Geriatrics: Mt I - Neurologic Disorders

Front 1

Increase of Lipofuscion (aging pigment) --> yellow granules deposited in the nerve cells secondary to mitochondrial/lysosome damage is commonly associated with what two neurologic disorders?

Back 1

Alzheimer's and Parkinson's

Front 2

T or F? Amyloid Beta has a high associated with Alzheimer's/Parkinson's and has the ability to cross the BBB as you get older?

Back 2

False. It is associated with Parkinson's and Pheochromyctoma

Front 3

___% decrease of cerebral blood flow and ___% in brain weight due to aging

Back 3

20 and 10% respectively

Front 4

What enzyme decrease affects the hippocampus (short term memory, new memories, spatial navigation and orientation)

Back 4

Decrease in acetylocholinesterase levels
-also decrease in muscarinic receptors (ACH) and Serotonin receptors (linked to Schizo and depression)

Front 5

What is the difference between redundancy and Plasticity?

Back 5

Redundancy is more cells whereas plasticity means the cells that you already have get "better"

Front 6

What is a TIA?

Back 6

Mini-stroke - temporary blockage of blood to the brain
-by definition: sx last <24 hours but 75% of the time sx last only < 5 min
-33% of time it is a sign of an impending stroke

Front 7

What are some symptoms of a TIA?

Back 7

1. Temp vision loss in 1 eye
2. Slurring of speech (Brocas)/difficulty in comprehension (Wernicke)/Aphasia
3. Weakness on one side (hemi)
4. Numbness on one side
5. TEMPORARY

Front 8

What is the most common cause of a TIA?

Back 8

Common cause is an Embolus in the artery- usually from plaque in the carotids

Front 9

First line of treatment of a TIA?

Back 9

Aspirin
-Prevention:
1. Anti-coagulant: Warfarin
2. Anti-platelet: Aspirin

Front 10

During an ECG on a patient experiencing an TIA, what feature is absent w/ atrial fibrillation?

Back 10

P-wave

Front 11

What is the 3rd leading cause of death in the US behind heart disease and cancer?

Back 11

Stroke - 72% of victims over 65
-MUST persist for more than 24 hours

Front 12

What is the difference between an Ischemic stroke and a Hemorrhagic stroke?

Back 12

Ischemic: vessel in brain gets clogged - 80-85% of cases, thrombosis vs. embolism, hypoperfusion, cerebral venous sinus thrombosis
-Tx: Clot busters - must be administered w/in 3 hours of 1st sx, anti-coagulants, anti-platelets

Hemorrhagic Stroke (more deadly) - 15-20%, weakened vessels bursts and blood compresses brain (aneurysm vs. AVM), 2 types: Intra-cerebral vs. Subarachnoid
-Tx: Surgery- relieve pressure, no blood thinners

Front 13

What symptoms occur in someone who has a right hemisphere stroke?

Back 13

Left side paralysis
-Decrease in perception and spatial abilities
-Can't accurately pick up an object
-Can't tell upside-down when reading
-Impairment in judgement (*Risk Takers)
-Left sided neglect - Left VF defect
-Short term memory problems

Front 14

What symptoms occur in someone who has a left hemisphere stroke?

Back 14

Right sided paralysis
-Aphasia
-*Cautious
-Short term memory problems
-Rt VF defect - rt neglect
-*Difficulties with math

Front 15

If the brainstem is affected by a stroke, what are some common symptoms?

Back 15

1. Decrease in smell and taste
2. Ptosis
3. Weakened EOMs
4. Balance problems
5. Problems with breathing and heart
6. Difficulty controlling body temp

Front 16

What is the most common risk factor for a stroke?

Back 16

HTN

Front 17

Parkinson's is characterized by a decrease in _____ secreting cells in the _______

Back 17

Dopamine, substantia nigra (80% lost)
-this causes a decrease in the amount of dopamine to the striatum (putamen + caudate nucleus) = changes circuits for movement

Front 18

T or F? In Parkinson's, there is a stimulation of the direct pathway and inhibition of the indirect pathway

Back 18

False. There is inhibition of the direct path and excitation of the indirect pathway

Front 19

T or F? A tremor seen in a Parkinson's patient is usually worse at rest and decreases when sleeping or with voluntary movement

Back 19

True

Front 20

List some symptoms of Parkinson's

Back 20

1. Tremor
2. Muscle Rigidity
3. Bradykinesia (slow to start and continue movements)
4. Akinesia (inability to start movements)
5. Cogwheel rigidity (short, jerky)
6. Shuffling gait
7. Stooped posture
8. Cognitive deficiencies
9. Speech difficulties
10. Infrequent blinking, decreased color discrimination and contrast sensitivity, CI

Front 21

What is the gold standard treatment for parkinson's?

Back 21

L-Dopa
-L-dopa + carbidopa = delays conversion until L-dopa reaches brain = enhances effectiveness at lower doses

Front 22

What structures does a Progressive Supra-Nuclear Palsy (PSP) affect?

Back 22

Basal ganglia, brainstem, cerebral cortex, cerebellum

Front 23

List some symptoms of PSP?

Back 23

1. Imbalance/falling (usually 1st sign)
2. Stiff steps, slow movements
3. Slurred speech
4. Irritation
5. Masked Expressions
6* Voluntary vertical gaze impaired (downward before upward), retraction of upper lids, blepharospasm, convergence problems, blurred vision, square wave jerks (trouble fixating)

Front 24

T or F? Patient with PSP will display a Bell's phenomenon

Back 24

False - patient typically does not display Bell's however, it is improved with vestibular ocular reflex (move head and eyes will roll up)

Front 25

Describe the differences between Parkinson's disease and PSP

Back 25

PSP - stand straight up vs. stoop in Parkinsons
-Speech worse in PSP
-Usually no tremors in PSP
-L-Dopa ineffective in PSP
PSP commonly misdiagnosed as Parkinson's

Front 26

What is Tardive Dyskinesia?

Back 26

Repetitive, involuntary movements secondary to long term use of anti-psychotics
-Can't stop moving vs Parkinson's (hard time moving)

Front 27

What are some causes of Excessive daytime sleepiness?

Back 27

1. sedating drugs
2. sleep apnea (breathing stops for longer than 10 secs)
3. hypothyroidism

-Can lead to increased risk of heart disease (oxygen decreases, CO2 increases)

Front 28

This disorder is characterized by a loss of mental function that affects everyday life and the most common one is Alzheimer's (2/3 of cases)

Back 28

Dementia

Front 29

T or F? Alzheimer's is curable and increases as a person gets older

Back 29

False. It does increase as we get older but it is incurable

Front 30

What typically is the 1st symptom of Alzheimer's?

Back 30

1. Memory Loss (1st)
2. Confusion
3. Getting lost
4. Short term memory
5. Apathy
6. Difficult expressing verbally
7. Wandering
8. Crying

Front 31

What causes destruction of connections b/w brain cells in someone with Alzheimer's?

Back 31

Large clumps of amyloid plaques and bundles (neurofibrillary tangles) ultimately lead to atrophy of brain
-Decrease in acetylcholine

Front 32

Alpha cells in the islets of Langerhans of the pancreas are responsible for what?

Back 32

Secreting glucagon which causes the liver to go thru glycogenolysis (glycogen converted to glucose and secreted in blood stream)

Front 33

Is Diabetes Type II insulin dependent?

Back 33

No. Beta secrete enough insulin, however there is an increase in peripheral resistance thus glucose remains in the blood (hyperglycemia)
-90% of DM is type II

Front 34

Why is frequent urination a sign of DM? (polyuria)

Back 34

Because the kidneys are overworking to try and rid the body of excess glucose by frequent urination (polyuria). Thrist signal is sent to dilute the blood and to regain water lost.

Front 35

What filtering unit is damaged during the progression of Diabetes?

Back 35

Glomeruli. Thickening of the BM (proteins leak into urine). Albumin in urine = earliest sign of kidney damage

Front 36

What is considered a normal fasting BS?

Back 36

< 100 = normal
100-125 considered pre-diabetic
>126 considered diabetic

RBS:
< 140 = normal
140-200 = pre
> 200 diabetic

Front 37

What does the HbA1c tell you?

Back 37

It tells you the amount of glycolated hemoglobin. In a poorly controlled diabetic - this % value is high. * The % value measures the patients AVE BS over the last 3 MONTHS
-Normal 3-6%
-ADA: Diabetic target = < 7% (ave of 170 mg/dl)
-With each 1% increase/decrease in HbA1c add or subtract 35 mg/dl

Front 38

Sulfonylureas work by....

Back 38

stimulating production of insulin in pancreas and improving peripheral and hepatic insulin sensitivity
-1st gen: Chlorpropamide (avoid in elderly due to long 1/2 T = hypoglycemic)
-2nd gen: Glipizide, Glyuride

-These drugs can lead to weight gain and exhaustion of beta cells

Front 39

Biguanides work by....

Back 39

Decreasing amount of sugar made in liver and may improve insulin sensitivity, lower lipid levels.
-*Metformin - Popular
-Can't be used in sign. renal/liver dz or CHF
-Can lead to weight loss and rarely causes hypoglycemia

Front 40

Alpha glucosadase inhibitors work by....

Back 40

lowering blood glucose levels after eating
-*Acarbose (ideal for elderly w/ mild hyperglycemia)

Front 41

Meglitinides work by....

Back 41

Stimulating production of insulin in the pancreas
-Repaglinide/Nateglinide - faster acting and usually stimulate insulin release only during meals
-Lower risk of hypoglycemia than sulfonylureas but also cause weight gain

Front 42

Thiazolidinediones work by...

Back 42

making the body more sensitive to insulin, decreasing peripheral resistance
-Increase HDL and decrease triglycerides and inflammation
-*Advandia, Actos
-can cause weight gain

Front 43

When should you use insulin?

Back 43

When insulin secretagogues fail
-Combos:
a. Metaglip (Glipizide/Metformin)
b. Glucovance (Glyburide/Met)
c. Avandamet (Rosiglitazone/Met)

Front 44

What is the most common complication of insulin treatment?

Back 44

Hypoglycemia - usually less than 70 mg/dl --> diabetic coma

Front 45

What is a potential cause of Hypoglycemia unawareness?

Back 45

Autonomic neuropathy causes decrease in epinephrine which causes loss of sx of hypoglycemia

Front 46

What two hormones does the Thyroid produce?

Back 46

Thyroxine (T4) and T3. 80% of T4 is converted to T3 by peripheral organs
-Iodine is needed to secrete these hormones
-TRH (post pit)--> TSH (ant pit) --> hormones (thyroid)

Front 47

What is the most common cause of Hypothyroidism?

Back 47

Hashimotos (body's own T cells attack the thyroid)
-Iodine deficiency = #1 cause worldwide

Front 48

What are some Sx of hypothyroidism?

Back 48

Fatigue
weight gain
brittle hair
decreased sweating
periorbital puffiness
Goiter (majority in hypo)
bradycardia
myexedema (majority in hypo)

Front 49

A decrease in TRH and TSH but an increase in T4 and T3 is characteristic of what disorder?

Back 49

Hyperthyroidism
-Most common cause = Graves
-also:
a. Amiodarone
b. Thyroid cancer
c. Thyroiditis

Front 50

List some Sx of Hyperthyroidism

Back 50

Weight loss
insomnia
palpitations
sweating
Goiter (only in Graves)
tachycardia
nervous
fine, soft hair
myexedema (graves
thickened nails (graves)
Von Grafe sign (graves

Front 51

List some complications of Hematology due to the aging process

Back 51

1. Decrease in stem cells in marrow
2. Decrease in humoral antibody response
3. Decrease in T cell function
4. Weakened antibodies
5. Increase in autoidiotype antibodies (weaken immunity)

Front 52

Why do 60% of cancer cases occur over the age of 65?

Back 52

Because of the decreased immune response, genetic mutations, carcinogens, hormone changes

Front 53

List some causes of Anemia

Back 53

1. Decrease in B12 - Megoblastic
2. Decrease in Folate - Megoblastic
3. Decrease in Iron - most common cause
4. Aplastic: Marrow doesn't make enough RBC - causes pancytopenia (decrease in WBC, RBC and platelets) - autoimmune
5. Pernicious: Decrease in parietal cells in the gastric mucosa (autoimmune) --> loss of intrinsic factor that is needed to bind to B12 so it can be absorbed into the ileum -- > B12 deficiency
6. Sickle Cell: abnormal, rigid RBC caused by Hb S. Less O2

Front 54

Abnormal WBC developing in bone marrow which prevents normal cells from forming is termed what?

Back 54

Leukemia

Front 55

A condition in which Plasma cells (Mature B cells) become abnormal and multiply rapidly in the bone marrow is called?

Back 55

Multiple Myeloma

Front 56

Reed-Sternberg Cells are found in which cancer of the lymphatic system?

Back 56

Hodgkins Lymphoma

Front 57

List some age related changes to the Respiratory system

Back 57

1. Calcification of costal cartilage
2. Lungs become more rigid
3. decrease in number of alveoli
4. Respiratory muscle atrophy
5. Decrease in vital capacity
6. Increase in residual volume due to inability of elastic recoil
7. Decrease surface area

Front 58

What is the 4th leading cause of death in the elderly with the most common cause being Strep

Back 58

Pneumonia
-Droplet spread most common way to spread
-Bacteria cause inflammation of alveoli --> decreases oxygen exchange and CO2 removal
-Sx:
a. High fever
b. Shortness of breath
c. Chest pain
d. Discolored sputum

Front 59

Where is the most likely source of a Pulmonary embolism that causes chest pain, palpitations and pink, foamy mucous?

Back 59

Clot from a deep vein in leg

Front 60

What two disease mix to form COPD?
-#1 reason = smoking

Back 60

Chronic Bronchitis and Emphysema
-CB: Bronchial tubes get inflammed and create mucous
-Emph: Alveoli damaged - walls b/d and larger sacks created --> less oxygen in blood

Front 61

What is the most common kind of Lung Cancer?

Back 61

Squamous Cell carcinoma

Front 62

By what % will kidney function decrease if a person lives to be 90?

Back 62

50%
-Decrease in glomerular filtration rate
-Decrease in kidney blood flow
-Decrease in functioning nephrons
-Bladder muscles weaken
-Decrease in kidney size
-Decrease in time it takes to clear drugs
-Decrease in bladder size
-Urinary incontinence

Front 63

What causes crows feet and lines around the nose and mouth as we get older?

Back 63

Loss of fat --> decrease in dermal thickness

Front 64

What is Senile Lentigo?

Back 64

Brown/liver spots due to sun exposure --> localized proliferation of melanocytes

Front 65

What is the cause of Rosacea?

Back 65

Etiology: Unknown
-Signs: Redness, papules/pustules, telangiectasia, rhinophymia
Tx: Tetracycline 250mg QID or Doxycycline 100mg BID

Front 66

What are the 3 stages of Herpes Zoster?

Back 66

1. Prodromal stage: pain, burning, numbing before rash
-Flu sx - usually lasts 48 hours
2. Active stage: Rash on one side, blisters (clear fluid for 1st 72 hours), blisters burst in 5 days
3. Postherpetic Neuralgia: Chronic pain where rash was - may last for years

Tx: Acyclovir 800 mg 5x/day for 10 days
-For PHN --> Tricyclic antidepressants

Front 67

Are melanomas metastatic?

Back 67

Very, causes great number of skin cancer related deaths
A: Not symmetric
B: Edges are not defined
C: Pigment not uniform
D: Greater than 6 mm
E: Changes

Front 68

What is Presbycusis?

Back 68

Hearing loss related to aging. Lose ability to hear high frequencies
-Decrease in hair cells in organ of Corti (inner ear)
-Eardrum and ossicles become fixed
-Other causes: Decrease in vascularity of the cochlear --> hypoxic