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303 Cards in this Set
- Front
- Back
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Older people lose __% brain weight.
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10
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What is lipofuscion? What diseases is it assoc w/?
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"Aging pigment" - yellow/brown pigment granules incr w/ age. Composed of lipid residues deposited in nerve cells secondary to mitochondrial/lysosome dmg; assoc w/ Alzheimers & Parkinsons
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What is Amyloid?
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Hard deposit made of proteins/polysacc in BVs/brain tissue. Amyloid beta has high assoc w/ Alzheimers, Pheochromcytoma; able to cross blood-brain barrier as get older
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What amyloid type is associated with Alzheimers/Pheochromcytoma?
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Amyloid beta
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T/F - Free radicals in elderly remains stable.
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False - incr
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T/F - Cerebral blood flow decr by 45% in elderly.
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False - 20%
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How is the hippocampus is affected in older folks? What are the impacts?
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Decr in acetylcholinesterase affects hippocampus (short term memory, new memories, spatial navigation and orientation, emotions)
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The decrease in this receptor is associated with Alzheimer's.
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Muscarinic (acetylcholine)
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T/F - A decrease in serotonin receptors is linked with Parkinson's and Alzheimer's.
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False - linked w/ schizophrenia and depression
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T/F - The decr in nerve cells of the spine in older folks also has an impact on the spine itself.
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False - does not really affect spine
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T/F - Nerve reinnervation and conduction are decr in older folks.
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True
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To compensate for loss of neurons, what does the brain of an older person do?
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Redundancy and plasticity
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What is a TIA?
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Transient Ischemic Attack - "mini stroke"
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Sx of a TIA last __ hrs but __% of the time Sx last __ min.
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≤24 hrs, 75%, <5 min
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__% of the time, a TIA is a sign of ___.
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33, impending stroke
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What is Amaurosis Fugax?
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Temporary loss in 1 eye (Sx of stroke)
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What is Aphasia? What is the name of the part of the brain that is affected?
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Aphasia = difficulty in understanding language; Wernicke's area
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If your stroke patient has slurred speech, you know that this part of the brain is affected.
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Broca's area
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What is hemiparesis?
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Weakness on one side of the body - assoc w/ stroke
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What is paresthesia?
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Numbness on one side of the body
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What is the key difference between a TIA and a stroke?
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TIA = temporary (hence TRANSIENT ischemic attack)
Stroke = more than 24 hrs |
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What is the most common cause of a TIA?
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Embolus in the artery of the brain; usually arises from plaque form carotids, but can also be from heart secondary to atrial fibrillation
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How can atrial fibrillaton cause an embolus?
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Abnormal signal to heart muscle causes improper pumping - blood sits in atrium then clots, then forms an embolus
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What is the first line Tx for TIA?
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Aspirin
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What are the preventative Tx for TIA?
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Anti-coag drugs - Warfarin
Anti-platelet drugs - Aspirin |
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Your patient's ECG shows a missing P-wave. What is this a sign of?
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TIA
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How is a carotid ultrasound useful with TIAs?
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Finds out if the pt's blood velocity is abnormal (faster with plaque)
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(#) Americans have a stroke each year.
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750,000
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Stroke is the (#) leading cause of death in the US.
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3rd behind heart disease and cancer
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__% of stroke victims are over age __.
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72%, 65
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What is more deadly, an ischemic or hemorrhagic stroke?
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Hemorrhagic
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What causes an ischemic stroke?
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BV in brain gets clogged causing ischemia
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__ to __% of stroke cases are ischemic.
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80-85%
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What is the difference between a cerebral thrombosis vs a cerebral embolism
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- Thrombosis = plaque develops in artery of brain
- Embolism = comes from remote site (dislodges) |
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How does shock or cardiac arrest cause a stroke?
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Decr blood to brain causing ischemic stroke
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Ischemic strokes can be caused by this type of deep vein thrombosis.
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Cerebral venous sinus thrombosis
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__ to __% of strokes are the hemorrhagic type.
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15-20%
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A weakened blood vessel that bursts and the blood compresses the brain is called a ____ stroke.
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hemorrhagic
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How are aneurysms different from Arteriovenous Malformations (AVMs)?
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- Aneurysm = weak BV that bursts
- AVM = unusually BV connections that are weak |
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How do you Tx an ischemic stroke?
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Clot busters - has to be used within 3 hrs of 1st Sx; anti-coagulants, anti-platelets
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Clot busters need to be used within __ hrs of the first Sx of an ischemic stroke.
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3
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T/F - The first line drug in every stroke patient is Aspirin.
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FALSE - no blood thinners for hemorrhagic strokes!
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How do you Tx hemorrhagic strokes?
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Surgery (no blood thinners)
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The following Sx are characteristic of what part of the brain: aphasia, VF defects, decr memory, hemineglect, confusion, dysphagia.
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Cerebral cortex
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T/F - A right hemisphere stroke results in (right/left) sided paralysis.
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left
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Your patient is enduring a stroke and says that he is feeling numb on his left side. What hemisphere is affected? What Sx are involved if there was brain damage?
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Right hemisphere
- Decr perceptual & spatial abilities - Can't accurately pick up objects - Can't tell upside-down when reading - Impairment in judgement (risk-taker) - Left sided neglect - Left VF defect - Short term memory probs |
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T/F - A stroke victim with decr spatial and perceptual abilities may have a right hemisphere stroke.
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True
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T/F - A person with a left hemisphere stroke can have problems with short term memory.
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True
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T/F - A person with a stroke which involves paralysis of the right side can have problems with short term memory.
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True
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Your patient is enduring a stroke and says that he is feeling numb on his right side. What hemisphere is affected? What Sx are involved if there was brain damage?
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Left hemisphere
- Aphasia - Cautious - Short term memory probs - Right VF defect - Right sided neglect - Difficulties with math |
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Your stroke patient can't add up the number of pills he takes from each bottle. You suspect a (right/left) hemisphere stroke.
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Left (trouble w/ math)
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With your stroke patient, you show two fingers with your left hand and one finger on your right hand on confrontation VFs, but the patient keeps seeing only the two fingers. This patient has a (left/right) hemisphere stroke.
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Right
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Your patient, after having his stroke, now has a hobby of cliff diving (but you knew that he used to be a big wuss). You suspect a (left/right) hemisphere stroke.
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Right (risk-takers)
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You hand your cover paddle over to your stroke patient, but he can't seem to accurately grasp it after several attempts. You suspect a (left/right) hemisphere stroke.
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Right
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T/F - If a stroke affects the brainstem, a ptosis may develop.
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True
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T/F - If a stroke affects the cortex, the patient can experience decr smell and taste.
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False - brainstem
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T/F - If a stroke affects the brainstem, the patient can have weak EOMs.
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True
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What are the Sx of a stroke affecting the brainstem?
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- Decr smell and taste
- Ptosis - Weakened EOMs - Balance probs - Probs w/ breathing and heart - Difficulty controlling body temp |
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What are the Sx of a stroke affecting the cerebellum?
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Difficulty walking, vertigo
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What is the most common risk factor for stroke?
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HTN
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T/F - Red meat is a risk for stroke.
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True
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Briefly discuss the pathophysiology of Parkinson's disease.
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Decr in dopamine secreting cells in substantia nigra; causes decr amt of dopamine sent to striatum (caudate nucleus+putamen), leads to change in circuits that regulate movement
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In parkinson's, the amt of dopamine sent to caudate nucleus and putamen (decr/incr).
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decr
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Parkinson's affects __% of the general pop.
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0.3%
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Mean age of parkinson's = ?
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60 yo
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In Parkinson's, there is an (inhibition/excitation) of the direct pathway and (inhibition/excitation) of the indirect pathway
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inhibition, excitation (if you want to move your arm, you can't; if you don't want to move your arm, it starts moving)
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Parkinson's tremor is worse at (movement/rest)?
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rest
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T/F - Parkinson's tremor decr when sleeping.
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True
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T/F - Parkinson's tremor incr with voluntary movement.
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False - decr
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T/F - Alzheimer's is assoc w/ muscle rigidity.
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False - Parkinson's
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Bradykinesia is assoc w/ (Parkinson's/Alzheimer's)?
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Parkinson's
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What is bradykinesia?
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Slow to start and continue movements (in Parkinson's)
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Cogwheel rigidity is associated with what disease?
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Parkinson's
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A shuffling gait and stooped posture with difficulty in starting movement is characteristic with (Tardive Dykinesia/Parkinson's)?
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Parkinson's
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What ocular problems are assoc w/ Parkinson's?
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- Infreq blinking (dry eye!)
- Decr color discrimination - Decr contrast sens - CI |
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T/F - Parkinson's involves speech and cognitive difficulties.
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True
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Tx Parkinson's?
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- L-Dopa (gold standard)
- L-Dopa + Carbidopa (delays conversion until L-dopa reaches brain, enhances effectiveness of lower dose) |
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Why can't dopamine simply be used as Tx for Parkinson's?
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Dopamine does not cross blood-brain barrier, but L-Dopa can
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Progressive Supranuclear Palsy affects what parts of the brain?
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Basal ganglia, brainstem, cerebral cortex, cerebellum
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What are the non-ocular Sx of Progressive Supranuclear Palsy?
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- imbalance/falling (first sign usually)
- stiff steps - slow movements - slurred speech - irritation - masked expressions |
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What are the ocular Sx of Progressive Supranuclear Palsy?
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- impaired voluntary vert gaze
- retraction of upper lids - blepharospasm - convergence difficulties - blurred vision - square wave jerks (can't fixate) |
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Your patient has an impaired voluntary vertical gaze - he has to move his neck up or down. Also, he has downward gaze before upward gaze difficulties. What do you suspect?
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Progressive supranuclear palsy (PSP)
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What is the typical first sign of Progressive Supranuclear Palsy?
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imbalance/falling down
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T/F - Ptosis is a sign of Progressive Supranuclear Palsy.
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False - upper lid retraction
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Your patient hates eyedrops. You did notice that while trying to instill your Flurosafe, he tried to force his eyes shut. But then you notice his gaze was straight ahead while trying to pry his eyes open. You suspect something...
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Progressive Supranuclear Palsy - missing Bell's Phenomenon
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In Progressive Supranuclear Palsy, vertical gaze limitation is improved with ___.
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vestibular ocular reflex (eye will go up if you move the head up/down)
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You suspect that your patient has either Parkinson's or PSP, but you noticed that the patient has an upright posture. This case has got to be...
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PSP (Parkinson's = stooped)
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Speech is worse in (PSP/Parkinson's)?
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PSP
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Tremors are seen in (PSP/Parkinson's/both)?
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Parkinson's
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T/F - You can Tx PSP with L-dopa.
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False - for Parkinson's
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T/F - Tardive dyskinesia patients have a hard time moving.
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False - can't stop moving (Parkinson's = hard time moving)
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Repetitive, involuntary movements secondary to long term use of antipsychotics is...
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Tardive dyskenesia
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Excessive daytime sleepiness in older folks can be attributed to (hyper/hypo)thyroidism?
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hypo
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Sleep apnea = ___ stops for __ secs or longer; leads to incr risk of _____.
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Breathing stops for 10 secs or longer; leads to incr risk of heart disease (decr O2, incr CO2)
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Dementia = ?
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Loss of mental fxn that affects daily life
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Most common form of dementia?
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Alzheimer's (2/3 of cases)
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T/F - Alzheimer's can be cured with Acetylcholinesterases.
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False - incurable; this is used more for cognitive Sx
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Alzheimer's affects __ million people in the US
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5
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Prevalence of Alzheimer's = __% over age __.
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42%, 85
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The first Sx of Alzheimer's is...
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memory loss
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Sx of Alzheimers?
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Memory loss (1st Sx), confusion, gets lost, can't remember new info (old and implicit memories affected less but eventually go too later), difficulty w/ finding words to say, apathy, wandering, aggression/crying, delusions
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Briefly describe the pathophysiology of Alzheimer's.
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Large areas of clumps (amyloid plaques) and bundles (neurofibrillary tangles) cause destruction of connections b/w brain cells (apoptosis/inflam), causing atrophy of brain (temporal lobe, parietal lobe, frontal cortex, cingulate gyrus)
Also decr in acetylcholine |
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Alpha cells in the ___ produces ___.
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Islets of langerhans in the pancreas, glucagon
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Beta cells in the ___ produces ___.
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Islets of langerhans in the pancreas, insulin
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Glucagon is responsible for...
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liver glycogenolysis - glucose stored in liver as glycogen is converted to glucose then secreted in blood
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Insulin is responsible for...
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decr amt of glucose in blood but incr uptake of glucose into cells
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T/F - DM 2 results in insulin resistance in peripheral tissues.
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True
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T/F - In DM 2, glucose stays in the bloodstream
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True
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__% of diabetics are DM 2.
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90
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__% of the pop over age __ has DM 2.
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20%, 65
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T/F - High cholesterol is a risk factor for DM type 2.
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True
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Identify and define the 3 P's in DM type 2?
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Polydipsia = kidney overworked b/c getting rid of of excess sugar thru urination (Polyuria); thirst signal is sent to dilute the blood and to regain water lost in urination
Also Polyphagia - insulin stimulates hunger |
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DM 2 involves suppression of immune system which causes...
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delay in wound healing
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In DM, what happens to the basement memb of the glomerulus? What is the impact?
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Thickening of BM causes proteins (albumin) leaking into urine; earliest sign of kidney dz
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What is the earliest sign of kidney disease?
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proteins (albumin) in urine
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What happens to the glomeruli in DM? What is the impact?
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Glomerulosclerosis (scarring of glomeruli); results in thickened lumen, decr in blood flow, ultimately to tissue damage in kidneys
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In DM, how does nerve damage in the kidneys affect renal fxn?
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Don't know that bladder is full; pressure leads to urine flowing back into kidneys causing damage to kidney tissue
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In DM, glucose in the urine is significant because...
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more likely for bacterial growth therefore incr chance of renal infection
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What vascular complication can occur as a result of DM causing renal damage?
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High BP since kidney impacts blood pressure - leads to quicker kidney disease progression
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What Tx (and how often to Tx) is required for end stage kidney dz? What is the general cause of this?
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Dialysis 3-4 hrs 1x/wk. Due to poison/waste filling up in blood
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Kidney dz involves (incr/decr) creatinine and (incr/decr) BUN.
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incr, incr
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When cells use protein, waste product is...
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urea (nitrogen)
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How does diabetes physiologically affect the nerves?
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BV damage causing decr blood flow, therefore nerve ischemia. Due to impaired axonal transport and structural breakdown of nerves
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DM neurological Sx?
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Numbness, *loss of sensation (can't feel when they step on something), loss of motor fxn, CN 3/4/6 palsy, Bell's palsy (CN 7)
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DM non-neurological Sx?
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Orthostatic hypotension, erectile dysfxn, hypoglycemia unawareness, high heart rate, carpal tunnel syndrome (decr blood flow to hands), diabetic foot ulcer
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T/F - DM 2 pts can have Bell's Palsy.
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True
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T/F - DM 2 pts tend to have low heart rate.
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False - high heart rate
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T/F - DM 2 has a protective effect against coronary artery dz.
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False - coronary artery dz 2-4x more likely in DM
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Your patient has a fasting blood sugar of 123. Is this normal?
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Pre-diabetic
<100 = normal 100-125 = pre-diabetic ≥126 = diabetic |
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What are the fasting BG ranges?
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<100 = normal
100-125 = pre-diabetic ≥126 = diabetic |
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What are the RBS ranges?
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<140 = normal
140-200 = pre-diabetic ≥200 = diabetic |
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Your patient has a random blood sugar of 123. Is this normal?
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Normal
<140 = normal 140-200 = pre-diabetic ≥200 = diabetic |
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The % value of HbA1c measures the pt's avg blood sugar over the last __ months.
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3
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HbA1c range?
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3-6%
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HbA1c goal for DM pts?
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<7%
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HbA1c of 7% represents an avg blood sugar of...
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170 mg/dl
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Every 1% change of HbA1c = ___ mg/dl change from 170 mg/dl.
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35 mg/dl
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8% HbA1c represents an avg blood sugar of...
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205 mg/dl (7% to 8% is a 35 mg/dl change, so add 35 to 170 mg/dl)
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How do sulfonylureas work?
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Stimulate insulin production in pancreas, improve peripheral and hepatic insulin sensitivity (insulin secretagogue)
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What is Chlorpromamide? What population should you avoid with this drug and why?
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1st generation sulfonylurea; avoid in elderly due to long 1/2 life (hypoglycemia)
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Name the two 2nd generation sulfonylureas mentioned. What is the advantage?
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Glipizide, glyuride (safer)
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Sulfonylureas can lead to weight (incr/decr) and beta cell (incr/decr) which can result in...
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incr, decr (beta cell exhaustion); could offset the benefits, could lead to hypoglycemia but 2nd generation less likely to do so
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How do biguanides work?
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Decr amt of sugar made in liver and can improve insulin sensitivity; also lowers lipid levels, rarely cause hypoglycemia, can lead to weight loss.
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T/F - Metformin decr amt of sugar made in liver.
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True
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T/F - Metformin improves insulin sensitivity but incr lipid levels thus causing weight gain.
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False - improves insulin sens but DECR lipid levels, thus causing weight loss
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T/F - Acarbose is a type of biguanide.
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False - Acarbose = alpha glucosidase inhibitor, Metformin = biguanide
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T/F - Biguanides are likely to cause hypoglycemia is a side effect
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False - rarely cause hypoglycemia
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This insulin Tx causes lower blood glucose after eating and is ideal for elderly pts w/ mild hyperglycemia.
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Acarbose (a type of alpha glucosidase inhibitor)
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How do meglitinides work?
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Stimulate production of insulin in pancreas; short acting insulin secretagogues
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What drug class is repaglinide?
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meglitinides
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What drug class is nateglinide?
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meglitinides
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T/F - Repaglinide/Nateglinide are faster acting and usually stimulate insulin release after meals.
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False - only DURING meals
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T/F - Meglitinides have a higher risk of hypoglycemia vs sulfonylureas.
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False - lower
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T/F - Nateglinide can cause weight gain.
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True
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Avandia falls under what drug class?
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Thiazolidinediones
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Actos falls under what drug class?
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Thiazolidinediones
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T/F - Avandia can cause weight gain.
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True
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T/F - Actos does not cause weight gain.
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False - does cause wt gain
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How do Thiazolidinediones work?
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body becomes more sensitive to insulin, decr periph insulin resistance. Incr HDL and decr triglycerides, decr inflammation, preserves B-cells.
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T/F - Thiazolidinediones decr periph insulin resistance
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True
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T/F - Thiazolidinediones incr HDL and incr triglycerides.
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False - decr triglycerides
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When is the use of insulin (vs other DM Tx) indicated?
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When insulin secretogogues fail
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Metaglip is a combo DM drug consisting of...
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glipizide + metformin
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What DM drug is a combo of glyburide + metformin?
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Glucovance
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Avandamet is a combo DM drug consisting of...
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rosiglitazone + metformin
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What is the most common complication of insulin Tx?
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hypoglycemia
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What are the Sx of hypoglycemia?
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hunger, palpitations, sweating, weakness, amnesia, confusion, tremors
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Hypoglycemia is when BG is less than __ mg/dl.
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70
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A DM pt with hypoglycemia will have skin that is (dry/sweaty).
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sweaty
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What is the significance of beta-blockers with hypoglycemia?
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B-blockers mask hypoglycemic Sx
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T/F - Hypoglycemia can result due to physical activity
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True - decr blood glucose due to physical activity
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T/F - Liver damage can result in hypoglycemia.
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True - hepatic insufficiency
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How does autonomic neuropathy impact hypoglycemia?
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Causes hypoglycemia unawareness. Decr in epinephrine causing loss of Sx of hypoglycemia incl tremors, palpitations. Also cause no glucose to be released by liver.
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T/F - 80% of T3 is converted to T4 by peripheral organs.
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False - T4 is converted to T3
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What is required for conversion of T4 to T3?
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iodine
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T/F - TRH activates TSH, which activates T3 and T4
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True
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TRH is made in the ___, TSH in the ___, and T3 and T4 in ___.
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hypothalamus, ant pituitary, thyroid
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Hypothyroidism = __% of people over 65 yo.
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2-5
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Hypothyroidism = (incr/decr) TRH, (incr/decr) TSH, (incr/decr) T4, (incr/decr) T3.
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incr, incr, decr, decr
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Most common cause of hypothyroidism in US?
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Hashimoto's
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Name the causes of hypothyroidism mentioned.
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Hashimoto's (most common), lithium, radioactive iodine (used in hyperthyroidism/grave's), thyroid surgery, neck radiation for tumors, iodine deficiency
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Most common cause of hypothyroidism outside US?
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iodine deficiency
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T/F - Hypothyroidism can cause fatigue.
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True
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T/F - Hypothyroidism can cause weight loss.
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False - weight gain
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T/F - Hypothyroidism can cause sweaty skin.
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False - dry skin
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T/F - Hypothyroidism can cause hair loss.
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True
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T/F - Hypothyroidism can cause mental problems.
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True
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T/F - Hypothyroidism can cause diarrhea.
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False - constipation
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T/F - Hypothyroidism can cause hypothermia.
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True
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T/F - Hypothyroidism can cause puffy eyelids.
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True - periorbital puffiness
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T/F - Hypothyroidism can cause goiter.
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True - majority found in hypothyroidism
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T/F - Hypothyroidism can cause tachycardia.
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False - bradycardia
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T/F - Hypothyroidism can cause hoarseness.
|
True
|
|
|
T/F - Hypothyroidism can cause myxedema.
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True - majority found in hypothyroidism
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|
|
Hyperthyroidism affects __% of the elderly
|
2
|
|
|
Hyperthyroidism = (incr/decr) TRH, (incr/decr) TSH, (incr/decr) T4, (incr/decr) T3.
|
decr, decr, incr, incr
|
|
|
Most common cause of hyperthyroidism? Mechanism?
|
Grave's; abnormal antibodies released by imm sys that mimic TSH
|
|
|
Causes of hyperthyroidism mentioned?
|
Grave's, nodules (secrete hormones w/o regulation), thyroiditis (virus), amiodarone (contains large amt of iodine), thyroid cancer
|
|
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How does amiodarone affect the thyroid?
|
Can cause hyperthyroidism b/c large amt of iodine
|
|
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T/F - Hyperthyroidism results in weight gain.
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False - weight loss
|
|
|
T/F - Hyperthyroidism results in insomnia.
|
True
|
|
|
T/F - Hyperthyroidism results in dry skin.
|
False - sweating
|
|
|
T/F - Hyperthyroidism results in diarrhea.
|
True
|
|
|
T/F - Hyperthyroidism results in tachycardia.
|
True
|
|
|
T/F - Hyperthyroidism results in brittle hair.
|
False - fine, soft hair
|
|
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T/F - Hyperthyroidism results in enlarged thyroid gland/goiter.
|
True - in Grave's
|
|
|
T/F - Hyperthyroidism results in sensitivity to heat.
|
True
|
|
|
T/F - Hyperthyroidism results in thickened nails.
|
True - in Grave's
|
|
|
T/F - Hyperthyroidism results in myxedema.
|
True - in Grave's
|
|
|
What is True Von Grafe's sign?
|
Lid lag on downgaze, seen in Grave's (hyperthyroidism)
|
|
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Grave's is associated with what eye signs/Sx?
|
Exophthalmos, double vision, true von grafe (lid lag on downgaze), dry eyes, optic atrophy
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|
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T/F - In the elderly, RBC life span and total blood volume are decreased.
|
False - stable
|
|
|
T/F - In the elderly, stem cells are stable in the marrow.
|
False - decr
|
|
|
T/F - In the elderly, the humoral antibody response (antibody released by B cells) decr.
|
True
|
|
|
T/F - In the elderly, T cell fxn decr (cell mediated immunity)
|
True
|
|
|
T/F - In the elderly, antibodies are weakened
|
True
|
|
|
T/F - In the elderly, there is a decr in autoidiotype antibodies
|
False - incr, which weakens immune system
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|
|
__% cancer cases occur over age 65.
|
60
|
|
|
__% deaths related to cancer in pts over age 65.
|
66
|
|
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Why is there an incr in cancer deaths in the elderly?
|
Decr imm response, genetic mutations, carcinogens causing more damage (change cell metabolism and damage DNA), hormone changes
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|
|
What are the causes of anemia mentioned?
|
Decr B12 (megoblastic)
Decr folate (megoblastic) Decr iron (most common cause) |
|
|
Most common cause of anemia?
|
Decr iron
|
|
|
What is aplastic anemia?
|
Bone marrow doesn't make enough blood cells, causing pancytopenia (decr WBC, RBC, platelets); autoimmune
|
|
|
What is pernicious anemia?
|
Decr in parietal cells in gastric mucosa (autoimm), leads to loss of intrinsic factor needed to bind B12 so can be absorbed into ileum; causes B-12 deficiency
|
|
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What is sickle cell anemia?
|
Abnormal, rigid RBCs caused by hemoglobin S; less oxygen
|
|
|
Decr in B12 can be seen in...
|
vegetarians, chronic alcoholics
|
|
|
Decr in folate can be due to...
|
not enough green leafy vegetables
|
|
|
What is leukemia? Where does it originate?
|
Abnormal WBCs developing in bone marrow (don't do work of normal WBCs), preventing normal blood cells from developing
|
|
|
What is multiple myeloma?
|
Plasma cells (mature B cells) become abnormal and multiply rapidly in bone marrow; interfere w/ production of normal blood cells and weakens bones
|
|
|
What is the main DDx factor between Hodgkins and Non-Hodgkins?
|
Reed-Sternberg cell = Hodgkins
|
|
|
What is cancer of the lymphatic system called? What is the cause?
|
Lymphoma (Hodgkins and Non-hodgkins); due to malignant lymphocytes (T cells, B cells, NK cells)
|
|
|
What happens to costal cartilage in older people?
|
Calcifies thus decr mobility of chest wall
|
|
|
T/F - Lungs become more rigid in older people.
|
True
|
|
|
T/F - Number and size of alveoli remain stable in elderly.
|
False - both decr
|
|
|
T/F - Respiratory muscles atrophy in older people.
|
True
|
|
|
An (incr/decr) in elastic recoil ability in elderly leads to an (incr/decr) in lung residual volume.
|
decr, incr
|
|
|
T/F - Elderly have a stable lung surface area.
|
False - decr (therefore decr area for gas exch)
|
|
|
Pneumonia is the (#) cause of death in the elderly.
|
4th
|
|
|
What is the highest infectious cause of death in the elderly?
|
Pneumonia
|
|
|
Most common cause of bacterial pneumonia?
|
Strep pneumoniae
|
|
|
Most common way of getting pneumonia?
|
Breathe infected droplets from someone who has it
|
|
|
Causes of pneumonia?
|
Bacterial, viral, fungal (coccidiomycosis), chemicals
|
|
|
What is the mechanism of pneumonia? Which specific structure in the lung is affected?
|
Bacterial infection in lungs, inflam response in alveoli (fills w/ fluid), results in difficult time getting O2 to and removing CO2 from blood
|
|
|
High fever, short breath, chest pain, discolored sputum are Sx of what condition?
|
Pneumonia
|
|
|
Pulmonary embolisms are usually from...
|
a clot from a deep vein in the leg
|
|
|
Shortness of breath, palpitations, pink/foamy mucous, and chest pain are Sx of...
|
pulmonary embolism
|
|
|
What causes pulmonary embolisms?
|
Blood clot from vein (venous thrombosis) dislodges and embolizes to pulmonary arteries
|
|
|
COPD is a mix of what two diseases?
|
Chronic bronchitis and emphysema
|
|
|
T/F - COPD is the narrowing of airways.
|
True
|
|
|
What happens in the lungs during chronic bronchitis? What structure is mainly affected?
|
Bronchial tubes that carry air to lungs get inflamed and create mucous
|
|
|
What happens in the lungs during emphysema? What structure is mainly affected?
|
Alveoli are damaged, walls break down and larger sacs are created; less O2 to blood
|
|
|
#1 cause of COPD?
|
Smoking
|
|
|
Sx of COPD?
|
Short breath (dyspnea), chronic cough, mucous in sputum
|
|
|
What is dyspnea?
|
Short breath
|
|
|
Most common cause of cancer related death in men and women...
|
lung cancer
|
|
|
Most common cause of lung cancer?
|
Smoking
|
|
|
Most common kind of lung cancer?
|
Squamous cell carcinoma
|
|
|
T/F - Lung cancer can, but typically does not metastasize.
|
False - high metastasis
|
|
|
Sx of lung cancer?
|
Short breath, wheezing, coughing, blood in sputum
|
|
|
If a person lives until __ yo, kidney fxn will decr by __%
|
90, 50%
|
|
|
T/F - In the elderly, bladder muscles weaken.
|
True - incomplete bladder emptying thus incr risk of infection
|
|
|
T/F - Kidney size remains stable in elderly.
|
False - decr size
|
|
|
T/F - Bladder size in elderly incr.
|
False - decr
|
|
|
What causes Crow's Feet?
|
Loss of fat, decr in dermal thickness, decr collagen/elastin, decr cell replacement
|
|
|
Women's skin is __ yrs worse since their skin is ___.
|
10, thinner
|
|
|
Decrease in skin replacement in elderly results in...
|
slower wound heal time; also causes rough, patchy skin
|
|
|
T/F - Elderly have a decr in sweat glands
|
True - decr in thermoregulation
|
|
|
What are senile lentigo?
|
Brown spots/liver spots, usually in sun exposed areas; localized proliferation of melanocytes
|
|
|
T/F - Both older men and women lose hair.
|
False - men get less, women get more
|
|
|
Fat in the elderly (incr/decr) in the face and hands and (incr/decr) around abdomen and thighs.
|
decr, incr
|
|
|
Cause of rosacea?
|
unknown
|
|
|
Tx Rosacea?
|
Tetracycline 250 mg QID
Doxycycline 100 mg BID |
|
|
Herpes zoster occurs between ages __ and __.
|
50, 70
|
|
|
__% of Americans past 80 yo will develop Zoster.
|
50
|
|
|
HZV is cause by this virus.
|
Varicella zoster (chicken pox)
|
|
|
HZV lays dormant in...
|
dorsal root ganglia
|
|
|
Describe the prodromal stage of HZV.
|
Pain, burning, numbing of affected area before rash; flu-like Sx e.g. fever, usually lasts 48 hrs
|
|
|
T/F - HZV does not respect the midline.
|
False - does respect midline since lies on one side of body (dermatome)
|
|
|
When do HZV blisters become cloudy?
|
3-4 days
|
|
|
When do HZV blisters burst?
|
5 days
|
|
|
How long do HZV blisters take to heal? Is there scarring?
|
a few weeks, typically scars
|
|
|
Your HZV pt has chronic pain where they had a rash - what is this? How long does it last?
|
postherpetic neuralgia - may last for years
|
|
|
Tx HZV?
|
Acyclovir 800mg 5x/day for 10 days (most effective if seen within 3 days of eruption)
|
|
|
Tx postherpetic neuralgia in HZV?
|
Tricyclic antidepressants
|
|
|
What is a melanoma?
|
Tumor of melanocytes
|
|
|
Most skin cancer related deaths due to...
|
melanomas
|
|
|
T/F - Melanomas are highly metastatic
|
True
|
|
|
ABCDE of melanomas?
|
Asymmetric
Borders poorly defined Color (pigment) not uniform Diameter usually >6mm Elevation changes |
|
|
Melanomas usually >__mm.
|
6
|
|
|
T/F - Exposure to sunlight as an adult is more significant in melanomas.
|
False - more important as a child
|
|
|
T/F - Family Hx incr risk of melanoma.
|
True
|
|
|
(Males/Females) more at risk for melanoma?
|
Males
|
|
|
Age >__yo is at higher risk for melanoma.
|
50
|
|
|
What is Presbycusis?
|
hearing loss due to aging
|
|
|
T/F - Elderly tend to lose their low frequency hearing ability.
|
False - high freq (e.g. birds chirping)
|
|
|
T/F - Elderly get a decr in hair cells in the organ of Corti (inner ear).
|
True
|
|
|
T/F - In the elderly, eardrum and attached ossicles become fixed.
|
True
|
|
|
__% of people over age 75 have hearing loss.
|
50
|
|
|
What are the causes of presbycusis?
|
- Decr hair cells in organ of corti (inner ear)
- Decr in vascularity of cochlea, decr in O2 |
|
|
T/F - Only left hemisphere stroke victims can have short term memory problems.
|
False - both left and right hemisphere stroke victims
|
|
|
Myxedema and goiter are mostly found in what disease?
|
Hypothyroidism
|
|
|
T/F - Chemicals can cause pneumonia
|
True
|
|
|
T/F - In sickle cell anemia, RBCs are stiff.
|
True
|
