Geriatrics Mt1 - Systemic Disease 1

Front 1

T/F - Arterial walls get thinner as you get older; this is what causes easy bruising in older folks.

Back 1

False - arterial walls get thicker

Front 2

Reduced blood flow to the tissues in older folks occurs because...

Back 2

narrowing of vascular lumen

Front 3

When you get older, how does the heart morphology change?

Back 3

Left ventricular wall gets thicker, Left atrium incr size

Front 4

In an older person's heart, the # of myocytes (incr/decr) and size of the remaining myocytes (incr/decr).

Back 4

decr, incr

Front 5

T/F - Older people's arteries tend to have an increase in plaques.

Back 5

True

Front 6

How many Americans are affected by CAD?

Back 6

14 million

Front 7

The ____ arteries carry (CO2/O2) rich blood to the ____.

Back 7

coronary, O2, myocardium

Front 8

What is the main cause of CAD?

Back 8

Atherosclerosis

Front 9

What forms oxidized LDLs?

Back 9

LDL (bad cholesterol) + oxidation (due to i.e. smoking)

Front 10

What causes the hardened plaques in arteries?

Back 10

Oxidation (also damages arteries) resulting in inflammatory response (incr C-reactive protein) + oxidized LDL = hardened plaque

Front 11

What is angina? Where does it typically occur?

Back 11

Chest pain, radiates to arms & legs, usually on LEFT side of body.

Front 12

What are statins?

Back 12

Cholesterol lowering drug

Front 13

What is the basic premise of an angioplasty?

Back 13

A balloon inserted into an artery is inflated and pushes the plaque aside.

Front 14

What is the basic premise of a coronary artery bypass?

Back 14

Bypass the area that has the plaque by inserting a vessel from the leg.

Front 15

What is the gold standard of testing CAD? Briefly describe it.

Back 15

Coronary Angiography - dye injected via catheter thru the groin.

Front 16

Normal BP?

Back 16

Systolic <120, Diastolic <80

Front 17

Pre-HTN BP?

Back 17

Systolic 120-139, Diastolic 80-89

Front 18

HTN Stage 1?

Back 18

Systolic 140-159, Diastolic 90-99

Front 19

HTN Stage 2?

Back 19

Systolic ≥160, Diastolic ≥100

Front 20

You measure Elmer Fudd's BP and get 150/92 RAS at 3:30 PM. Does Elmer have hypertension? If so, what stage?

Back 20

You cannot conclude HTN, because you only measured once. To Dx HTN, you need 2 or more readings taken at each of 2 or more visits.

Front 21

What is the proper way to Dx HTN?

Back 21

You need 2 or more readings taken at each of 2 or more visits.

Front 22

Primary HTN has (no cause/a cause) and has an incidence of __%.

Back 22

No cause, 90-95%

Front 23

Secondary HTN has an incidence of __%

Back 23

5-10%

Front 24

About __% of adults present w/ HTN past the age of 65.

Back 24

62%

Front 25

BP = ___ + ___

Back 25

Cardiac output + systemic vascular resistance

Front 26

What causes an increase of cardiac output in HTN?

Back 26

Narrowing of vessels causes difficulty in blood flow, which increases cardiac output to push blood through, therefore increasing BP (therefore causing HTN).

Front 27

What is the mechanism of renal disease causing HTN?

Back 27

↑Renin (due to renin producing tumor), ↑Angiotensin II, ↑Vasoconstriction + ↑aldosterone, ↑Na reabsorption in kidneys, ↑BP

Front 28

T/F - Renal disease is a cause of primary HTN.

Back 28

False - secondary HTN (remember primary HTN has no cause)

Front 29

T/F - Cushing's sydrome can cause HTN.

Back 29

True

Front 30

T/F - Pheochromocytoma is a renal disease that can cause HTN.

Back 30

False - an endocrine disease

Front 31

What is Pheochromocytoma?

Back 31

Tumor of the medulla of the adrenal glands, leads to increase in secretion of epinephrine, causing vasoconstriction thus incr BP

Front 32

Where does pheochromocytoma originate?

Back 32

In the chromaffin cells

Front 33

What is Cushing's Syndrome?

Back 33

Incr ACTH from pituitary secondary to pituitary adenoma, which incr cortisol from adrenal gland. Cortisol incr epinephrine effects, which causes vasoconstriciton thus incr BP

Front 34

T/F - Most Cushing's syndrome pts have HTN.

Back 34

True (80%)

Front 35

T/F - NSAIDs and steroids can cause HTN

Back 35

True

Front 36

What is the action of diuretics for HTN?

Back 36

Decr cardiac output

Front 37

Which HTN drug dilates arterioles and veins?

Back 37

Alpha-1 adrenergic blockers

Front 38

Which HTN drug decr cardiac output and renin?

Back 38

Beta blockers

Front 39

What is the action of Ca2+ channel blockers for HTN?

Back 39

Decr cardiac output, vasodilation

Front 40

What is the action of ACE inhibitors for HTN?

Back 40

Decr angiotensin II

Front 41

T/F - Pseudohypertension is significant, not commonly found in older folks.

Back 41

False - almost always found in elderly

Front 42

What happens in pseudohypertension? DDx vs HTN?

Back 42

Vessels get stiff and thick secondary to calcium deposition in walls; DDx by considering overall health of pt e.g. damage to organs, etc.

Front 43

Bradycardia = ___ BPM. Tachycardia = ___ BPM

Back 43

60, 100

Front 44

What is congestive heart failure?

Back 44

Heart can't pump enough blood to rest of body's organs

Front 45

What is peripheral artery disease?

Back 45

Obstruction of periph arteries especially to legs.

Front 46

About __% of Americans 65+ are affected by peripheral artery disease.

Back 46

20

Front 47

What is infective endocarditis? What is the common cause?

Back 47

Infection of endocardium (innermost layer that lines chambers), commonly caused by S. aureus

Front 48

___% of infective endocarditis involve pts over 60.

Back 48

25-50%

Front 49

Hypotension BP?

Back 49

<100/60

Front 50

What is a decr in BP secondary to impairment of baroreflex response?

Back 50

Hypotension

Front 51

What is valvular heart disease?

Back 51

Dysfxn of 1 or more of the 4 heart valves

Front 52

What heart valves are on the left side? Right side?

Back 52

Left = mitral, aortic. Right = tricuspid, pulmonic

Front 53

Stenosis = ?

Back 53

Stenosis = narrowing of vessel/valve

Front 54

Regurgitation = ?

Back 54

Regurgitation = blood goes in reverse direction

Front 55

What causes the greater decrease in bone density in women vs men?

Back 55

Loss of estrogen

Front 56

What is sarcopenia?

Back 56

Loss in muscle mass, assoc w/ incr age

Front 57

A decrease in bone density starts between the ages of __ to __.

Back 57

40 to 50

Front 58

What happens to the articular cartilage as you get older?

Back 58

Becomes brittle

Front 59

T/F - Non-articular cartilage continues to grow as we get older.

Back 59

True

Front 60

What causes the loss of elasticity and regenerative ability in older people?

Back 60

Decrease in fibroblasts

Front 61

___ million Americans have osteoporosis.

Back 61

10

Front 62

T/F - Incidence of osteoporosis remains stable with incr age

Back 62

False - incr with age

Front 63

Describe Type 1 osteoporosis.

Back 63

Post-menopausal. Decr estrogen thus incr bone sensitivity to PTH thus incr calcium release/reabs from bones. Also incr osteoclasts

Front 64

Describe Type 2 osteoporosis.

Back 64

Senile. Decrease in bone formation.

Front 65

Describe Type 3 osteoporosis.

Back 65

Osteoporosis secondary to meds e.g. corticosteroids

Front 66

What is considered normal bone loss?

Back 66

BMD is 1 SD below normal mean of a BMD of a young adult.

Front 67

Daffy Duck has 3.5 SD below the mean BMD of a young adult. Does he have osteoporosis?

Back 67

Yes (greater than 2.5 SD = osteoporosis)

Front 68

T/F - Excessive alcohol consumption is not a risk factor for osteoporosis.

Back 68

False - it is a risk factor

Front 69

T/F - Smoking is a risk factor for osteoporosis

Back 69

True

Front 70

What is the proper calcium supplement dosage for Tx osteoporosis?

Back 70

1200-1500 mg

Front 71

T/F - For Tx osteoporosis, 600-800 mg Vitamin D is recommended.

Back 71

False - 600-800 IU

Front 72

What osteoporosis Tx increases bone density and decreases fractures by 50%?

Back 72

Bisphosphonates (Foxamax)

Front 73

T/F - Weight bearing exercises has a negative effect on osteoporosis.

Back 73

False - it is a Tx

Front 74

What is the most common form of arthritis?

Back 74

Osteoarthritis

Front 75

T/F - Osteoarthritis only affects the synovium.

Back 75

False - affects the entire joint (articular cartilage of the synovial joints, synovial fluid, subchondral bone, and joint capsule)

Front 76

What is the pathologic process involved in osteoarthritis?

Back 76

Cartilage develops tears, chondrocytes try to keep up but cannot, eventually underlying bones exposed

Front 77

At what age range do 100% men and women have osteoarthritis?

Back 77

75-79 yo

Front 78

Osteoarthritis = (incr/decr) pain with activity, (incr/decr) pain with rest.

Back 78

incr, decr

Front 79

T/F - Obesity is a cause of primary osteoarthritis.

Back 79

False - secondary

Front 80

Name two primary osteoarthritis etiologies

Back 80

Idiopathic, decr in proteoglycans

Front 81

Rheumatoid Arthritis = __% of the population.

Back 81

1%

Front 82

Rheumatoid Arthritis affects (men/women) __x more.

Back 82

women 3x more

Front 83

Peak of incidence of Rheumatoid Arthritis is __ to __ yrs old.

Back 83

40-60

Front 84

Rheumatoid Arthritis pathologic process?

Back 84

Autoimmune inflam disease of joint that causes synovitis (inflamed synovial joints)

Front 85

What is the key Sx of Rheumatoid Arthritis?

Back 85

Morning stiffness - feel pain with inactivity (DDx vs osteoarthritis)

Front 86

What autoimmune disease involves Polyarthritis?

Back 86

Rheumatoid Arthritis

Front 87

What are the Rheumatoid Arthritis criteria?

Back 87

At least 6 weeks of the following: - Morning stiffness >1hr for most mornings, - Arthritis of >3 joints/joint groups, - Arthritis of hands, - Symmetric arthritis, Also: (+) RF, radiological changes showing joint erosion, ***Need 4 out of 6 to Dx RA

Front 88

Giant Cell Arteritis pathologic process?

Back 88

Inflammatory vasculitis of unknown etiology affecting large and medium sized arteries; involves infiltrates composed of mononuclear cells surr by giant cells

Front 89

What arteries are most often involved in Giant Cell Arteritis?

Back 89

Extracranial vertebral, superficial temporal, posterior ciliary, ophthalmic

Front 90

Mean age of onset for Giant Cell Arteritis = ?

Back 90

70 yo

Front 91

Giant Cell Arteritis is __x more in (males/females).

Back 91

3, females

Front 92

T/F - Giant Cell Arteritis is associated with Polymyalgia rheumatica.

Back 92

True

Front 93

Your 70 yr old female patient complains of fever, recent HA, tender scalp, pain on chewing, and a decrease in vision. You would guess that she has...

Back 93

Giant Cell Arteritis

Front 94

What tests are involved in Dx Giant Cell Arteritis? What kind of results would you find?

Back 94

- High ESR (at least >50 mm/h but usually >100 mm/h), - High C-reactive protein, - Temporal artery biopsy (gold standard)

Front 95

Tx Giant Cell Arteritis?

Back 95

Steroids

Front 96

T/F - In older folks, attn span, comprehension, and vision perception are stable.

Back 96

True

Front 97

T/F - Older folks have decreased selective attention.

Back 97

True

Front 98

T/F - Older folks have stable logical analysis.

Back 98

False - decr

Front 99

T/F - Older folks have difficulty in learning complex new tasks.

Back 99

True

Front 100

T/F - The ability for older folks to learn new languages is stable.

Back 100

False - decr

Front 101

T/F - Older folks have stable new memories, and decreased old memories.

Back 101

False - decr new memories, stable old memories

Front 102

T/F - The personality of older folks does not change.

Back 102

True

Front 103

T/F - Older folks tend to be less cautious since their senses are diminished.

Back 103

False - more cautious

Front 104

T/F - Older folks tend to have a high suicide rate.

Back 104

True - >70 yo has highest rate of suicide, due to depression

Front 105

What is one of the most common psychiatric disorders of the elderly?

Back 105

Depression

Front 106

Depression affects __ million Americans aged __ or older.

Back 106

5, 65

Front 107

T/F - According to Dr. Y's notes, sleeping too much is a Sx of depression.

Back 107

True

Front 108

Why do older people tend to get gallstones?

Back 108

Decr in bile acid synthesis

Front 109

Drugs tend to stay (longer/shorter) in older people. Why?

Back 109

Longer - decr in hepatic blood flow by 35%

Front 110

Older folks have a (incr/decr/stable) taste.

Back 110

decr

Front 111

Older folks have a (incr/decr/stable) saliva production.

Back 111

decr

Front 112

Older folks have a (incr/decr/stable) gastric mucosa, which leads to?

Back 112

decr, leads to ulcers (incr H. pylori)

Front 113

Older folks have a (incr/decr/stable) in gastric emptying. What is the impact of this?

Back 113

Decr thus feel full = weight loss

Front 114

Older folks have a (incr/decr/stable) in diverticulosis

Back 114

incr

Front 115

Older folks have a (incr/decr/stable) insulin production; what does this lead to?

Back 115

decr, leads to DM type 2

Front 116

__% of adults over age __ are completely missing teeth. What is this condition called?

Back 116

33, 65. Endentulism.

Front 117

Most common cause of tooth loss in older folks = ?

Back 117

Periodontal disease (gingivitis and periodontitis)

Front 118

T/F - DM is considered a risk factor for tooth loss in older folks.

Back 118

True

Front 119

T/F - Rheumatoid Arthritis is considered a risk factor for tooth loss in older folks.

Back 119

True

Front 120

T/F - Tooth loss is linked to dementia.

Back 120

True (no teeth = 3.57x more likely to have cognitive impairment)

Front 121

What is the term for difficulty in swallowing?

Back 121

Dysphagia

Front 122

Most common cause of difficulty in swallowing?

Back 122

Stroke

Front 123

Constipation in 65 yo: __% of men, __% women.

Back 123

26, 34

Front 124

Constipation is defined with what characteristics?

Back 124

At least 25% of time: - Straining, - Hard stools, - Feeling of incomplete evacuation, Also: fewer than 2 bowel movements a week, *At least 2 of these over 12 mo period

Front 125

T/F - Hyperthyroidism is a cause of constipation.

Back 125

False - HYPOthyroidism

Front 126

T/F - Stroke is a cause of constipation

Back 126

True

Front 127

T/F - Calcium channel blockers can be a cause of constipation

Back 127

True

Front 128

T/F - Fecal incontinence can be caused by constipation.

Back 128

True - harder stools can damage rectum and reduce sphincter function

Front 129

T/F - Chronic laxative use does not cause fecal incontinence.

Back 129

False - chronic laxative use CAN cause fecal incontinence

Front 130

__% of the western population develop a colorectal tumor by age __, and __% become malignant.

Back 130

50%, 70, 10%

Front 131

Colorectal tumors are the (#) most common cancer in the western world.

Back 131

3rd

Front 132

Where do colorectal tumors arise from?

Back 132

Adenomatous polyps in the colon

Front 133

T/F - Colorectal tumor risk is not increased by smoking.

Back 133

False - risk is incr w/ smoking

Front 134

Eating lots of red meat with low vegetable, fruit, fish, chicken is a risk factor for what condition?

Back 134

Colorectal tumors

Front 135

Hx of ulcerative colitis, IBD, and Crohn's disease are risk factors for what condition?

Back 135

Colorectal tumor

Front 136

What is the difference betw a sigmoidoscopy vs colonoscopy?

Back 136

Sigmoidoscopy = lighted probe that goes into rectum and lower colon, Colonoscopy = lighted probe that goes into rectum and throughout entire colon

Front 137

What happens to the immune system of older folks as noted by Dr. Y?

Back 137

Decr in T-lymphocyte production/proliferation leading to decr antibodies vs new pathogens and decr cell mediated imm response

Front 138

T/F - Older folks have a decreased number of Natural Killer Cells.

Back 138

False - no change or incr. (NKCs = kills cells w/o prior contact)

Front 139

How do macrophages behave in older folks?

Back 139

Slower in getting rid of antigens and cancer cells. (Macrophages = first that pathogens encounter)

Front 140

What flesh-eating bacteria is found in nursing homes?

Back 140

Strep pyogenes

Front 141

T/F - Older folks have a decr libido.

Back 141

False - it's a myth

Front 142

Name the causes of Erectile Dysfxn.

Back 142

Nerve dmg, DM (70%), kidney dz, neuro dz, vascular dz (most common), alcohol, smoking, Rx drug use (200 drugs that can cause ED)

Front 143

Cialis is used for what condition in older folks?

Back 143

Erectile dysfxn

Front 144

What are the risk factors for decr VA in erectile dysfxn Rx use?

Back 144

HTN or crowded nerve

Front 145

What is the most common gynecologic cancer?

Back 145

Endometrial cancer

Front 146

Endometrial cancer occurs in women between ages __ and __.

Back 146

50, 59

Front 147

Endometrial cancer pathologic process?

Back 147

Too much estrogen vs progesterone leading to thickened endometrium, leading to cancer.

Front 148

An enlarged prostate that compresses the urethra is called...

Back 148

Benign Prostate Hyperplasia

Front 149

__% of men over __ yo have Benign Prostate Hyperplasia.

Back 149

90%, 80

Front 150

This drug is known to cause floppy iris syndrome and is used to treat ____.

Back 150

Flomax (alpha-adrenergic blocker), treats Benign Prostate Hyperplasia. Relaxes muscles in prostate and bladder.

Front 151

Prostate cancer is what type of cancer exactly?

Back 151

Adenocarcinoma

Front 152

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

Back 152

Prostate cancer

Front 153

Avg Dx of prostate cancer = ?

Back 153

70 yo

Front 154

T/F - Diagnosis of prostate cancer is usually done by rectal examination.

Back 154

False - look at PSA (Prostate Specific Antigen) but not always accurate

Front 155

What methods are used to Dx prostate cancer?

Back 155

PSA (Prostate Specific Antigen), ultrasound, biopsy

Front 156

End of the reproductive era for females = ?

Back 156

Menopause

Front 157

When does menopause usually occur?

Back 157

After 40

Front 158

How is menopause diagnosed?

Back 158

No period for 12 consecutive mos

Front 159

What risks are involved with menopause?

Back 159

Decr estrogen incr risk of osteoporosis, heart dz, Alzheimer's, wrinkling, and poor bladder control.

Front 160

T/F - Fecal incontinence can be worse with menopause.

Back 160

False - bladder control.

Front 161

T/F - Menopause can incr the risk of Parkinson's.

Back 161

False - Alzheimer's

Front 162

T/F - Menopause results in decr estrogen, which has a positive effect on heart disease.

Back 162

False - incr risk for heart dz

Front 163

Breast cancer affects 1 in __ women.

Back 163

8

Front 164

Breast cancer is the (#) killer behind lung cancer.

Back 164

2nd

Front 165

T/F - Breast cancer is highly metastatic.

Back 165

True

Front 166

T/F - Obesity incr risk of breast cancer.

Back 166

True (overweight)

Front 167

T/F - Alcohol incr risk of breast cancer.

Back 167

True

Front 168

What are the risk factors for breast cancer?

Back 168

Age, genes, menopause after 55, overweight, alcohol, BCP (no definitive proof)

Front 169

What is the surgical Tx of breast cancer?

Back 169

Mastectomy - removal of breast

Front 170

Breast cancer is a risk for women that have menopause after age __.

Back 170

55

Front 171

T/F - Benign Prostate Hyperplasia increases risk for prostate cancer.

Back 171

False - does NOT raise risk for prostate cancer