Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Anesthesia Principles > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

Frailty reflects a decrease in ____ and an inability to respond to physiological challenges presented by the stress of surgery.

A

FRC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Frailty signs include?

A 
weight loss
fatigue
imparied grip
low physical activity
slow gait
cognitive decline (sometimes)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Frailty is an independent predictor of

A

in-hospital mortality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

With aging, there is an overall reduction in neuronal _____ capacity

A

regenerative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

In elderly how doe sthe mass of the brain change?

A

decreases by @15%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Why does the mass of the brain decrease with age?

A

D/t cell loss and shrinkage of cell volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Neural connections play a critical role in brain function are are responsible for the ___ of the brain.

A

neural plasticity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

W/ aging, neural plasticity _____ and neuronal connectivity may ______.

A

decrease; increase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

In the elderly there is an impairment of what NT signal transduction pathways?

A

dopamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Why is the impairement of dopamine signal transduction pathways important to note int he elderly?

A

may explain the susceptibility of elderly to extrapyramidal s/e of dopamine receptor antagonists

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

in the eldelry, cv changes include decreased ____ and ____ compliance

A

vascular and myocardial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

In the elderly there is a decrease in what?

A

autonomic responsiveness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Functional capacity of ____ METS is associated w/ potential adverse outcomes.

A

<4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

4 METS equals what?

A

can walk to mailbox and back

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

10 mets equals what?

A

running on treadmill 1minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

1 met equals what?

A

lying in bed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Why is there a decline in HR in the elderly?

A

increased vagal tone and decreased sensitivity to adrenergic receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Maximal HR declines by @ ____ per year over the age of 50.

A

1 beat/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Eldelry patients undergoing echo evaluation have an increased incidence of _____ dysfunction.

A

diastolic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Why do eldelry patients may poorly tolerate perioperative fluid administration?

A

D/t distolic dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Fluids in elderly patients w/ poor diastolic function may result in ?

A

elevated LVEDP and pulmonary congestion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Why do elderly patients have an exaggerated decrease in BP with induction?

A

diminished cardiac reserve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

In elderly patients, a ____ cirrculation time ___ the onset of IV drugs and ___ the onset of inhalation drugs.

A

prolonged
delays
speeds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What 3 physiologic changes of the respiratory system occur in the elderly?

A

mechanical
gas exchange
sensing mechanism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

In eldelry, what elastic changes occur, if any?

A

decrease in elasticity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What happens to the chest wall in elderly patients?

A

becomes stiffer as lung tissue loses its intrinsic elastic recoil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Respiratory muscle mass remains the same but reserve ability decreases in eldelry patients. T/F

A

F - muscle mass is also decreasaed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What should be done to prevent periop hypoxia in the elderly?

A

longer preoxygenation
increased inspired O2 concentrations
PEEP
pulmonary toliet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What factors increase risk of postop pulmonary complications?

A 
older age
COPD
OSA
malnutrition
abdominal or thoracic surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

___ and ___ O2 consumption decline with age

A

basal and maximal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

When does peak weight normally occur?

A

60 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What metabolic changes occur in elderly patients that would affect temperature?

A

heat production decreases
heat loss increases
hypothalamic centers reset at lower level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What regulates temperature?

A

hypothalamus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Why are hormone productions reduced in the elderly?

A

endocrine gland atrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Deficiences of what metabolic hormones are often present in the elderly?

A 
insulin
thyroxine
growth hormone
renin
aldosterone
testosterone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Diabetes affects @___% of patients older than 70

A

15

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Aging is associated with a decreased response to what agents?

A

Beta adrenergic

38
Q

What happens to the kidneys with age?

A

blood flow and mass is decreased

39
Q

The decreased capacity to handle water and electrolyte loadsmakes proper fluid management more critical; elderly patients aremore predisposed to developing ____ and _____.

A

hypokalemia

hyperkalemia

40
Q

The motility of the ____ area is altered with aging.

A

oropharyngeal/upper esophageal area
colon
Gi drug metabolism

41
Q

THe rate of biotransformation and ____ production decreases in the elderly patient.

A

albumin

42
Q

What levels are reduced in elderly men?

A

plasma cholinesterase

43
Q

A BMI of ___ indicates poor nutrtion

A

<18.5

44
Q

A albumin ____ indicates poor nutrition

A

<3

45
Q

Malnutrition is indicated by an unintended weight loss of ____ within 6 months.

A

10%

46
Q

What happens to the brain size with age?

A

mass decreases

47
Q

Where is neuronal loss prominent in elderly?

A

cerebral cortex, esp. frontal lobes

48
Q

CBF ____ in edlery

A

decreases 10-20%

49
Q

The syntehesis of ____ is reduced in the elderly

A

NT

50
Q

What binding sites are reduced in the eldelry patient?

A

serotonergic
adrenergic
GABA

51
Q

Does MAC increase, decrease, or stay the same in the elderly?

A

decrease

52
Q

Administration of given volume of epidural LA tends to result in ____ in the elderly

A

mroe extensive spread

53
Q

What is an early hallmark of dementia?

A

intellectual decline

54
Q

What is an anesthesia concern in patients with dementia?

A

ability to provide informed consent

55
Q

What are risk factors for falls in the elderly?

A

poor muscle strength
neural damage in the basal ganglia and cerebellum
peripheral neuropathy

56
Q

Polypharmacy is the norm for the eldelry. T/F

A

true

57
Q

What kind of pharmacologic changes occur in the elderly?

A

Pharmacokinetic

Pharmacodynamic

58
Q

Why are eldelry aptients more sensitive to anesthetics?

A

loss of neuronal tissue or poorly defined changes in receptor function

59
Q

In elderly patients, TBW decreases by what amount >

A

10-15%

60
Q

In elderly patients, with a decreased TBW, rapid IV admin of an anesthetic dug will ______ the ____ plasma concentration

A

increase; initial

61
Q

____ increases as muscle mass decreases in eldelry pateints

A

body fat

62
Q

Lipid soluble drugs have a large ____ in elderly patients

A

Volume of distribution

63
Q

Drugs metabolized by P450 may have reduced clearance of about ____ in eldelry pateints.

A

30-40%

64
Q

MAC increases, decreases, or stays the same with incrased age?

A

decreases

65
Q

MAC values decreases by about _____ per ____ after the age of 40 for volatiles.

A

4-6%

decade

66
Q

Dosage adjustment of Propofol for elderly pateints?

A

50% decrease

67
Q

Is etomidate an analgesis?

A

no

68
Q

Is etomidate an amnestic?

A

yes

69
Q

Etomidate has a smaller initial ___ than Propofol or thiopental

A

Vd

70
Q

There is not an increase in sensitvity to Etomidate in elderly pateints. T/F

A

False - there is, lower induction doses are recommended

71
Q

What is a common concern post-op with Etomidate?

A

vomiting

VOMITDATE

72
Q

The central Vd of Thipental ___ in the elderly?

A

decreases

73
Q

What is the suggested dose decrease for Thiopental in elderly?

A

50-80%

74
Q

What is Midazolam metabolized to?

A

hydroxymidazolam

75
Q

Is the metabolite of Midazolam active or inactive?

A

active

76
Q

How is Midazolam excreted?

A

kidneys

77
Q

What would cause an accumulation of Midazolam?

A

diminished renal function

78
Q

Are elderly patients sensitive to Midazolma?

A

yes

79
Q

What happens to opioid receptor system with aging?

A

receptor density
receptor affinity
receptor binding
may all change

80
Q

What affects the choice of opioids to use in the elderly?

A

pharmacokinetics

81
Q

Are the pharmacodynamics of NMBD altered with age?

A

no

82
Q

Are the pharmacokinetics of NMBD altered with age?

A

yes

83
Q

In elderly patients, recovery from NMBD is increased by as much as what?

A

50%

84
Q

The impact of residual NMBD block on ____ function can be very significant in the elderly.

A

pharyngeal function

85
Q

Age is an indication for invasive monitoring. T/F

A

false

86
Q

Over-hydration can lead to what?

A

CHF

87
Q

Fluid resuscitation and blood component therapy should be used ___ in eldelry.

A

judiciously

88
Q

____ Hgb and Hct may be more desirable in the elderly.

A

higher

89
Q

what type of dysfunction is very common in the elderly after surgery?

A

neurocognitive

90
Q

Hospitalized patients with delirium have up to a ___ x higher risk of developing other medical complications.

A

10

91
Q

What is the strongest predisposing factor for postop delrium?

A

preexisting dementia

Anesthesia Principles (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions