Barash Geriatrics

Front 1

Reduction in CI is from

Back 1

less requirement, not degeneration. Contractility not changed until 8th decade.

Front 2

does he heart atrophy with age?

Back 2

The heart does not atrophy with age.

Front 3

Aging reduces the _______ and _________ responses to adrenergic stimulation and beta=agonists.

Back 3

Aging reduces the inotropic and chronotropic responses to adrenergic stimulation and beta=agonists. Less EF enhancement under stress.

Front 4

The stiffer ventricle and atrium do not undergo complete relaxation until

Back 4

relatively late in diastole and passive ventricular filling, which occurs during early diastole, is significantly reduced.

Front 5

Progressive change in _______ function, dependent of synchronous function.

Back 5

distolic

Front 6

Small decreases in _______ (PPV, hemorrhage, vasodilators) may significantly compromise SV.

Back 6

venous return

Front 7

Systolic HTN with increased arterial pulse pressure is a major CV risk factor; caused by

Back 7

increased large artery stiffness d/t fibrotic replacement of elastic tissue. Reduces the ability of the aorta and large arteries to store hydraulic energy and increased vascular impedance to ejection of stroke volume. Leads to a prgressive and sustained rise in LV wall tension and workload that produces symmetric ventricular hypertriophy.

Front 8

"Ringing" charachteristic of radial artery waveform in geriatric partients from

Back 8

incresed vascular stiffness and loss of arterial cross-sectional area that cause increased reflection of radial artery waveform.

Front 9

Age related loss of elasticity occurs in the lungs and CV system; an increase in fibrous connective tissue in lung parenchyma and

Back 9

degeneration/cross-linking of lung elastin.

Front 10

All elderly patients eventually demonstrate some degree of emphysema-like increases in

Back 10

lung compliance, but calcification and stiffening of costrochondral joints reduce CW compliance so net pulmonary compliance is essentially unchanged. Nevertheless, loss of lung elastic recoil is the primary anatomic mechanism by which aging exerts deleterious effects on pulmonary gas exchange.

Front 11

Breakdown of alveolar septae also reduces total alveolar surface area, increasing both

Back 11

anatomic and alveolar dead space. This causes increased shunting and dead space.

Front 12

Closing capacity/volume

Back 12

increases. Small airways patency is compromised.

Front 13

VC is

Back 13

compromised because RV increases at the expense of IRV and ERV.

Front 14

Skeletal calcification and increased airway resistance

Back 14

increase work of breathing and predispose geriatric patients to postoperative ventilatory failure.

Front 15

CV and ventilatory response to hypoxia or hypercarbia is

Back 15

delayed in onset and is smaller.

Front 16

Opioid induced CW rigidity occurs more

Back 16

frequently.

Front 17

Hepatic enzyme function is

Back 17

unchanged but liver tissue mass declines 40% by 80 years and hepatic blood flow is proportionally reduced.

Front 18

Loss of hepatic tissue mass largely explains the reduced

Back 18

rates of plasma clearance and prolonged clinical effects of narcotics.

Front 19

1/3 of renal mass lost by 80 years. RBF decreases by

Back 19

10% per decade in early adulthood, especially in renal cortex, although the loss is masked by diffuse interstitial fibrosis and increase in intra-renal fat. 1/3 of glomeruli and tubular structures disappear and sclerosis impairs filtration by producing diverticula and impairing arteriole continuity.

Front 20

Serum creatinine remains normal because of

Back 20

loss of skeletal muscle mass

Front 21

Geriatric patients do not require a unique fluid replacement protocol, but do

Back 21

have a lower functional reserve.

Front 22

Diminished thirst, poor diet and diuretic agent use for tx of HYN predispose debilitated elderly to

Back 22

intracellular dehydration.

Front 23

Decreased immune responsiveness, decreased B and T-cell activity, immunoglobulin E. Elderly are predisposed to

Back 23

strep pneumonia, meningitis and septicemia. Sepsis is 2nd to respiratory failure in M/M with trauma.

Front 24

Changes in body composition reduce basal metabolic requirements

Back 24

by 10-15%. Impaired thermoregulatory vasoconstriction. 2x faster loss of heat.

Front 25

glucose

Back 25

Impaired of ability to handle glucose challenge, even though insulin release/timing is normal. Impairment of insulin function or tissue sensitivity.

Front 26

Men lose 10-15 of TBW from

Back 26

adipose gain and muscle loss..limited to intracellular compartment.

Front 27

Plasma volume, red cell mass and ECF volumes

Back 27

remain unchanged.

Front 28

Decreased circulating blood volume are typically only in

Back 28

bedridden or those with essential HTN.

Front 29

Brain mass decrease

The most active, specialized neurons suffer the most.

Back 29

20% by 80 years (mostly grey matter/neruons. glial unchanged) CSF volume increases to offset. (low-pressure hydrocephalus).

Front 30

Decreased CBF is a consequence of

Back 30

atrophy, not a cause. BBB remains intact.

Front 31

Aging does not impair autoregulation of

Back 31

cerebrovascular resistance and the vasoconstrictor response to hyperventilation remains intact.

Front 32

Crystallized intelligence (language, personality) d

Back 32

o not decline with increasing age.

Front 33

PNS threshold intensities for perceptions

Back 33

increase.

Front 34

Reduced peripheral motor nerve conduction velocity and impairment of efferent corticospinal transmission

Back 34

increases the latency between intention of onset of motor activity.

Front 35

Neurogenic skeletal muscle atrophy causes

Back 35

20-50% decreases in strength and steadiness.

Front 36

Adrenal tissues atrophy and cortisol secretion declines at least

Back 36

10% by age 80, although plasma %'s of nor-epi are 2-4x higher, this is offset by age-related depression of beta-adrenergic end organ responsiveness. (an endogenous beta-blockade)

Front 37

There is ______ change in alpha or muscarinic cholinergic activity.

Back 37

little

Front 38

The autonomic reflex responses that maintain CV and metabolic hemostasis are progressively

Back 38

impaired, evidenced by hypotension after induction.

Front 39

The autonomic nervous system is

Back 39

under-damped and is characterized by wider variation from baseline.

Front 40

IV Morphine requirements are

Back 40

inversely related to age and a higher block is achieved with the same LA dose. Segmental dose requirements are reduced.

Front 41

MAC values

Back 41

decline as much as 30% d/t increased sensitivity.

Front 42

inter-compartmental transfer of drugs.

Back 42

Delayed

Front 43

NMB ED50

Back 43

unchanged or increased. Duration prolonged.

Front 44

_____ largely determines M and M. Outcomes r/t prior functional level.

Back 44

Age-related disease, not aging itself

Front 45

"best' single anesthetic technique.

Back 45

none

Front 46

Use depth of anesthesia required to prevent awareness only, higher increases

Back 46

M/M.

Front 47

Full recovery of psychomotor function _____

Back 47

delayed.

Front 48

Psychometric disruption

Back 48

in 10-15% of patients remains after 3 months.