Geriatrics

question

Over the age of 65 what is the number one killer?
answer

Heart Disease
question

Over the age of 65 what is the number two killer?
answer

Cancer
question

Over the age of 65 what is the number three killer?
answer

Stroke
question

Over the age of 65 what is the number four killer?
answer

Chronic Lower Respiratory Disease (CLRD)
question

Over the age of 65 what is the number five killer?
answer

Flu/Pnuemonia
question

Over the age of 65 what is the number six killer?
answer

Alzheimer’s
question

Over the age of 65 what is the number seven killer?
answer

Diabetes
question

Over the age of 65 what is the number eight killer?
answer

Renal Disease
question

Over the age of 65 what is the number nine killer?
answer

Trauma
question

Over the age of 65 what is the number ten killer?
answer

Septicemia
question

What percentage of population in 2020 will be over 65 years old?
answer

20%
question

T/F: The >85 is the fastest growing segment of the population
answer

True
question

What percentage of >65 year olds have some form of heart disease?
answer

34%
question

Heart Rate x Stroke Volume =
answer

Heart Rate x Stroke Volume = Cardiac output
question

T/F: EF%= EDV/SV (EF = Ejection Fraction)
answer

False; EF% = SV/EDV
question

Do cardiac stents require antibiotics?
answer

No
question

T/F: NSAIDS raise blood pressure
answer

True
question

For a patient with hypertension or stable angina, what moderate dosages of LA are recommended?
answer

72mg lido 36 mcg epi Or 40mg lido/ 36 mcg epi (maybe if severe CHD?)
question

What does climbing one flight of stairs equal on the MET scale?
answer

4 METs
question

With a patient that has a history of cardiac arrhythmias, what INR is the limit to proceed with surgery using local measures?
answer

INR 3.0 or less is safe to proceed with surgery with local measures
question

T/F: A patient with a history of infective endocarditis should have antibiotic prophylaxis?
answer

True
question

T/F: A patient with a repaired congenital defect with graft material that treated years ago needs a antibiotic prophylaxis
answer

False Does not need antibiotic prophylaxis unless it was within 6 months, the graft material prevented epithelization, or MD orders
question

Local Anesthetics conversions: 1:1000 = _mg/mL
answer

1:1000 = 1mg/mL
question

Local Anesthetics conversions: 1:10,000 = _mg/mL
answer

1:10000 = 0.1mg/mL
question

Local Anesthetics conversions: 1:100,000 = _mg/mL
answer

1:100,000 = .01mg/mL or 10mcg/mL
question

Local Anesthetics conversions: 1% = _g/ 100mL = _mg/mL
answer

1% = 1g/ 100mL = 10 mg/mL
question

Local Anesthetics conversions: 2% = _mg/mL
answer

2% = 20mg/mL
question

Local Anesthetics conversions: 3% = _mg/mL
answer

3% = 30 mg/mL
question

Local Anesthetics conversions: 4% = _mg/mL
answer

4% = 40 mg/mL
question

Local Anesthetics conversions: 1 ppm = _mg/mL
answer

1 ppm = 1mg/L
question

How much should one reduce LA dosage for a healthy elderly individual over the age of 65?
answer

Reduce dose by 20%
question

What is the max dosage of 2% lidocaine with 1:100k epi = _mg/kg
answer

2% lidocaine with 1:100k epi = 7mg/kg
question

What is the max dosage of 4% articaine with 1:200k epi = _mg/kg
answer

4% articaine with 1:200k epi = 7mg/kg
question

What is the max dosage of 0.5% Bupivicaine with 1:100k epi = _mg/kg
answer

0.5% Bupivicaine with 1:100k epi = 1-2 mg/kg (Increase in cardiotoxicity)
question

What is the max dosage of 3% mepivicaine (plain) = _mg/kg
answer

3% mepivicaine (plain) = 4-5 mg/kg
question

What does IMRT stand for?
answer

Intensity Modulated Radiation Therapy
question

What level of radiation is it a concern for osteoradionecrosis?
answer

50 Gy or 5000 rads increases risk
question

When is it safest to treat a patient with chemotherapy?
answer

One week prior to their next dose of chemo treatment (or 17-20 days after dose)
question

For a patient on chemotherapy, what are the lower lab limit values for: 1) ANC 2) Platelets
answer

ANC > 500 Platelets > 50,000
question

For a patient undergoing chemotherapy, at what ANC level do you consider pre/post antibiotics?
answer

ANC<1000
question

T/F: Elective dental treatment can be performed on a patient with TIAs within the past six months?
answer

False No elective treatment
question

__% of >65 year olds and __% of > 85 year olds have diabetes
answer

10% of >65 year olds and 25% of > 85 year olds have diabetes
question

T/F: Patients with diabetes are at four times the risk for a myocardial infarction
answer

True
question

T/F: Non-dialysis days should be treatment day for a patient with stage III chronic kidney disease (CKD)
answer

True
question

T/F: You can have a normal ejection fraction and have diastolic heart failure
answer

true
question

T/F: For chronic kidney disease patients there is no dosage adjustment for local anesthesia
answer

True (no dosage adjustment per se judicious use warranted)
question

What is the peak age of diagnosis for Parkinson’s disease?
answer

55-65 years old
question

What are the three major types of arthritis?
answer

1) Rheumatoid arthritis 2) Osteoarthritis 3) Crystal arthroathies
question

T/F: The proximal interphalangeal joints are known as Herberdeen’s nodes
answer

False: The proximal interphalangeal joints are known as Bouchard’s nodes
question

T/F: Subjective is what the patient says
answer

True
question

What percentage of diagnoses are made or suggested by history?
answer

90%
question

What do the vital signs tell us?
answer

The general metabolic status of the patient
question

T/F: The history is given by the patient
answer

True
question

T/F: The historian (dentist) records the history
answer

True
question

Difference between subjective and objective
answer

Subjective = what the patient says, personal interpretations Objective = what you can view, see or test,
question

What is the difference between signs and symptoms?
answer

Signs – Visual cues to other people, something witnessed Symptoms – something felt/experienced by the patient
question

What do you need from a patient that is on immune modulators before rendering treatment?
answer

Labs (platelets, CBC, ect.)
question

What is the function of pacemaker?
answer

To control heart rhythms, uses electric pulses to make the heart beat at a normal rate
question

Is it your duty to change the dosage of medications that a patient is prescribed by a physician?
answer

No
question

T/F: In the elderly, the first pass metabolism is diminished therefore there is a decrease in bioavailability
answer

False: In the elderly, the first pass metabolism is diminished therefore there is an INCREASE in bioavailability
question

In terms of fat and the elderly, what pharmacokinetic changes in distribution should be considered?
answer

Increased fat reduces volume of distribution for hydrophilic meds, and the opposite for lipophilic
question

T/F: Pharmacokinetic changes in the elderly such as protein binding are equivocal
answer

True
question

T/F: There is a decreased elimination of drugs due to a lower renal clearance in the elderly
answer

True
question

What is “ejection fraction”?
answer

Stroke volume/end diastolic volume
question

With congestive heart failure (CHF) at what ejection fraction (in percent) is CHF considered mild, moderate, severe?
answer

Ejection fraction Mild <55% Moderate <45% Severe <30%
question

T/F: An increase in afterload lessens stroke volume
answer

True
question

What is preload?
answer

Preload is the end diastolic volume that stretches the right or left ventricle of the heart to its greatest dimensions under variable physiologic demands
question

What is afterload?
answer

Afterload is the pressure in the wall of the left ventricle during ejection.
question

What is homeostenosis and what are its implications?
answer

The progressive constriction of homeostatic reserve that happens with aging in each organ system. Can lead to frailty, increased susceptibility to infection; can cause heart attack, confusion, death
question

What are the implications of a DNR order?
answer

Do not give CPR or intubate the person if they need it
question

What documentation is necessary for a DNR?
answer

DNR form filled out and signed by the patient, attorney, and medical provider
question

What percentage of patients take less than the prescribed dose (non-compliance)?
answer

90%
question

What percentage of patients take drug holidays?
answer

20%
question

T/F: Patient and MD agree only 1/3 of the time as to what meds the patient is taking
answer

True
question

What percentage of patients make omissions in dosing?
answer

40%
question

T/F: NSAIDs can interact with multiple Rx medications and cause hypertension
answer

True
question

How many people over the age of 65 reside in nursing homes? What percent of elderly?
answer

1.5 Million people ~5% of the elderly
question

What is the average length of stay in a nursing home?
answer

830+ days
question

Of the 5% elderly living in nursing homes (give the breakdown): Ages 65-74 = __% Ages 75-84 = __% Ages 85+ = __%
answer

Ages 65-74 = 14% Ages 75-84 = 36% Ages 85+ = 50%
question

By 2040, __ million people age 65 and older will require nursing home care
answer

By 2040, 4 million people age 65 and older will require nursing home care
question

T/F: More males than females in nursing homes
answer

False; More females (~75%)
question

What cardiovascular changes occur in the elderly?
answer

Heart pumps less effectively
question

What happens to renal function as we age?
answer

Renal function decreases Declines 1% per year after age 30 Decreased mass by 30% in elderly Glomerular filtration declines 10% per decade
question

What are adverse drug reactions?
answer

Result of therapy that was neither intended or elected which causes significant issues
question

T/F: Allergies are a type of adverse drug reaction
answer

True (6-11% of adverse drug reactions)
question

How will left ventricular hypertrophy affect afterload directly?
answer

Decreases afterload
question

If heart muscle contractility decreases, how does that affect the afterload?
answer

Increases afterload
question

How do aortic stenosis and aortic valvulopathy affect afterload?
answer

Increases aortic pressure and increases afterload
question

What does ADL’s stand for?
answer

Activities of Daily Living
question

What does IADL’s stand for?
answer

Instrumental Activities of Daily Living
question

What is the definition of ADL?
answer

A range of common activities whose performance is required for personal self-maintenance and independent community residence
question

Preparing meals, managing money and shopping are IADL’s or ADL’s?
answer

IADL’s Complex abilities needed for independent living.
question

T/F: Chronological age is a poor indicator of functional ability
answer

True
question

T/F: Ejection fractions under 55% are abnormal
answer

True
question

T/F: Some patients in diastolic heart failure have a normal ejection fraction (65%)
answer

True
question

What is the maximum amount of lidocaine/epinephrine?
answer

72 mg lidocaine 36 mcg epinephrine
question

What are the two critical things you need to know about radiation?
answer

1. Where did they irradiate (FOV)? 2. What was the dosage of radiation?
question

What follow up questions would you ask for diabetes?
answer

What type of diabetes do you have? When was it diagnosed? What medications do you take for it? How often do you check your glucose? Do you ever pass out due to low blood glucose?
question

What level HbA1c do you want?
answer

Ideally <6.5
question

If patient with diabetes, what would you do prior to an appointment where you are prepping for a 6 unit anterior bridge?
answer

-Might consider altering insulin dose (no regular + 1/2 NPH) – GET MD CONSULT – Take pre-operative blood sugar level -have patient eat breakfast and schedule AM appointments -Post operative nutrition such as Glucerna
question

What patients are prone to latex allergies?
answer

1. Cystic Fibrosis 2. Spina Bifida/Neural tube defects 3. Pts with multiple drug and/or food allergies 4. Sulfite drug allergies (sulfite in anesthetic with epi.)
question

What is the aspirin triad?
answer

Asthmatic + Aspirin Allergy + Nasal Polyps
question

What is a safety implication for medications for BP control?
answer

Orthostasis
question

What is a safety implication for medications for depression?
answer

Low BP
question

What is are safety implications for medications such as beta blockers/glycosides/CaChannel Blockers?
answer

Be careful with epinephrine vasoconstrictors
question

What is a safety implication for medications for medications with rhythm control (amiodarone)?
answer

Caution epinephrine vasoconstrictors
question

For a 1 person transfer, what angle should the wheelchair be positioned at to the dental chair?
answer

30 degrees (with wheels locked and leg supports out of the way)
question

T/F: The aortic valve gets the most damaged over time, leading to aortic stenosis which increases afterload
answer

True
question

What is P-E congruence?
answer

Person-environment congruence–the fit between the person’s abilities and the environment he/she lives in (needs versus demands of environment basically)
question

___ of dentate residents have significant oral problems requiring care in nursing homes
answer

3/4
question

___ of edentulous patients had oral health problems requiring care in nursing homes
answer

2/3
question

___ of teeth requiring follow up care were ROOT TIPS already in nursing homes
answer

1/5
question

What is the S1 sound?
answer

Closure of AV valve
question

What is S2 sound?
answer

Closure of pulmonic valve
question

What is S3 sound?
answer

Not a normal sound, fluid back-up thus CHF
question

What is S4 sound?
answer

contraction of the atria
question

What is DHPOA?
answer

Durable health care power of attorney = you do not need permission to perform treatment unless the person becomes disabled and incompetent
question

Ejection fraction is normal between what percentages?
answer

55-70%

Get instant access to
all materials

Become a Member