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171 Cards in this Set

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T/F - Arterial walls get thinner as you get older; this is what causes easy bruising in older folks.
False - arterial walls get thicker
Reduced blood flow to the tissues in older folks occurs because...
narrowing of vascular lumen
When you get older, how does the heart morphology change?
Left ventricular wall gets thicker, Left atrium incr size
In an older person's heart, the # of myocytes (incr/decr) and size of the remaining myocytes (incr/decr).
decr, incr
T/F - Older people's arteries tend to have an increase in plaques.
True
How many Americans are affected by CAD?
14 million
The ____ arteries carry (CO2/O2) rich blood to the ____.
coronary, O2, myocardium
What is the main cause of CAD?
Atherosclerosis
What forms oxidized LDLs?
LDL (bad cholesterol) + oxidation (due to i.e. smoking)
What causes the hardened plaques in arteries?
Oxidation (also damages arteries) resulting in inflammatory response (incr C-reactive protein) + oxidized LDL = hardened plaque
What is angina? Where does it typically occur?
Chest pain, radiates to arms & legs, usually on LEFT side of body.
What are statins?
Cholesterol lowering drug
What is the basic premise of an angioplasty?
A balloon inserted into an artery is inflated and pushes the plaque aside.
What is the basic premise of a coronary artery bypass?
Bypass the area that has the plaque by inserting a vessel from the leg.
What is the gold standard of testing CAD? Briefly describe it.
Coronary Angiography - dye injected via catheter thru the groin.
Normal BP?
Systolic <120, Diastolic <80
Pre-HTN BP?
Systolic 120-139, Diastolic 80-89
HTN Stage 1?
Systolic 140-159, Diastolic 90-99
HTN Stage 2?
Systolic ≥160, Diastolic ≥100
You measure Elmer Fudd's BP and get 150/92 RAS at 3:30 PM. Does Elmer have hypertension? If so, what stage?
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.
What is the proper way to Dx HTN?
You need 2 or more readings taken at each of 2 or more visits.
Primary HTN has (no cause/a cause) and has an incidence of __%.
No cause, 90-95%
Secondary HTN has an incidence of __%
5-10%
About __% of adults present w/ HTN past the age of 65.
62%
BP = ___ + ___
Cardiac output + systemic vascular resistance
What causes an increase of cardiac output in HTN?
Narrowing of vessels causes difficulty in blood flow, which increases cardiac output to push blood through, therefore increasing BP (therefore causing HTN).
What is the mechanism of renal disease causing HTN?
↑Renin (due to renin producing tumor), ↑Angiotensin II, ↑Vasoconstriction + ↑aldosterone, ↑Na reabsorption in kidneys, ↑BP
T/F - Renal disease is a cause of primary HTN.
False - secondary HTN (remember primary HTN has no cause)
T/F - Cushing's sydrome can cause HTN.
True
T/F - Pheochromocytoma is a renal disease that can cause HTN.
False - an endocrine disease
What is Pheochromocytoma?
Tumor of the medulla of the adrenal glands, leads to increase in secretion of epinephrine, causing vasoconstriction thus incr BP
Where does pheochromocytoma originate?
In the chromaffin cells
What is Cushing's Syndrome?
Incr ACTH from pituitary secondary to pituitary adenoma, which incr cortisol from adrenal gland. Cortisol incr epinephrine effects, which causes vasoconstriciton thus incr BP
T/F - Most Cushing's syndrome pts have HTN.
True (80%)
T/F - NSAIDs and steroids can cause HTN
True
What is the action of diuretics for HTN?
Decr cardiac output
Which HTN drug dilates arterioles and veins?
Alpha-1 adrenergic blockers
Which HTN drug decr cardiac output and renin?
Beta blockers
What is the action of Ca2+ channel blockers for HTN?
Decr cardiac output, vasodilation
What is the action of ACE inhibitors for HTN?
Decr angiotensin II
T/F - Pseudohypertension is significant, not commonly found in older folks.
False - almost always found in elderly
What happens in pseudohypertension? DDx vs HTN?
Vessels get stiff and thick secondary to calcium deposition in walls; DDx by considering overall health of pt e.g. damage to organs, etc.
Bradycardia = ___ BPM. Tachycardia = ___ BPM
60, 100
What is congestive heart failure?
Heart can't pump enough blood to rest of body's organs
What is peripheral artery disease?
Obstruction of periph arteries especially to legs.
About __% of Americans 65+ are affected by peripheral artery disease.
20
What is infective endocarditis? What is the common cause?
Infection of endocardium (innermost layer that lines chambers), commonly caused by S. aureus
___% of infective endocarditis involve pts over 60.
25-50%
Hypotension BP?
<100/60
What is a decr in BP secondary to impairment of baroreflex response?
Hypotension
What is valvular heart disease?
Dysfxn of 1 or more of the 4 heart valves
What heart valves are on the left side? Right side?
Left = mitral, aortic. Right = tricuspid, pulmonic
Stenosis = ?
Stenosis = narrowing of vessel/valve
Regurgitation = ?
Regurgitation = blood goes in reverse direction
What causes the greater decrease in bone density in women vs men?
Loss of estrogen
What is sarcopenia?
Loss in muscle mass, assoc w/ incr age
A decrease in bone density starts between the ages of __ to __.
40 to 50
What happens to the articular cartilage as you get older?
Becomes brittle
T/F - Non-articular cartilage continues to grow as we get older.
True
What causes the loss of elasticity and regenerative ability in older people?
Decrease in fibroblasts
___ million Americans have osteoporosis.
10
T/F - Incidence of osteoporosis remains stable with incr age
False - incr with age
Describe Type 1 osteoporosis.
Post-menopausal. Decr estrogen thus incr bone sensitivity to PTH thus incr calcium release/reabs from bones. Also incr osteoclasts
Describe Type 2 osteoporosis.
Senile. Decrease in bone formation.
Describe Type 3 osteoporosis.
Osteoporosis secondary to meds e.g. corticosteroids
What is considered normal bone loss?
BMD is 1 SD below normal mean of a BMD of a young adult.
Daffy Duck has 3.5 SD below the mean BMD of a young adult. Does he have osteoporosis?
Yes (greater than 2.5 SD = osteoporosis)
T/F - Excessive alcohol consumption is not a risk factor for osteoporosis.
False - it is a risk factor
T/F - Smoking is a risk factor for osteoporosis
True
What is the proper calcium supplement dosage for Tx osteoporosis?
1200-1500 mg
T/F - For Tx osteoporosis, 600-800 mg Vitamin D is recommended.
False - 600-800 IU
What osteoporosis Tx increases bone density and decreases fractures by 50%?
Bisphosphonates (Foxamax)
T/F - Weight bearing exercises has a negative effect on osteoporosis.
False - it is a Tx
What is the most common form of arthritis?
Osteoarthritis
T/F - Osteoarthritis only affects the synovium.
False - affects the entire joint (articular cartilage of the synovial joints, synovial fluid, subchondral bone, and joint capsule)
What is the pathologic process involved in osteoarthritis?
Cartilage develops tears, chondrocytes try to keep up but cannot, eventually underlying bones exposed
At what age range do 100% men and women have osteoarthritis?
75-79 yo
Osteoarthritis = (incr/decr) pain with activity, (incr/decr) pain with rest.
incr, decr
T/F - Obesity is a cause of primary osteoarthritis.
False - secondary
Name two primary osteoarthritis etiologies
Idiopathic, decr in proteoglycans
Rheumatoid Arthritis = __% of the population.
1%
Rheumatoid Arthritis affects (men/women) __x more.
women 3x more
Peak of incidence of Rheumatoid Arthritis is __ to __ yrs old.
40-60
Rheumatoid Arthritis pathologic process?
Autoimmune inflam disease of joint that causes synovitis (inflamed synovial joints)
What is the key Sx of Rheumatoid Arthritis?
Morning stiffness - feel pain with inactivity (DDx vs osteoarthritis)
What autoimmune disease involves Polyarthritis?
Rheumatoid Arthritis
What are the Rheumatoid Arthritis criteria?
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
Giant Cell Arteritis pathologic process?
Inflammatory vasculitis of unknown etiology affecting large and medium sized arteries; involves infiltrates composed of mononuclear cells surr by giant cells
What arteries are most often involved in Giant Cell Arteritis?
Extracranial vertebral, superficial temporal, posterior ciliary, ophthalmic
Mean age of onset for Giant Cell Arteritis = ?
70 yo
Giant Cell Arteritis is __x more in (males/females).
3, females
T/F - Giant Cell Arteritis is associated with Polymyalgia rheumatica.
True
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...
Giant Cell Arteritis
What tests are involved in Dx Giant Cell Arteritis? What kind of results would you find?
- High ESR (at least >50 mm/h but usually >100 mm/h), - High C-reactive protein, - Temporal artery biopsy (gold standard)
Tx Giant Cell Arteritis?
Steroids
T/F - In older folks, attn span, comprehension, and vision perception are stable.
True
T/F - Older folks have decreased selective attention.
True
T/F - Older folks have stable logical analysis.
False - decr
T/F - Older folks have difficulty in learning complex new tasks.
True
T/F - The ability for older folks to learn new languages is stable.
False - decr
T/F - Older folks have stable new memories, and decreased old memories.
False - decr new memories, stable old memories
T/F - The personality of older folks does not change.
True
T/F - Older folks tend to be less cautious since their senses are diminished.
False - more cautious
T/F - Older folks tend to have a high suicide rate.
True - >70 yo has highest rate of suicide, due to depression
What is one of the most common psychiatric disorders of the elderly?
Depression
Depression affects __ million Americans aged __ or older.
5, 65
T/F - According to Dr. Y's notes, sleeping too much is a Sx of depression.
True
Why do older people tend to get gallstones?
Decr in bile acid synthesis
Drugs tend to stay (longer/shorter) in older people. Why?
Longer - decr in hepatic blood flow by 35%
Older folks have a (incr/decr/stable) taste.
decr
Older folks have a (incr/decr/stable) saliva production.
decr
Older folks have a (incr/decr/stable) gastric mucosa, which leads to?
decr, leads to ulcers (incr H. pylori)
Older folks have a (incr/decr/stable) in gastric emptying. What is the impact of this?
Decr thus feel full = weight loss
Older folks have a (incr/decr/stable) in diverticulosis
incr
Older folks have a (incr/decr/stable) insulin production; what does this lead to?
decr, leads to DM type 2
__% of adults over age __ are completely missing teeth. What is this condition called?
33, 65. Endentulism.
Most common cause of tooth loss in older folks = ?
Periodontal disease (gingivitis and periodontitis)
T/F - DM is considered a risk factor for tooth loss in older folks.
True
T/F - Rheumatoid Arthritis is considered a risk factor for tooth loss in older folks.
True
T/F - Tooth loss is linked to dementia.
True (no teeth = 3.57x more likely to have cognitive impairment)
What is the term for difficulty in swallowing?
Dysphagia
Most common cause of difficulty in swallowing?
Stroke
Constipation in 65 yo: __% of men, __% women.
26, 34
Constipation is defined with what characteristics?
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
T/F - Hyperthyroidism is a cause of constipation.
False - HYPOthyroidism
T/F - Stroke is a cause of constipation
True
T/F - Calcium channel blockers can be a cause of constipation
True
T/F - Fecal incontinence can be caused by constipation.
True - harder stools can damage rectum and reduce sphincter function
T/F - Chronic laxative use does not cause fecal incontinence.
False - chronic laxative use CAN cause fecal incontinence
__% of the western population develop a colorectal tumor by age __, and __% become malignant.
50%, 70, 10%
Colorectal tumors are the (#) most common cancer in the western world.
3rd
Where do colorectal tumors arise from?
Adenomatous polyps in the colon
T/F - Colorectal tumor risk is not increased by smoking.
False - risk is incr w/ smoking
Eating lots of red meat with low vegetable, fruit, fish, chicken is a risk factor for what condition?
Colorectal tumors
Hx of ulcerative colitis, IBD, and Crohn's disease are risk factors for what condition?
Colorectal tumor
What is the difference betw a sigmoidoscopy vs colonoscopy?
Sigmoidoscopy = lighted probe that goes into rectum and lower colon, Colonoscopy = lighted probe that goes into rectum and throughout entire colon
What happens to the immune system of older folks as noted by Dr. Y?
Decr in T-lymphocyte production/proliferation leading to decr antibodies vs new pathogens and decr cell mediated imm response
T/F - Older folks have a decreased number of Natural Killer Cells.
False - no change or incr. (NKCs = kills cells w/o prior contact)
How do macrophages behave in older folks?
Slower in getting rid of antigens and cancer cells. (Macrophages = first that pathogens encounter)
What flesh-eating bacteria is found in nursing homes?
Strep pyogenes
T/F - Older folks have a decr libido.
False - it's a myth
Name the causes of Erectile Dysfxn.
Nerve dmg, DM (70%), kidney dz, neuro dz, vascular dz (most common), alcohol, smoking, Rx drug use (200 drugs that can cause ED)
Cialis is used for what condition in older folks?
Erectile dysfxn
What are the risk factors for decr VA in erectile dysfxn Rx use?
HTN or crowded nerve
What is the most common gynecologic cancer?
Endometrial cancer
Endometrial cancer occurs in women between ages __ and __.
50, 59
Endometrial cancer pathologic process?
Too much estrogen vs progesterone leading to thickened endometrium, leading to cancer.
An enlarged prostate that compresses the urethra is called...
Benign Prostate Hyperplasia
__% of men over __ yo have Benign Prostate Hyperplasia.
90%, 80
This drug is known to cause floppy iris syndrome and is used to treat ____.
Flomax (alpha-adrenergic blocker), treats Benign Prostate Hyperplasia. Relaxes muscles in prostate and bladder.
Prostate cancer is what type of cancer exactly?
Adenocarcinoma
What is the most common type of cancer in the US for men?
Prostate cancer
Avg Dx of prostate cancer = ?
70 yo
T/F - Diagnosis of prostate cancer is usually done by rectal examination.
False - look at PSA (Prostate Specific Antigen) but not always accurate
What methods are used to Dx prostate cancer?
PSA (Prostate Specific Antigen), ultrasound, biopsy
End of the reproductive era for females = ?
Menopause
When does menopause usually occur?
After 40
How is menopause diagnosed?
No period for 12 consecutive mos
What risks are involved with menopause?
Decr estrogen incr risk of osteoporosis, heart dz, Alzheimer's, wrinkling, and poor bladder control.
T/F - Fecal incontinence can be worse with menopause.
False - bladder control.
T/F - Menopause can incr the risk of Parkinson's.
False - Alzheimer's
T/F - Menopause results in decr estrogen, which has a positive effect on heart disease.
False - incr risk for heart dz
Breast cancer affects 1 in __ women.
8
Breast cancer is the (#) killer behind lung cancer.
2nd
T/F - Breast cancer is highly metastatic.
True
T/F - Obesity incr risk of breast cancer.
True (overweight)
T/F - Alcohol incr risk of breast cancer.
True
What are the risk factors for breast cancer?
Age, genes, menopause after 55, overweight, alcohol, BCP (no definitive proof)
What is the surgical Tx of breast cancer?
Mastectomy - removal of breast
Breast cancer is a risk for women that have menopause after age __.
55
T/F - Benign Prostate Hyperplasia increases risk for prostate cancer.
False - does NOT raise risk for prostate cancer