Ageing Skin and GIT

Question 1

In ageing there are lots of changes to the skin. Which of the following does NOT typically occur?

1 - reduced number/function of sweat glands
2 - increased number of Langerhans cells
3 - reduced subdermal fat
4 - thinner epidermis
5 - weakened dermo-epidermal junction

Answer 1

2 - increased number of Langerhans cells
- there is a decrease in Langerhans cells
- this is associated with reduced immune response

Question 2

As we age there are a significant number of changes including:

• reduced number/function of sweat glands
• increased number of Langerhans cells
• reduced subdermal fat
• thinner epidermis
• weakened dermo-epidermal junction

Which of the following can these changes increase elderly patients risk of?

1 - dry (xerosis) cracked and itchy (pruritis) skin
2 - cellulitis
3 - susceptible to trauma
4 - reduced wound healing
5 - all of the above

Answer 2

5 - all of the above

Question 3

In ageing skin, there is a reduction in the subdermal fat layer, reduced number of sweat glands and reduced capillary number in the dermis. Which aspect of skin function is this most likely to affect?

1 - heat regulation
2 - proprioception
3 - production
4 - protection

Answer 3

1 - heat regulation
- sweat glands do not cool down
- poor circulation to redistribute blood to warm patients
- less fat as an insulator

• can cause hypothermia or hyperthermia in elderly patients

Question 4

Proprioception and touch is reduced in aging skin. Which 2 receptors have been shown to have the largest reduction that contribute to proprioception?

1 - ruffini endings
2 - nocioceptors
3 - meissners corpuscles
4 - pacinian corpuscles

Answer 4

3 - meissners corpuscles
4 - pacinian corpuscles

Question 5

In ageing skin there is a reduction in the precursors of which vitamin in the skin?

1 - B12
2 - C
3 - B1
4 - D

Answer 5

4 - D
- vit D synthesis reduces by 50% between 20-80
- increased risk of fragility fractures and sarcopenia

Question 6

Older patients are advised to get some sun exposure due to their reduced ability to synthesise vitamin D. However, excessive sun exposure can lead to which of the following?

1 - Cellular dysplasia
2 - Atypical cells
3 - Disorganization in epidermis
4 - Elastosis in dermis
5 - Inflammatory infiltrate localized to the perivascular areas
6 - all of the above

Answer 6

6 - all of the above
- these are all forms of photoageing / extrinsic ageing

Question 7

Are skin tumours more common in young or elderly patients?

Answer 7

• elderly patients

Question 8

Elderly patients are more susceptible to skin tumours. Which of the following is NOT a cancerous skin tumour?

1 - squamous cell carcinoma
2 - basal cell carcinoma
3 - actinic keratosis
4 - melanoma

Answer 8

3 - actinic keratosis

Question 9

As we age there are changes to the GIT that can be anatomical, physiological and/or neuroendocrine. Which of the following typically does NOT occur in the ageing oropharynx?

1 - decreased smell and taste
2 - reduced saliva production
3 - oral transit time of food is reduced
4 - reduced cough reflex
5 - increased dental disease

Answer 9

3 - oral transit time of food is reduced
- oral transit time is typically increased

Question 10

As we age there are changes to the GIT that can be anatomical, physiological and/or neuroendocrine. All of the following typically occur in the ageing oropharynx:

1 - decreased smell and taste
2 - reduced saliva production
3 - oral transit time of food is increased
4 - reduced cough reflex
5 - increased dental disease

Which one of these has the largest effect on xerostomia?

Answer 10

2 - reduced saliva production
- xerostomia means dry mouth

• patients with dry mouth contributes to malnutrition

Question 11

In ageing there are changes in the oesophagus and in the ability to swallow. Which of the following is NOT an aspect of ageing that directly contributes to the oesophagus and swallowing?

1 - reduced peristaltic contractions
2 - reduction in enteric neurons
3 - impaired HCL production
4 - laxity of gastro-oesophageal junction
5 - oesophageal dilation

Answer 11

3 - impaired HCL production

• gastro-oesophageal junction responsible for stopping stomach contents entering the oesophagus

Question 12

In ageing patients have a the following:

• reduced peristaltic contractions due to reduced enteric neurons
• laxity of gastro-oesophageal junction
• oesophageal dilation

Which 2 of the following are most likely to occur due to the above problems?

1 - incisional hernia
2 - gastro-oesophageal reflux disease
3 - aspiration pneumonia
4 - peptic ulcer

Answer 12

2 - gastro-oesophageal reflux disease
3 - aspiration pneumonia

Question 13

In ageing there is an increase in the atrophic gastritis (inflammation and thinning of stomach wall), a reduction in gastric acid secretion and delayed gastric emptying. Which of the following is NOT a condition that is caused by these changes?

1 - gastric malabsorption (iron and Ca2+)
2 - peptic ulceration
3 - bacterial overgrowth
4 - increased incidence of coeliac disease

Answer 13

2 - peptic ulceration

Question 14

In ageing there are a number of changes that can occur in the large bowel, such as:

• reduced neurons in the myenteric plexus
• increased intra-abdominal pressure required for stool excretion
• delayed gut transit time
• reduced stool water content

Which 2 of the following conditions are most likely to be present in elderly patients due to the above changes?

1 - constipation
2 - crohn’s disease
3 - diverticulitis
4 - ulcerative colitis

Answer 14

1 - constipation
3 - diverticulitis

Question 15

Anorexia in ageing has been associated with reduced appetite, earlier satiety, less hunger and therefore food intake. Which of the following has NOT been linked with these in ageing?

1 - increase gut hormones like cholecystokinin
2 - increased leptin and insulin
3 - impaired gastric fundal compliance and early satiety
4 - atrophy of villi

Answer 15

4 - atrophy of villi