THE GERIATRIC CLIENT EXAM 1
PRIMARY CARE 202/2025 WITH
QUESTIONS AND ALL CORRECT
ANSWERS
Treatmt of acute glacoma and education - CORRECT ANSWER *referral to
opthalmologist
*intraocular pressure must be lowered by use of osmotic diuretic intravenously or orally
and miotic eye drops, bilateral txmt due to risk of the other eye
Education: for those w/ a hx importance of reg eye exams and reporting of symptoms
What are the symp of cataract - CORRECT ANSWER 1.diminished vision in one or both
eyes, poor night vision, sensitivity to glare ...progression is gradual therefore changes
may go unnoticed until visual loss is advanced
2.may present w/ improvmt in near vision, c/o difficulty reading, seeing a yellow tint or
washed out colors, recent hx of falls
Diagnostic test for cataracts/treatment - CORRECT ANSWER 1. no diagnostic tests
other than visual acuity and exam of the eye
2. refer to opthalmologist (silt test/dilation will reveal white/gray/brownish opacities
Treatment:
1.determined by ophthalmol...usually surgical
cataract education - CORRECT ANSWER 1.decrease sun exposure to UV B radiation
by wearing sun glasses, and large brimmed hat.
2. nutritionally balanced diet
3. decrease alcohol/smoking
4. eye exams
5. prompt help when experiencing any symptoms. 164
Driving assessment - CORRECT ANSWER 1. office based driving tests sample things
such as, processing speed, visual attention, and executive function.
2. Trail Making Test (TMT) - screening tool in predicitive driving eval.
3. Useul field of view (UFOV) for predicitive value in driving ability.
4. MMSE is a predicitive measure of driving, a cut of score of 24/30 is predicitive that a
road test is warrented.
focus 4
Geriatric syndrome - CORRECT ANSWER Geriatricians have embraced the term
"geriatric syndrome", using it extensively to highlight the unique features of common
health conditions in the elderly. Geriatric syndromes, such as delirium, falls,
,incontinence and frailty, are highly prevalent, multifactorial, and associated with
substantial morbidity and poor outcomes. Nevertheless, this central geriatric concept
has remained poorly defined
Geriatric syndromes include a number of conditions typical of, if not specific to, aging,
such as dementia, depression, delirium, incontinence, vertigo, falls, spontaneous bone
fractures, failure to thrive, and neglect and abuse. Geriatric syndromes are associated
with reduced life expectancy.56 To be considered a geriatric syndrome, these
conditions must interfere with a person's daily life. Dementia must be moderate to
severe; delirium must occur as a result of medications or organic diseases that do not
commonly affect the central nervous system (e.g., urinary or upper respiratory
infections); incontinence must be complete and irreversible; and falls must occur at least
three times a month or the fear of falling must prevent regular activities such as walking.
Depression is of special interest, because it is associated with decreased life
expectancy, even when it is
cytochrome P enzyme p5 - CORRECT ANSWER 1. Important in drug metabolism
1a. Biotransformation occurs in all body systems but primarily in the liver, Enzymatic
activity (cytochrome P enzyme) alters and detoxifies the drug and prepares it for
excretion.
2. When prescribing to an elderly pt, it is critical to understand whether the drug
inhibits/induces the CYP enzyme.
3.This is a major source of adverse drug interactions, since changes in CYP enzyme
activity may affect the metabolism and clearance of various drugs. For example, if one
drug inhibits the CYP-mediated metabolism of another drug, the second drug may
accumulate within the body to toxic levels. Hence, these drug interactions may
necessitate dosage adjustments or choosing drugs that do not interact with the CYP
system.
Assessment of vital signs in the elderly p35 - CORRECT ANSWER 1. remains
unchanged in the elderly, HCP taking a BP should collect the VS attentively, accurately,
carefully, & completely.
2. Thermoregulation changes in elderly...may have lower core body temp at baseline & r
less likely to have much of a febrile response to infx
3. Due to CVD & arrthmyias attention to the pulse rate and rhythm & careful measuremt
of the BP r essential... pulse deficit (diff b/w hrtbeat at the apex and the radial pulse is
checked...arrthmias.
Tools to assess cognitive function - CORRECT ANSWER 41
validated tools for cogn func...2 have been used primarily in the cilinical setting
1. Mini Mental Status Exam
2. Mini-Cog (shorter version-3 ?s & clock)
Delirum test: Confusion Assessment Method (CAM)
Alcohol withdrawl - CORRECT ANSWER 550
Patients with symptoms of alcohol w/drawl should be hospitilized.
,*Stage 1: Anxiety, insomnia, nausea, and abdominal pain characterize this stage, which
begins 8 hours after the last drink.
*Stage 2: High blood pressure, increased body temperature, unusual heart rate, and
confusion come with this stage, which begins 24-72 hours after the last drink.
*Stage 3: Hallucinations, fever, seizures, and agitation come with this stage, which
tends to begin 72+ hours after the last drink.
All symptoms tend to decrease within 5-7 days.
Financial capacity (focus 4 notes) - CORRECT ANSWER warning signs of diminished
financial capacity: memory loss, disorganization, decline in checkbook mangmt skills,
arithmetic mistakes, conceptual conusion, impaired judgement
Exercise resources - CORRECT ANSWER p24-25
What is the goal of geriatric primary care? - CORRECT ANSWER is to maximize
independence and functional status and shorten the morbidity period in the life of each
older adult. (notes-lecture 1)
What is the fastest growing segment of the US population? - CORRECT ANSWER the
age group 85 yrs and older
True or False
Falls are the leading cause of death due to unintentional injury among older adults? -
CORRECT ANSWER True
Falls often cause what among its suvivors? - CORRECT ANSWER Injuries from falls
lead to: fear of falling; sedentary behavior; impaired function; and lower quality of life.
What is the goal of of Healthy People 2020? - CORRECT ANSWER to improve the
health of all Americans, initiated by the dept of Health and Human services. The
benchmarks are established with the monitoring of progress over time in order to:
encourage collaborations across communities and sectors; empower individuals toward
making informed health decisions; and to measure the impact of prevention activities.
T or F
An unfortunate and alarming statistic is 1 to 2 million older adults in the United States
are injured or mistreated by a loved one or a caregiver. - CORRECT ANSWER True
Note on minorities - CORRECT ANSWER by 2050 persons from groups that have long
been counted as statistical minorities will be the emerging majority. In reality, the
number of ethnic elders in the United States may be or will become substantially higher.
Who is a vulnerable population in the elderly? - CORRECT ANSWER Older adults of
color have been described as facing "double jeopardy" for health disparities because of
, two risk factors for vulnerability (age and ethnicity). For black women, the risk becomes
triple jeopardy and poverty adds a fourth factor. According to Kung et al., 2008,
What are the leading causes of death? - CORRECT ANSWER Heart disease, stroke,
and cancer remain the leading causes of death, although there have been significant
declines in death due to heart disease. Stroke fell from the third leading cause of death
for the first time in five decades (Minino, Xu, Kochanek, 2010).
More than 30% of older adults are not immunized against what 2 things? - CORRECT
ANSWER More than 30% of older adults are not immunized against pneumonia or
influenza. In an average year, influenza causes approximately 36,000 deaths and
200,000 hospitalizations in the United States. Older adults are at high risk for influenza
and pneumonia-related deaths.
What is health disparity? - CORRECT ANSWER Healthy People 2020 defines a health
disparity as "a particular type of health difference that is closely linked with social,
economic, and/or environmental disadvantage. If a health outcome is seen in a greater
or lesser extent between populations, there is disparity. Health disparities adversely
affect groups of people who have systematically experienced greater obstacles to
health based on several factors. These factors include an individual's racial or ethnic
group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or
physical disability; sexual orientation or gender identity; geographic location; or other
characteristics historically linked to discrimination or exclusion."
What are health determinants? - CORRECT ANSWER Powerful, complex relationships
exist between health and biology, genetics, and individual behavior, and between health
and health services, socioeconomic status, the physical environment, discrimination,
racism, literacy levels, and legislative policies. These factors, which influence an
individual's or population's health, are known as determinants of health. It is important to
recognize the impact that social determinants have on health outcomes of specific
populations.
Note about calculation of creatinine clearance - CORRECT ANSWER One value of
particular signif to the HCP with prescriptive privileges is the calculation of creatinine
clearance in the estimation of renal function. Reduced renal func, particularly the GFR,
affects the clearance of may drugs and creatinine clearnace provides an index of renal
func for use in choosing doses of renally eliminated or nephrotoxic drugs (digoxin, H2
blockers, lithium and water soluble antibx). The use of serum drug con measuremts or
timed urine specimens is recommended until more acceptable methods of calculating
renal func in this population become aval. p3 kennedy-malone
What is the most profound pharmackinetic change in the aging adult? - CORRECT
ANSWER reduced elimination of drugs... by age 70, an indiv might reasonably have a
40-50% decrease in renal func even in the absence of disease. kidney func changes
may prolong the half lives of drugs. This is particularly important for drugs that are
excreted unchanged in the urine and for drug categ. known to be particularly
PRIMARY CARE 202/2025 WITH
QUESTIONS AND ALL CORRECT
ANSWERS
Treatmt of acute glacoma and education - CORRECT ANSWER *referral to
opthalmologist
*intraocular pressure must be lowered by use of osmotic diuretic intravenously or orally
and miotic eye drops, bilateral txmt due to risk of the other eye
Education: for those w/ a hx importance of reg eye exams and reporting of symptoms
What are the symp of cataract - CORRECT ANSWER 1.diminished vision in one or both
eyes, poor night vision, sensitivity to glare ...progression is gradual therefore changes
may go unnoticed until visual loss is advanced
2.may present w/ improvmt in near vision, c/o difficulty reading, seeing a yellow tint or
washed out colors, recent hx of falls
Diagnostic test for cataracts/treatment - CORRECT ANSWER 1. no diagnostic tests
other than visual acuity and exam of the eye
2. refer to opthalmologist (silt test/dilation will reveal white/gray/brownish opacities
Treatment:
1.determined by ophthalmol...usually surgical
cataract education - CORRECT ANSWER 1.decrease sun exposure to UV B radiation
by wearing sun glasses, and large brimmed hat.
2. nutritionally balanced diet
3. decrease alcohol/smoking
4. eye exams
5. prompt help when experiencing any symptoms. 164
Driving assessment - CORRECT ANSWER 1. office based driving tests sample things
such as, processing speed, visual attention, and executive function.
2. Trail Making Test (TMT) - screening tool in predicitive driving eval.
3. Useul field of view (UFOV) for predicitive value in driving ability.
4. MMSE is a predicitive measure of driving, a cut of score of 24/30 is predicitive that a
road test is warrented.
focus 4
Geriatric syndrome - CORRECT ANSWER Geriatricians have embraced the term
"geriatric syndrome", using it extensively to highlight the unique features of common
health conditions in the elderly. Geriatric syndromes, such as delirium, falls,
,incontinence and frailty, are highly prevalent, multifactorial, and associated with
substantial morbidity and poor outcomes. Nevertheless, this central geriatric concept
has remained poorly defined
Geriatric syndromes include a number of conditions typical of, if not specific to, aging,
such as dementia, depression, delirium, incontinence, vertigo, falls, spontaneous bone
fractures, failure to thrive, and neglect and abuse. Geriatric syndromes are associated
with reduced life expectancy.56 To be considered a geriatric syndrome, these
conditions must interfere with a person's daily life. Dementia must be moderate to
severe; delirium must occur as a result of medications or organic diseases that do not
commonly affect the central nervous system (e.g., urinary or upper respiratory
infections); incontinence must be complete and irreversible; and falls must occur at least
three times a month or the fear of falling must prevent regular activities such as walking.
Depression is of special interest, because it is associated with decreased life
expectancy, even when it is
cytochrome P enzyme p5 - CORRECT ANSWER 1. Important in drug metabolism
1a. Biotransformation occurs in all body systems but primarily in the liver, Enzymatic
activity (cytochrome P enzyme) alters and detoxifies the drug and prepares it for
excretion.
2. When prescribing to an elderly pt, it is critical to understand whether the drug
inhibits/induces the CYP enzyme.
3.This is a major source of adverse drug interactions, since changes in CYP enzyme
activity may affect the metabolism and clearance of various drugs. For example, if one
drug inhibits the CYP-mediated metabolism of another drug, the second drug may
accumulate within the body to toxic levels. Hence, these drug interactions may
necessitate dosage adjustments or choosing drugs that do not interact with the CYP
system.
Assessment of vital signs in the elderly p35 - CORRECT ANSWER 1. remains
unchanged in the elderly, HCP taking a BP should collect the VS attentively, accurately,
carefully, & completely.
2. Thermoregulation changes in elderly...may have lower core body temp at baseline & r
less likely to have much of a febrile response to infx
3. Due to CVD & arrthmyias attention to the pulse rate and rhythm & careful measuremt
of the BP r essential... pulse deficit (diff b/w hrtbeat at the apex and the radial pulse is
checked...arrthmias.
Tools to assess cognitive function - CORRECT ANSWER 41
validated tools for cogn func...2 have been used primarily in the cilinical setting
1. Mini Mental Status Exam
2. Mini-Cog (shorter version-3 ?s & clock)
Delirum test: Confusion Assessment Method (CAM)
Alcohol withdrawl - CORRECT ANSWER 550
Patients with symptoms of alcohol w/drawl should be hospitilized.
,*Stage 1: Anxiety, insomnia, nausea, and abdominal pain characterize this stage, which
begins 8 hours after the last drink.
*Stage 2: High blood pressure, increased body temperature, unusual heart rate, and
confusion come with this stage, which begins 24-72 hours after the last drink.
*Stage 3: Hallucinations, fever, seizures, and agitation come with this stage, which
tends to begin 72+ hours after the last drink.
All symptoms tend to decrease within 5-7 days.
Financial capacity (focus 4 notes) - CORRECT ANSWER warning signs of diminished
financial capacity: memory loss, disorganization, decline in checkbook mangmt skills,
arithmetic mistakes, conceptual conusion, impaired judgement
Exercise resources - CORRECT ANSWER p24-25
What is the goal of geriatric primary care? - CORRECT ANSWER is to maximize
independence and functional status and shorten the morbidity period in the life of each
older adult. (notes-lecture 1)
What is the fastest growing segment of the US population? - CORRECT ANSWER the
age group 85 yrs and older
True or False
Falls are the leading cause of death due to unintentional injury among older adults? -
CORRECT ANSWER True
Falls often cause what among its suvivors? - CORRECT ANSWER Injuries from falls
lead to: fear of falling; sedentary behavior; impaired function; and lower quality of life.
What is the goal of of Healthy People 2020? - CORRECT ANSWER to improve the
health of all Americans, initiated by the dept of Health and Human services. The
benchmarks are established with the monitoring of progress over time in order to:
encourage collaborations across communities and sectors; empower individuals toward
making informed health decisions; and to measure the impact of prevention activities.
T or F
An unfortunate and alarming statistic is 1 to 2 million older adults in the United States
are injured or mistreated by a loved one or a caregiver. - CORRECT ANSWER True
Note on minorities - CORRECT ANSWER by 2050 persons from groups that have long
been counted as statistical minorities will be the emerging majority. In reality, the
number of ethnic elders in the United States may be or will become substantially higher.
Who is a vulnerable population in the elderly? - CORRECT ANSWER Older adults of
color have been described as facing "double jeopardy" for health disparities because of
, two risk factors for vulnerability (age and ethnicity). For black women, the risk becomes
triple jeopardy and poverty adds a fourth factor. According to Kung et al., 2008,
What are the leading causes of death? - CORRECT ANSWER Heart disease, stroke,
and cancer remain the leading causes of death, although there have been significant
declines in death due to heart disease. Stroke fell from the third leading cause of death
for the first time in five decades (Minino, Xu, Kochanek, 2010).
More than 30% of older adults are not immunized against what 2 things? - CORRECT
ANSWER More than 30% of older adults are not immunized against pneumonia or
influenza. In an average year, influenza causes approximately 36,000 deaths and
200,000 hospitalizations in the United States. Older adults are at high risk for influenza
and pneumonia-related deaths.
What is health disparity? - CORRECT ANSWER Healthy People 2020 defines a health
disparity as "a particular type of health difference that is closely linked with social,
economic, and/or environmental disadvantage. If a health outcome is seen in a greater
or lesser extent between populations, there is disparity. Health disparities adversely
affect groups of people who have systematically experienced greater obstacles to
health based on several factors. These factors include an individual's racial or ethnic
group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or
physical disability; sexual orientation or gender identity; geographic location; or other
characteristics historically linked to discrimination or exclusion."
What are health determinants? - CORRECT ANSWER Powerful, complex relationships
exist between health and biology, genetics, and individual behavior, and between health
and health services, socioeconomic status, the physical environment, discrimination,
racism, literacy levels, and legislative policies. These factors, which influence an
individual's or population's health, are known as determinants of health. It is important to
recognize the impact that social determinants have on health outcomes of specific
populations.
Note about calculation of creatinine clearance - CORRECT ANSWER One value of
particular signif to the HCP with prescriptive privileges is the calculation of creatinine
clearance in the estimation of renal function. Reduced renal func, particularly the GFR,
affects the clearance of may drugs and creatinine clearnace provides an index of renal
func for use in choosing doses of renally eliminated or nephrotoxic drugs (digoxin, H2
blockers, lithium and water soluble antibx). The use of serum drug con measuremts or
timed urine specimens is recommended until more acceptable methods of calculating
renal func in this population become aval. p3 kennedy-malone
What is the most profound pharmackinetic change in the aging adult? - CORRECT
ANSWER reduced elimination of drugs... by age 70, an indiv might reasonably have a
40-50% decrease in renal func even in the absence of disease. kidney func changes
may prolong the half lives of drugs. This is particularly important for drugs that are
excreted unchanged in the urine and for drug categ. known to be particularly
