Geriatrics End Of Rotation Exam
UPDATED Exam Questions and
CORRECT Answers
what percent of hospitalized patients develop delirium? what is the in hospital and one-year
mortality rate? - CORRECT ANSWER- ✔✔33% develop delirium
22-76% hospital mortality (as high as the rates for MI or sepsis)
35-45% one year mortality
do patients with or without dementia have more severe deficits as a result of delirium? -
CORRECT ANSWER- ✔✔without (higher mortality risk and worse recovery in ADLs)
how long for a patient to return to baseline after delirium? - CORRECT ANSWER- ✔✔4-6
weeks
CAM score (confusion assessment method for the ICU) in diagnosing delirium - CORRECT
ANSWER- ✔✔1. acute onset and fluctuating course
2. inattention
3. disorganized thinking (rambling)
4. altered LOS (hypervigilant to lethargic, or a mix of both)
*first 2 required + one of the last 2* = delirium
brain failure - CORRECT ANSWER- ✔✔increased stress/demand on the brain (especially
one with prior injury/damage) --> leads to delirium
metabolic threshold model vs cholinergic model of delirium - CORRECT ANSWER-
✔✔metabolic: low cortical glucose --> cerebral metabolic insufficiency
cholinergic: depleted cortical acetylcholine (hence why we don't give anti-cholinergics to
elderly)
,ideal room environment to treat delirium - CORRECT ANSWER- ✔✔calm, quiet, well lit
pharmacologic management of delirium - CORRECT ANSWER- ✔✔*none shown to
improve outcomes*
1. benzos (lorazepam)
2. antipsychotic (haloperidol)
what kidney functions change as we age? - CORRECT ANSWER- ✔✔1) GFR decreases
2) CrCl decreases
3) RBF decreases 10% per decade after 40
4) lower overall renal function can result in toxic drug accumulation
why do old people usually have low B12? - CORRECT ANSWER- ✔✔stomach mucosa
thins --> decrease in gastric parietal cells --> less HCl and intrinsic factor production --> less
absorption of B12
basic vs instrumental ADLs - CORRECT ANSWER- ✔✔*basic*
DEATH:
dressing/bathing
eating
ambulating
toileting
hygiene
*instrumental*
using phone, taking meds, managing money, laundry
abnormal get up and go - CORRECT ANSWER- ✔✔normal is <10 seconds
>20 seconds requires further testing to make sure there isn't increased risk of falls
, what nutrient do beta-blockers deplete? - CORRECT ANSWER- ✔✔CoQ10 --> heart failure
name 8 nutrient deficiencies in the elderly - CORRECT ANSWER- ✔✔protein
omega-3 fatty acids
dietary fibers
vitamins B6, B12
vitamin E
calcium
magnesium
potassium
define: constipation - CORRECT ANSWER- ✔✔- less than 3 BMs per week
- straining with defecation
- sensation of incomplete bowel evacuation
what is the cause of diarrhea in constipation? - CORRECT ANSWER- ✔✔liquid stool can
come around the solid stool, presenting as diarrhea
which medications cause constipation - CORRECT ANSWER- ✔✔- laxative overuse
- opioids
- anticholinergics
- antacids with aluminum
how does low vitamin B impact GI function? - CORRECT ANSWER- ✔✔colon muscle
dysfunction/constipation
top 4 risk factors for constipation - CORRECT ANSWER- ✔✔1) low fluids
2) low activity
3) meds/opiods
4) poor diet (too much milk, tea, alcohol)
UPDATED Exam Questions and
CORRECT Answers
what percent of hospitalized patients develop delirium? what is the in hospital and one-year
mortality rate? - CORRECT ANSWER- ✔✔33% develop delirium
22-76% hospital mortality (as high as the rates for MI or sepsis)
35-45% one year mortality
do patients with or without dementia have more severe deficits as a result of delirium? -
CORRECT ANSWER- ✔✔without (higher mortality risk and worse recovery in ADLs)
how long for a patient to return to baseline after delirium? - CORRECT ANSWER- ✔✔4-6
weeks
CAM score (confusion assessment method for the ICU) in diagnosing delirium - CORRECT
ANSWER- ✔✔1. acute onset and fluctuating course
2. inattention
3. disorganized thinking (rambling)
4. altered LOS (hypervigilant to lethargic, or a mix of both)
*first 2 required + one of the last 2* = delirium
brain failure - CORRECT ANSWER- ✔✔increased stress/demand on the brain (especially
one with prior injury/damage) --> leads to delirium
metabolic threshold model vs cholinergic model of delirium - CORRECT ANSWER-
✔✔metabolic: low cortical glucose --> cerebral metabolic insufficiency
cholinergic: depleted cortical acetylcholine (hence why we don't give anti-cholinergics to
elderly)
,ideal room environment to treat delirium - CORRECT ANSWER- ✔✔calm, quiet, well lit
pharmacologic management of delirium - CORRECT ANSWER- ✔✔*none shown to
improve outcomes*
1. benzos (lorazepam)
2. antipsychotic (haloperidol)
what kidney functions change as we age? - CORRECT ANSWER- ✔✔1) GFR decreases
2) CrCl decreases
3) RBF decreases 10% per decade after 40
4) lower overall renal function can result in toxic drug accumulation
why do old people usually have low B12? - CORRECT ANSWER- ✔✔stomach mucosa
thins --> decrease in gastric parietal cells --> less HCl and intrinsic factor production --> less
absorption of B12
basic vs instrumental ADLs - CORRECT ANSWER- ✔✔*basic*
DEATH:
dressing/bathing
eating
ambulating
toileting
hygiene
*instrumental*
using phone, taking meds, managing money, laundry
abnormal get up and go - CORRECT ANSWER- ✔✔normal is <10 seconds
>20 seconds requires further testing to make sure there isn't increased risk of falls
, what nutrient do beta-blockers deplete? - CORRECT ANSWER- ✔✔CoQ10 --> heart failure
name 8 nutrient deficiencies in the elderly - CORRECT ANSWER- ✔✔protein
omega-3 fatty acids
dietary fibers
vitamins B6, B12
vitamin E
calcium
magnesium
potassium
define: constipation - CORRECT ANSWER- ✔✔- less than 3 BMs per week
- straining with defecation
- sensation of incomplete bowel evacuation
what is the cause of diarrhea in constipation? - CORRECT ANSWER- ✔✔liquid stool can
come around the solid stool, presenting as diarrhea
which medications cause constipation - CORRECT ANSWER- ✔✔- laxative overuse
- opioids
- anticholinergics
- antacids with aluminum
how does low vitamin B impact GI function? - CORRECT ANSWER- ✔✔colon muscle
dysfunction/constipation
top 4 risk factors for constipation - CORRECT ANSWER- ✔✔1) low fluids
2) low activity
3) meds/opiods
4) poor diet (too much milk, tea, alcohol)
