geriatrics

Question 1

Top 6 causes of mortality in Canada/USA

Answer 1

1. Heart disease and CVD
2. Malignant neoplasms
3. Cerebrovascular disease
4. Chronic lower respiratory disease
5. Accidents
6. Alzheimer’s Disease

Question 2

Diagnosis of Alzheimer’s

Answer 2

1. anterograde amnesia (inability to learn new info)
2. any one of the following:
   - apraxia (loss of ability to perform learned movements despite intact motor fxn)
   - agnosia (failure to identify objects)
   - disturbance in executive function
   - mood alterations

Question 3

earliest and most severely affected areas of brain in alzheimer’s

Answer 3

hippocampus and temporal lobe

Question 4

microscopic pathology in alzheimer’s

Answer 4

• senile plaques (beta-amyloid proteins)

- neurofibrillary tangles

Question 5

3 major genes fo autosomal dominant Alzheimer’s disease

Answer 5

1. amyloid precursor protein (APP) gene at chromosome 21 (esp people with Down’s syndrome)
2. presenilin-1 at chrom 14 (early onset)
3. presenilin-2 at chrom 1 (early onset)

Question 6

testing/imaging for Alzheimer’s

Answer 6

• presumptive diagnosis made w/ mental status testing (orientation, verbal recall, language, visual-spatial)
• EEG (generalized slowing, nonspecific)
• MRI: dilation of lateral ventricles, widening of cortical sulci
• Single photon electron computed tomography (SPECT): hypometabolism in temporal and parietal lobes

Question 7

Tx (drugs) for Alzheimer’s: AChE Inhibitors

Answer 7

Rivastigmine
Donezepil (mild to moderate AD)
- C/I include risk of ulcers/GI bleed, COPD, ulcers, asthma, CAD, CHF, bradycardia, arrythmia

Question 8

pathophysiology of Osteoarthritis

Answer 8

articular cartilage deteriorates d/t reduction of proteoglycan, then body can’t repair cartilage faster than rate of deterioration –> osteophytes (bone spurs) are made

Question 9

joint stiffness in osteoarthritis

Answer 9

• localized, gradually progressive, intermittent flare ups
• joint stiffness after inactivity
• • waking in am, after sitting, worse with activity

Question 10

Which hand joints are enlarged in OA

Answer 10

• DIPs (Heberden’s nodes)
• PIPs (Bouchard’s nodes)
• Carpometacarpal joint of thumb
• -MCPs are usually not affected

Question 11

4 hallmark radiologic findings in OA

Answer 11

1. Joint space narrowing (usu asymetrical)
2. subchondral sclerosis
3. subchondral cysts
4. osteophytes

Question 12

Imaging for transient ischemic attacks

Answer 12

Noncontrast cranial CT

Question 13

labs to run if suspect malnutrition

Answer 13

CBC, electrolytes, Ca, Mg, PO4, Cr, liver function tests (including albumin, INR, bilirubin), B12, folate, TSH, transferrin, lipid profile, and urinalysis

Question 14

Tx for urinary incontinence

Answer 14

Tolterodine - urinary antispasmodic; anticholinergic

- interacts with drugs inhibiting CYP-2D6 (fluoxetine, amiodarone, cimetidine)