Geriatric and Pediatric Chemistry

Question 1

T/F in 2010 there was a dec in population 65 and older

Answer 1

false there was a 34% increase

Question 2

What year did life expectancy go down? Why? Approx ages?

Answer 2

2021 went down 1 year

covid

females: 80
Males: 75

Question 3

T/F there is notable growth in populations 65+ and shrinking in 14yrs

Answer 3

true because less people are having kids

Question 4

Gerontology

Answer 4

study of aging

Question 5

Geriatrics

Answer 5

clinical medicine focusing on care of aged pts

Question 6

General changes in aging

Muscle

Answer 6

Total body muscle mass decreases with age, strong genetic component

Decreased creatinine production

Question 7

General changes in aging
Bone

Answer 7

total bone density decreased, much more dramatic in women post menopause

serum calcitonin increased
PTH increased

Question 8

GI system general changes in aging
ag…
what is low production?
increased?
decreased? v/c/a

Answer 8

atrophic gastritis, low stomach acid production

increased malnutrition
decreased VIT B12, Calcium/Albumin

Question 9

General changes in aging
Urinary
causes
what is decreased in size?
increased?
decreased?

Answer 9

golmerulous diseases, decreased kidney size, Dec GFR

increases EPO, ANP, BNP
Decreased renin, response to ANP

Question 10

Gen changes in aging
Immune system
what shrinks?
increased?
decreased?

Answer 10

thymus shrinks
increased ANAs
decreased T/B cells, HSC, thymosin

Question 11

Gen changes aging
endocrine system
what is normal?
slightly inc?

increased?
decreased:g/p/a

Answer 11

ACTH norm, epinephrine norm, TSH slight inc

increased noepinephrine
decreased GH, Peak melatonin, aldosterone

Question 12

Gen changes in aging
Sex hormones

Answer 12

menopause (before geriatric age) decreased estrogen/progrestrogen

andropause - decreased testosterone

Question 13

Gen changes in aging
Glucose metabolism
what is unchanged?
what is likely to manifest illness with???

Answer 13

insulin secretion unchanged
genetic type 2 likely to manifest illness with increased age, bmi lack of excersise

Question 14

Lab testing w age
Muscle

Answer 14

muscle decreases with age, creatinine slight increase w decreased renal function

Question 15

Lab testing with age
Bone
o
lack of?
hypo?

needs?

low…
increased

Answer 15

osteoporosis, lack of sex hormones, hypogonadism

needs calcium/VitD

low serum calcium and increased PTH/calcium loss increases ALP

Question 16

Lab testing w age
GI
increased: c/g/f
decreased:f/t/a/t

Answer 16

increased CRP
GGT
Fibrinogen

decreased ferritin, transferrin, ALB, TP

Question 17

Lab testing w age
Urinary
enlarged?
increased?
obstruct?

Answer 17

enlarged prostate
increased PSA, urinary obstruction

Question 18

Lab testing w age
Immune
induced?

Answer 18

infection induced morbitity/mortality

Question 19

Lab testing w age
Endocrine
increased: a/e/p/t/a

decreased: D/I/G/A

Answer 19

increased ANP/EPO/PTH/TSH AHD/AVP

decreased DHEA, IGF-1, GH, aldosterone

Question 20

Lab testing w age
Glucose metabolism

Answer 20

insulin sensitivity decreases
prevelence in type 2 diabetes

Question 21

Refrence ranges with geriatrics

most common?
death due to?

Answer 21

gender specific and age specific, little data for approporiate age specific ref ranges for older adults (most are not considered normal)

Most common hypertension/cholesterol

death due to covid/heart disease

Question 22

Age associated changes in drug absorption

Absorption

Distribution

Answer 22

absorption: rate of abs slows w age

distribution: highly water sol drugs tend to be more conc because decreased body water

Question 23

Age associated changes in drug absorption

Metabolism

Elimination

Answer 23

Metab: hepatic blood flow/mass decrease w age/liver response

Elim: renal flow/mass dec gradual dec in GFR

Question 24

Atypical presentations of common disease

Answer 24

multiple coexisiting/interacting problems

excersice increases lifespan and improves quality of life in old people

Question 25

Neonates/baby clinical chem respiration

Answer 25

infant at birth initiates active respiration

Question 26

Neonates/baby clinical chem Growth

Answer 26

at birth baby is 3.2 kg, below 10th percentile is small

Question 27

Neonates/baby clinical chem Organ development what matures during the first yr of life

Answer 27

GFR and renal tube function mature during first year of life

Question 28

Neonates/baby clinical chem Premature/immature intra.... pre programed for

Answer 28

intrauterine development pre programmed for 38-40 wks of gestation

Question 29

Neonates/baby clinical chem Phlebotomy blood collection from infants is complicated by?

Answer 29

blood collection from infants is complicated by pt size and ability to communicate

Question 30

Preanalytical concerns infants choice of?

Answer 30

samples in tubes of many sizes, evaporation of sample choice of analyzer: onyl a few preform multiple procedures on sample volumes

Question 31

POCT in peds factors: t eval device analytical

Answer 31

expanding in pediatrics factors: turn aroundtimes eval of POCT devices device limitations for ped use analytical preformance not as good

Question 32

Reg of blood gas and pH in neonates

Answer 32

requires lung/kidney to be sufficiently mature to reg acid/base metabolism at 24 wks gestational lung expresses two types Type 1 and Type 2

Question 33

gestational lung cells types Type 1 Type 2

Answer 33

Type 1 pneumocytes: gas exhange Type 2 pneumocytes: secretion of sufactant (lecthin/sphignomyelin)

Question 34

Surfactant

Answer 34

required for lungs to expand and transfer blood gases following delivery

Question 35

RDS

Answer 35

failure to excrete CO2 and the levels rise casusing Respiratory Acidosis

Question 36

Blood gas/acid base measurement what can be measured ? how? some analyzers can take.... many can measure

Answer 36

oxygen can be measured using non invasive transcuaneous (same with CO2) some analyzers can take small capillaru samples, many can measure lactate, urea, bilirubin/creatininine

Question 37

Disorders affecting electrolytes and water balance cause of? must be treated to prevent?

Answer 37

cause of hypernatremia/hyponatremia both must be treated to prevent seizures

Question 38

Physiologic jaundice what is processed slowly? failure to adequately?

Answer 38

pharmocologic agents processed slower in neonates failure to adequately metabolise bilirubin

Question 39

Diabetes what homeostasis hepatic met of? type 1 is... type 2 significance?

Answer 39

blood glucose homeostatsis, hepatic met. of glucose, Type 1 juvenile type 2 grown quickly in last 30yrs

Question 40

Nitrogen Metabolism what has central role metabolic intraconversions of.... synth of: met breakdown of products of .....:....

Answer 40

liver central role metabolic intraconversions of AA/synth of non essential AA synth of proteins: ALb/transferrin Met of breakdwon products of nitrogen turn over: ammonia

Question 41

Blood amonia in children vs newborns

Answer 41

Higher in newborns than older children

Question 42

Nitrogenous end products as markers of renal function high ... in neonates, but low..... what increases w muscle mass what is typically not done? what is used? possible?

Answer 42

high ammonia in neonates but low creatninine/uric acid Creatinine incr w muscle mass creat clearance not typically done eGFR used Cystatin C possible

Question 43

Calium and bone growth norm growth requires integration endocrine? lack of vit D? total calcium ?

Answer 43

normal growth requires integration of calcium/phosph/magnese and endocrine reg from VITD, PTH calcitonin Lack VITD ricketts 98% total calcium is bone

Question 44

HPTS what is secreted from where...to? between?

Answer 44

hypothal secretes TRH, 3AA, INTO PORTAL blood system between hypothal and anterior pituitary

Question 45

HPACS regulates...

Answer 45

regulates minerals/carb metabolism

Question 46

Growth factors

Answer 46

GH inhibiting factor (somatostatin) GH releasing hormone

Question 47

Sexual maturation what is supressed in young children/infants?

Answer 47

GnRH supressed in infants/young children

Question 48

Basic components of immune system

Answer 48

innate and adaptive immune system

Question 49

Components of the immune system

Answer 49

skin, phagocytes, B/T cells, APR abs

Question 50

Neonate Ab production what immunoglobulin classes does a fetus synth?

Answer 50

fetus synth small amounts of IgM and tiny amounts of IgA

Question 51

Immune disorders Hypogammaglob SCID

Answer 51

transient hypogammaglobulina - prematurity delayed onset of Ig production/unknown cause SCID: Lack of humoral/cellular immunity (boy in bubble)

Question 52

CF

Answer 52

caucasions, CFTR gene mutation

Question 53

Newborn screen for populations p 2 s c g

Answer 53

phenylketoniria, 21-H deficiency, sicke cell, CF, galacosemia