Foundation

Question 1

What are the top 3 types of cancers in men?

Answer 1

1) Lung (adenocarcinoma, SCLC)
2) Prostate (carcionoma)
3) Colon (rectosigmoid adenocarcinoma)

Question 2

What are the top 3 types of cancers in women?

Answer 2

1) Lung (adenocarcinoma, SCLC)
2) Breast (invasive ductal carcinoma)
3) Colon (rectosigmoid adenocarcinoma)

Question 3

What is a main mechanism of CVS changes in an elderly individual?

Answer 3

Blood vessel walls thicken → Impaired blood circulation → MI + CVA

Question 4

How does respiratory function change with age?

Answer 4

Respiratory capacity decreases with age → restricts oxygen to brain

Question 5

What is the most common cause of dementia in the elderly?

Answer 5

Alzheimer’s

Question 6

What are 3 components of the micro and macropathology of alzheimer’s?

Answer 6

Macro:
1) Cortical atrophy
2) Widening of cerebral sulci
3) Compensatory ventricular enlargement

Micro:
1) Neuritic plaques
2) Neurofibrillary tangles
3) Amyloid angiopathy

Question 7

Why are the elderly prone to subdural hematomas?

Answer 7

Cortical atrophy → stretched bridging veins → more prone to venous bleeds

Question 8

What are the 2 most common forms of osteoporosis?

Answer 8

1) Postmenopausal
2) Senile osteoporosis

Question 9

How does the distribution of affected bones differ in post-menopausal and senile osteoporosis?

Answer 9

Postmenopausal:
- cancellous compartment of vertebral bodies (eg. compression fracture of vertebrae)

Senile:
- thinning of cortical bone (eg. fracture of femoral neck)

Question 10

What is a histological feature of osteoporosis?

Answer 10

Thin trabeculae that are not interconnected

Question 11

What are 2 common causes of pathological fractures in the elderly?

Answer 11

1) Osteoporosis
2) Metastatic carcinomas

Question 12

What is the most common cause of emphysema?

Answer 12

Centrilobular emphysema

Question 13

What are 3 malignancies associated with chronic sun exposure?

Answer 13

1) Basal cell carcinoma
2) Squamous cell carcinoma
3) Melanoma

Question 14

What is actinic keratosis?

Answer 14

Premalignant condition where chronic sun exposure leads to epidermal dysplasticity

Question 15

What is dermal elastosis?

Answer 15

Loss of skin elasticity with chronic sun exposure
- thickening and degeneration of elastic fibers

Question 16

What is a common benign skin lesion in the elderly?

Answer 16

Seborrheic keratoses

Question 17

What are 3 main complications of DM?

Answer 17

1) Diabetic nephropathy → nephrotic syndrome

2) Diabetic retinopathy → open angle glaucoma

3) Diabetic neuropathy (eg. peripheral neuropathy, neuropathic ulcers)

Question 18

What are 3 main complications of hypertension?

Answer 18

1) Intracerebral haemorrhage (malignant hypertension/stroke)

2) Concentric LV hypertrophy

3) Nephrosclerosis (hyaline arteriolosclerosis)

Question 19

What are 4 sequelae of atherosclerosis?

Answer 19

1) IHD
2) Cerebral infarction
3) Ischemic Colitis
4) Aortic aneurysms
5) Renal artery stenosis
6) Popliteal artery stenosis

Question 20

What are 2 common sites of ischaemic colitis?

Answer 20

1) Superior and inferior mesenteric artery (splenic flexure)

2) Inferior mesenteric and hypogastric artery (rectum)

Question 21

What are 2 complications of inguinal hernias?

Answer 21

1) Strangulation (constriction of blood vessels → ischaemia)

2) Constriction of bowel loops → extraluminal IO

Question 22

What are the 12 hallmarks of aging?

Answer 22

Integrative:
1) Dysbiosis
2) Chronic inflammation
3) Altered intercellular communication
4) Stem cell exhaustion

Antagonistic:
5) Cellular senescence
6) Mitochondrial dysfunction
7) Dysregulated nutrient sensing

Primary:
8) Genomic instability
9) Telomere attrition
10) Epigenetic alterations
11) Loss of peotrostasis
12) Disabled macroautophagy

Question 23

What is sarcopenia?

Answer 23

Skeletal muscle mass loss
→ Decline in muscle strength & quality

Question 24

What is fraility?

Answer 24

Complex, multidimensional (physical, social, cognitive), and cyclical state of diminished physiologic reserve
→ ↑vulnerability to adverse clinical outcomes (eg. disability, falls, death) and stressors (eg. chemotherapy, surgery)

Question 25

What are 3 ways frailty impact management?

Answer 25

1) a/w increased mortality and morbidity 2) ↑risk of complications 3) Limited evidence for treatments (not represented in large trials)

Question 26

What are 5 components of the physiology of aging?

Answer 26

1) ↓Baroreceptor sensitivity 2) ↓Balance/Proprioception 3) ↓Vision (esp at night) 4) ↓Reflex speed for correction 5) Gait changes

Question 27

What is homeostenosis?

Answer 27

Diminished ability to maintain homeostasis under stress

Question 28

Why do elderly have atypical presentations in sepsis?

Answer 28

Thymic involution

Question 29

Why might older adults with pneumonia not present with SOB?

Answer 29

1) ↓responsiveness to hypoxia and hypercapnia 2) ↓protective reflexes in airways 3) minimal exertion?

Question 30

Why are older patients at increased risk of aspiration pneumonia?

Answer 30

1) Poor oral hygiene (eg. tooth decay) → frailty 2) Prolonged oropharyngeal phase 3) Delay in opening of UES 4) Abnormalities in swallowing reflex (eg. BG lesions) 5) Lack of protective reflex (eg. cough)

Question 31

What is anorexia of aging?

Answer 31

Physiological loss of appetite with aging

Question 32

Why are older patients more susceptible to cardiac arrythmias?

Answer 32

1) Fibrosis of conduction system 2) Decrease in number of sino-atrial pacemaker cells 3) Axonal degeneration of neurons supplying atria 4) Epicardial fat deposition

Question 33

Why are older patients more prone to TIAs?

Answer 33

1) ↑prevalence of atherosclerosis 2) Vessels susceptible to occlusion/rupture

Question 34

What are 3 ways hormones change as we age?

Answer 34

1) attenuation of pulsatile hormone secretion 2) Abrupt decrease in estrogen after menopause 3) ↓Testosterone and DHEA → impaired sexual function, ↓muscles osteoporosis