Block 3 June

Question 1

Cytokine mediated weight loss with muscle wasting:

Answer 1

cachexia

Question 2

loss of appetite

Answer 2

anorexia

Question 3

When is the “tipping point” between living and actively dying?

Answer 3

1-2 weeks before death

Question 4

1st body part to “die”?

Answer 4

lower extremities

Question 5

2nd body system to lose function during active dying?

Answer 5

GU/GI

Question 6

3rd body system to lose function during active dying?

Answer 6

mouth and esohagus

Question 7

Why are upper extremities preserved so long?

Answer 7

easy for heart to perfuse

Question 8

Late metabolic acidosis causes which breathing pattern?

Answer 8

Kussmaul breathing

hyperpnea

Question 9

Breathing pattern associated with damage to respiratory CNS centers or metabolic encephalopathies?

Answer 9

Cheyne-Stokes respirations

“oscillatory overcompensation”

Question 10

Breathing pattern due to damage to medulla oblongata?

Answer 10

Ataxic respirations

-irregular pauses of irregular lengths

Question 11

Breathing pattern due to cerebral ischemia?

Answer 11

Agonal respiration

“fish out of water”

-grunts, groans, myoclonus

Question 12

Hear loss occurs when?

Answer 12

very late

Question 13

Time of death?

Answer 13

cardiopulmonary arrest

Question 14

Basis for dosing enteral opiates?

Answer 14

half-life

Question 15

Biggest problem with opiate equianalgesic dosing?

Answer 15

incomplete cross tolerance

Question 16

problems with methadone

Answer 16

difficult to dose (start low, go slow)

long QT syndrome (check EKG if reach 30 mg/day)

Question 17

patients never build tolerance to which opiod side effect?

Answer 17

constipation

Question 18

Pathophysiology of anorexia:

Answer 18

hypothalamus fails to respond to orexigenic signals

Question 19

Sarcopenia

Answer 19

muscle wasting

Question 20

two causes of cachexia:

Answer 20

metabolic change

reduced food intake

Question 21

can anorexia/cachexia syndrome be fully reversed?

Answer 21

no

Question 22

four primary symptoms of ACS:

Answer 22

muscle loss

anorexia

fatigue

early satiety

Question 23

fatigue and weakness

Answer 23

pre-cachexia

Question 24

fatigue and weakness

anorexia

> 5% weight loss

more likely to be clinically evident

Answer 24

cachexia

Question 25

>10% weight loss irreversible underlying condition is usually irreversible

Answer 25

Refractory cachexia

Question 26

possible rx for cachexia used as antidepressant may increase lean body mass

Answer 26

methylphenidate

Question 27

possible rx for cachexia increased appetite and pleasure from eating no change in GF/cytokines increased fat deposition

Answer 27

dronabinol

Question 28

possible rx for cachexia hypothalamic stimulation progestin analogue adipose deposition

Answer 28

megestrol acetate

Question 29

better alternative to pts with with advanced dementia than feeding tube:

Answer 29

oral assisted feeding

Question 30

Meds that are dangerous in old people?

Answer 30

Beers list

Question 31

Preferred rx for dementia/delirium?

Answer 31

antipsychotics * try to avoid benzos - like getting the person drunk-->unknown effect

Question 32

Does oxygen treat dyspnea or air hunger?

Answer 32

no O2 treats sats but not patient's feeling

Question 33

3 treatments for mucus management in SOB?

Answer 33

hydration saline nebs guaifenesin

Question 34

what to avoid in treating SOB?

Answer 34

essential oils

Question 35

meds for SOB?

Answer 35

opiates treat anxiety inhalers disease modifiers

Question 36

full body edema

Answer 36

anasarca

Question 37

an unstable or crucial time or sate of affairs whose outcome will make a decisive difference for better or worse:

Answer 37

crisis

Question 38

four stories told by people relating to coping with terminal/life threatening illness:

Answer 38

1. signature stories 2. public/private -- surface/deep 3. secret 4. untold

Question 39

what you see is not always obvious....

Answer 39

Iceberg theory

Question 40

How people define their family:

Answer 40

Family mobiles

Question 41

three phases associated with life threatening illness:

Answer 41

1. period of impact 2. the battle 3. period of defeat -- looking to the future?

Question 42

four types of losses and their impact:

Answer 42

1. loss of possesions 2. loss of self 3. developmental loss 4. loss of significant others