Test Bank For Ham’s Primary Care Geriatrics: A Case-Based Approach 7th Edition By Richard, Exams of Nursing

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Test Bank For Ham’s Primary Care Geriatrics: A

Case-Based Approach 7th Edition By Richard J.

Ham

Triggers of Rosacea flushing - ANSWER> Sunlight Hot showers Exercise Alcohol Spicy foods Rosacea can progress to - ANSWER> Rhinophyma -- enlarged bulbous nose Rhinophyma is associated with - ANSWER> Rosacea Treatment of Rosacea - ANSWER> Sunscreen Topical antibiotics -- Metronidazole, Sodium sulfacetamide Oral antibiotics -- Minocycline, Doxycycline Laser treatment Where do pressure ulcers MC develop? - ANSWER> Bony prominences -- sacrum, heels and trochanteric areas Risk factors for pressure ulcers - ANSWER> Bed or chair confinement Immobility Length of stay Anemia

Fecal incontinence Decreased body weight Poor nutritional status Diabetes Presence of fracture (HIP MC) Decreased serum albumin Non-blanchable erythema Norepinephrine injections Male CVA history What are the stages of pressure ulcers? - ANSWER> I -- blanchable hyperemia II -- ulcer extends through epidermis III -- full thickness skin loss with damage/ necrosis to subcutaneous tissue IV -- full thickness wounds with damage/ necrosis to surrounding muscle, bone or other structures Complications of pressure ulcers - ANSWER> Wound colonization (unavoidable) Infection (tx with topical antibiotics unless spread to the bone then systemic are needed) Infection can be prevented by occlusive dressing, but wound colonization cannot Treatment of pressure ulcers - ANSWER> Moist environment Topical dressing

Growth factor Adjunctive therapies Debridement (remove necrotic tissue) Surgery (recurrence, does not work with frail patients) Stasis dermatitis occurs as a result of - ANSWER> Chronic venous insufficiency MC associated with varicose veins Where does stasis dermatitis occur MC? - ANSWER> Calves, dorsal feet, anterior shins and ankles Primary lesions: Red brown hyperpigmented macules and papules Secondary lesions: Erythematous patches with fine crackling and scales Calves, anterior shin, dorsal feet and ankle - ANSWER> Stasis dermatitis Prevention and treatment of stasis dermatitis - ANSWER> Compression stockings and leg elevation Steroid ointment for eczematous lesions Lesion and location/ characteristics of scabies - ANSWER> 3 - 8mm linear or serpinginous ridges (burrows) that occur in INTERDIGITAL SPACES, volar wrist, penis and areola

Intensely pruritic and can stay pruritic even after treating Complications of scabies - ANSWER> Nodular - pruritic hypersensitivity rxn to reminants of mites Norweigian - immunocompromised people Treatment of scabies - ANSWER> Permethrin -- most effective topical treatment Oral Ivermectin -- 2 doses 2 weeks apart MC nerves effected by herpes zoster - ANSWER> Ophthalmic branch of trigeminal Thoracic Cervical Lesions of herpes zoster - ANSWER> Primary: Vesicles on erythematous base Secondary: Pustules and crusts 1 - 2 adjacent dermatomes What do you do if you see a hutchinson's sign? - ANSWER> Urgently refer to ophthalmologist Slit lamp exam --> dendritic lesions HERPES KERATITIS

Complications of herpes zoster - ANSWER> Herpes keratitis Postherpetic neuralgia Disseminated zoster Treatment of herpes zoster - ANSWER> Acyclovir, valacyclovir, famciclovir MUST BE GIVEN 48-72 HOURS Does not prevent post-herpetic neuralgia IV acyclovir for severe or disseminated Herpes zoster vaccine recommended in patients over - ANSWER> 60 Describe lesion of actinic keratosis - ANSWER> Rough, adherent, scaly, white papules and plaques Gritty sandpaper texture More readily palpated than visualized Treatment of actinic keratosis - ANSWER> Cryotherapy 5 - Fluorouracil Imiquimod Seborrheic keratosis presentation - ANSWER> 5 - 20 mm light brown and dark papules and plaques with rough, warty surface

5 - 20mm light brown and dark papules and plaques with rough, warty surface - ANSWER> Seborrheic keratosis Treatment of seborrheic keratosis - ANSWER> Cryotherapy Cutterage Shave removal Where does seborrheic dermatitis occur? - ANSWER> On the face between eyebrows, nasolabial folds, scalp and chest Erythematous plaque and patches and greasy pealing scales What causes seborrheic dermatitis? - ANSWER> Overgrowth of commensal yeast malessezia globosa Bright red cherry or purple benign skin elevations caused by overgrowth of blood vessels usually occurring on trunk but can be anywhere - ANSWER> Cherry angioma Only remove if they bleed Pigmented or hyperpigmented, pedunculated lesions that occur on the neck, axilla and groin - ANSWER> Skin tag - acrochordons Where do acrochordons occur? - ANSWER> Neck, axilla, groin NAG

Flat, light brown patches on sunexposed skin - ANSWER> Age spots - Lentigos - liver spots Tx - lighten with hydroquinone MC skin cancer - ANSWER> Basal cell carcinoma Basal cell carcinoma presentation - ANSWER> Waxy papules with central depression and rolled border Bleed easy in center and ulcerate Telangectasias on surface Diagnosis of basal cell carcinoma - ANSWER> Shave biopsy - all thats needed usually Punch biopsy if you want to distinguish melanoma Treatment of basal cell carcinoma - ANSWER> Surgery/Mohs surgery Precursor to squamous cell - ANSWER> Actinic keratosis Rough, adherent scaly white papules and plaques with gritty sandpaper texture More easily palpable than visualized Describe the lesion of squamous cell carcinoma - ANSWER> Shallow ulcer with elevated margins and covered in plaque Chronically scaly, deep ulcer or cutaneous horn

Diagnosis of squamous cell carcinoma - ANSWER> Incisional biopsy CT or MRI for metastasis ABCD of melanoma - ANSWER> Asymmetry, border, color (dark black and blue but variable), diameter >6mm Treatment of squamous cell - ANSWER> Excision with clear margins Mohs if on face Treatment of melanoma - ANSWER> Wide surgical excision Adjuvant therapy depends on TNM staging of melanoma T or F: GERD predisposes to esophageal cancer which often presents only in late stages in older people - ANSWER> T Lab findings GERD - ANSWER> Iron deficiency anemia What do you always order for an elderly patient with esophagitis and anemia? - ANSWER> EGD Diagnostic study GERD - ANSWER> EGD - upper endoscopy Differential diagnosis GERD - ANSWER> MALIGNANCY - r/o

ACS

Aortic dissection Pulmonary disease Stroke Complications of GERD - ANSWER> Esophagitis Esophageal ulcerations Stricture Bleeding Barrett's esophagus Esophageal adenocarcinoma Lifestyle modifications GERD - ANSWER> Small, frequent meals Do not eat 3-4 hours before bed Sleep with head elevated Avoid peppermint, chocolate, acidic foods, caffeine Minimize caffeine, nicotine and fatty foods Combo with PPI usually A patient has been diagnosed with GERD and has been given lifestyle modifications to make as well as Pantoprazole (PPI). What is she at risk for? - ANSWER> Osteoporosis Decreased efficacy of Clopidogrel for cardiac stents What are side effects of PPI use? - ANSWER> Osteoporosis Bacterial overgrowth in the small intestine Inc susceptibility to enteric pathogens Drug interactions (Clopidogrel)

Increased risk of aspiration pneumonia Decreased B12 or iron absorption Increased risk of H. pylori gastritis Acute interstitial nephritis Refractory GERD treatment - ANSWER> Fundoplication Treatment of achalasia - ANSWER> Pneumatic dilation Botox Surgery Corkscrew on barium swallow of esophagus - ANSWER> Diffuse esophageal spasm Diagnosis of PUD - ANSWER> Endoscopy Treatment PUD - ANSWER> PPI for 8 weeks to ensure healing Stop NSAID/aspirin Gastric - document healing with EGD 8-12 weeks later to make sure it is not malignant What should you never do in diverticulitis? - ANSWER> Colonoscopy What do you do to evaluate a lower GI bleed and what are other causes besides diverticular? - ANSWER> AVM, Ischemia, IBD, Cancer

A patient has LLQ pain, fever and leukocytosis. On exam, they are hemodynamically stable without any palpable masses or peritoneal signs. What is this and how do you manage it? - ANSWER> Outpatient Clear liquids 2-3 days Oral antibiotics covering gram + and - If symptoms dont resolve in 48-72 hours get a CT scan Complications of diverticulitis and how they present - ANSWER> Abscess, stricture, fistula, perforation Hypotension, tachycardia, lethargy, confusion There is a high level of occlusion of the ______ in elderly - ANSWER> IMA Causes of colonic ischemia - ANSWER> IMA thrombus or embolus Congestive heart failure Cardiac arrhythmias Shock Vasculitis Hematologic disorders Infection Medications (NSAID, digitalis, vasopressin, pseudoephedrine, sumatriptan, cocaine, amphetamine, gold)

How does acute colonic ischemia present? - ANSWER> Loose, bloody stool Hemodynamically unstable Peritoneal signs A patient with suspected colonic ischemia has peritoneal signs. What do you do? - ANSWER> Surgical exploration Treatment of colonic ischemia - ANSWER> Without peritoneal signs

• Fluids, bowel rest and broad spectrum antibiotics Peritoneal signs
• Surgical exploration immediately What types of esophageal cancer are most common? - ANSWER> Upper - squamous cell carcinoma Lower - adenocarcinoma Risk factors of esophageal cancer - ANSWER> Smoking Alcohol HPV History of head and neck radiation Hx achalasia Plummer vinson syndrome Barrett esophagus GERD

Symptoms of esophageal cancer and what test do you do for it?

• ANSWER> Dysphagia -- solids then liquids Weight loss Chest pain Hiccups SOB Anemia Do ENDOSCOPY WITH BIOPSY Test for esophageal cancer - ANSWER> Endoscopy with biopsy Most gastric cancers are - ANSWER> Adenocarcinomas Signs and symptoms of gastric cancer - ANSWER> Anorexia Weight loss Vague abdominal pain Early satiety Nausea, vomiting Hematemesis Hematochezia Lymphadenopathy Palpable mass Bowel obstruction Ascites Dependent edema Dx of gastric cancer - ANSWER> Endoscopy with biopsy

Most colorectal cancers are - ANSWER> Adenocarcinomas Symptoms of colon cancer - ANSWER> Right -- fatigue, weakness, anemia Left -- change in bowel habits, colicky pain, constipation/ obstruction Rectal -- hematochezia, urgency, tenesmus Elevated alk phos in colon cancer suggests - ANSWER> Metastatic disease Dx of colorectal cancer - ANSWER> Colonscopy with biopsy Most pancreatic cancers occur where? - ANSWER> Head of pancreas Better prognosis of pancreatic cancer if it is in the - ANSWER> Ampulla Symptoms of pancreatic cancer - ANSWER> Vague epigastric or LUQ pain Jaundice Diarrhea Acute pancreatitis without known cause Lab findings pancreatic cancer - ANSWER> Glycosuria Hyperglycemia Elevated amylase and lipase

Hyperbilirubinemia CA 19- 9 Diagnosis of pancreatic cancer - ANSWER> CT scan Endoscopic US to guide fine needle biopsy ERCP can clarify ambiguous CT Describe functional incontinence - ANSWER> Confused, altered cognition, LARGE VOLUME URINE LEAKAGE Normal structural and functional urinary system Small urine volume leakage associated with laughing, coughing and bending - ANSWER> Stress incontinence Intra-abdominal pressure greater than urethral spinchter closing pressure Loss of urine due to uninhibited detrusor activity at low urine volumes - ANSWER> Urge incontinence Small or large fluid leakage, abrupt urgency and frequency Abrupt onset small or large urine urgency and frequency - ANSWER> Urge incontinence Loss of urine secondary to excessive bladder volume due to impaired bladder contractions - ANSWER> Overflow incontinence

Mainstay treatment for urinary incontinence - ANSWER> Anticholinergics Vaginal bulge and stress incontinence - ANSWER> Pelvic organ prolapse Treatment of pelvic organ prolapse - ANSWER> Pessary with estrogen cream BPH presentation - ANSWER> Increased frequency Post void dribble Incomplete bladder emptying Nocturia Urinary stream weakness How do you make a diagnosis of BPH? - ANSWER> Symmetrically enlarged, firm and rubbery prostate on DRE Transabdominal or transrectal US Treatment of BPH - ANSWER> Alpha adrenergic blockers

• end in ZOSIN Surgery
• Open prostatectomy
• TURP
• TUIP

Symptoms of prostate cancer - ANSWER> Lower genital tract symptoms New onset of erectile dysfunction Hematuria/ hematospermia Pathologic fracture Diagnosis of prostate cancer - ANSWER> Biopsy guided by transrectal US PSA over 10 suggests Symptoms of prostatitis - ANSWER> Fever Irritative voiding symptoms Perineal or suprapubic pain Exquisitely tender prostate on DRE Treatment of bacterial prostatits - ANSWER> Admission for IV abx (ampicillin/ gentamicin) 48 hours afebrile discharge on abx 4-6 weeks MCC of chronic prostatitis - ANSWER> Gram negative rod Enterococcus is the only gram positive Symptoms of chronic prostatitis - ANSWER> Asymptomatic Irritative voiding symptoms Low back/ perineal pain Prostate can be normal, boggy or indurated

U/A normal Must culture prostatic secretions or post prostatic massage urine Tx: TMP/SMX for 6-12 weeks Treatment of chronic prostatitis - ANSWER> TMP/SMX for 6- 12 weeks How do you make a diagnosis of nonbacterial prostatitis - ANSWER> Diagnosis of exclusion Presents just like chronic prostatitis

• Irritative voiding
• Low back or perineal pain
• Normal U/A Treatment of nonbacterial prostatitis - ANSWER> Trial of erythromycin 2 weeks, if helps continue for 3-6 weeks Treatment of erectile dysfunction - ANSWER> Vacuum constrictive devices Phosphodiesterase 5 inhibitors
• Siladenafil, Avanafil, Tadalafil, Vardenafil
• FIL MCC erectile dysfunction - ANSWER> Vascular disease

2nd - neuro TM should be - ANSWER> Gray and translucent Hearing loss refer to - ANSWER> Audiologist Pathology is ENT Audiogram of presbycusis - ANSWER> High frequency affected (8KHz) Low frequency spared (250Hz) Downsloping Infectious causes of sensorineural hearing loss - ANSWER> Bacterial, viral or fungal labyrinthitis (tinnitus and vertigo too) Meningitis Syphilis and lyme disease (sudden onset) Herpes zoster oticus (sudden unilateral temporal or permanent loss, tinnitus, vertigo or dysequillibrium, facial weakness) - dx by isolating vesicular fluid Describe autoimmune caused sensorineural hearing loss and what causes it - ANSWER> Antibodies attack cochlea and vestibular apparatus Progressive and bilateral hearing loss SLE Polyarteritis nodosum

IBD (Crohn's/ UC) Granulomatosis Polyangiitis Ototoxic drugs - ANSWER> Hearing loss, tinnitus, vertigo Aminoglycosides (-mycin, amikacin) Loop diuretics (Furosemide, Torsemide) Antimalarials (Chloroquine, Quinine) NSAID (aspirin, ketorolac) Platinum based chemo (Cisplatin, Carboplatin) What is Meniere's disease? - ANSWER> Debilitating episodic rotational vertigo Hearing loss with tinnitus and aural fullness Lasts 20 min - 24 hours (usually 1-2 hours) Sudden monocular vision loss without pain or redness Widespread or segmental retinal pallor with edema Cherry red spot on fovea Retinal arteries attenuated (thin) Box car segmentation of retinal veins - ANSWER> Retinal vascular occlusion What are symptoms of retinal vascular occlusion? - ANSWER> Sudden monocular vision loss No pain, no redness Widespread or segmental pallor of retina with edema Retinal arteries attenuated (thinned)

Box car segmentation of retinal veins Treatment of retinal artery vascular occlusion Sudden monocular vision loss without pain. Widespread or segmental retinal pallor with edema. Retinal arteries thinned. Box car segmentation of retinal veins. - ANSWER> Hyperventilation Paracentesis to decrease IOP IV acetazolamide to decrease IOP Ocular massage to dislodge clot Transient monocular blindness - ANSWER> Amaurosis fugax Curtain pulled over eye - ANSWER> Amaurosis fugax Amaurosis fugax is a symptom of - ANSWER> TIA Decreased perfusion What is amaurosis fugax? - ANSWER> Transient monocular vision loss Sudden transient vision loss in one or both eyes CURTAIN TIA

How does a retinal detachment present and how do you manage it? - ANSWER> Curtain over vision No pain, no redness Refer to ophthalmology immediately and tilt their head back Surgically reattached Curtain over eye that lasts a few minutes - ANSWER> Amaurosis fugax Curtain over eye that lasts until its fixed - ANSWER> Retinal detachment No pain or redness What kind of cancer is oral cancer MC? - ANSWER> Squamous cell carcinoma Risk factors oral cancer - ANSWER> Age, alcohol, smoking Persistent leukoplakia and erythroplakia - ANSWER> Oral cancer Biopsy Biggest RF of OA - ANSWER> Age What is spondylosis? - ANSWER> Osteoarthritis of the spine

Narrowing of intervertebral space Symptoms of spondylosis are relived with - ANSWER> Leaning forward Treatment of osteoarthritis - ANSWER> Non-pharm

• Exercise, weight loss, cane, insoles, acupuncture Pharm
• NSAID, analgesics, steroid injections, visco whatever, glucosamine and costochondroitin Surgery
• Total joint arthroplasty (hip and knee) MC fractures in osteoporosis - ANSWER> Hip, spine and wrist Wrist may have colles fx - silver fork deformity Gold standard imaging for osteoporosis - ANSWER> DEXA scan How will a hip fracture look? - ANSWER> Leg shortened, externally rotated and abducted Treatment of hip fractures - ANSWER> Intracapsular - arthroplasty Intertrochanteric - internal fixation with screws Subtrochanteric - internal fixation with screws

Height loss, kyphosis and Dowagers hump suggests - ANSWER> Multiple vertebral fracture due to osteoporosis Presentation of vertebral fracture with osteoporosis - ANSWER> Height loss, kyphosis, Dowagers hump Complain of neck pain Tx osteoporosis - ANSWER> Biphosphonates Where does RA usually affect? - ANSWER> MCP, PIP (SPARES DIP) MTP Cervical spine (spares rest of the spine) What are the swan neck and boutonniere deformities seen in chronic RA? - ANSWER> Swan neck - flexed DIP, extended PIP Boutonniere - flexed PIP, extended DIP Treatment of rheumatoid arthritis - ANSWER> Non-pharm -- exercise, PT Pharm -- NSAID, DMARD, steroid, biologicals DMARD ex -- methotrexate, hydroxychloroquine, Leflunomide, Sulfalazine Steroids - acute flare up Surgery - total joint replacement What is delirium? - ANSWER> Acute change in baseline mental status

Cognitive changes Inattention Disorganized speech Altered level of consciousness Signs and symptoms of delirium - ANSWER> Acute change in baseline mental status Cognitive changes Inattention Disorganized thinking Altered level of consciousness Psychomotor agitation Perceptual disturbances Hallucinations/ delusions Emotional lability Sleep/ wake disturbances Dementia is impairment in at least __ of the following domains:

• ANSWER> 2 of these
• Memory
• Executive functioning
• Language
• Visuospatial function
• Personality/ behavior Signs and symptoms of dementia - ANSWER> Early
• Repeating stories