601 midterm

Question 1

Changes found in the airway of older persons

Answer 1

-Upper airway nasal passages less cartilaginous reducing patency
-Proximal and distal airways become less cartilaginous resulting in airtrapping
-increased soluble and cellular inflammation
-alveoli increase in size and decrease in elasticity
-increased apoptosis and senescence markers
-skeletal muscle atropies and diaphragm weakens leading to inadequate ventilation

Question 2

when does the respiratory system decline and by how much per year

Answer 2

age 40, 35-50ml/year

Question 3

most common pulmonary related symptoms in older adults

Answer 3

-rhinitis
-dyspnea
-cough
-wheezing and chest tightness

Question 4

chronic rhinosinusitis symptoms

Answer 4

-longer than 12 weeks
-nasal discharge
-nasal congestion or obstruction
-facial pain or pressure
-loss of smell
(2+ is diagnostic)

Question 5

risk factor for chronic rhinosinusitis

Answer 5

-increasing age
-smoking

Question 6

older adults with chronic rhinosinusitis also are frequently colonized with

Answer 6

staph aureus

Question 7

Otitis media is frequently seen with what

Answer 7

chronic rhinosinusitis

Question 8

bacterial rhinosinusitis is associated with what symptoms

Answer 8

-purulent nasal discharge
-facial pain or pressure

Question 9

treatment of clear nasal discharge in rhinosinjusitis

Answer 9

-analgesics
-saline irrigation
-decongestants (caution in old people with HTN and BPH)

Question 10

When to rx abx for rhinosinusitis

Answer 10

when symptoms are present for 7+ days and continue to worsen

Question 11

CRS treatment

Answer 11

-saline irrigation
-topical nasal steroids (cause epistaxis)

Question 12

S/S of asthma

Answer 12

-nocturnal wheezing/dyspnea
-cough
-chest tightness
-improvement of FEV1 of at least 12% after SABA is key

Question 13

Diagnostic tests for asthma

Answer 13

-improvement of FEV1 of at least 12% after SABA is key
-Provication tests (methacholine challenge)
-sputum esinophilia
-elevated IgE
-elevated fractional excretion of nitric oxide

Question 14

Diagnostic tests for COPD

Answer 14

-reduced and irreversible FEV1/FVC <70%

Question 15

Symptoms of COPD

Answer 15

-dyspnea
-cough
-sputum production
-wheezing
-chest pain

Question 16

COPD grading scale

Answer 16

mild: >80%
mod: 50-80%
severe: 30-50%
very severe <30% or FEV1 <50%

Question 17

General COPD treatment

Answer 17

-inhaler therapies (bronchodialators and iCS)
-smoking cessation
-supplemental o2
-pulmonary rehabilitation

Question 18

Interstitial lung disease

Answer 18

a spectrum of diffusee parenchymal and fibrotic lung injuries with interstitial pulmonary fibrosis being the most closely related to aging

Question 19

simptoms of ILD

Answer 19

-clubbing
-dyspnea
-cough
-crackles
-rales
-restrictive ventilatory impairment on PFT
-diffuse intersititial opacities
-alveolointerstitial inflammation with fibrosis

Question 20

IPF and ILD can mix with COPD and lead to what on pft

Answer 20

psudonormilization

Question 21

ILD chest radiographs will show

Answer 21

-reticular opacities in the mid and low lung
-CT will show subplural reticulation and honeycombig

Question 22

Risk factors for PE

Answer 22

-CANCER
-surgery
-fractures
-bed rest
-sedentary periods

Question 23

criteria used for PE

Answer 23

wells and geneva

Question 24

Diagnostic tests for PE

Answer 24

-D-dimer (although it increases with age anyway)
-Ultrasound for DVT
-CT pulmonary angiogram

Question 25

contraindications for a CT pulonary angiography

Answer 25

-renal impairment
-dye allergies

Question 26

Treatment for PE in those without renal insufficiency or obese

Answer 26

-Direct oral anticoagulants (apixaban, dabigatran, rivaroxaban)

Question 27

Treatment of PE in cancer

Answer 27

low-molecular weight heparin

Question 28

COPD patients should always have what vaccinatons

Answer 28

-Flu
-Pne

Question 29

Pneumo vaccinations in older adults

Answer 29

For all over 65:
-PCV13 (prevnar 13) first
-PPSV23 one year later for immunocompetent (8weeks for immunocompromised)

a second immunization of PPSV23 for those over 65 5 years fro the first with one year from the pSCV13

Question 30

Flu vaccinations

Answer 30

-yearly for everyone over 65

Question 31

shingles vaccinaton

Answer 31

Shingrix for all over 65 even if previously immunized with zostavax

2 doses (2-5mo apart)

Question 32

TDAP

Answer 32

One dose after 65 then Td every 10

Question 33

5 A’s in smoking cessation

Answer 33

Ask, advise, agree, assist and arrange

Question 34

other methods of pain reduction than opioids

Answer 34

-exercise
-topical analgesics
-tai chi
-PT
-accupuncture
-massage
-nonopioids

Question 35

as the body ages, what happens to total body of water

Answer 35

-total volume of water decrases (resulting in a higher blood concentration of stuff)

Question 36

protein needs of the older adult

Answer 36

1-1.5g/kg and should make up 12-20% of calories

Question 37

fiber needs in the older adult

Answer 37

14g per 1000 calories with 64 oz of water

Question 38

thirst sensation in old age

Answer 38

is blunted

Question 39

of fruit and veggie servings needed

Answer 39

5 to get K+, Vitamin A, C, E

Question 40

b12 in older adults

Answer 40

absorption is less efficient
encourage b12 fortified foods

Question 41

activity reccomendations

Answer 41

150min of moderate every week
or
75 vigorous intensity weekly

Question 42

when does the benifit of ASA exceed risk and when to start, continue and stop

Answer 42

when CVD risk is high and bleeding risk is low
Start if CVD over 15%
Continue of over 10%
stop if over 5% and bleeding risk is high.