Ageing COPY

Question 1

what is sarcopenia?

Answer 1

loss of muscle mass and function as a result of ageing

Question 2

why can silent MIs occur in older people?

Answer 2

may have some degree of autonomic nervous system dysfunction

Question 3

why do old people suffer from hypothermia more often than younger people during illness?

Answer 3

because old people suffer more from gram negative bacteria- can cause hypothermia

Question 4

what are the 5 broad spectrum antibiotics with a high C. diff risk?

Answer 4

• cephlasporins
• co-amoxiclav
• ciprofloxacin
• clindamycin
• clarithromycin

Question 5

what is the SEPSIS 6 protocol?

Answer 5

GIVE
-oxygen
-antibiotics
-fluids
TAKE
-bloods for culture
-bloods to measure lactate
-measure urine output

Question 6

where are telomeres found?

Answer 6

the end of each chromosome arm

Question 7

what happens to telomeres with each cell replication?

Answer 7

progressively shorten

Question 8

what happens when a telomere becomes too short to sustain cell replication?

Answer 8

cell senescence

Question 9

what is a hayflick number?

Answer 9

a number which represents the maximum number of times a cell can divide (ie before telomeres become too short)

Question 10

why can stem cell undertake continuous replication?

Answer 10

they contain telomerase which re-extends shortened telomeres

Question 11

what are the 4 main cellular responses to damage?

Answer 11

• repair
• apoptosis
• senescence
• malignant transformation

Question 12

at what age does muscle mass start to decline?

Answer 12

around 30 years old

Question 13

what is sarcopenic obesity?

Answer 13

when sarcopenic wasting of muscles is combined with an infiltration of fat into the muscle

Question 14

compare primary and secondary sarcopenia?

Answer 14

primary: sarcopenia is solely related to age
secondary: sarcopenia is due to contibuting factors in addition to age

Question 15

what metabolic condition can arise as a consequence of sarcopenia?

Answer 15

insulin resistance and diabetes

Question 16

what is the only proven intervention for sarcopenia?

Answer 16

exercise

• resistance training
• aerobic training

Question 17

what is the suggested physical activity levels for people over 65?

Answer 17

same as target for 18-64

150 minutes of moderate intensity activity a week
or 75 minutes vigorous activity a week

strength and balance work twice a week

Question 18

how does a syringe driver administer medicines?

Answer 18

continuous subcutaneous infusion

Question 19

what is the access for a syringe driver?

Answer 19

butterfly needle with connector tubing

Question 20

how many medicines can be mixed in a syringe driver?

Answer 20

up to 3

Question 21

what is a stroke?

Answer 21

rapidly developing symptoms or signs of focal or global loss of brain function lasting longer than 24 hours with a vascular cause

Question 22

compare a transient ischaemic attack to a stroke?

Answer 22

symptoms last less than 24 hours

Question 23

what are the 3 types of stroke?

Answer 23

• haemorrhage
• subarachnoid haemorrhage
• infarct

Question 24

what are the 4 classification of an infarct stroke?

Answer 24

• cardioembolic
• atheroembolic
• small vessel disease
• other

Question 25

compare cardioembolic and atherembolic strokes?

Answer 25

cardioembolic: fibrin dependent- red thrombus atheroembolic: platelet dependent- white thrombus

Question 26

what is the frontal lobe responsible for?

Answer 26

personality emotional response social behaviour

Question 27

what is the dominant parietal lobe responsible for?

Answer 27

calculations language planned movement appreciation of size, shape, weight and texture

Question 28

what is the non-dominant parietal lobe responsible for?

Answer 28

spatial orientation | constructional skills

Question 29

what is the occipital lobe responsible for?

Answer 29

analysis of vision

Question 30

what is the dominant temporal lobe responsible for?

Answer 30

auditory perception speech and language verbal memory smell

Question 31

what is the non-dominant temporal lobe responsible for?

Answer 31

auditory perception music non-verbal memory smell

Question 32

what investigations will reveal the presence of a stroke? (infarct/haemorrhage)

Answer 32

CT scan | MRI scan

Question 33

what is the acute management of a stroke?

Answer 33

``` thrombolysis/thrombectomy imaging swallow assessment antiplatelets stroke unit care ```

Question 34

what is the time limit for IV alteplase/tissue plasminogen activator (tPA)?

Answer 34

within 4.5 hours from onset of symptoms

Question 35

when is endovascular therapy used for the treatment of strokes?

Answer 35

- alternative/additional therapy for patients who respond poorly to thrombolysis - if patient cannot have thrombolysis due to very high bleeding risk

Question 36

what class of drugs are used as secondary prevention for a cardioembolic stroke?

Answer 36

anticoagulants

Question 37

what class of drugs are used as secondary prevention for ischaemic, non-cardioembolic strokes?

Answer 37

antiplatelets (first line clopidogrel)

Question 38

what scoring system calculates the risk of strokes in a patient with AF?

Answer 38

CHA2-DS2-VASC score

Question 39

at what CHA2-DS2-VASC score is antithrombotic therapy recommended?

Answer 39

1- oral anticoagulant or aspirin | 2 or more (or 1 major)- oral anticoagulant

Question 40

what is the 1 month, 6 month, 1 year mortality rate after a hip fracutre?

Answer 40

1 month- 10% 6 months- 20% 1 year- 30%

Question 41

what is the most common valvular heart disease?

Answer 41

aortic stenosis

Question 42

why can aortic stenosis lead to falls?

Answer 42

reduced cardiac output, reduced brain perfusion leading to syncope

Question 43

compare the falls assessment tools 'Berg Balance Test' and 'Tinetti Score'?

Answer 43

berg balance test only assesses balance, tinetti score also assesses gait

Question 44

when the timed up and go test (TUG) is longer than what time does the falls risk increase?

Answer 44

20s

Question 45

what is the evidence based treatment for falls?

Answer 45

-strength and balance training (minimum three times per week for 12 weeks) -environmental modifications -medication review -calciuim/vit D supplements if vit D deficient

Question 46

what BP measurements should you take in a patient presenting with falls?

Answer 46

lying and standing BP

Question 47

what is delirium?

Answer 47

acute change in cognition and attentitivity which tends to fluctuate

Question 48

what is the time period of the cognition change in delirium?

Answer 48

hours to days

Question 49

compare the onset of dementia, delirium and depression?

Answer 49

dementia- slow, insidious delirium- sudden depression- abrupt with life changes

Question 50

compare the course and reversibility of dementia, delirium and depression?

Answer 50

dementia- progressive, irreversible delirium- fluctuating, usually reversible depression- worse morning, reversible with treatment

Question 51

what are the types of delirium?

Answer 51

hyperactive delirium hypoactive delirium mixed type

Question 52

what are 10 predisposing factors to delirium?

Answer 52

- age - pre-existing dementia - co-morbidities - post-op - terminal illness - sensory impairment - polypharmacy - depression - alcohol dependency - malnutrition

Question 53

what are the 2 subtypes of dementia?

Answer 53

- Alzheimers | - vascular

Question 54

what are the 4 main hallmarks of delirium?

Answer 54

acute and fluctuating inattention altered level of consciousness disorganised thinking

Question 55

what does the 4AT tool for delirium assess?

Answer 55

- alertness - AMT4 (simple questions) - attention - acute change/fluctuating course

Question 56

if medication is needed in delirium, what is first line?

Answer 56

haloperidol

Question 57

when is haloperidol contraindicated in delirium?

Answer 57

alcohol withdrawal | parkinsons disease

Question 58

if medication is needed in a patient with parkinsons with delirium, what is first line?

Answer 58

quetiapine

Question 59

if medication is needed in a alcohol withdrawn patient with delirium, what is first line?

Answer 59

benzodiazepines (lorazepam)

Question 60

why must you be careful when using lorazepam for delirium?

Answer 60

once it wears off the patient can become paradoxically more agitated

Question 61

with AAA screening, at what size of aneurysm is the patient sent for op assessment?

Answer 61

greater than 5.4cm

Question 62

who is eligible for AAA screening?

Answer 62

all men over 65 years old

Question 63

who is eligible for bowel screening?

Answer 63

between 50 and 74 years old | after 75 you can still be screened if you would like to be

Question 64

who is eligible for breast screening?

Answer 64

women aged 50 -70 | after 60 you can still be screened if you would like to be

Question 65

at what age are you eligible for the annual flu vaccine?

Answer 65

65 and over

Question 66

at what age are you eligible for the one off pneumococcal vaccine?

Answer 66

65 and over

Question 67

at what age are you eligible for the one off shingles vaccine?

Answer 67

70 years old | plus catch up cohorts

Question 68

what type of environment do acidic drugs require for absorption?

Answer 68

acidic environment | pH less than 7.35

Question 69

what type of environment do alkaline drugs require for absorption?

Answer 69

basic environment | pH more than 7.35

Question 70

what is the main carrier of basic drugs?

Answer 70

alpha-1-acid glycoprotein | aka orosomucoid ORM

Question 71

what is the main carrier of acidic drugs?

Answer 71

albumin

Question 72

how do you calculate the therapeutic index?

Answer 72

lethal dose 50 / effective dose 50

Question 73

as age increases what happens to the therapeutic window of most drugs?

Answer 73

becomes smaller