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Ageing Flashcards

1
Q

what is sarcopenia?

A

loss of muscle mass and function as a result of ageing

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2
Q

why can silent MIs occur in older people?

A

may have some degree of autonomic nervous system dysfunction

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3
Q

why do old people suffer from hypothermia more often than younger people during illness?

A

because old people suffer more from gram negative bacteria- can cause hypothermia

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4
Q

what are the 5 broad spectrum antibiotics with a high C. diff risk?

A
  • cephlasporins
  • co-amoxiclav
  • ciprofloxacin
  • clindamycin
  • clarithromycin
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5
Q

what is the SEPSIS 6 protocol?

A 
GIVE
-oxygen
-antibiotics
-fluids
TAKE
-bloods for culture
-bloods to measure lactate
-measure urine output
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6
Q

where are telomeres found?

A

the end of each chromosome arm

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7
Q

what happens to telomeres with each cell replication?

A

progressively shorten

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8
Q

what happens when a telomere becomes too short to sustain cell replication?

A

cell senescence

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9
Q

what is a hayflick number?

A

a number which represents the maximum number of times a cell can divide (ie before telomeres become too short)

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10
Q

why can stem cell undertake continuous replication?

A

they contain telomerase which re-extends shortened telomeres

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11
Q

what are the 4 main cellular responses to damage?

A
  • repair
  • apoptosis
  • senescence
  • malignant transformation
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12
Q

at what age does muscle mass start to decline?

A

around 30 years old

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13
Q

what is sarcopenic obesity?

A

when sarcopenic wasting of muscles is combined with an infiltration of fat into the muscle

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14
Q

compare primary and secondary sarcopenia?

A

primary: sarcopenia is solely related to age
secondary: sarcopenia is due to contibuting factors in addition to age

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15
Q

what metabolic condition can arise as a consequence of sarcopenia?

A

insulin resistance and diabetes

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16
Q

what is the only proven intervention for sarcopenia?

A

exercise

  • resistance training
  • aerobic training
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17
Q

what is the suggested physical activity levels for people over 65?

A

same as target for 18-64

150 minutes of moderate intensity activity a week
or 75 minutes vigorous activity a week

strength and balance work twice a week

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18
Q

how does a syringe driver administer medicines?

A

continuous subcutaneous infusion

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19
Q

what is the access for a syringe driver?

A

butterfly needle with connector tubing

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20
Q

how many medicines can be mixed in a syringe driver?

A

up to 3

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21
Q

what is a stroke?

A

rapidly developing symptoms or signs of focal or global loss of brain function lasting longer than 24 hours with a vascular cause

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22
Q

compare a transient ischaemic attack to a stroke?

A

symptoms last less than 24 hours

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23
Q

what are the 3 types of stroke?

A
  • haemorrhage
  • subarachnoid haemorrhage
  • infarct
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24
Q

what are the 4 classification of an infarct stroke?

A
  • cardioembolic
  • atheroembolic
  • small vessel disease
  • other
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25
Q

compare cardioembolic and atherembolic strokes?

A

cardioembolic: fibrin dependent- red thrombus
atheroembolic: platelet dependent- white thrombus

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26
Q

what is the frontal lobe responsible for?

A

personality
emotional response
social behaviour

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27
Q

what is the dominant parietal lobe responsible for?

A

calculations
language
planned movement
appreciation of size, shape, weight and texture

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28
Q

what is the non-dominant parietal lobe responsible for?

A

spatial orientation

constructional skills

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29
Q

what is the occipital lobe responsible for?

A

analysis of vision

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30
Q

what is the dominant temporal lobe responsible for?

A

auditory perception
speech and language
verbal memory
smell

31
Q

what is the non-dominant temporal lobe responsible for?

A

auditory perception
music
non-verbal memory
smell

32
Q

what investigations will reveal the presence of a stroke? (infarct/haemorrhage)

A

CT scan

MRI scan

33
Q

what is the acute management of a stroke?

A 
thrombolysis/thrombectomy
imaging
swallow assessment
antiplatelets
stroke unit care
34
Q

what is the time limit for IV alteplase/tissue plasminogen activator (tPA)?

A

within 4.5 hours from onset of symptoms

35
Q

when is endovascular therapy used for the treatment of strokes?

A
  • alternative/additional therapy for patients who respond poorly to thrombolysis
  • if patient cannot have thrombolysis due to very high bleeding risk
36
Q

what class of drugs are used as secondary prevention for a cardioembolic stroke?

A

anticoagulants

37
Q

what class of drugs are used as secondary prevention for ischaemic, non-cardioembolic strokes?

A

antiplatelets (first line clopidogrel)

38
Q

what scoring system calculates the risk of strokes in a patient with AF?

A

CHA2-DS2-VASC score

39
Q

at what CHA2-DS2-VASC score is antithrombotic therapy recommended?

A

1- oral anticoagulant or aspirin

2 or more (or 1 major)- oral anticoagulant

40
Q

what is the 1 month, 6 month, 1 year mortality rate after a hip fracutre?

A

1 month- 10%
6 months- 20%
1 year- 30%

41
Q

what is the most common valvular heart disease?

A

aortic stenosis

42
Q

why can aortic stenosis lead to falls?

A

reduced cardiac output, reduced brain perfusion leading to syncope

43
Q

compare the falls assessment tools ‘Berg Balance Test’ and ‘Tinetti Score’?

A

berg balance test only assesses balance, tinetti score also assesses gait

44
Q

when the timed up and go test (TUG) is longer than what time does the falls risk increase?

A

20s

45
Q

what is the evidence based treatment for falls?

A

-strength and balance training
(minimum three times per week for 12 weeks)
-environmental modifications
-medication review
-calciuim/vit D supplements if vit D deficient

46
Q

what BP measurements should you take in a patient presenting with falls?

A

lying and standing BP

47
Q

what is delirium?

A

acute change in cognition and attentitivity which tends to fluctuate

48
Q

what is the time period of the cognition change in delirium?

A

hours to days

49
Q

compare the onset of dementia, delirium and depression?

A

dementia- slow, insidious
delirium- sudden
depression- abrupt with life changes

50
Q

compare the course and reversibility of dementia, delirium and depression?

A

dementia- progressive, irreversible
delirium- fluctuating, usually reversible
depression- worse morning, reversible with treatment

51
Q

what are the types of delirium?

A

hyperactive delirium
hypoactive delirium
mixed type

52
Q

what are 10 predisposing factors to delirium?

A
  • age
  • pre-existing dementia
  • co-morbidities
  • post-op
  • terminal illness
  • sensory impairment
  • polypharmacy
  • depression
  • alcohol dependency
  • malnutrition
53
Q

what are the 2 subtypes of dementia?

A
  • Alzheimers

- vascular

54
Q

what are the 4 main hallmarks of delirium?

A

acute and fluctuating
inattention
altered level of consciousness
disorganised thinking

55
Q

what does the 4AT tool for delirium assess?

A
  • alertness
  • AMT4 (simple questions)
  • attention
  • acute change/fluctuating course
56
Q

if medication is needed in delirium, what is first line?

A

haloperidol

57
Q

when is haloperidol contraindicated in delirium?

A

alcohol withdrawal

parkinsons disease

58
Q

if medication is needed in a patient with parkinsons with delirium, what is first line?

A

quetiapine

59
Q

if medication is needed in a alcohol withdrawn patient with delirium, what is first line?

A

benzodiazepines (lorazepam)

60
Q

why must you be careful when using lorazepam for delirium?

A

once it wears off the patient can become paradoxically more agitated

61
Q

with AAA screening, at what size of aneurysm is the patient sent for op assessment?

A

greater than 5.4cm

62
Q

who is eligible for AAA screening?

A

all men over 65 years old

63
Q

who is eligible for bowel screening?

A

between 50 and 74 years old

after 75 you can still be screened if you would like to be

64
Q

who is eligible for breast screening?

A

women aged 50 -70

after 60 you can still be screened if you would like to be

65
Q

at what age are you eligible for the annual flu vaccine?

A

65 and over

66
Q

at what age are you eligible for the one off pneumococcal vaccine?

A

65 and over

67
Q

at what age are you eligible for the one off shingles vaccine?

A

70 years old

plus catch up cohorts

68
Q

what type of environment do acidic drugs require for absorption?

A

acidic environment

pH less than 7.35

69
Q

what type of environment do alkaline drugs require for absorption?

A

basic environment

pH more than 7.35

70
Q

what is the main carrier of basic drugs?

A

alpha-1-acid glycoprotein

aka orosomucoid ORM

71
Q

what is the main carrier of acidic drugs?

A

albumin

72
Q

how do you calculate the therapeutic index?

A

lethal dose 50 / effective dose 50

73
Q

as age increases what happens to the therapeutic window of most drugs?

A

becomes smaller

Ageing (1 decks)

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