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DT4 Exam 3 > Clinical > Flashcards

Clinical Flashcards

1
Q

can cause liver toxicity

A

herbal therapies

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2
Q

interacts with grapefruit juice

A

simvastatin, pravastatin, atorvastatin

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3
Q

raises blood pressure

A

licorice

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4
Q

thyroid medication administration

A

empty stomach 30 min before eating and other meds or 2 hrs after a meal

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5
Q

administration bisphosphonates

A

empty stomach 1 hr before eating and other meds, cannot lie down

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6
Q

functional changes in elderly that impact medications

A 
GFR declines 35-50%
body fat increases
serum albumin decreases
hepatic blood decreases
less stomach acid-hard to absorb iron and Ca
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7
Q

problems with anticholinergics

A

memory loss and confusion

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8
Q

problems with NSAIDS

A

GI bleeding without warning

give PPI with it (but can cause renal insufficiency)

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9
Q

problems with benzodiazepines

A

confusion and falls, diazepam can have prolonged half life due to fat soluble

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10
Q

Beers list

A

potentially inappropriate medications for the elderly

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11
Q

new recommendations

A

nitrofurantoin until GFR>30
dont use benzos-can use trazodone
avoid PPI greater than 8 weeks, use H2 blockers

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12
Q

reduce dose for GFR

A

gabapentin/pregabalin
H2 blockers-rantidine, famotidine
endoxaban/rivaroxaban
avoid NSAIDs if low GFR

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13
Q

life expectancy

A

Hispanic women longest

Black men shortest

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14
Q

homeostenosis

A

decreased reserve with aging

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15
Q

body composition changes with aging

A

loss of lean body mass
decrease in skeletal muscle mass
decrease in bone mass
increase in total body adipose tissue-more fat, accumulates in muscles and organs

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16
Q

implications change in body composition changes with aging

A

increase in half life of lipophilic drugs

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17
Q

temperature change in elderly

A

risk increased for hyper and hypothermia

does not mount fever to infection

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18
Q

body fluid regulation in elderly

A

total body water decreased

thirst sensation diminished

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19
Q

blood pressure regulation in elderly

A

higher BPs or orthostatic hypotension

>150/90 acceptable (not HTN)

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20
Q

changes in senses in elderly

A

dark adaptation decreases
near vision declines
high frequency hearing declines
sense of smell declines

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21
Q

cardiovascular changes in elderly

A 
increase wall thickness
decreased elastin
both systolic and diastolic BP increase
adipose infiltrates SA node
calcification-aortic sclerosis
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22
Q

beta adrenergic stimulation in elderly

A

basal and stress levels of epi and NE are higher

tissue response is diminished

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23
Q

neurological system in elderly

A 
encoding slower
storage and retrieval slower
decreased multi task
reduction in number and size of spinal cord motor neurons 
decrease nerve terminals and NT release
neuropathy
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24
Q

respiratory changes in elderly

A

decreased elasticity
decreased FEV1
decreased O2 sat

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25
Q

GI changes in elderly

A

presbyesophagus

hepatic metabolic function may decline

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26
Q

renal changes in elderly

A

steady decline in most

implications in drug metabolism

27
Q

immune changes in elderly

A

thymic involution-less naive lymphocytes
decreased T cell proliferation
decrease in some cytokines
decreased Ab response to vaccines

28
Q

skeletal changes in elderly

A

loss of cortical thickness
increase in porosity
thinning of trabeculae, loss of trabecular connections

29
Q

shorter elderly

A

war of discs

pathologic-from arthritis or osteoporosis

30
Q

changes in reproductive system

A

vaginal dryness

BPH (avoid alpha agonist decongestants)

31
Q

pain in elderly

A

blunting sensation may minimize complaints

32
Q

HA in elderly

A

uncommon as new complaint

could be from temporal arteritis, trigeminal neuralgia, herpes zoster, subdural hematoma, metastatic disease

33
Q

chest pain in elderly

A

pain causing MSK disorders more common in elderly

Zoster as pain before rash

34
Q

abdominal pain in elderly

A

more life threatening

more serious

35
Q

pneumonia in elderly

A

can present as change in mental status or delirium

36
Q

weakness and fatigue in elderly

A

apathetic hyperthyroidism

takes longer to recover from immobility

37
Q

anorexia and weight loss in elderly

A 
malignancy and inflammatory disorders 
CHF or COPD
drug SE
memory loss
depression
hyperthyroidism
38
Q

strategies for demented patient

A 
get attention
speak calmly 
use yes or no
repeat and rephrase
do not argue
39
Q

congenital adrenal hyperplasia

A

impaired cortisol synthesis

AR

40
Q

classic CAH

A

salt wasting 75%-hypovolemic shock, hyperkalemia
high risk of adrenal insufficiency
precocious puberty
short stature

41
Q

nonclassic CAH

A

no genital ambiguity
onset in adolescence
angregen excess-oligomenorrhea, hirsutism, acne

42
Q

genetics of 21 hydroxylase locus

A

HLA linkage
6p21.3
point mutations-salt wasting CAH

43
Q

effective treatment CAH

A

glucocorticoid and mineralocorticoid treatment

44
Q

prenatal diagnosis and treatment

A 
dexamethasone at risk
chorionic villus sampling at 8-10 weeks
-karyotype, DNA analysis (RFLP, PCR)
amniocentesis at 16 weeks
-karyotype, DNA analysis, HLA typing, amniotic fluid for 17Oh progesterone
45
Q

male treatment

A

stop dexamethasone

46
Q

unaffected females

A

stop dexamethasone

47
Q

affected females

A

continue dexamethasone

48
Q

MEN I

A

parathyroid neoplasia
pituitary neoplasia
pancreatic islet neoplasia
AD

49
Q

MEN II

A

thyrocalcitonin (medullary carcinoma)
pheochromocytoma
parathyroid neoplasia
AD

50
Q

MEN IIa

A

medullary thyroid carcinoma
pheochormocytoma
parathyroid neoplasia

51
Q

MEN IIa variants

A

familial medullary thyroid carcinoma
MEN 2a with cutaneous lichen amyloidosis
MEN 2a with Hirschsprung disease

52
Q

MEN IIb

A

medullary thyroid carcinoma
pheochromocytoma

marfinoid habitus, intestinal ganlioneuromatosis and mucosal neuromas

53
Q

medullary thyroid carcinoma

A

neoplasm of follicular cells
secretes cacitonin, CEA
hyperpalsia to nodular to micro carcinoma to macro carcinoma
most common in MEN 2B
death-airway obstruction, liver and lung mets

54
Q

RET proto-oncogene

A

tyrosine kinase receptor
knocks out-GI, kidney, sympathetic nervous system
interacts with glial cell-derived neutrophic factor

55
Q

MEN 2a screening

A

pentagastrin stimulated calcitonin and 24 h urine metanephrines yearly
calcium biyearly

56
Q

familial medullary throid carcinoma

A

no RET mutation

annual calcitonin and neck US

57
Q

steps involved in work up of genetic patient

A 
history
examination
testing
establishment of diagnosis
counseling
58
Q

family history

A

pedigree-3 generations
include miscarriages
ask about consanguinity
inquire about ethnic origins

59
Q

testing for chromosomes

A

routine
high resolution
microdeletion FISH
microarray CGH

60
Q

molecular/DNA testing

A

disease specific testing

whole geneome/exome sequencing

61
Q

metabolic studies

A

amino acids

organic acids

62
Q

microdeletion syndromes

A 
Williams
Langer-Giedion
WAGR
Prader-Willi
Angelman
Smith Magines
Miller Dieker
Retinoblastoma
DiGeorge
VeloCardioFacial
63
Q

Ashkenazi Jew disorders

A 
Tay Sachs
Canavan
familial dysautonomia
Fanconi anemia C
NP type A
Bloom syndrome
mucolipidosis IV
Gaucher
CF

DT4 Exam 3 (5 decks)

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