Which of the following characteristics of heart failure w/ reduced left ventricular function? (multiple answers)

Systolic failure - EF is low; left ventricular wall progressively dilates, Ventricular contraction unable to sufficiently eject the blood fwd

Which of the following characteristics of heart failure w/ preserved left ventricular function? (multiple answers)

Diastolic failure - EF normal, Myocardium is causing insufficient filling of the ventricles, Usually assoc w/ chronic HTN w/ L ventricular hypertrophy

With anemia, which of the following is a risk?

Inadequate supply of oxygen to tissues - lead to tachycardia & angina

Which of the following tests can we do to examine cognition to determine if the brain is affected by impaired perfusion?

Trails A & B test, counting backward by 7, & stroop test

Left ventricular wall dilates to enlarge chamber > further myocardial dysfunction > insufficient blood ejection

Heart failure w/ reduced left ventricular function

Which of the following is the primary impact diabetes has on the older population?

Impacts micro & macrocirculation

Which of the following are the causes of a decline in PaO2 with age? (multiple answers)

Dec in alveolar gas exchange surface area & dec in CNS responsiveness, Loss of elasticity of MSK sys & dec in mm fibers

Risk factors for coronary artery disease include which of the following? (multiple answers)

Age, gender, & stress, Smoking, diabetes, HTN, obesity, inactivity, abnormal lipid profile, fam hx

Which of the following are signs & symptoms of DVT?

Peripheral edema, venous distention, & pain

CAD risk stratification involves which of the following? (multiple answers)

Determine if pt has signs/symptoms consistent with CAD, Once all risk factors determined, PT can decide risk level of cardiac event, Establish how many risk factors pt has

Which of the following electrolytes reflect renal function & the efficiency of glomerular function?

Creatinine & blood urea nitrogen

Which of the following are diastolic dysfunction signs/symptoms in left ventricular HF? (multiple answers)

Dyspnea, tachypnea, cough, wheezing, rales, hypoxemia, orthopnea, S3 abnormal <3 sound, systolic murmu

What are the age-associated changes in connective tissue at the connective tissue structure level?

Inc stiffness; dec water content; dec strength; dec cross-sectional area

What is the clinical implication of tachycardia?

Need to be cautious when exercising patients - raising HR

Which of the following are the most common problems resulting in hospitalizations in older adults?

CAD, HF, pneumonia, UTIs/sepsis, & dizziness/falls

Which of the following are diastolic dysfunction signs/symptoms in right ventricular HF?

Jugular vein distension, liver engorgement, peripheral edema

What are the changes in muscle structure & function associated with aging as a consequence of sarcopenia? (3 answers)

Deficits in absolute & in specific force generation; mm activation deficits, Deteriorating muscle quality & metabolism, mm atrophy & weakness; impaired regeneration of muscle

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Geriatrics exam 2 pt. 1

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Answers

1
Which of the following characteristics of heart failure w/ reduced left ventricular function? (multiple answers)
Systolic failure - EF is low; left ventricular wall progressively dilates
Usually assoc w/ chronic HTN w/ L ventricular hypertrophy
Diastolic failure - EF normal
Ventricular contraction unable to sufficiently eject the blood fwd
2
Which of the following characteristics of heart failure w/ preserved left ventricular function? (multiple answers)
Ventricular contraction unable to sufficiently eject the blood fwd
Diastolic failure - EF normal
Myocardium is causing insufficient filling of the ventricles
Usually assoc w/ chronic HTN w/ L ventricular hypertrophy
3
With anemia, which of the following is a risk?
Blood clot formation & subsequent loss of perfusion to tissues
Inadequate supply of oxygen to tissues - lead to tachycardia & angina
4
At the ankle, which motion do we primarily see decreases in?
Inversion
PF
DF
Eversion
5
Low levels of ___ are associated with starvation, dehydration, & liver failure.
Creatinine & blood urea nitrogen
Na+ & K
CO2
Blood urea nitrogen
6
Which of the following tests can we do to examine cognition to determine if the brain is affected by impaired perfusion?
Trails A & B test, counting backward by 7, & stroop test
Finger-to-nose, heel-to-shin, & stroop test
Intermittent claudication, capillary refill, peripheral pulses
Finger-to-nose, intermittent claudication, & counting backward by 7
7
Left ventricular wall dilates to enlarge chamber > further myocardial dysfunction > insufficient blood ejection
Heart failure w/ reduced left ventricular function
Heart failure with preserved left ventricular function
8
Which of the following electrolytes are key to maintaining cellular membrane potential?
CO2
Creatinine & blood urea nitrogen
Cl-
Na+ & K
9
There is an annual __ decrease in power associated with aging.
2%
1.5%
2.5%
3%
10
Which of the following is the primary impact diabetes has on the older population?
Increases peripheral sensation
Enhances micro & macrocirculation
Impacts micro & macrocirculation
Decreases likelihood of falls
11
Which of the following are the causes of a decline in PaO2 with age? (multiple answers)
Dec in alveolar gas exchange surface area & dec in CNS responsiveness
Dec elasticity in heart, dec mm fibers, & dec in alveolar exchange area
Loss of elasticity of MSK sys & dec in mm fibers
Dec ROM, inc alveolar gas exchange, inc CNS responsiveness
12
Provides information about the body's response to an infectious disease
Arterial blood gases
Electrolytes
Serum glucose levels
WBC analysis
13
Risk factors for coronary artery disease include which of the following? (multiple answers)
Age, gender, & stress
LE edema, dizziness, syncope, orthopnea, & tachycardia
Smoking, diabetes, HTN, obesity, inactivity, abnormal lipid profile, fam hx
Alcohol consumption, dizziness, syncope, & orthopnea
14
After clotting, which of the following are the patient most at risk of?
Stroke & DVT
PE & stroke
DVT & PE
Stroke & HF
15
How much does PaO2 decline per year after the age of 60 years of age?
10 mmHg
5 mmHg
1 mmHg
3 mmHg
16
Which of the following is the correct way to figure out rate pressure product?
RR x SBP
DBP x SBP
HR x SBP
HR x DBP
17
What is the normal PaO2 range?
80-100 mmHg
20-50 mmHg
60-100 mmHg
50-100 mmHg
18
Which of the following are signs & symptoms of DVT?
Peripheral edema, venous distention, & pain
SOB, abnormal breath sounds, oxygen desaturation, & respiratory failure
Pain, dec ROM, dec MMT, & venous distention
SOB, dec performance, dec breath sounds, & limited ROM
19
Patients with a coagulation level that is too high are at risk of ___.
Clotting
Bleeding
20
Sarcopenia > dec in protein reserve > diminished capacity to meet protein synthesis demands of disease or injury
Path to failure
Muscle atrophy & weakness
Sarcopenia
Path to frailty
21
What are used to assist in the dx of diseases such as cancer, or medical events like CHF, MI, or liver dyfunction
CBC
Serum enzymes & markers
Coagulation profile
Electrolytes
22
With altered WBCs, need to monitor vital signs to ensure an infections has not caused tachycardia & hypotension
False
True
23
Interventions for joint mobility have been shown to improve with multiple-mode exercise programs
True
False
24
Loss of muscle strength is more ___ than the loss of muscle mass.
Rapid
Slow
25
Which movements do we see decline the least in the cervical spine with age?
Extension & lateral flexion
Flexion & extension
Rotation & lateral flexion
Rotation & flexion
26
A gradual decline in cervical ROM is seen after what age?
60
40
50
30
27
Which inspiratory-to-expiratory ratio can be associated with obstructive lug diseases like asthma or chronic bronchitis
1:1
1:2
1:3
2:1
28
CAD risk stratification involves which of the following? (multiple answers)
Determine if pt has signs/symptoms consistent with CAD
Once all risk factors determined, PT can decide risk level of cardiac event
Determine patient comorbidities
Establish how many risk factors pt has
29
What motions are most impacted at the shoulder joint with aging?
Extension & IR
Flexion & ER
ER & IR
Abduction & flexion
30
When do we get max DF during gait?
Midstance
Heel strike
Late stance phase
Late swing
31
Which of the following electrolytes reflect renal function & the efficiency of glomerular function?
Cl-
Na+ & K
CO2
Creatinine & blood urea nitrogen
32
Which of the following are diastolic dysfunction signs/symptoms in left ventricular HF? (multiple answers)
Dyspnea, tachypnea, cough, wheezing, rales, hypoxemia, orthopnea
S3 abnormal <3 sound, systolic murmu
Jugular vein distension, liver engorgement, peripheral edema
Fatigue, angina, activity intolerance, exertional dyspnea, narrow PP
33
What are the age-associated changes in connective tissue at the connective tissue structure level?
Inc stiffness; dec water content; dec strength; dec cross-sectional area
Dec proliferation; altered control of apoptosis; dec response to GFs
Fragmentation of collagen
Altered response to loading
34
What is the clinical implication of tachycardia?
Need to be cautious with transfers
Patient should be able to transfer independently
Need to be cautious when exercising patients - raising HR
Need to exercise & focus on raising HR
35
Elevated platelets
Anemia
Neutropenia
Thrombocytopenia
Thrombocytosis
36
Which of the following are the most common problems resulting in hospitalizations in older adults?
CAD, HF, pneumonia, UTIs/sepsis, & dizziness/falls
HTN, HF, CAD, sepsis, diabetes, & orthostatic hypotension
Sepsis, diabetes, pneumonia, peripheral neuropathy, orthostatic hypotension
Dizziness/falls, CAD, HF, sepsis, & HTN
37
Given how much strength & power are lost annually with aging, which is more appropriate to work on with older adults?
Strength
Power
38
Acute inflammation of the lungs caused by a bacterial, viral, or fungal pathogen
HF
Asthma
Diabetes
Pneumonia
39
Vibration of chest wall - result of sound transmitting through lung tissue
Rales
Fremitus
Wheezing
Crackles
40
Which of the following are diastolic dysfunction signs/symptoms in right ventricular HF?
Fatigue, angina, activity intolerance, exertional dyspnea, narrow PP
Jugular vein distension, liver engorgement, peripheral edema
Dyspnea, desaturation, cyanosis, tachypnea, hypoxiz
Dyspnea, tachypnea, cough, wheezing, rales, hypoxemia, orthopnea
41
Stride decreases with aging
True
False
42
___ is commonly elevated in the presence of heart or renal failure.
Blood urea nitrogen
Creatinine & blood urea nitrogen
Na+ & K
CO2
43
Which of the following is the correct calculation to determine the appropriate PaO2 for a patient?
109 - 0.75 x age
109 - 0.85 x age
109 - 0.56 x age
109 - 0.43 x age
44
Which of the following have the highest incidence of infections in older adults?
Pulmonary infections & kidney infections
UTI & kidney infections
UTI & pulmonary infections
Gastric infections & UTIs
45
What should the inspiratory-to-expiratory ratio be?
1:2
1:3
2:1
1:1
46
Age-related loss of muscle that is more than muscle atrophy & is associated with disuse & inactivity.
Weakness
Atrophy
Frailty
Sarcopenia
47
RBC count too low
Anemia
Thrombocytosis
Polycythemia vera
Thrombocytopenia
48
What are the changes in muscle structure & function associated with aging as a consequence of sarcopenia? (3 answers)
Altered endocrine function & its consequences
Deficits in absolute & in specific force generation; mm activation deficits
Deteriorating muscle quality & metabolism
mm atrophy & weakness; impaired regeneration of muscle
49
We need to include conditions/dx that are relevant to current episode of care as well as previous episodes of care
True
False
50
Definition of sarcopenia has expanded to include loss of muscle strength (& power) and functional quality
False
True
51
In what plane do we see the most changes with hip motion & aging?
Transverse
Frontal
Sagittal
52
Thickness & density of ___ bone tend to decrease with advancing age.
Cortical
Trabecular
Subchondral
53
Any total RPP value of _____ indicates an increased risk for heart disease.
>9,000
>15,000
>10,000
>5,000
54
Which movements do we see decline the most in the cervical spine with age?
Extension & lateral flexion
Rotation & flexion
Flexion & extension
Rotation & lateral flexion
55
Which of the following are systolic dysfunction signs/symptoms in right ventricular HF?
Dyspnea, desaturation, cyanosis, tachypnea, hypoxiz
Fatigue, angina, activity intolerance, exertional dyspnea, narrow PP
Dyspnea, tachypnea, cough, wheezing, rales, hypoxemia, orthopnea
Jugular vein distension, liver engorgement, peripheral edema
56
Muscle size means muscle strength
False
True
57
Usually a comprehensive list of medical dx/conditions from past hx may not be accurate/current
False
True
58
When monitoring patients on anticoagulation therapy, international normalized ratio should be in what range?
15-20 s
12.8-14.6 s
0.8-1.2
25-38 s
59
Which of the following are causes of dec fremitus? (multiple answers)
Air in healthy lung replaced w/ something else
Inc thickness of chest wall
Lung consolidation
Excess air in lungs
60
We can use RPP information to do which of the following? (multiple answers)
Use to design safe exercise program below anginal threshold
Document MET level where symptoms appear; progress rehab plan
Document hypothesized cause of symptoms; monitor progression of disease
To stop exercise as soon as they reach the anginal threshold
61
AROM & PROM both decrease with age, but which one tends to decline more?
PROM
AROM
62
What is one age-related change to articular cartilage that occurs independently of OA (pathology) changes?
Decreased ROM
Decreased thickness & density
Increased laxity
Tendency to calcify
63
In the thoracic & lumbar spine, which of the following mvmts has minimal loss with aging?
Flexion
Extension
Sidebending
Rotation
64
There is an annual __ decrease in strength associated with aging.
2%
3%
2.5%
1.5%
65
What is the clinical implication of hypotension?
Need to be cautious with transfers
Need to be cautious when exercising patients - raising HR
Patient should be able to transfer independently
Need to exercise & focus on raising HR
66
In the thoracic & lumbar spine, which of the following mvmts becomes the most limited with aging?
Extension
Flexion
Rotation
Sidebending
67
Dec in protein reserve from sarcopenia make it more difficult to meet inc protein demands that come w/ disease or injury
True
False
68
What are the age-associated changes in connective tissue at the cellular level? (2 answers)
Dec proliferation; altered control of apoptosis; dec response to GFs
Fragmentation of collagen
Inc stiffness; dec water content; dec strength; dec cross-sectional area
Altered response to loading
69
Which inspiratory-to-expiratory ratio may indicate hyperventilation, reducing PaO2, possibly associated w/ anxiety
1:2
2:1
1:1
1:3
70
Indicate the ability of the patient's blood to clot
Serum enzymes & markers
Electrolytes
Coagulation profile
CBC
71
Elevation in total WBCs
Thrombocytopenia
Leukocytosis
Thrombocytosis
Leukopenia
72
Which of the following is septic shock defined by? (2 answers)
Metabolic abnormalities defined as lactate level > 50 mg/dL
Needing a vasopressor to maintain a mean arterial pressure > 80 mmHg
Needing a vasopressor to maintain a mean arterial pressure > 65 mmHg
Metabolic abnormalities defined as lactate level > 18 mg/dL
73
ventricle walls thicken > norm or slightly small chamber dec myocardium ability to relax for sufficient filling
Heart failure w/ reduced left ventricular function
Heart failure with preserved left ventricular function
74
___-based questions are important to ask when screening for cardiovascular, metabolic, & oncologic conditions.
Symptom
Psychosocial
Time
75
A subset of sepsis where the individual is also experiencing circulatory dysfunction
Septic shock
UTI
Sepsis
Infection
76
What are the changes in metabolic function associated with aging as a consequence of sarcopenia? (3 answers)
Diseases & conditions associated with skeletal muscle decline
Mitochondrial dysfunction; apoptosis; influence of genetics
Altered endocrine function & its consequences; cytokines & adiposity
mm atrophy & weakness; impaired regeneration of muscle
77
When monitoring patients on anticoagulation therapy, partial prothrombin should be in what range?
12.8-14.6 s
0.8-1.2 s
15-20 s
25-38 s
78
What joint ROM of the UE is most affected by aging?
Wrist
Elbow
Shoulder
Cervical spine
79
Which of the following are systolic dysfunction signs/symptoms in left ventricular HF? (multiple answers)
Dyspnea, tachypnea, cough, wheezing, rales, hypoxemia, orthopnea
S3 abnormal <3 sound, systolic murmu
Fatigue, angina, activity intolerance, exertional dyspnea, narrow PP
Dec mental status, dec urination, cool, pale, diaphoresis
80
Which of the following will be elevated in allergic responses?
Lymphocytes
Neutrophils
Platelets
Eosinophils
81
With polycythemia vera, which of the following is a risk?
Blood clot formation & subsequent loss of perfusion to tissues
Inadequate supply of oxygen to tissues - lead to tachycardia & angina
82
Which BMI is assoc w/ an increase in mortality in hospitalized patients as well as older adult community dwellers?
<20
<18
<17
<19
83
Decreased platelets
Thrombocytosis
Anemia
Neutropenia
Thrombocytopenia
84
Which of the following will be elevated in the presence of bacterial or fungal infections?
Lymphocytes
Eosinophils
Neutrophils
Platelets
85
Hip ___ ROM decreases by more than 20% which may relate to decreased walking speed.
Extension
ER
IR
Flexion
86
An estimate of myocardial oxygen consumption; should increase as workload increases. Known as "anginal threshold"
RR
BP
HR
Rate pressure product
87
Which of the following electrolytes are used to assist in the analysis of the body's acid-base balance?
Cl-
Creatinine & blood urea nitrogen
Na+ & K
CO2
88
RBC count too high
Thrombocytosis
Anemia
Thrombocytopenia
Polycythemia vera
89
What are the age-associated changes in connective tissue at the molecular level? (2 answers)
Inc stiffness; dec water content; dec strength; dec cross-sectional area
Fragmentation of collagen
Dec proliferation; altered control of apoptosis; dec response to GFs
Inc structural protein cross-linkages; dec proteoglycan size
90
Which of the following are signs & symptoms of PE?
Pain, dec ROM, dec MMT, & venous distention
SOB, abnormal breath sounds, oxygen desaturation, & respiratory failure
SOB, dec performance, dec breath sounds, & limited ROM
Peripheral edema, venous distention, & pain
91
Which of the following are causes of inc fremitus? (multiple answers)
Lung consolidation
Air in healthy lung replaced w/ something else
Excess air in lungs
Inc thickness of chest wall
92
Decreased total WBCs
Thrombocytopenia
Leukopenia
Leukocytosis
Thrombocytosis
93
Which of the electrolytes are used for further analysis of acid-base balance through calculation of the anion gap?
Cl-
Creatinine & blood urea nitrogen
Na+ & K
CO2
94
Which of the following will be elevated in the presence of viral infections?
Neutrophils
Lymphocytes
Platelets
Eosinophils
95
When monitoring patients on anticoagulation therapy, prothrombin should be in what range?
15-20 s
12.8-14.6 s
0.8-1.2 s
25-38 s
96
Which of the following is an important clinical implication (per Dr. Burns) of decreased DF with aging?
Decreased gait speed
Inadequate heel strike
Gait is impaired
Sit-to-stand becomes harder
97
Which of the following are signs/symptoms of sepsis?
Fever; hypertension; RR <12; HR >100; infection
Hypotension; fever >101.3; elevated HR > 90; RR > 20; confirmed infection
Dizziness; orthostatic hypotension; HR <90; confirmed infection
Hypertension; RR <12; HR >100; no infection
98
Muscle mass represents the protein reserve of the body. Sarcopenia leads to a ___ in protein reserves.
Increase
Decrease
99
Aid in clotting. Release of growth factors contributes to cellular repair & regeneration
Platelets
RBC
Electrolytes
WBC
100
In patient's with high coagulation levels, which of the following do we want to watch & monitor for?
Decreased strength, limited ROM, pain, & swelling
Effusion, pain, change in temperature, & limited ROM
Ecchymosis, edema, pain, decreased strength, & limited ROM
Edema, ecchymosis, limits in limb range of position, pain & neuro changes

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