Exam I Flashcards
(123 cards)
1
Q
What are the GI Sx experienced by the elderly?.
A
Dysphagia, gastrointestinal reflux and constipation due to selective degeneration from the aging nervous system.
2
Q
What causes hypochlorhydria?
A
Chronic PPI use, vagotomy, gastric resections
3
Q
What can hypochlorhydria predispose an elderly pt to?
A
Bacterial overgrowth—>Malnourishment
4
Q
What type of pancreatic changes occur with aging?
A
Secretagogue-stimulated lipase, chymotrypsin and bicarbonate concentration in pancreatic juice have all been shown to decline with aging.
5
Q
What type of hepatic changes occur with aging?
A
Shrinks in size; not much changes microscopically
6
Q
What occurs in the small intestine?
A
Decrease in number of villi and crypts
7
Q
What are the four major contributors to “Anorexia of Aging?
A
Decreased energy expenditure, decrease exercise, physiological changes with aging, pathological changes with aging
8
Q
What are some examples of physiological changes associated with aging?
A
Hormonal, cytokines, decrease in taste and small, changes in GI tract
9
Q
What are some examples of pathological changes associated with aging?
A
Medical, Drugs, Psychological, Social
10
Q
When do BMI and body weight begin to decline?
A
There’s a steady increase until the 50s-60s, then it declines
11
Q
What increases with aging?
A
Body fat increases
12
Q
What is the average decrease in fat-free mass per decade?
A
3 kg after the age of 50
13
Q
Increased fat causes what secondary Sx?
A
Reduced physical activity, reduced levels of GH, reduced sex hormone, decreasing metabolic rate
14
Q
What types of organ fat particularly increase?
A
Intrahepatic and intraabdominal
15
Q
What senses decline with aging?
A
Decrease in smell and taste sensitivity
60% of subjects 65 to 80 years and more than 80% of subjects aged >80 years had developed a reduced sense of smell and taste compared to less than 10% of those <50 years
16
Q
What is thought to cause a decline in sense of smell and taste?
A
May be caused by reduced number of taste buds and changes in the olefactory epithelium
17
Q
How does appetite change with aging?
A
Feeling of fullness/satiety
18
Q
Why do appetite changes occur?
A
Reduced sensitivity to GI distension and rapid antral filling leading to early satiety
19
Q
What part of the brain controls hunger/satiety?
A
Hypothalamus
20
Q
What mediator is release to mediate hunger and INHIBIT satiety and where is it secreted?
A
Neuropeptide Y; nucleus arcuatus
21
Q
What mediator stimulates satiety, also produced by the nucleus arcuatus?
A
Pro-opoimelacortin
22
Q
What pancreatic hormone is increased that increases satiety in response to lipid and proteins?
A
CCK
23
Q
What other hormone is increased that improperly signals adequate fat stores?
A
Leptin
24
Q
Is Insulin increased or decreased in the elderly?
A
Elevated insulin and decreased glucose tolerance
25
Increased insulin levels stimulate/inhibit what 2 molecules?
Amplies lipten secretion and inhibits ghrelin
26
What are some of the signs/Sx of nutrient deficiency?
```
decline in functional status
impaired muscle function
decreased bone mass
immune dysfunction
anemia
reduced cognitive function
poor wound healing
delayed recovering from surgery
higher hospital and readmission rate and mortality
```
27
What vitamin deficiency causes Dry scaly skin?
Zinc/ F.A.
28
What vitamin deficiency causes Follicular hyperkeratosis?
Vitamin A, C
29
What vitamin deficiency causes Petechiae?
Vitamin C, K
30
What vitamin deficiency causes photosensitive dermatitis?
Niacin
31
What vitamin deficiency causes poor would healing?
Zinc, Vitamin C
32
What vitamin deficiency causes scrotal dermatitis?
Riboflavin
33
What deficiency causes thin/depigmented?
Protein
34
What vitamin deficiency causes easy pluckabilty?
```
Protein, zinc
Is this module for real?
```
35
What vitamin deficiency causes transverse depigmentation of the nails?
Albumin
36
What vitamin deficiency causes spooned nails?
Iron
37
What vitamin deficiency causes night blindness?
Vitamin A, ZInc
38
What vitamin deficiency causes conjunctival inflammation?
Riboflavin
39
What vitamin deficiency causes Keratomalacia?
Vitamin A
40
What vitamin deficiency causes bleeding gums?
Vitamin C, riboflavin
41
What vitamin deficiency causes glositis?
Niacin, piridoxin, riboflavin
42
What vitamin deficiency causes atrophic papillae ?
Iron
43
What vitamin deficiency causes Hypogeusia?
Zinc, Vitamin A
44
What vitamin deficiency causes thyroid enlargement?
Iodine
45
What deficiency causes parotid enlargement ?
Protein
46
What vitamin deficiency causes diarrhea?
Niacin, folate, B12
47
What deficiency causes Hepatomegaly?
Protein
48
What vitamin deficiency causes Bone tenderness?
Vitamin D
49
What vitamin deficiency causes Joint Pain?
Vitamin C
50
What vitamin deficiency causes muscle tenderness?
Thiamine
51
What vitamin deficiency causes muscle wasting?
Protein, selenium vitamin D
52
What deficiency causes edema?
Protein
53
What vitamin deficiency causes ataxia?
B12
54
What vitamin deficiency causes tetany?
Calcium, Mg
55
What vitamin deficiency causes parathesias?
Thiamine, B12
56
What vitamin deficiency causes Dementia?
B12, niacin
57
What vitamin deficiency causes hyporeflexia?
Thiamine
58
What are some commonly used markers to detect nutritional deficiencies?
Albumin, transferrin, retinol-binding protein, thyroxine-binding protein
59
What is wasting?
Involuntary loss of weight
60
What causes wasting?
Due to poor dietary food intake due to disease or just physiologic and leads to negative energy balance
61
What is cachexia?
Involuntary loss of fat-free mass (muscle, organ, tissue, skin and bone) or body cell mass
62
What causes cachexia?
Caused by catabolism and results in body consumption
63
What response is associated with cachexia?
Acute immune response
64
What cytokines are released to cause cachexia? What do they cause?
IL-1, IL-6, TNFα; have profound effects on hormone production and metabolism and cause increased resting energy expenditure.
65
Is nitrogen balance positive or negative to cause loss in muscle mass? Why does this occur?
Negative balance; Due to amino acids from muscle to the liver, an increase in gluconeogenesis and a shift of albumin production to acute phase proteins
66
What is sacropenia?
Decline in SkM mass
67
What causes sarcopenia?
Reduced physical activity;
cytokines, decrease in sex hormones, glucocorticoids, and catecholamine levels (all increase pro-inflammatory cytokines);
neural loss from spinal cord and strokes causing weakness and muscle wasting
68
What is the effect on cytokine on SkM?
Acute phase proteins break down muscle
69
What are some Cardiac Rx that cause anorexia in older people?
Amiodorone, furosemide, digoxin, spironolactone
70
What are some Neuro Rx that cause anorexia in older people?
Levodopa, fluoxetine, Li
71
What are some GI Rx that cause anorexia in older people?
H2 antagonists, PPI
72
What are some Antibiotics Rx that cause anorexia in older people?
Metronidazole, griseofluvin
73
What are some oncology Rx that cause anorexia in older people?
All Chemo Rx
74
What are some MsK Rx that cause anorexia in older people?
Colchines, NSAIDS, penicillamine, methotrexate
75
What are some psychological things that cause weight loss?
Delirium, Dementia/Alzheimers, Depression, Anxiety, Alcoholism, Bereavement
76
What are some social things that cause weight loss?
Poverty, isolation, inability to prepare or obtain food
77
What are the risk factors for Alzheimer Disease?
Age, High serum cholesterol in midlife, Glucose intolerance and Type II DM, and Elevated divalent transitional metals (Fe, Cu, Zn)
78
What are the deposits found in the brain in Alzheimer Disease?
B-amyloid plaques which are toxic to synapses and may dampen excitatory transmission
79
What's the other thing found in the brain of Alzheimer patients?
Neurofibrillary tangles (Tau Protein)
80
In what types of neurons do you seen filamentous inclusions of tau protein?
Pyramidal neurons
81
What is the major component of neurofibrillary tangles?
The hyperphosphorylated and aggregated form
82
What is thought to increase the incidence of amyloid accumulation and impaired protein folding?
Oxidative stress
83
What deficiency has been linked to the build-up of AB and tau?
Deficiency of cholinergic projections
84
What organelle releases free radicals?
A dysfunctional mitochondria
85
What is thought to perpetuate the cycle of protein oxidation and aggregation?
Vascular injury and inflammation in the form of strokes, white matter lesions, activated microglia and reactive astrocytes
86
Mutations in what channels may play a factor in the early onset of familial AD?
Calcium channels
87
Excess _________ stimulation results in excess calcium release from the _________.
Glutamenergic; Endoplasmic reticulum
88
What kinds of synapses decline in pts with mild cognitive impairment?
Hippocampal synapses
89
What presynaptic vesicle protein is reduced ~25% in mild AD?
Synaptophysin
90
What is the best correlate between AD and dementia?
With advancing disease, synapses are disproportionately lost relative to neurons
91
What is the role of neurotrophin?
Neurotrophin promotes proliferation, differentiation, and survival of neurons and glia, and they mediate learning, memory, and behavior.
92
Is neurotrophin activity increased/decreased with AD?
Levels of neurotrophin in cholinergic neurons in the basal forebrain are normally high; these are severely reduced in late stage AD.
93
Decreased expression of what receptors which are essential for cognitive processing is found in AD?
Presynaptic alpha-7 nicotinic acetylcholine receptors and muscarinic receptors
94
What is the principle risk factor for AD and when does this factor begin to double?
Age; risk doubles every 5 years after the age of 65
95
What disease affects 60-90% of patients with AD?
Ischemic disease
96
Mutations in this gene account for 1/2 of the few AD cases are the early-onset, familial type.
Presenilin
| Pre-senile, I guess?
97
Define mild cognitive impairment.
Mild cognitive impairment represents an intermediate state of cognitive function between the changes seen in aging and those seen in dementia and often Alzheimer disease.
98
Are patients with mild cognitive impairment at increased risk for AD or dementia?
Dementia
99
Describe what "Normal Aging" looks like
```
Gradual cognitive decline, typically memory. Decline is minor and does not compromise ability to function
Subtle forgetfulness (i.e. misplacing objects and have difficulty recalling words)
```
100
Is mild cognitive impairment usually recognize by the patient experiencing it?
Yes
101
What are the 2 types of mild cognitive impairment?
Amnesic and Non-amnesic
102
Define Amnesic impairment
Significant memory impairment that does not meet the criteria for dementia. Pts and families are aware of forgetfulness. Other cognitive capacities, such as executive function, use of language, and visuospatial skills are preserved and functional activities are intact.
103
Define a Non-Amnesia impairment
Subtle decline in functions not related to memory, affecting attention, use of language, or visuospatial skills.
104
Define Dementia
Cognitive deficits are affecting daily functioning to the extent that there is loss of independence in the community.
105
What type of Tx has been shown to be beneficial with MCI?
Cognitive rehabilitation has shown to have potential benefit. This includes the use of mneumonics, association strategies, and computer-assisted training programs.
106
A pt MUST have at least one of these 2 things to be Dxed with Depression
1. Depressed mood
| 2. Loss of interest or pleasure in previously pleasurable activities
107
Name the Sx, of which there must be at least 5, that are required for Dx of Depression
```
Significant weight gain or loss
Insomnia or hypersomnia
Psychomotor agitation or retardation
Fatigue
Feelings of worthlessness or inappropriate guilt
Impaired concentration
Recurrent thoughts of death
```
108
Is depression more common in young adults or the elderly?
Young adults, but in older people the manifestations are much more severe
109
What setting worsens the incidence of depression in the elderly population?
Going into a nursing home. More likely if the patient is coming from their own home; less likely if they are coming straight from the hospital
110
What are some diseases associated with depression?
Functional status, asthma and chronic obstructive pulmonary disease, gastric problems, arthritis, and heart failure
111
What can depression lead?
Depression can lead patients to smoke, be obese, be impoverished, develop diabetes or heart disease and to have a stroke
112
Depression often follows what disease?
Acute coronary artery syndrome
113
What drug can have beneficial effects in treating both a pt's depression and cardiac Sx?
SSRIs
114
What is the biggest roadblock when Txing a depressed, elderly pt?
They often times cannot afford the medication
115
State the 10 pre-disposing factors for delirium
| Hint: FAPPMMIIHH
1. Functional Impairment
2. Advanced Age
3. Parkinson disease
4. Preexisting dementia
5. Multiple comorbidities
6. Male sex
7. Impaired hearing
8. Impaired vision
9. Hx of alcohol abuse
10. Hx of stroke
116
State the 11 Precipitating factors for delirium.
| Hint: NNEEESSAUDP
1. New acute medical problem
2. New psychoactive medication
3. Exacerbation of chronic medical problem
4. Environmental change
5. Electrolyte disturbances
6. Surgery/anesthesia
7. Sepsis
8. Acute stroke
9. Urine retention/fecal impaction
10. Dehydration
11. Pain
117
What are some of the labs and testing necessary for a Dx of delirium?
Laboratory testing, brain imaging, and electroencephalography (EEG) (may or may not be useful in Dx)
These, however; do not substitute for history and physical examination in the diagnosis of delirium.
118
What measure are considered the cornerstone of delirium Tx?
Nonpharmacologic measures
There are no FDA approved drugs that Tx delirium,
Comfort and reassurance by the hospital staff and provision of a sitter or family companion may be preferable to drug therapy.
119
What are some Rx that have off-label uses that can be beneficial in the Tx of delirium?
Haloperidol, Olanzapine, Quetiapine, Risperidone, Lorazepam
120
What are the DOC and second line Rx for delirium?
DOC: Haloperidol
| Second-Line: Lorazepam
121
Which Rx are atypical antipsychotics?
Olanzapine, Quetiapine, Risperidone
122
Which Rx is the typical antipsychotic?
Haloperidol
123
To which Rx class does Lorazepam belong?
Benzodiazepine
