Geriatrics: Mt I - Systemic Diseases

Front 1

What happens to the lining of the heart as you get older?

Back 1

Increased left ventricular wall thickness and an increase in left atrial size
-Number of myocytes does not increase but their size does

Front 2

What is the main cause of Coronary Artery Disease?

Back 2

Atherosclerosis

Front 3

What is the primary sx of CAD?

Back 3

Angina - chest pain that usually radiates down the left arm

Front 4

List some treatment options for CAD

Back 4

1. Lifestyle changes
2. Aspirin
3. B-Blockers
4. Ca Channel Blockers
5. Angioplasty
6. Coronary Bypass

Gold standard in testing = Coronary angiography

Front 5

A patient with a BP reading of 134 / 93 is considered in which catergory?

Back 5

Stage I. Although the systolic is pre-hypertensive, the diastolic is considered Stage I

Front 6

What must happen to consider Hypertension a true diagnosis?

Back 6

2 or more readings taken at 2 or more visits

Front 7

Which class of Hypertension accounts for 90-95% of the population and typically has no cause?

Back 7

Primary (essential)
-62% of adults present w/ HTN past age of 65

Front 8

Which two components make up Blood pressure?

Back 8

Cardiac Output + Systemic vascular resistance
-As either one increases so does BP

Front 9

How does Renal Disease contribute to Secondary HTN?

Back 9

1. Renal disease: Renin increase --> increase angiotension II --> Increases vasoconstriction and aldosterone levels --> increases Na reabsorption in kidneys = Increase BP

Front 10

What two Endocrine disease can be related to increased HTN (Secondary)

Back 10

1. Pheochromocytoma: Tumor of Medulla (origin - chromaffin cells) --> leads to increased epinephrine levels (vaso-c) --> increases BP
2. Cushings: increase ACTH from pituitary adenoma --> increases cortisol from adrenals --> cortisol increases effects of epinephrine = Increase BP

Front 11

List some treatments for HTN

Back 11

1. Lifestyle changes
2. Diuretics: decrease cardiac output
3. Alpha 1 - adrenergic blockers: dilate arterioles and veins
3. B-Blockers - decrease cardiac output and renin
4. Ca Blockers: decrease in CO and vasodilation
5. ACE inhibitors: decreases angiotensin II --> decreases vaso-c and aldosterone

Front 12

What is the main cause of Pseudohypertension?

Back 12

-Vessels get stiff due to calcium being deposited in walls

Front 13

List some other cardiovascular diseases common in the elderly

Back 13

1. Arryhthmias
2. Heart Failure
3. Peripheral artery disease: obstruction especially to legs. ~ 20% over age 65
4. infective endocarditis: infection of endocardium (innermost) - Staph. Aureus
5. Hypotension: due to impairment of baroreflex response of body
6. Valvular heart disease: dysfunction of 1 or more of valves: Stenosis vs. Regurgitation

Front 14

List some other cardiovascular diseases common in the elderly

Back 14

1. Arryhthmias
2. Heart Failure
3. Peripheral artery disease: obstruction especially to legs. ~ 20% over age 65
4. infective endocarditis: infection of endocardium (innermost) - Staph. Aureus
5. Hypotension: due to impairment of baroreflex response of body
6. Valvular heart disease: dysfunction of 1 or more of valves: Stenosis vs. Regurgitation

Front 15

List some other cardiovascular diseases common in the elderly

Back 15

1. Arryhthmias
2. Heart Failure
3. Peripheral artery disease: obstruction especially to legs. ~ 20% over age 65
4. infective endocarditis: infection of endocardium (innermost) - Staph. Aureus
5. Hypotension: due to impairment of baroreflex response of body
6. Valvular heart disease: dysfunction of 1 or more of valves: Stenosis vs. Regurgitation

Front 16

Decrease in bone density in women is mainly due to what?

Back 16

Sudden loss of estrogen

Front 17

List the 3 types of Osteoperosis

Back 17

1. Type I (post menopausal): decrease in estrogen leads to bones more sensitive to PTH --> increases calcium release/reabsorption. Increase in OsteoCLASTS
2. Type 2 (SENILE): Decrease in bone formation
3. Type 3 (Osteoperosis second to meds such as corticosteroids)

Front 18

How is BMD related to osteoperosis?

Back 18

If BMD is 1 SD below mean BMD of young adult then there is bone loss. If greater than 2.5 SD then = osteoperosis

Front 19

What is the most common treatment option for someone with Osteoperosis?

Back 19

Bisphosphonates (Fosomax): increases bone density and decreases fracture by 50%

Front 20

What is the most common form of Arthritis?

Back 20

Osteoarthritis - affects entire joint
-100% of pop b/w 75-79

Front 21

T or F? Someone with osteoarthritis has increased pain w/ activity and decreased pain with rest?

Back 21

True
-RA feels worse when resting and better when moving around

Front 22

What is the criteria set by the American College of Rheumatology for the classification?
-must have 4 of 6

Back 22

1. Morning stiffness or more than 1 hour for the majority of 6 weeks
2. Arthritis of > 3 joint for at least 6 weeks
3. Arthritis of hands for at least 6 weeks
4. Symmetric arthritis for at least 6 weeks
5. + RF
6. Radiological changes showing joint erosion

Front 23

Inflammatory vasculitis of unknown etiology that affects medium and large sized arteries is known as?

Back 23

Giant Cell Arteritis
-Commonly involved arteries
1. Extracranial vertebral
2. Superficial temporal
3. Posterior Ciliary
4. Ophthalmic

Front 24

What are some symptoms of Giant Cell?

Back 24

1. Mean age = 70 (mainly females)
2. Occurs 25% w/ Polymyalgia rheumatica (shoulder/pelvic pain)
3. Fever, new onset of HA
4. Tender scalp
5. Jaw claudication (chewing hurts)
6. Decrease in vision

Front 25

What is the gold standard to diagnose Giant Cell?

Back 25

Temporal Artery Biopsy

Front 26

What characteristics are decreased in someone with psychiatric disorders?

Back 26

1. Selective attention
2. logical analysis
3. learning complex, new tasks
4. learning new foreign language

Front 27

T or F? New memory formation remains stable while old memories are hard to recall

Back 27

False. NEW memory formation is more difficult while old memory retrieving remains stable

Front 28

What is one of the most common psychiatric disorders of the elderly and is also considered a common risk factor for suicide in people over 70 yo?

Back 28

Depression

Front 29

List some age related changes of the Gastrointestinal tract

Back 29

1. Decrease in bile acid synthesis --> increase in gallstones
2. Decrease in hepatic blood flow by 35% - drugs stay in longer
3. Decrease in taste
4. Decrease in saliva production
5. Decrease in gastric mucosa --> ulcers
6. Decrease in gastric emptying
7. increase in diverticulosis
8. decrease in insulin secretions--> Type II DM

Front 30

What is the most common cause of tooth loss?

Back 30

Periodontal disease (gingivitis and periodontitis)
-Risk factors:
1. Don't brush
2. male
3. smoking
4. HTN
5. DM
6. RA

Front 31

List 2 theories as to why having no teeth is a risk factor for developing cognitive impairment

Back 31

1. Prolonged inflammation/infection
2. Less balanced diet

Front 32

What is the most common cause of Dysphagia? (difficulty swallowing)

Back 32

Strokes

Front 33

How is constipation defined?

Back 33

1. Straining at least 25% of time
2. Hard stools at least 25% of time
3. Feeling of incomplete evacuation at least 25% of time
4. Fewer than 2 bowel movements/week
-At least 2 of these over a 12 month period

Front 34

List some common causes of Constipation

Back 34

1. Idiopathic
2. Decrease in dietary fiber
3. Tumors
4. Hypothyroidism
5. Stroke
6. Drugs (narcotics, NSAIDs, antacids, antidepressants, CCB)

Front 35

List some causes of Fecal Incontinence

Back 35

1. Weakened sphincter due to aging
2. Constipation
3. Nerve damage secondary to strokes
4. Loss of storage capacity in the rectum
5. Surgery (especially to tx hemorrhoids)
6. Rectal Cancer
7. Chronic laxative use

Front 36

What percentage of the western population will develop a colorectal tumor by age of 70?

Back 36

50%
-10% become malignant
-3rd most common cancer in western world
-arise from adenomatous polyps

Front 37

What is the difference between Sigmoidoscopy and Colonoscopy?

Back 37

Sigmoidoscopy - lighted probe that goes into the rectum and lower colon
Colonoscopy - probe that goes into rectum and thruout entire colon - can biopsy asap

Front 38

List some age related problems associated with infectious disease

Back 38

1. Decrease in T-lymphocyte production --> decrease in antibody production to new pathogens and cell mediated immunity response
-No change or increase in natural killer cells (kills cells with no prior contact)
-Macrophages (first encounter) are slower in getting rid of antigens and difficulty in getting rid of cancer cells

Front 39

T or F? Libido decreases with age

Back 39

False - myth

Front 40

What is the most common type of cancer in the US for men?

Back 40

Prostate Cancer - 2nd leading cause of death behind lung cancer
-ave dx = 70 y/o
-Usually dx by look at PSA (used for screening). Ultrasound or Biopsy best for diagnosing

Front 41

Menopause is diagnosed how?

Back 41

no period for 12 consecutive months
-Decrease in estrogen

Front 42

What is the 2nd biggest killer behind lung cancer in women?

Back 42

Breast Cancer
-High ability to metastasize