Morphology

Linear
Scratch, streak, line, stripe
Skin: Morphology

Polycyclic
annular lesions merge
Skin: Morphology

Solitary or discrete
Individual and distinct lesions that remain separate
Skin: Morphology

Target
Iris, resembles iris of eye, lesions with concentric rings of color.
Skin: Morphology

Zosteriform
Liner arrangement along a nerve route.
Skin

Impetigo.
Skin infection caused by staph, primary lesion is a thin walled vesicle that breaks easily. There is lateral extension of the superficial leasion with HONEY COLORED CRUST at the edge.
Skin

Carbuncle
Necrotizng infection of skin and subcutaneous tissue composed of a grou of furnucles (boils) - staph - much larger than furucle, may heal with significant scarring.
Skin

cellulitis
Inflamation of cellular tissue, particularly purulent inflamation of dermis, subcutaneus tissue and soft tissue.
Skin: Fungal infections

Candida Balanitis
inflamation of superficial tissues of penile head caused by candid albicans
Skin: Fungal infections

Candida Intertrigo
irritation of the folds of the skin, common in warm moist body areas like underarms, groin, under breasts, under folds of skin of abdomen of persons who are obese.
Skin: Fungal infections

Tinea capitus
scalp (trichophyton 80% or microsporum) tx with selsun blue (NEVER head and shoulders)
Skin: Fungal infections

Tinea corporis
Ringworm (trichophyton or microsporum)
Skin: Fungal infections

Tinea crusis
Jock itch
Skin: Fungal infections

Tinea pedis or mannum
pedis, athletes foot and mannum hand. Tx. Aluminum subacetate sol. soaks (if dry, use miconozole, etc.; powder if wet)
Skin: Fungal infections

Tinea unquim
onchomycosis, toe nails T. rubrum 80% of all cases
Skin: Fungal infections

Tinea Versicolor
Hypo/hyperpigmentaton macules on limbs. fungual infection of the skin caused by the yeast Pityrosprum orbiculare). Tx with selsun blue (on at night, bathes in am.)
Keratoses and Skin Cancers:

Actinic Keratoses
small patches that occur on sun exposed parts of the body. Asymptomatic and consicered premalignant although 1:1000 leasions per year grogress to squamous cell carcinoma. Rough in texture. May be tender.
Keratoses and Skin Cancers:

Squamous cell cancer. No treatment needed.
Arise out of actinic keratoses and develop in the course of a few months. Has 3-7% potential for mets. Occurs subsequent to prolonged sun exposure on exposed parts in fair skinned individuals who sunburn easily. Friable (bleeds easily). Surgical excision
Keratoses and Skin Cancers:

Seborrheic Keratosis
Benign skin lesions, common in elderly. Appears "stuck on" and is 3-20 mm in dm.
Keratoses and Skin Cancers:

Basal Cell Carcinoma
THE MOST COMMON SKIN CANCER. Found mostly in 60-70 Y/O. Papule or nodule that may have a central scab or erosion. Most common on face. Little risk of mets, but cosmetic deformity f untreated for prolonged period. Surgical excision.
Keratoses and Skin Cancers:

Malignant Melanoma
Highest mortality rate of all skin ca with median age of 40 at dx. May metastasize to any organ. Rapid or indolent (slow) growth. Asymmetry Border irregularity Color variation D>6 mm Elevation Enlargement
Keratoses and Skin Cancers:

Atopic Dermatitis (eczema)
intense itching along a typical pattern of distribution with remission and and exacerbation. Sensitive to low humidity, winter, triggered by sweating, ointments, hot baths and animal dander.
Keratoses and Skin Cancers:

Allergic Contact Dermatitis
Acute or chronic condition characterized by skin inflammation at the site of contact with chemicals or allergens.
Keratoses and Skin Cancers:

Psoriasis
Benign hyperproliferative inflammation of the skin that can be acute or chronic; Koebners phenomenon: Injury or irritation tends to induce lesions of psoriasis. Has pitting of the nails strongly suggests psoriasis, Auspitz sign - droplets of blood when scales removed.
Keratoses and Skin Cancers:

Pityriasis Rosea
Mild, acute inflammatory disorder, more common in females (50% more than males) 1-30 age group, sprin and fall seasons; self limiting. Initial lesion 2-10 cm "herald patch". Christmas tree pattern - follows cleavage lines on the trunk.
Keratoses and Skin Cancers:

Lyme Disease
Most common vector born disease in the us. Multisystem inflammatory disorder caused by spirochete transmission. Distinctive "bulls-eye" macular or popular rash. Flu like, sick, fever,chills.
Keratoses and Skin Cancers:

Warts
Common: Children and young adult
Filiform: found near moth, beard, periorbital and paranasal.
Flat: forhead, back of hands, mouth and beard area
Plantar: point of maximum pressure.
Genital: HPV most common viral STD.
Pyelonephritis is a bacterial infection in the kidney and renal pelvis. What are the two F's that are the hallmark symptoms?
Fever and Flank pain
What is the key symptom of a lower UTI?
Dysuria
What is the treatment of choice for geriatric UTI's?
Trimethprim/Suflamethoxazole DS BID x 7-10 days and ciprofloxacin 250 mg BID X 7-10 days.
What are the instructions for taking Boniva (Ibandronate)?
Take 1 hr. before eating and sit up 1 hr. after.
What are the instructions for taking Foxamax (alendronate)?
Take 30 min. before eating and sit up for 30 min. after.
What is the daily requirement for a woman over 65 for calcium?
1500 mg
What is the main reason for osteoporosis?
Hypoestrogen.
What are the risks of HRT?
MI, DVT, Breast Ca.
A woman has a breast lump that is firm, fixed, and non-tender. What is it likely to be?
Cancer
A lump palpated that is mobile, tender, and squishy, what is it likely to be?
Fibrocystic or a lipoma.
Regarding the symptoms of PDD (premenstrual dysphoric disorder), what is the time element.
It occurs 7-10 days prior to menses and ends when the menses begins.
The difference between the symptoms of a UTI and epididymitis is what?
Scrotal edema.
What tests are done for epididymitis?
STD, Urine Culture, and scrotal ultrasonography if condition worses or febrile episodes unresponsive to antibiotics.
Regarding ipididymitis, there is a positive phrens. What is that?
Lift the scrotum and it feels better. If there is torsion there is a negative phrens.
Acute Bacterial Prostatitis. What are the symptoms?
Fever/chills, low back pain, dysuria, urgency/frequency, nocturia. The PE: fever. prostate on palpation is very painful, it is swollen, may be warm and tender, may be firm or boggy.
Treatment for prostatits is what?
Over 35 years old, Bacrim DS BID for 2-4 weeks.
BPH is the most common cause of bladder obstruction in men over 50 years old. What treats it?
Terazocin or Prazocin.
PSA tests for prostatic specific antigens. What is the lowest normal to be concerned about?
4 ng/ml. If it is 10 there is almost surely prostate cancer.
What percent of patients have a normal PSA, yet are diagnosed with prostate cancer.
40%
Which should come first; PSA or DRE?
PSA. A DRE can increase the PSA.
Who definitely should be on a medication for BPH?
Men over 50 with BPH.
Regarding AIDS, the killer pneumonia is no longer PCP, but now Pneumocystis jirovecii (PJP). What is the prophylactic treatment?
Bactrim DS.
What is the most common allergic reaction?
Allergic drug eruption.
What is the treatment for an allergy to a drug.
Stop the drug and use an antihistamine for itching.
What is the most common dermatological problem among elderly?
Itching, or senile pruritis.
What are some symptoms of frost bite?
numbness, pain, tingling, burning sensation. 1st through 4 degree issues like a burn.
Treatment for frost bite.
Don't touch, rub, or use pressure.
Causes of Cellulitis
Prior trauma, underlying skin lesion, diabetes, pedal edema, and venous and lymphatic compromise.
What does cellulitis look like?
It is tender, pain, swelling, red and warm. sounds like infection to me.
Proten is measured by?
Albumin. Below 3.5% indicated protein malnutrition and retards healing
B12 deficiency may result in what?
Anemia, depression, anorexia, fatigue
Vitamin C. What happens with too much or too little?
Too much can cause anorexia and gastric irritation. Too little can cause scurvy. No evidence it helps wound healing.
What is Vitamin E good for?
Cardiovascular, memory, antioxidant, immunity. Caution - may act as anticoagulant.
Iron supplements can cause what?
Anorexia, diarrhea, constipation.
What are some causes of dysphagia?
Myasthenia gravis, Parkinson's disease,CVA, Amyotrophic lateral sclerosis, MS, Bulbar poliomyelitis, Polyneuropathies, Muscular dystrophies, endocrine myopathy/structural lesions, CA, Cricoid Webs, Anterior cervical osteophytes, postsurgical scarring, inflammatory lesions.
What is Odynophagia?
Painful swallowing.
Workup for dysphagia.
R/O metabolic, endocrine pathology, barium swallow, endoscopy, esophageal manometry (motility disorders), CXR for aspiration, Refer to SLP, GI, Dentist, neurologist.
Cachexia
Increased protein breakdown, metabolic demands, changed protein synthesis, increased cytokinin producion.
Cachexia is a syndrome manifested by?
anorexia, weight loss, metabolic alterations and weakness.
Cachexia is associated with?
Cancer, pulmonary disease, end-stage cardiac, RA, end stage dementia. Cardiac disease associated cachexia / incr BMR, protein synthesis, enteropathy and early satiety resulting in protein losses.
Management of cachexia.
Treat underlying pathology, control pain, manage depression, manage early satiety, deal with fatigue, control GI upset/N/V, address xerostoma.
Labs for workup
CBC with diff, B12, folate, lipids, liver panel, lytes, ca, Phosophorous,BUN, Creat, thyroid profile, Glucose.
Pharmacokinetic changes and the elderly.
Absorption: No change
Distribution: less lean body mass can cause increased plasma concentration.
Metab: decreased liver metab, blood flow and body mass leads to prolonged drug effects.
Excretion: Decreased GFR, tubular secretion, and renal mass reduces renal clearance on most drugs.
Receptor changes in elderly.
May up or down regulate with age.
Common Adverse Reactions in elderly.
CNS: sedation, memory loss, dizziness, depression, confusion.
Anticholinergic: Blurred vision, urinary retention, constipation dry mouth.
Effects on movement and balance
Effects on bone and supporting structures.
Most common Drugs to cause CNS S/E
Benzo's, antipsychotics, beta-blockers, steroids, cimetidine, reserpine, narcotics, diuretics.
Most common drugs to cause anticholinergic S/E
Cholinergic agonists, tricyclic antidepressants, antipsychotics
Most common drugs to cause S/E on balance and movement.
Neuroleptics, metronidazole, phenytoin, ASA, aminoglycosides, furosemide, beta-blockers, vasodilators, metoclopramide.
Most common drugs to cause S/E on bone and supporting structures.
Steroids, heparin, Li.
Issues related to safe drug use.
45% are reported for nonadherence, multiple medication: over age 65 medicaid pts take over 13 drugs per year.
More OTC.
Often use medications belonging to someone else and often herbs
Risks associated with polypharmacy.
Increased morbidity,medical expense, AE, incidence of depression,nursing home admission.
OTC offenders to polypharmacy.
Cimetidine, Niacin, antacids, laxatives, CA (may decrease absorbance of thyroid hormones), tetracyclines.
Herbal agents that complicate polypharmacy.
Aloe (PO): incr. cardiac glycosides and thiazides.
Feverfew: potentiates anticoagulants.
Garlic: potentiates oral antidiabetics.
Gingko: potentiates anticoagulants.
Ginseng: decreases effect of furosemide and has estrogen effects.
Hawthorn: interacts with antihypertensives and cardiac medicines.
St. John's Wort: incr. s/e of SSRI's.
Kava-kava: increases effects of benzo's, etoh. and other cns depressants.
Licorice: conraindicated in pts taking cardiac glycosides and thiazides.
Green tea: potentiates anticoags.
How much acetaminophen is toxic?
over 4G/day
If patient is allergic to PCN what are they likely allergic to?
Cephalosporins
Antibiotics with renal clearance:
PCN, Cephalosporins, Aminoglycosides, Quinolones, tetracyclines, vancomycin.
Antibiotics with hepatic clearance:
Macrolides (azithromycin, clarithromycin, erythromycin), Clindamycin, Flagyl (also renal), Linezolid [(Zyvox) also cleared by renal.]
Antifungals cleared by renal
Amphotericin, Flucytosine, Fluconazole, Ketoconazole (also hepatic), Miconazole (also hepatic).
Antifungals cleared by liver.
Griseofulvin, Itraconazole.
Warfarin monitoring, used for systemic embolism.
To prevent embolism INR should be 2.0-3.0 (target 2.5). If INR is elevated above 5 the next doses are held until it is back in range. May use VITK to reverse effects within 24 hours.
Heparin IV used for venous thrombosis and PE; monitoring.
CBC with platelets Q 3 days.
PTT 6 hours after bolus and 6 hours after each dosage result. Monitor PTT Q 24 hours and readjust heparin drip prn.
Antidote to heparin?
Protamine Sulfate. DO NOT USE IN PATIENTS ALLERGIC TO FISH.