Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Semester 4 > AGE > Flashcards

AGE Flashcards

1
Q

4 types of dementia

A

1) alzhiemers
2) vascular
3) with lewy bodies
4) frontotemporal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

ADME changes with increasing age

A

absorption

  • decrease in gastric secretions–> alkaline–> decreased absorption as most drugs are WA
  • decreased gastric motility
  • decreased gastric BF

distribution

  • low body water
  • low lean body mass
  • increase in fat

reduced vol of distribution of hydrophilic drugs but inc. conc for set volume in elderly (low water)
increased for lipophilic

metabolism

  • low liver mass
  • low hepatic BF
  • dec. enzyme activity (eg, P450)

elimination
-low renal bf–> low GFR
-low kidney mass/function for excretion
increase half-life of drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

7As of alziehmers clinical presentation

A 
anosognosia
aphasia
ataxia
amnesia
apraxia
agnosia
apathy
altered perception
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

pathophysiology main features of Alzheimers dementia

A
  • amyloid beta plaques (from improper cleavage of amyloid precursor protein) - toxic to nerves
  • neurofibillary tangles (hyperphosphorylated Tau protein) - axonal damage
  • vascular pathology–> inflammation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

difference between Parkinsons and DWL

A

PDD = symptoms before 12 months / more motor symptoms

DWL = within 12 months of having / cognitive symptoms before motor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

types of vascular dementia

A

small vessel

  • occlusion of single deep perforating artery
  • white matter

large vessel

  • one infarct
  • grey matter
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

2 language subtypes of frontal temporal dementia

A

semantic - fluent talking but forgetting words

progressive non-fluent aphasia - slow, hesitant speech

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what can alcoholism cause

A

frontal damage/change
thiamine (vit. B1) deficiency

wernicke’s encephaly (reversible/manageable)

  • ataxia
  • impaired consciousness
  • ophthalmoplegia

korsakoff’s (irreversible)

  • anterograde/retrograde amnesia
  • good attention
  • confabulates a lot
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

strehler’s concept for true ageing process (helps differentiate disease vs age)

A

universal - changes present in every species
(disease = individual)

intrinsic - changes not due to exogenous source
(disease = intrinsic/extrinsic)

progressive - changes occur progressively over time - one direction
(disease = progressive but can be halted/reversed)

deleterious - should eventually be harmful to organism
(disease = can be cured/halted)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

difference between primary and secondary prevention

A 
primary = preventing developing a disease
secondary = preventing progression of disease via early treatment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

syncope

A

loss of consciousness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

age related changes resulting in fall

A

NEURO

  • brain atrophy–> loss of neurones–> less synaptic transmission–> slower processing speed
  • loss of proprioceptive activity –> loss of tone

VESTIBULAR

  • balance impairment
  • bradykinesia (slow)

SENSORY impairment

SARCOPENIA

GAIT CHANGE
-decreased stride length/speed/hip flexion + extension

VISUAL

  • lower acuity
  • decreased reaction to light changes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is poly pharmacy

A

taking more than 4/5 drugs regularly

appropriate poly pharmacy = EACH drug is required/necessary

can lead to prescribing cascade

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what do you see with Dementia with lewy bodies

A

neuronal inclusions (lewy neutriles, amyloid plaques)
phosphorylated neurofilaments
ubiquinated alpha-synuclein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

drug treatment for dementia

A

AchE inhibitors = rivastigmine(patch)/donepezil(oral)

NMDA receptor antagonist = memantine

avoid antipsychotics (they block DA receptors)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

geriatric giants (5)

A
  1. immobility
  2. instability (Causes =DAME)
  3. intellectual impairment
  4. incontinence (reversible causes= diapers)
  5. iatrogenic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

risk factors of delirium

A

hip fracture
>65yrs
dementia
severe illness

18
Q

brain mainly affected with the 4 different dementias

A

alzheimers = frontal/parietal (hippocampus)

vascular =

LWD = brainstem / paralimbic/neocortical

fronto temporal = frontal/temporal

19
Q

criteria for true ageing process (s

A

Strehler’s concepts

  • universal
  • intrinsic (photo-ageing is not true ageing)
  • progressive (happens over time)
  • deleterious
20
Q

most common cause for falls

A

Incorrect shifting of bodyweight

21
Q

presbycusis

A

hearing loss

22
Q

fragility fractures

A

fractures that occur as a result of normal activities e.g. a fall from standing height.

colles fracture = a type of fragility fracture - putting their hands out as they fall

23
Q

2 types of management with hip fractures

A

conservative - don’t operate (almost 100% mortality)

operative - perform surgery on the hip, the exact type of surgery depends on the type of fracture and the patient’s pre-morbid state

24
Q

hip surgical options for intracapsular fractures (no blood flow)

A

hemiarthroplasty -(half hip replacement) replace the head of femur

total hip replacement - if patient is young

cannulated screws - using your own bone is better than putting in the prosthesis

25
Q

hip surgical options for extra capsular fractures (blood flow maintained)

A

trochanteric
- dynamic hip screw (screws slides down on itself as fracture heals)

subtrochanteric (less common)
-intradmedullary nail - form head of femur and pinned at the knee

26
Q

ADME of older people

A

absorption

  • higher pH
  • decreased gastric motility/BF

distribution

  • decreased water/lean body mass(muscle) –> high conc of drug when drank but low hydrophilic distribution
  • increased body fat
  • less albumin (proteins in blood due to nutrition) –> more free drugs in blood

metabolism

  • atrophy liver
  • increased half life

excretion
-poor liver/kidney function

27
Q

aims of using the STOPP/START on patients

A

Improve the appropriateness of their medication

Prevent them suffering ADRs due to their drug regime

Reduce the drug costs

28
Q

Factors affecting compliance

A

cognitive impairment

  • not understanding why they are taking it
  • forgetting

manual dexterity

  • immobile
  • cant open

visual impairment
-cant see

unpleasant side effects

29
Q

rules for rational prescribing for elderly people

A

Avoid prescribing prior to diagnosis

Start with a low dose and titrate slowly

Avoid starting 2 agents at the same time

Reach therapeutic dose before switching or adding agents

Consider non-pharmacologic agent

regular review and discussions

Consider different formulations

30
Q

what memory is preserved in elderly

A

semantic and primary memory

31
Q

difference between delirium and dementia

A 
delirium = fluctuating 
dementia = progressive
delirium = acute onset  hrs to days
dementia = months to yrs

attention/consciousness is altered in delirium (not in dementia)

delirium = hopefully irreversible
dementia = irreversible

psychomotor is altered in delirium - not in dementia

32
Q

how do we diagnose osteoporosis/ osteopenia

A

do a DEXA scan/ measure BMD

T score = number of SDs from mean expected adult (0=normal)
Z score = age matched

osteopenia = t score between -1 and -2.5

osteoporosis = > -2.5

33
Q

treatment for osteoporosis

A

first: ensure diet includes calcium/vit D
- HRT (but bad long term usage)
- bisphosphonates (inhibit osteoclasts) eg. risedronate/alendronate
- PTH analogues
- Denosumab - antibody against RANK ligand thus preventing osteoclast differentiation

34
Q

difference between osteoporosis and osteomalacia

A

osteoporosis = reduced bone mass–> brittle bones

osteomalacia = reduced bone mineralisation–> soft bones

35
Q

why do we age theories

A

wear + tear

evolutionary

non-evolutionary

  • antagonistic pleiotropic gene
  • mutation accumulation (due to a collection of late acting deleterious genes that were passed on because as you age the powers of natural selection decline)
  • disposable soma theory
36
Q

how do we age theories

A

neuroendocrine

cellular/molecular

  • wear and tear
  • HSP
  • cross-linkages (altering function)
  • hayflick (+fibrobalsts of young people vs older)

Genetic

  • telomeres (length eventually shorten)
  • Geronto-genes and longevity assurance genes

genomic stability

  • error catrostrophe (accumulation)
  • Somatic mutation and DNA repair (repair ability declines–> accumulation)
  • free radicals (protection reduces)
  • mitochochondrial

cell senescence
normal pre-senescent cell—–insults over time–> senescent cell (Stops dividing + resistant to apoptosis)–> accumulation

37
Q

what kind of hypertension is common in elderly

A

isolated systolic HT

high systolic BP but low diastolic BP

38
Q

changes in arteries of elderly

A
  • stiffen (loss of elastin/ increased collagen/calcification)
  • reduced compliance (due to stiffening)
  • reduced NO production–> constrcited–> increased atheroma risk
  • raised systolic also contributes to stiffening wall
39
Q

resp changes in elderly

A
  • reduced SA (alveoli = thinner/more dilated/reduced elastic recoil)
  • V/Q mismatch
  • but no change to CO2 excretion (if there is = pathological cause not ageing)

-no change to total lung capacity
but decrease in FEV/FVC
higher residual volume

40
Q

diagnosis of frailty

A

phenotype model : testing present/absent

  • slow walking speed
  • self report exhaustion
  • reduced muscle strength
  • sedentary behaviour
  • unintentional weight loss

cumulative deficit model

  • 32 baseline variables
  • more individuals have wrong with them, the more they are likely to be frail
  • allows frailty to be gradable
41
Q

comprehensive geriatric assessment (CGA)

A

process of good, holistic care delivered within a geriatric medicine focused MDT, which goes above and beyond simply managing the acute problem the person has presented with(looking at whole picture)
provides patient centred care for frail older people

looks at 
PHYSICAL
FUNCTIONAL
PSYCHOLOGICAL
SOCIOECONOMIC/ENVIRONMENTAL

Semester 4 (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions