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Exam Revision > Ageing > Flashcards

Ageing Flashcards

1
Q

what is sarcopenia

A

age related loss of muscle mass + strength/function

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2
Q

criteria for sarcopenia

A

low muscle mass
low muscle strength
low physical performance

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3
Q

why might a patients body weight remain normal despite decreased muscle mass

A

‘sarcopenic obesity’

- loss of muscle mass with increased fat

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4
Q

Tx for sarcopenia

A

exercise

decrease sedentary time

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5
Q

what is the pathology behind ageing

A

random molecular damage during cell replication
reduction in bodys adaptive reserve capacity

inactivity, poor diet, inflammation increase this damage

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6
Q

4 main cellular responses to damage

A

repair
apoptosis
senescene
malignant transformation

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7
Q

what is frailty

A

loss of homeostasis + resilience
increased vulnerability to decompensation after a stressor event
increased risk of falls, delirium, disability, death

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8
Q

how is frailty scored

A

1 point for each:

  • unintentional weight loss
  • low grip strength
  • self reported exhaustion
  • low physical activity levels
  • slow walking speed
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9
Q

categories of frailty depending on score

A 
0= non frail
1-2 = pre-frail
3+ = frail
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10
Q

what is the onset of delirium

A

SUDDEN!

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11
Q

criteria for delirium

A

acute onset, fluctuating inattention + one of

  • altered level of consciousness (e.g. drowsiness)
  • disorganised thinking
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12
Q

predisposing factors to delirium

A 
increased age 
pre-existing dementia 
co-morbidity 
post operation 
depression
polypharmacy
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13
Q

what are the types of delirium

A

hypoactive
hyperactive
mixed

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14
Q

which type of delirium is most common + how does it present

A

hypoactive (50%)

acute onset fluctuating inattention, withdrawn/sleepy/ drowsy

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15
Q

presentation of hyperactive delirium

A

acute onset fluctuating inattention + agitation/aggression/wandering

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16
Q

assessment of delirium

A

4AT

CAM

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17
Q

what drug worsens delirium

A

benzodiazepines

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18
Q

tx of delirium

A

haloperidol

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19
Q

tx of delirium in Parkinson’s/Lewy body dementia

A

quetiapine 25mg

haloperidol will worsen Parkinson’s

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20
Q

what is primary open angle glaucoma

A 
chronic optic neuropathy due to increased IOP
risk factors:
- family history 
- myopia (short sighted) 
- hypertension 
- diabetes
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21
Q

symptoms of primary open angle glaucoma

A

nasal scotoma progressing to tunnel vision
decreased visual acuity
optic disc cupping (increased ratio)
optic disc pallor

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22
Q

tx primary open angle glaucoma

A

latanaprost - increases uveoscleral outflow

timolol - reduces aqueous production (avoid in asthmatics as it is a beta blocker)

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23
Q

symptoms of acute angle closure glaucoma

A 
severe eye pain - eye feels 'stony hard'
red eye 
halos around lights
pain worse in dark rooms 
decreased visual acuity 
semi dilated pupil 
N+V
24
Q

Tx acute angle closure glaucoma

A

pilocarpine - causes pupil constriction

acetezolamide - decreases aqueous secretions

25
Q

features of dry age related macular degeneration

A

drusen build up - yellow deposits
affects central vision first
distortion of straight lines

26
Q

features of wet age related macular degeneration

A

new vessels form which are fragile + leak

- sudden vision loss

27
Q

Tx wet age related macular degeneration

A

Anti- VEGF injections

Photodynamic therapy

28
Q

how does ageing affect cognition + proprioception

A

reduced reaction time

poor sensory awareness + increased postural sway

29
Q

intrinsic risk factors for falls

A 
CV- arrhythmia, heart disease
MSK- arthritis, sarcopenia
Neuro- parkinsons, stroke
Vision- decreased visual acuity 
Other- low BMI, malnourished
30
Q

what is orthostatic hypotension

A

fall in systolic BP >20 mmHg
or
fall in diastolic BP >10mmHg after 3 mins of standing

31
Q

what is BPPV

A

dizziness triggered by change in head position

32
Q

how is BPPV diagnosed

A

Hallpike manœuvre

33
Q

how is BPPV treated

A

epley manoeuvre

34
Q

drugs that can induce falls

A 
benzo's 
neuroleptics
anti-hypertensives
anti-depressants
anticholinergics
35
Q

what do acidic drugs bind to

A

albumin

36
Q

what do basic drugs bind to

A

alpha 1 acid glycoprotein

37
Q

what kind of environment do acidic drugs need

A

acidic environment

38
Q

what kind of environment do basic drugs need

A

basic environment

39
Q

what can affect the volume of distribution in the elderly

A

they have low albumin but high A-1 acidic glycoprotein

increased fat = increases the volume of distribution + half life of lipophilic drugs e.g. diazepam

decreased body water = decreased volume of distribution of hypophilic drugs e.g. lithium

40
Q

how is first mass metabolism in the elderly affected

A

it is decreased due to decreased liver function (decreased size, blood flow + presence of disease)

41
Q

how is renal metabolism in the elderly affected

A

decreased GFR

42
Q

what drugs due potassium rich foods (e.g. bananas, oranges, leafy green veg) interact with

A

ACEi
ARBS
spironolactone

43
Q

what drugs do vitamin E and F interact with

foods rich in E + F are apples, spinach, broccoli, nuts

A

warfarin

44
Q

what does grapefruit + statins cause

A

myalgia

45
Q

what foods induce cytochrome P450 system

A

grapefruit, apple, cranberry

46
Q

what vaccines can the elderly get

A

annual influenza >65 years

one off pneumococcal >65 years

one pff shingles vaccine >70 years

47
Q

exercise recommendations for >65

A

150 mins moderate or 75 mins vigorous per week

+ 2 strength exercise days per week

48
Q

symptomatic tx in palliative care for

  • pain
  • distress
  • nausea/ agitation
  • resp secretions
A

pain - morphine
distress- midazolam
nausea/agitation - levomepromazine
resp secretions - buscopan

49
Q

what is the frontal lobe responsible for

A 
personality 
emotional response
social behaviour 
throught + reasoning 
voluntary movement
50
Q

what would a lesion in frontal lobe result in

A

disinhibition
lack of initiative
antisocial behaviour

51
Q

what is dominant parietal lobe responsible for

A

language

52
Q

what is the non-dominant parietal lobe responsible for

A

spatial awareness

53
Q

what is the dominant temporal lobe responsible for

A

auditory perception
verbal memory
smell
receptive speech

54
Q

tx acute ishaemic stroke in 4.5 hours

A

thrombolysis

55
Q

what is used to assess stroke risk in AF patients

A

CHA2DS2VASc score

56
Q

management breakdown of CHA2DS2VASc score

A 
0 = no therapy 
1= aspirin 75-325 mg daily 
>2 = oral anticoagulation recommended

Exam Revision (32 decks)

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