Geriatrics 2

Question 1

Which factor remains unchanged in the healthy geriatric patient?
a. pulse pressure
b. systolic function of the heart
c. systemic vascular resistance
d. lusitropy

Answer 1

b. systolic function of the heart

Question 2

What happens to BP as we age?

Answer 2

increases

Question 3

What happens to pulse pressure as we age?

Answer 3

increased

Question 4

What happens to diastolic function as we age?

Answer 4

decreased

Question 5

What happens to systolic function as we age?

Answer 5

no change

Question 6

What happens to stroke volume as we age?

Answer 6

decreased

Question 7

What happens to cardiac output as we age?

Answer 7

decreased

Question 8

What happens to heart rate as we age?

Answer 8

decreased

Question 9

Arterial stiffness increases__________ to a greater degree than __________

Answer 9

SBP; DBP

Question 10

A decreased cardiac output leads to a

Answer 10

prolonged circulation time

Question 11

Which factor decreases as a result of the aging process?
a. baroreceptor sensitivity
b. incidence of orthostatic hypotension
c. plasma norepinephrine concentration
d. sympathetic tone

Answer 11

a. baroreceptor sensitivity

Question 12

What happens to SNS tone as we age?

Answer 12

increased

Question 13

What happens to PNS tone as we age?

Answer 13

decreased

Question 14

What happens to baroreceptor function as we age?

Answer 14

decreased

Question 15

What happens to ability to thermoregulate as we age?

Answer 15

decreased

Question 16

What happens to responsiveness to catecholamines as we age?

Answer 16

decreased

Question 17

________ dysfunction is associated with the normal aging process

Answer 17

Autonomic

Question 18

There is _____________ concentration in the plasma as we age

Answer 18

higher norepinephrine

Question 19

The decreased PNS tone may lead to

Answer 19

encumberment of the ability of anticholinergics to increase heart rate

Question 20

Reduced baroreceptor response increases the risk of

Answer 20

orthostatic hypotension
syncope
greater degree of hemodynamic compromise following sympathectomy

Question 21

By what percentage does MAC decrease for each decade of life after 40 years of age?

Answer 21

6% per decade

Question 22

What happens to brain mass as we age?

Answer 22

decreased

Question 23

What happens to neurotransmitter activity in the brain as we age?

Answer 23

decreased

Question 24

What happens to the peripheral nerve quantity and function as we age?

Answer 24

decreased

Question 25

The most common perioperative CNS complication in the elderly is

Answer 25

postoperative delirium

Question 26

Postoperative delirium tends to occur _______________, while postoperative cognitive dysfunction tends to occur _________

Answer 26

early in the postoperative period; weeks to months after surgery

Question 27

Treatment for postoperative delirium includes

Answer 27

reversing the underlying cause
antipsychotics
minimizing polypharmacy

Question 28

What is the treatment for postoperative cognitive dysfunction?

Answer 28

there’s no specific treatment

Question 29

Most cases of POCD resolve

Answer 29

after about 3 months and are mild

Question 30

Risk factors for postoperative delirum include

Answer 30

drugs
electrolyte imbalance
lack of drugs (withdrawal)
infection (UTI and respiratory)
reduced sensory input
intracranial dysfunction
urinary retention and fecal impaction
myocardial event, male gender
(spells delirium)

Question 31

What is the presentation of postoperative delirium?

Answer 31

disordered behavior
perception
memory
psychomotor skills

Question 32

What is the presentation of postoperative cognitive dysfunction?

Answer 32

subtle and difficult to pinpoint
impaired concentration, comprehension, and psychomotor skills

Question 33

Risk factors for postoperative cognitive dysfunction include

Answer 33

advanced age (most significant risk factor)
pre-existing cognitive deficit
cardiac surgery
long duration of surgery
high ASA status
low level of education
anesthetic agents

Question 34

_________ matter atrophies at a faster rate than _________ matter

Answer 34

grey; white

Question 35

The dose of IV induction agents for the elderly patient should be reduced by

Answer 35

30-40%

Question 36

What is the sensitivity of the elderly persons brain to anesthetic agents?

Answer 36

increased

Question 37

Alzheimer’s disease is characterized by

Answer 37

decreased acetylcholine

Question 38

Parkinson’s disease is characterized by

Answer 38

decreased dopamine in the basal ganglia

Question 39

Identify the statements that MOST accurately describe neuraxial anesthesia in the elderly patient. (select 2)
a. spinal anesthesia is associated with a lesser spread of local anesthetic
b. CSF volume is increased
C. epinephrine test dose has a higher rate of a false-negative result
d. epidural anesthesia is associated with a greater spread of local anesthetic

Answer 39

c. epinephrine test dose has a higher rate of a false-negative result
d. epidural anesthesia is associated with a greater spread of local anesthetic

Question 40

Describe the elderly patients sensitivity to epidural anesthetics.

Answer 40

increased

Question 41

Describe the elderly patients’ sensitivity of nerve tissue to local anesthetics.

Answer 41

increased

Question 42

Describe the elderly patients’ sensitivity to intrathecal anesthetics

Answer 42

increased

Question 43

Describe the difficulty of neuraxial block placement in the elderly patient.

Answer 43

increased

Question 44

Describe the elderly patient’s response to epi test dosing.

Answer 44

decreased

Question 45

What is the CSF volume of the elderly patient?

Answer 45

decreased resulting in greater spread of LA