Transcript Math Jeopardy

Developed by
Bree Johnston MD MPH
Eric Widera MD
Mike Harper MD
UC San Francisco
Based on
The Game Show Jeopardy! &
Geriatric Jeopardy from our colleagues at
UCLA and other institutions
Click Here to Start
Click here for
Double Geripardy
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Final Geripardy
Delirium
Aging*
Rock Stars
AARP definition
Falls
InconMedicare &
tinence MediCaid
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Fat emboli may be one
explanation for the
high prevalence of
delirium with this
condition
What is hip
fracture?
Robertson BD and TJ The Journal of Bone
& Joint Surgery 2006; 88: 2060-68.
This commonly
used sleeper will
increase the risk of
of delirium by
about 70%
What is
diphenhydramine?
(benadryl)
Agostini JV, Leo-Summers
LS, Inouye SK.
Arch Intern Med. 2001 Sep
24;161(17):2091-7
Sleep promotion
Activity
Hydration
Vision and Hearing Aids
Re-orientation
Targeting what
conditions can reduce
the incidence of
delirium?
Inouye S et al N Engl J Med. 1999
Mar 4;340(9):669-76
The Confusion Assessment
Method (CAM) requires
these two elements plus
EITHER disorganized
thinking OR altered level of
consciousness
What are Acute Change in
Mental Status AND
Inattention?
Inouye SK et al. The confusion assessment
method. A new method for detection of
delirium.
Ann Intern Med. 1990 Dec 15;
113(12):941-8.
The use of this class of
medications as first line
treatment for agitated
delirium is based more on
expert opinion than RCTs
What are antipsychotics?
Inouye SK. Delirium in
older persons.
N Engl J Med. 2006 Mar
16;354(11):1157-65.
He was born Robert
Zimmerman on May,
24th, 1941, in Duluth,
Minnesota
Who is
Bob Dylan?
In the 1960’s this guitarist
was often referred to as
“God”
Who is Eric Clapton?
(age 61)
Though not well known for
this, this aged Rocker
attended the London School
of Economics
Who is Mick Jagger?
This band did its first
tour in over 20 years
in 2006,
“Uncut. Uncensored.
Unrepentant.”
Who is the “Who”?
Sometimes known as
“Shaky”, this Rocker does a
major benefit for a Bay Area
School for physically
challenged children every fall
Who is Neil Young?
(age 61)
These can reduce hip
fractures
dramatically….but
patients don’t like to
use them
What are hip
protectors?
Kannus et al. NEJM 2000 343; 1506-1513
This exercise has been
associated with reduced
fall risk, improved
balance, and reduced fear
of falling
360 [PubMed - indexed for MEDLINE]
What isTai Chi?
Wolf SL, Barnhart HX, Kutner NG, McNeely E,
Coogler C, Xu T. Atlanta FICSIT Group.
J Am Geriatr Soc. 1996 May;44(5):489-97.
Li F, Tai Chi and fall reductions in older
adults: a randomized controlled trial.
J Gerontol A Biol Sci Med Sci. 2005
Feb;60(2):187-94.
Antidepressants, diuretics,
and sedative-hypnotics,
based on this metaanalysis
What medications
are associated with
an increased risk of
falls?
Leipzig RM, Cumming RG, Tinetti ME. J Am
Geriatr Soc. 1999 Jan;47(1):40-50.
Leipzig RM, Cumming RG, Tinetti ME. J Am
Geriatr Soc. 1999 Jan;47(1):30-9.
A meta-analysis
published in JAMA
suggests that this
intervention is
associated with a
decreased risk of FALLS
and FRACTURES
What is ingestion of
Vitamin D?
Bischoff-Ferrari HA et al; JAMA
2004; 291(16):1999-2006
Of the following interventions, the one
that has been most strongly associated
with a decreased risk of falls in an RCT:
• A multifactorial intervention
targeting risk factors for falls
• Prescription of a walker
• Prescription of thick soled athletic
shoes
• Aerobic exercise training
What is
“A multifactorial
intervention targeting
risk factors for falls”?
Tinetti M, et. al. New
England Journal of Med.
1994;331:821-827.
45-60 a day of these
daily may help reduce
stress episodes
What are pelvic
floor (“Kegel”)
exercises?
Cochrane Database Syst Rev.
2001;(1):CD001407..Hay-Smith EJ, Bo
Berghmans LC, Hendriks HJ, de Bie RA, van
Waalwijk van Doorn ES.
•Refractory retention
•Recurrent UTI’s
•Hematuria
•Bladder stones
•Renal impairment due
to BPH
What are
indications for
TURP with BPH?
McConnell JD, Barry MJ,
Bruskewitz RC. Agency for Health
Care Policy and Research.Clin Pract
Guidel Quick Ref Guide Clin. 1994
Feb;(8):1-17.
Oxybutinin & tolteridine,
to name 2
What are medications
used to treat urge
incontinence?
Ouslander J. Management of
overactive bladder.
N Engl J Med. 2004
19;350(8):786-99.
The mnemonics
DRIP & DIAPPRERS are
two ways to remember
these
What are potentially reversible causes of
incontinence?
•
•
•
•
D –delirium, diabetes
R – Restricted mobility
I – Infection, impaction
P - pharmeceuticals
• D – Delirium
• I – Infection
• A – Atrophy
(urethrovaginal)
• P – Pharmaceuticals
• P – Psychiatric
• E – Endocrine (DM,
Calcium, DI)
• R – Restricted mobility
• S – Stool Impaction
Adapted From Joe Ouslander (DRIP)
and Neil Resnick (DIAPPERS)
Symptoms of urgency with
an elevated post void
residual volume
What is DHIC?
(detrusor hyperactivity with impaired
contractile function)
Resnick NM, Yalla SV. Detrusor hyperactivity
with impaired contractile function. An
unrecognized but common cause of incontinence
in elderly patients.
JAMA. 1987 Jun 12;257(22):3076-81.
Medicare will only pay for a
home health aid while this
condition is met
What is
receiving skilled
services at
home?
The vast majority of
patients in this innovative
program for frail elders
have both MediCaid and
Medicare
What is PACE?
(in San Francisco, On
Lok)
Bodenheimer T: Long-term care for frail
elderly people--the On Lok model. N Engl
J Med. 1999 Oct 21;341(17):1324-8.
It pays for about
50% of nursing
home care
What is MediCaid?
http://.cms.hhs.gov/statistics/nhe
Between $2250 and $5100
What is the so called
“Donut Hole” of lack of
coverage in the Medicare
bill of 2003
www.medicare.gov
99215
What is the highest complexity CPT code for an
Established Outpatient?:
Key Components (2 of 3 meet or exceed requirements)
E/M Comprehensive History
E/M Comprehensive Exam
E/M High Complexity Medical Decision
Problem Severity
E/M Moderate Severity Problem
E/M High Severity Problem
Physician Time: 40 minutes
Iatrogenesis
Pharm
Potpouri
Aging
Bones
& muscles
Dementia
Aging
Celebrities
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An age related delay in
excretion of a sodium load
by the kidney and decrease
in LV wall compliance can
make this common clinical
intervention hazardous in
older people
What is IV fluid
administration?
Chest, 1999; 115: 15851645
Functional decline,
impaired ambulation,
and orthostasis can
result from this
What is bedrest?
Creditor MC Ann Int Med
1993; 118 (3) 219-23
This intervention is the
standard of care for patients at
risk for pressure ulcers.
What is turning
the patient every
two hours?
Patterson, J., Bennett, R. JAGS, 1995. 43:919-927
A major focus of JCAHO,
they can result in death by
strangulation
What are restraints?
Evans D. J. Adv. Nursing 2003;
41(3) 274-282
Early post-op removal of these
devices has been shown to decrease
reduce antibiotic use after surgery
What are indwelling
urinary catheters?
Stephan F. et al. SO
Clin Infect Dis. 2006 Jun
1;42(11):1544-51
According to Goodman and
Gilman, this OTC drug
“Despite [its] widespread
use… has marginal, if any,
efficacy in constipation.
What is docusate?
(colace)
Goodman and Gilman’s The
Pharmocologic basis of
theraputics. New York: McGrawHill, 1996:917-937
The first line drug for
most cases of mild
osteoarthritis
What is acetaminophen?
Zhang, W. Jones, A.
Doherty, M.
Ann Rheum Dis, 2004.
Aug;63(8):901-7
The recommended first line
class of drugs for isolated
systolic hypertension
What are thiazide diuretics?
Chobanian, A. et al.
JAMA, 2003.
May 21;289(19):256072.
Despite being on many
hospital formularies in
p.o. and i.v. forms, this
analgesic is not
recommended in elders
What is meperidine?
O'Connor, A. Am J Med,
2005.
118(8): 885-9.
Though commonly
prescribed, there is no
evidence that this
antidepressant is safer or
more efficacious than other
agents (or placebo) in the
treatment of insomnia
What is trazadone?
Mendelson, W.
J. Clin Psychiatry. 2005
Apr;66(4):469-76
Age related
decreases in muscle
mass and strength
can be attenuated
by this
What is exercise?
This injury, common
among the Mets, usually
occurs in elders who
have not achieved many
mets
What is rotator cuff
injury?
Elevated levels of this
vitamin have been
associated with reduced
bone density and
increased risk of fracture
What is Vitamin A?
Feskanich D. et. al.
JAMA, Jan 2002; 287: 47 - 54.
The potential risk of
osteosarcoma limits use
of this medication to 1-2
years max
What is What is
teriperitide?
Toxicol Path 2002 MayJune 30 (3) 312-21
According to the FDA, the
number needed to harm
=75 for this (previously)
popular drug
What is Vioxx?
(for AMI or sudden cardiac death)
Commonly used to control
behavioral symptoms in
dementia, this class of
drugs has been associated
with an increased risk of
death
What are
antipsychotics?
Schneider L at al JAMA, 2005;
294: 1934-43.
This type of dementia
commonly presents with
visual hallucinations and
extreme sensitivity to
neuroleptics
What is Lewy Body
Dementia?
McKeith LG et al Neurology
1996; 47: 1113-24
Language difficulties and
personality changes are
characteristic of this type
of dementia
What is frontotemporal dementia
(FTD)?
Kertesz A. The Neurologist
2003; 9: 311-317
Cognitive impairment, a
vertical gaze palsy, and
parkinsonian symptoms
are seen in this type of
dementia
Progressive supranuclear
Palsy (PSP)
Burn D & Lees A. PSP: Where are
we now? Lancet Neurology 2002. 1:
359-69
Dementia made the
appearance of this
celebrity controversial in
the movie “Bowling for
Columbine”
Who is Charleton
Heston?
At age 100, this man was
asked “You smoke eight to
ten cigars a day – what does
your doctor say about all of
this?”
He replied “My doctor is
dead.”
Who was George
Burns?
Kathrine Hepburn had
this condition
What is essential
tremor?
The ex-president had the
same condition as his dog.
(We need the name of the
president AND the condition)
Who is George H.W. Bush and
his dog Millie?
And
What is Hyperthyroidism
(Graves)
Trent Lott said this at this politician’s
100th birthday party:
“I want to say this about my state:
When ____ ran for president, we voted
for him. We’re proud of it. And if the
rest of the country had of followed our
lead, we wouldn’t have had all these
problems over all these years, either.”
Who is Strom Thurmond?
Though often copied, this
jazz musician is the likely
originator of the quote: “If
I’d known I was going to
live this long, I’d have
taken better care of
myself.”
Who is Eubie Blake?
The Final Jeopardy
Category is:
The Nobel Prize & Dementia
This UCSF Scientist was
instrumental in the
understanding of the role of
prions in neurologic diseases
of the CNS
Who is Stanley Prusiner?