Mcphs Geriatrics Rotation Final

Front 1

The pathognomonic feature is an acute change in baseline mental status developing over hours to days.

Back 1

Delirium

Front 2

With this you see perceptual disturbances, such as hallucinations, or paranoid delusions. This occurs as a fluctuating course with an increase or decrease in symptoms over a 24 hour period.

Back 2

Delirium

Front 3

This is defined as memory impairment and at least 1 or more of the following; language impairment, apraxia (inability to perform previously learned tasks); visuospatial deficits; decreased executive functioning (poor abstraction, planning, judgement).

Back 3

cognitive impairment and dementia

Front 4

This is the most common form of dementia, accounting for approximately sixty six percent of patients with dementia.

Back 4

Alzheimer's Disease

Front 5

Mild Cognitive Impairment is associated with an increased risk of ?

Back 5

Alzheimer's Disease

Front 6

What is the genetic testing used to detect dementia/alzheimers?

Back 6

APOE genotyping

Front 7

Routine brain imaging in the diagnostic evaluation of a patient with cognitive impairment or dementia is controversial.

True or False?

Back 7

True

Front 8

These drugs for tx of Alzheimer's Disease have modest benefits on cognition, physical functioning, and behavior.

Back 8

Acetylcholinesterase inhibitors

Front 9

These result from disease in 1 or more organ systems related to balance; sensory input (visual, vestibular, and proprioceptive), central (neurological) processing; and effector output (neuromuscular and musculoskeletal).

Back 9

Falls and Mobility Disorders

Front 10

This may result in a syncopal fall; loss of consciousness may not be reported because of amnesia for the event.

Back 10

Transient cerebral hypoperfusion

Front 11

What are the acute factors that may contribute to falls and mobility disorders?

Back 11

Infectious, toxic, metabolic, ischemic, or iatrogenic.

Front 12

Medications, especially what class of drugs, increase the risk for falls?

Back 12

Psychotropic drugs

Front 13

This is effective in decreasing falls in the community, nursing home, and assisted-living-settings.

Back 13

Multifactoral intervention

Front 14

Exercise, particularly this, should be offered as part of a multifactoral intervention for high-risk older adults.

Back 14

Balance training

Front 15

For low risk older adults, this type of exercise is likely effective as a single intervention to prevent falls.

Back 15

group-based balance exercises

Front 16

These are highly protective against hip fractures?

Back 16

Hip protector pads

Front 17

This should come to mind if you see any combination of resting tremor, bradkykinesia, rigidity, and postural instability.

Back 17

Parkinson's Disease

Front 18

What is the norm with Parkinson's, asymmetric or symmetric onset?

Back 18

Asymmetric onset.

Front 19

Parkinson's responds well to what drug in most cases?

Back 19

Levodopa

Front 20

True or False?

Long acting carbidopa-levodopa has not been found to reduce dyskinesias compared with short acting carbidopa-levodopa.

Back 20

True

Front 21

What are the newer drugs used for Parkinson's TX? They have been fround to be similar in effectiveness to levodopa for symptom control and disability reduction. They also have been associated with fewer complications than levodopa alone at 2-5 years.

Back 21

Dopamine Agonists - Pramipexole, Ropinirole, Amantadine

Front 22

This drug has been found to be more effective than placebo against drug-induced psychosis caused by Parkinson's Drugs (dopamine agonists primarily), and has not been found to worsen Parkinsonism. It also had a positive effect on tremor.

Back 22

Clozapine

Front 23

These drugs, if used to TX psychosis associated with Parkinsons, will actually make the Parkinson's worse?

Back 23

Typical Antipsychotics - Haloperidol

Front 24

These are characterized by a bilateral action tremor of the hands and forearms and possibly the head, voice, trunk and legs.

Back 24

Essential tremor

Front 25

This often has no other neurological signs, the patient has a positive family history, and their is a beneficial response to alcohol.

Back 25

Essential tremor

Front 26

What are two drugs used to TX essential tremor?

Back 26

Primidone and propranolol

Front 27

What are two interventional therapies for essential tremor and which one is associated with fewer adverse events.

Back 27

Unilateral thalamotomy and deep brain stimulation.

Deep brain stimulation is associated with fewer adverse events.

Front 28

This is associated with the following:

Depressed mood
Loss of interest or pleasure in almost all activities
Unintentional weight change, lack of energy, change in sleep pattern, psychomotor retardation or agitation, excessive guilt, or poor concentration.
Suicidal ideation or recurrent thoughts of death
Somatic rather than mood complaints in the elderly.

Back 28

Depression

Front 29

What three antidepressants are usually avoided in the elderly?

Back 29

MAOI's

TCA's

Fluoxetine - Long half life and CP450 inhibitor.

Front 30

If someone has a history of manic episodes: grandiosity, decreased need for sleep, pressured speech, racing thoughts, distractibility, increased activity, excessive spending, hypersexuality.

May be associated with psychosis

Depressive episodes may alternate with mania.

Mania may present for the first time in elderly patients, usually in those with a history of depressive episodes.

Back 30

Bipolar Disorder

Front 31

This is characterized by sudden, recurrent, unexpected panic attacks with palpitations, dizziness, sensation of dyspnea or choking. Attacks may include trembling, chest pain or discomfort, nausea, diaphoresis, paresthesias, and depersonalization.

Back 31

Panic Disorder

Front 32

Panic disorder can be accompanied with this?

Back 32

Agoraphobia - Fear of being in places where attack might occur

Front 33

This is an irrational fear leading to intentional avoidance of a specific feared object, event, or situation.

Back 33

Social and/or Specific Phobias

Front 34

What is the TX for panic disorder?

Back 34

Cognitive Behavioral TX

Front 35

What is the first line therapy for TX phobias?

Back 35

Behavioral Therapy

Front 36

This is when a patient has unrealistic or excessive worry about two or more life circumstances. Worry is recurrent and difficult to control. Physiological symptoms of restlessness, fatigue, irritability, muscle tension, and sleep disturbance can occur.

Back 36

Generalized Anxiety Disorder

Front 37

What is one of the most effective TX's for generalized anxiety disorder.

Back 37

Cognitive Behavioural Therapy

Front 38

This occurs when a patient has a history of exposure to a traumatic event. Intrusive thoughts, nightmares and flashbacks can occur. Avoidance of thoughts, feelings, or situations associated with the trauma occur. Isolation, detachment from others, emotional numbness can occur. Symptoms of arousal such as sleep disturbance, irritability and hypervigilance can occur.

Back 38

Post Traumatic Stress Disorder

Front 39

Post Traumatic Stress Disorder is frequently associated with what two things?

Back 39

Depression and Substance Abuse

Front 40

What is the TX for PTSD?

Back 40

SSRIs and TCAs can be used, also group and individual cognitive behavioral therapy.

Front 41

This is when a patient shows a loss of ego boundaries and gross impairment in reality testing. Prominent delusions, auditory/visual hallucinations can occur. Pts have a flat or inappropriate affect. Disorganized speech, thought processes, or behavior can occur.

Back 41

Schizophrenia and Psychotic Disorders

Front 42

What are the mainstays of therapy for Schizophrenia and Psychotic Disorders?

Back 42

Antipsychotic agents such as risperidone, olanzapine, quetiapine, and clozapine.

Front 43

This is when a pt complains of poor sleep quality. Daytime symptoms of fatigue, irritability, or problems with concentration can occur. This diagnosis is made clinically.

Back 43

Insomnia

Front 44

What are the various TX options for insomnia?

Back 44

Sleep Hygiene

Behavioral Therapy

Bright light therapy

Prescription Meds - Benzodiazepines

Non Prescrip. Meds - Diphenhydramine, Melatonin

Front 45

This can be a possibility if the patient is snoring, choking, and having altered breathing during the night. Pts may have daytime sleepiness. Morning headache and cardiovascular complications may be present. Polysomonography is used to confirm the diagnosis.

Back 45

Sleep Apnea

Front 46

This is when a pt is acting out dreams with movements and behaviours. May present with injury in patient or bed partner. Often associated with other neurological disorders, such as dementia and Parkinson's disease. Diagnosis is made by polysomnography.

Back 46

REM Sleep Behavior Disorder

Front 47

What drug has been shown to TX REM sleep behavior disorder in 90% of cases?

Back 47

Clonazepam

Front 48

What is the best pharmacological TX for Periodic Limb Movement Disorder and Restless Legs Syndrome?

Back 48

Dopaminergic agents - Carbidopa-Levidopa, or doapmine agonistis such as pramipexole or ropinirole

Front 49

This is a lens opacity that can be observed through a well dilated pupil with an ophthalmoscope or slit lamp.

Back 49

Cataracts

Front 50

Symptoms of this may include blurred vision, increased glare, multiple images, alterations in color, and streaking of lights at night.

Back 50

Cataracts

Front 51

What are the three main types of cataracts?

Back 51

Nuclear, Cortical, and Posterior Subscapular

Front 52

This is characterized by degeneration of the macular retina, leading to symptoms of central vision loss or distortion.

Back 52

Age-Related Macular Degeneration

Front 53

This is often the first sign of macular degeneration.

Back 53

The appearance of drusen, or yellow-white deposits apparent under the retina during dilated eye exam.

Front 54

Prompt ophthalmic evaluation is necessary to assess the need for laser therapy whenever a pt with this experiences sudden vision loss.

Back 54

Age Related Macular Degeneration

Front 55

What are the two modifiable risk factors currently known for Age Related Macular Degeneration development?

Back 55

Hypertension and Smoking

Front 56

This is characterized by microaneurysms, intraretinal hemorrhages, hard exudates, macular edema, and cotton wool spots (retinal infarcts).

Back 56

Nonproliferative diabetic retinopathy

Front 57

This is typified by neovascularization of the optic disk and retina, preretinal and vitreous hemorrhages and development of fibrotic vitreoretinal bands, which lead to retinal wrinkling and tractional retinal detachment.

Back 57

Proliferative diabetic retinopathy

Front 58

These two things help to minimize the development and progression of diabetic retinopaty.

Back 58

Good glycemic control and aggressive treatment of hypertension.

Front 59

The risk of of developing severe visual loss from proliferative diabetic retinopathy and macular edema can be reduced significantly by the use of ?

Back 59

Laser photocoagulation

Front 60

Diagnosis of this is based on optic disk examination, intraocular pressure, and visual field measurement. Diagnosis is made on the basis of routine periodic ophthalmoscopy and tonometry.

Back 60

Glaucoma

Front 61

TX for glaucoma focuses on lowering what?

Back 61

Intra ocular pressure

Front 62

The most common pattern of hearing loss in older adults is this? It is a bilateral high frequency sensorineural hearing loss that occurs with advancing age.

Back 62

Presbycusis

Front 63

The reversible causes of conductive hearing loss in the elderly include what three things?

Back 63

Otitis externa, cerumen impaction, foreign objects obstructing canal.

Front 64

What are two reasons for outer ear causes of conductive hearing loss?

Back 64

Infection and Tumors

Front 65

What six reasons can cause conductive hearing loss in the middle ear?

Back 65

1. Infection
2. Tumors
3. Cholesteatoma (hearing loss and recurrent ear drainage)
4. Otosclerosis (bony overgrowth affecting footplate of the stapes)
5. Tympanic membrane perforation
6. Vascular (Benign pragangliomas such as glomus tympanicum or jugulare tumors - look like red, blanchable mass behind the tympanic membrane)

Front 66

What are nine reasons for inner ear hearing loss in the elderly?

Back 66

1. Presbycusis
2. Noise
3. Infection
4. Meniere's disease - low frequency hearing loss with vertigo
5. Trauma
6. Tumors
7. Endocrine/Systemic - Diabetes, Hypo/Hyperthyroidism, syphilis
8. Iatrogenic- drugs that are ototoxic
9. Neurogenic - Stroke, TIA, MS, Arnold Chiari malformations.

Front 67

These significantly improve the quality of life of patients with sensorineural hearing loss.

Back 67

Hearing aids

Front 68

This is a cost effective means of auditory rehabilitation for individuals with advanced sensorineural hearing loss that cannot be adequately treated with hearing aids.

Back 68

Cochlear implants

Front 69

This is a sudden but brief loss of consciousness and postural tone with rapid recovery.

Back 69

Syncope

Front 70

What is the main cause of syncope and presyncope in geriatric patients.

Back 70

Cardiovascular problems.

Front 71

What are the special tests to diagnose the underlying cause of syncope? 8 things

Back 71

1. EKG
2. Echocardiography
3. Ambulatory monitoring
4. Tilt Table Testing
5. Continuous loop event recording
6. Neurological studies
7. Brain imaging, carotid ultrasonography, and Magnetic resonance angiography
8. Psychiatric evaluation.

Front 72

It is important to differentiate syncope from what?

Back 72

dizziness

Front 73

What should be the first disease associated with syncope in the elderly?

Back 73

Cardiac

Front 74

Dizziness is defined by four symptom categories, what are they?

Back 74

1. vertigo
2. dysequilibrium
3. presyncope
4. light headedness

Front 75

Several important findings must not be missed when evaluating dizziness. This includes what six things?

Back 75

Syncope
Signs of infection
Mental status changes
Neurological findings
Signs of fluid loss

Front 76

This presents as a neurological deficit or headache of abrupt onset.

Back 76

Stroke

Front 77

Hemorrhagic strokes can be classified as what two things?

Back 77

Intracerebral or subarachnoid

Front 78

What is essential for diagnosis of stroke?

Back 78

Urgent neuroimaging

Front 79

What must be included in the differential diagnosis of stroke?

Back 79

Must exclude non-vascular causes

Front 80

What is the only approved TX available for acute ischemic stroke?

Back 80

rt-PA (recombinant tissue - type plasminogen activator) Pt must have this administered within a 3 hour window of the acute ischemic stroke.

Front 81

This is indicated in prevention of cardioembolic stroke (A. fib, high risk cardiac lesions).

Back 81

Warfarin

Front 82

This is a proven intervention to prevent stroke in patients with symptomatic stenosis of the carotid artery.

Back 82

Carotid endarterectomy

Front 83

This is a useful agent in preventing vasospasm after subarachnoid hemorrhage.

Back 83

Nimodipine

Front 84

This is substernal chest discomfort lasting at least 30 minutes. ST-Segment elevation or depression in 2 or more electrocardiographic leads with or without T-wave inversions or Q waves. Elevated levels of cardiac biomarkers, especially troponin I or T, or creatinine kinase-MB.

Back 84

Acute Myocardial Infarction

Front 85

What is the initial TX for acute MI?

Back 85

MONA - Morphine, Oxygen, Nitrates, Aspirin

Front 86

This is anginal chest discomfort of increasing severity or duration. ST-segment depression or T-wave inversion on the ECG. Absence of elevation of cardiac biomarkers.

Back 86

Unstable Angina

Front 87

What is the prompt TX for unstable angina?

Back 87

Aspirin, Nitrates and Beta-Blockers

Front 88

This is when a patient has chest discomfort provoked by exertion or emotional stress and relieved by rest or nitroglycerin. Exercise or pharmacological stress test demonstrating myocardial ischemia. Angiographic evidence of significant coronary artery obstruction.

Back 88

Chronic Coronary Heart Disease

Front 89

With this you will see chest pain, SOB, dizziness, syncope, harsh systolic ejection murmur at the right upper sternal border radiating to the carotid arteries. Echocardiography demonstrates a calcified aortic valve with increased systolic velocities and reduced orifice area.

Back 89

Aortic stenosis

Front 90

With this you will see dyspnea, palpitations, chest pain. You will hear a decrescendo diastolic murmur in the left third and fourth intercostal spaces. Echocardiography helps diagnose this.

Back 90

Aortic Insufficiency

Front 91

This can show up with a Hx of rheumatic fever or prior streptococcal infection. Exertional fatigue, hemoptysis, symptoms of heart failure are seen. Opening snap and mid diastolic rumbling murmur are heard. Echocardiogram demonstrating thickened mitral valve with restricted motion.

Back 91

Mitral Stenosis

Front 92

With this you will see exertional dyspnea or fatigue, orthopnea, peripheral edema. A holosystolic murmur at the apex radiating to the axilla can be heard. Echocardiography demonstrates this.

Back 92

Mitral regurgitation

Front 93

With this there is extertional dyspnea, fatigue, orthopnea, lower extremity swelling. Pulmonary rales, elevated jugular venous pressure, and peripheral edema are seen. Echocardiography reveals LV systolic or diastolic dysfunction.

Back 93

Heart Failure

Front 94

This is defined by exercise intolerance, shortness of breath, fatigue, palpitations, dizziness, and syncope. Sinus bradycardia, sinus pauses, paroxysmal supraventricular tachyarrhythmias accompanied by bradyarrhythimas are seen on EKG.

Back 94

Sick Sinus Syndrome

Front 95

Diastolic HTN is defined as?

Back 95

BP >90

Front 96

Systolic HTN is defined as?

Back 96

BP >140

Front 97

In the presence of normal diastolic BP (<90), systolic HTN is referred to as?

Back 97

Isolated systolic HTN

Front 98

What is the first drug of choice for stage 1 HTN (140-159/90-99)?

Back 98

Thiazide

Front 99

What agents improve HTN in geriatric patients.

Back 99

Beta Blockers
ACE inhibitors
Dihydropyridine CCBs

Front 100

common symptoms of this are leg discomfort with ambulation, rest pain, nonhealing ulcers, or gangrene. Abnormal pulse exam is seen in most patients. Evidence of systemic atherosclerosis is common. Hx of DM, tobacco use, HTN and/or hyperlipidemia is usually present.

Back 100

Peripheral Arterial Disease

Front 101

This should be used to screen for Peripheral Arterial Disease in outpatient primary care practices.

Back 101

Ankle-Brachial Index

Front 102

An Ankle Brachial Index of what is considered abnormal?

Back 102

<0.9

Front 103

Patients with evidence of atherosclerotic peripheral arterial disease should receive what to reduce risk of cerebrovascular and cardiovascular morbidity and mortality?

Back 103

antiplatelet therapy

Front 104

With this pitting edema, skin changes, including hyperpigmentation and varicose veins, limb pain with prolonged standing and chronic edema which can result in ulcer formation above the medial malleolus can be seen.

Back 104

Chronic venous insufficiency

Front 105

What is the mainstay of therapy for chronic venous insufficiency?

Back 105

Sized to fit compression garments are the mainstay of therapy

Front 106

This is usually seen with unilateral limb involvement, nonpitting edema involving the dorsum of the foot with squaring of the toes, a history of cellulitis, malignancy, surgery or trauma may be present. Skin changes of chronic venous insufficiency are absent.

Back 106

Lymphedema

Front 107

This is the most common secondary cause of lymphedema in the US?

Back 107

Cellulitis

Front 108

This is the test of choice to confirm the diagnosis of lymphedema.

Back 108

Lymphoscintigraphy

Front 109

What is the optimal therapy for lymphadema?

Back 109

decongestion techniques
excercise
daily use of compression garment

Front 110

Surgery, especially orthopedic, immobility and malignancy are common risk factors for this. Typical complaints include acute limb pain and swelling for DVT, pleuritic chest pain and SOB for pulmonary embolism.

Back 110

Venous thromboembolism

Front 111

What noninvasive diagnostic testing is included to diagnose venous thromboembolism?

Back 111

Venous duplex ultrasonography
ventilation perfusion scanning
Spiral (helical) CT

Front 112

This is characterized by episodic wheeze, dyspnea, cough, and chest tightness. Dyspnea and cough are often worse at night. Spirometry will show airflow obstruction that is at least partially reversible.

Back 112

Asthma

Front 113

The symptoms of this are dyspnea, cough, sputum production, and wheeze. The risk factors for this are smoking and air pollution. Spirometry will show airflow obstruction that is not fully reversible.

Back 113

COPD

Front 114

This is seen with excessive daytime sleepiness. Risk factors for this include obesity, or anatomic narrowing of the upper airway. Overnight sleep study will usually show abnormal breathing events.

Back 114

Sleep related breathing disorders (Sleep Apnea)

Front 115

This is the most common cause of cancer mortality in the 60-80 year age range in both sexes.

Back 115

Lung Cancer

Front 116

Which type of lung cancer is not surgically curable and has a generally poorer prognosis?

Back 116

Small cell lung carcinoma

Front 117

What are the best ways to diagnose a pulmonary embolism?

Back 117

Ventilation perfusion lung scan

Helical computed tomography scan

Pulmonary angiogram

Front 118

With this you will seen dyspnea, nonproductive cough, lung crackles and clubbing on physical exam

Back 118

Interstitial lung disease

Front 119

GERD is experienced monthly by at least 40% of elderly persons and usually requires ongoing therapy. What are the best therapeutic approaches in the elderly?

Back 119

TX of reflux can be started with a PPI along with initiation of lifestyle changes.

Front 120

What are the two main causes of peptic ulcer disease?

Back 120

NSAIDS or Helicobactor pylori

Front 121

Dyspepsia in the elderly requires what kind of work up?

Back 121

endoscopy to rule out ulcer or cancer.

Front 122

Acute episodes of upper gastrointestinal bleeding usually present with what three things?

Back 122

Hematemesis

Melena

Increased BUN/Creatinine ratio

Front 123

When working with a patient who has urinary incontinence, what are the various factors that should be considered before treatment?

Back 123

Search for the following: functional, comorbid, medications and fluid balance factors that can precipitate and exacerbate incontinence.

Front 124

This is seen with an abrupt rise in BUN or serum creatinine. Oliguria is common but not necessary. Early symptoms can be nonspecific or absent.

Back 124

Acute Renal Failure

Front 125

If you see proteinuria (by dipstick or quantitative). Microscopic hematuria or red blood cell casts, HTN is usual and peripheral edema is common.

Back 125

Glomerular disease

Front 126

This should be considered if refractory or new-onset HTN is seen after age 50, progressive renal insufficiency, decreased renal blood flow is seen by doppler or MRI.

Back 126

Renovascular disease

Front 127

If a patient has bilat. small kidneys by ultrasound, progressive azotemia over time, and a loss of urine concentrating ability.

Back 127

Chronic renal failure

Front 128

If a patient has plasma sodium under 130 mmol/L, plasma chloride concentration under 90 mmol/L, and their plasma osmolality is decreased (<270 mOsm/kg) this can mean what?

Back 128

Hyponatremia

Front 129

Plasma Na over 150 mmol/L, Plasma Chloride over 110 mmol/L, Plasma osmolality over 300 mOsm/kg can mean what?

Back 129

Hypernatremia

Front 130

What is TX for hyponatremia?

Back 130

Restriction of water intake, give IV normal saline if patient is hypovolemic. Limit the rate of correction of hyponatremia to 1-2 mmol/L/h.

Front 131

What is TX for hypernatremia?

Back 131

Electrolyte free water must be administered to reduce Plasma Na and plasma osmolality toward normal.

Solution should be dextrose and water. If patient is hypovolemic, 1/2 normal saline can be given.

Front 132

Older patients who are treated with chronic steroids should be aggressively screened and treated for what?

Back 132

Osteoporosis

Front 133

With this the pt's Hx will suggest mechanical pain, examination suggests loss of articular cartilage, radiographs confirm loss of articular cartilage, morning stiffness < 30 minutes in duration, if present at all.

Back 133

Osteoarthritis

Front 134

What is initial therapy for osteoarthritis?

Back 134

Acetaminophen < 1000 mg 4 times a day

Front 135

This is a significant risk in elderly patients who are treated with NSAIDS.

Back 135

Gastropathy

Front 136

This is an acute onset of monoarticular or polyarticular joint inflammation, lower extremity predominance in early years, presentations often are atypical in older persons, synovial fluid analysis is important to confirm diagnosis and exclude septic arthritis.

Back 136

Gout

Front 137

Acute attacks of gout can be TX how?

Back 137

NSAIDS, colchicine, or corticosteroids.

Front 138

In gout patients on uric acid lowering therapy, achieving sustained lowering of the serum uric acid to ? will permit better clearance of existing urate crystals and provide better protection against future gout attacks.

Back 138

< 6 mg/dL

Front 139

This is seen as symmetric, polyarticular inflammatory arthritis with a characteristic pattern of joint involvement. Evidence of inflammation by history, examination, and laboratory tests is necessary.

Back 139

Rheumatoid arthritis

Front 140

What is the initial TX of rheumatoid arthritis?

Back 140

Prednisone for a short period

Front 141

This is seen with new onset headache, jaw claudication, scalp tenderness and loss of vision. Forty to sixty percent of patients will report concomitant symptoms of polymyalgia rheumatica. Acute phase reactants (erythrocyte sedimentation rate, C-reactive protein) are usually elevated. Temporal artery biopsy is often diagnostic.

Back 141

Giant Cell Arteritis

Front 142

These three things inhibit bone resorption, increase spine and hip density, and significantly decrease the incidence of vertebral and hip fractures in post menopausal women with osteoporosis.

Back 142

Bisphosphonates
Alendronate
Risedronate

Front 143

This drug has beneficial side effects of estrogen on bone while avoiding the adverse effects on the uterus and breast. It reduces the risk of vertebral fractures but not nonverterbral fractures.

Back 143

Raloxifine

Front 144

This has weak antifracture efficacy at the vertebral spine.

Back 144

calcitonin

Front 145

What are the three primary areas for pressure ulcers?

Back 145

Sacrum, heels, and trochanteric areas.

Front 146

Pressure ulcers are most likely in what patients?

Back 146

orthopedic and ICU patients

Front 147

These are the most common benign epithelial tumor of adulthood. The trunk is more affected than the extremeties, head and neck. Primary lesions are 5-20 mm light brown to dark brown - black papules and plaques with a rough warty surface.

Back 147

Seborrheic keratosis

Front 148

This is a precursor lesion to squamous cell carcinoma

Back 148

Actinic keratosis

Front 149

Distribution of these lesions includes the face, lips, ears, dorsal hands, and forearms (photodistribution).

Back 149

Actinic keratosis

Front 150

Palpation of these reveals a gritty, sandpaper like texture. Lesions are often more readily palpated then visualized.

Back 150

Actinic keratosis

Front 151

These primary lesions are usually translucent or pearly papules or nodules. Often with visible telangiectasias. Secondary changes include central ulceration or crusting.

Back 151

Basal Cell Carcinoma

Front 152

This is the most common skin cancer and is related to chronic UV light exposure

Back 152

Basal Cell Carcinoma

Front 153

This is derived from the keratinocytes above the basal layer of the epidermis. Often with actinic keratoses as a precusor lesion.

Back 153

Squamous Cell Carcinoma

Front 154

Primary lesions are firm indurated papules, plaques or nodules. Secondary changes include rough adherent scale, central erosion, or ulceration with crust.

Back 154

Squamous Cell Carcinoma

Front 155

This can cause a reduced feeling of general well being. Minimally reduced psychomotor skills can be present, as well as reduced intelligence. Normal serum T4, free T4, T3, and free T3. There is an increased serum TSH. There is also dyslipidemia present.

Back 155

Subclinical Hypothyroidism

Front 156

This is when you have A. Fib, Osteopenia/osteoporosis, shortened systolic time interval, suppressed levels of serum TSH, and Normal T4, free T4, T3 and free T3.

Back 156

Subclinical Hyperthyroidism

Front 157

With this you see dry skin, increased weakness, paresthesias, memory loss and depression, constipation, cold intolerance, cardiomegaly, anemia, elevated serum TSH, low serum T4, free T4, T3, and free T3, radioiodine uptake is usually low, and hyponatremia.

Back 157

Hypothyroidism

Front 158

This has an alteration in mental state or coma, hypothermia, history of hypothyroidism, elevated serum TSH, low serum T4 and free T4, Hyponatremia.

Back 158

Myxedema Coma

Front 159

This will show up with weight loss, cardiac arrhythmias, angina or hear failure, change in bowel habits, muscle wasting, functional decline, change in cognition, suppressed TSH, and increased T4, free T4, T3, and free T3.

Back 159

Hyperthyroidism

Front 160

This is if a patient has thyroid nodules, occasional compressive symptoms of dyspnea, dysphagia, pain in neck, cervical adenopathy.

Back 160

Nodular thyroid, disease and neoplasia.

Front 161

With this a patient will present with weakness, abdominal pain, nausea and vomiting, low blood pressure, hyperkalemia, hyponatremia, and inappropriate response of plasma cortisol to cosyntropin (ACTH 1-24.

Back 161

Acute adrenal insufficiency

Front 162

This is when a patient presents with central obesity, DM, muscle wasting, easy bruising, purple striae, HTN, poor wound healing, elevagted serum cortisol and urinary free cortisol, lack of normal suppression of serum cortisol with dexamethasone

Back 162

Cushing's Syndrome

Front 163

What are the most common infections in the elderly?

Back 163

UTI, respiratory tract infection, gastroenteritis, and skin and soft tissue infections.

Front 164

Viral respiratory infections, especially if caused by what two things, can have a significant morbidity and mortality.

Back 164

Influenza and respiratory syncytial virus.

Front 165

What are the most common organisms causing UTI's in the elderly?

Back 165

E. Coli
Klebsiella pneumoniae
Proteus mirabilis
Staphylococci