Aging Physiology - Test 3

Question 1

Describe three major changes seen in the cardiovascular system in old age.

Answer 1

1. Stiff arteries -> increased systolic blood pressure, decreased diastolic blood pressure (higher pulse pressure), and increased afterload
2. Left ventricular hypertrophy (from increased afterload and collagen deposition) –> 3. Impaired filling (can lead to dyspnea!) leads to atrial hypertrophy -> a-fib

Question 2

Explain why max heart rate decreases with age.

Answer 2

There is decreased beta-1 responsiveness

Question 3

Is there reduced nitric oxide activity in old age? What is the consequence of this?

Answer 3

Yeah - less vasodilation (endothelial dysfunction)

Question 4

Is it normal for a brain to lose some volume over time?

Answer 4

Yeah

Question 5

Is a mild loss of cognition normal in old age?

Answer 5

Yeah

Question 6

Describe the changes to total lung capacity, residual volume, vital capacity, FEV1, and diffusion capacity that occur with old age.

Answer 6

TLC stays the same because the decreased compliance from kyphosis negates the decreased elastic recoil

Residual volume increases with age due to decreased elastic recoil

Vital capacity decreases due to reduced diaphragm strength and increased RV

FEV1 decreases because the diameter of small airways decreases

Diffusion capacity declines by 5%/decade after age 40

Question 7

What is the medical term for the loss of muscle mass, often seen in old age?

Answer 7

Sarcopenia

Question 8

What happens to TSH and thyroid hormone levels as we age?

Answer 8

They all drop

Question 9

What happens to glucose tolerance as we age?

Answer 9

It drops due to fewer beta cells -> less insulin

Question 10

What happens to renin and aldosterone levels as we age?

Answer 10

Drop

Question 11

What happens to GHRH, GH, and IGF-1 levels as we age?

Answer 11

Drop

Question 12

What normal physiologic change of aging predisposes old people to becoming hyponatremic?

Answer 12

Increased vasopressin/ADH secretion

Question 13

Decreased ________ increases old people’s risk of dental caries, makes it harder to swallow, and makes food taste shitty.

Answer 13

salivation

Question 14

Why are older people more susceptible to developing GERD?

Answer 14

Decreased tone of the esophageal sphincter

Question 15

You see a 83 year old female with RA that is brought in by folks from the skilled nursing facility with an acute onset of ataxia and confusion (oriented to person but not time and place). She has diminished proprioception on exam. Blood smear shows hypersegmented neutrophils. Describe the pathophysiology of this woman’s condition.

Answer 15

She took NSAIDs to manage her RA –> gastritis –> damage to parietal cells –> no intrinsic factor –> no B12 absorption in the distal ileum (pernicious anemia) –> B12 deficiency anemia and neurologic sequelae

Question 16

A 77 year old male presents to the ED with delirium. After some IV fluids, he calms down and you take a history. He states that he has had LLQ pain and tenderness and felt like he may have had a mild fever one day ago. CT scan shows pericolonic thickening of the sigmoid colon. Describe why older people are susceptible to this condition.

Answer 16

Messed up rhythmic contractions of the colonic mucosa –> constipation –> risk of diverticulosis and diverticulitis

Question 17

Describe each type of incontinence:

Stress

Urge

Overflow

Functional

Mixed

Answer 17

Stress incontinence is when you piss a little while sneezing or lifting an object or something - due to decreased strength of pelvic floor muscles

Urge incontinence is when you piss a little because you suddenly had to piss super bad - due to detrusor muscle spasms

Overflow incontinence is when you’re a leaker - due to something like BPH where there is post-void residual, or fucked up detrusor muscle contraction

Functional incontinence is due to factors that don’t include the GU system (eg. immobility –> can’t get to bathroom in time)

Mixed is a mix of stress + urge incontinence

Question 18

What happens to your senses with age?

Answer 18

They start to suck