Final Flashcards
1
Q
By 2030, it is estimated that __% or #__ Americans will be older than 65.
A
22%
70.2 million
2
Q
The average life expectancy for women in the US is ___.
A
79.5
3
Q
The average life expectancy for men in the US is ___.
A
72.7
4
Q
What are 5 theories of aging?
A
Cellular "supply limits" theory Free radical damage theory Autoimmune theory Programmable cell death theory Telomere length theory
5
Q
What mutation is in 50% of all cancers?
A
p53 gene
6
Q
The process of cell division has what effect on telomere length?
A
Shortens it
7
Q
What role does telomeres have in the life of a cell?
A
After a certain number of divisions, the telomeres become too short to participate in chromosome duplication -> cell death
8
Q
Can you artificially increase the length of telomeres?
A
Yes, but results are disappointing
9
Q
What is an activity that can increase telomere length?
A
Meditation
10
Q
In which cells is telomerase expressed?
A
Certain adult stem cells, precursor cells to sperm, activated WBCs
11
Q
Greater telomerase activity is associated with ___
A
more rapid accumulation of coronary artery plaque
12
Q
What is the relationship between PPIs and NSAIDs?
A
PPIs are protective against ulcer formation d/t NSAIDs
13
Q
What is the relationship between H2 inhibitors and NSAIDs?
A
H2 inhibitors speed up ulcer formation and gastritis d/t NSAID use
14
Q
SSRI use is associated with what deficiencies?
A
B-vitamins, B6, B12, Folic acid,
15
Q
PPI and H2 blocker use is associated with what deficiencies?
A
B12, Ca, Fe, Mg
Any nutrient that depends upon acidic environment
16
Q
Metformin use is associated with what deficiencies?
A
B12
17
Q
Statin use is associated with what deficiencies?
A
CoQ10
18
Q
BCP use is associated with what deficiencies?
A
B5, B6, B12
19
Q
Seizure medication use is associated with what deficiencies?
A
Folic acid
20
Q
Population: Kyphosis
A
F>M, older age
21
Q
Anatomical changes: Kyphosis
A
Slight knee/hip flexion -> shortened stature
22
Q
What is a major cause of peripheral vision loss?
A
Glaucoma
23
Q
What are two major causes of central vision loss?
A
Cataracts, macular degeneration
24
Q
What type of glaucoma is more common outside of the United States, especially in Asian countries?
A
Closed-angle glaucoma
25
SSx: Acute angle closure glaucoma
Sudden ocular pain and decreased vision, red eye, N/V, fixed/mid-dilated pupil, seeing halos around lights
26
Acute angle closure is ___
an ocular emergency
27
What is the MC type of glaucoma in the United States?
Open-angle glaucoma
28
SSx: Open-angle glaucoma
Gradual visual field loss, increased cup-disc ratio, painless, no acute attacks
29
Pop: Open-angle glaucoma
Uncommon <40
~1% aged 40-65
5% >65
30
What nutrient deficiency is related to diminished taste?
Zn
31
How should you talk to a patient with difficulty hearing?
Low-pitched voice
32
Exostoses
Formation of new bone on bone surface
33
MC type of arthritis
Osteoarthritis
34
PARQ: Alpha agonist
Sit up slowly so BP can adjust for the first 6 weeks
35
Why are beta blockers contraindicated in elderly patients with diabetes?
Blunts hypoglycemic response
36
In addition to diabetes, what other condition is contraindicated for beta blocker use in the elderly?
COPD
37
In most instances, what should be the initial antihypertensive therapy in the elderly?
Low-dose diuretic
38
What is a first-line option in elderly patients who present with isolated systolic hypertension?
CCB
39
Innervation: Detrusor muscle
S2-S4
40
Parasympathetic innervation of the detrusor muscle causes ___.
Bladder contraction, evacuation of urine
41
Comorbidity: incontinence
Pressure sores, social isolation, depression, UTI, falls
42
What is the MC reason for acute urinary incontinence?
Bladder infection
43
What are the 4 main causes of acute urinary incontinence?
Delirium
Restricted mobility
Infx, inflammation, impaction
Pharmaceuticals
44
What is the MC cause drug-induced incontinence?
Diuretics
45
Acute onset of incontinence in a pt with ___ is a medical emergency.
known or suspected malignancy
46
Triad of acute urinary incontinence, acute/subacute dementia, wide-based gait indicates ___.
Normal pressure hydrocephalus
47
What is the MC form of chronic incontinence in the geriatric population?
Urge incontinence
48
Urge incontinence is AKA ___
"spastic" or "overactive" bladder
49
Stress incontinence triggers
coughing, sneezing, laughing, bending over
50
What conditions can be associated with urge incontinence?
Parkinson's disease, Alzheimer's disease, stroke, surgery, MS, irritation to bladder wall
51
What conditions are associated with overflow incontinence?
Diabetic neuropathy, spinal cord injury
52
PE: Overflow incontinence
Absence of anal reflex and "saddle" sensation
53
Overflow incontinence is AKA ___.
Neurogenic or atonic bladder
54
What conditions are associated with functional incontinence?
Confusion, dementia, poor eyesight, poor mobility
55
Initial work-up in all cases of incontinence
UA -> culture/sensitivity
56
What treatment is a valid option for all types of incontinence?
Kegel exercises
57
Work-up: Hematuria
UA
Scope
Cytology
S-sonogram (KUB)
58
Tx: Stress incontinence related to vaginal atrophy
Topical estrogen
59
What drug class is commonly used in urge incontinence?
Anticholinergic
60
Anticholinergic medications are contraindicated with which comorbidity?
Acute angle glaucoma
61
What is the MC cause of injury-related morbidity in the elderly?
Falls
62
__% of all fall-related deaths occur in the elderly.
70%
63
What conditions can contribute to falls?
BP fluctuations, orthostatic hypotension, post-prandial hypotension
64
What receptors tend to degenerate with age, contributing to falls?
Cervical mechanoreceptors
65
PE: Elderly pt at high-risk for falls
Loss of LE proprioception, diminished ankle reflexes
66
The risk of falling increases with ___.
increased chronic disability
67
There are approximately ___ vertebral fractures every year.
700,000
68
Primary vs. Secondary osteoporosis
Primary - d/t aging
| Secondary - d/t other conditions
69
Risk factors: osteoporosis
FHx, hyperthyroidism, excess supplemental thyroid, Cushing's disease, Hyperparathyroidism, Glucocorticoid use, prolonged immobilization
70
Increased luceny may not be present on X-rays in osteoporosis until ___
30-40% of bone mass has been lost
71
T-score
STD DEV score for healthy 30 year old adult
72
Z-score
STD DEV score for matched peer (age, sex, race)
73
Normal T-score
> -1
74
Osteopenia: T-score
-1 to -2.5
75
Osteoporosis: T-score
< -2.5
76
NTX is measured in ___
urine, blood
77
CTC is measured in ___
blood
78
Elevated NTX correlates with __
diminished bone density
79
What is a FRAX score used for?
10-year probability of bone fracture risk at hip/spine/shoulder/extremity
80
How is FRAX score calculated?
BMD at femoral neck + clinical risk factors
81
How common is osteoporosis in post-menopausal women?
1 in 4
82
Why do men appear to show a diminished response to medications for osteoporosis?
Usually do not get treatment until advanced stage
83
Lifestyle recommendations: Osteoporosis
Weight-bearing exercise, quit smoking
84
What forms of calcium may be better absorbed in patients with diminished levels of stomach acid?
Calcium citrate/lactate/gluconate
85
Is vitamin D protective against osteoporosis?
Only in combination with calcium
86
What other nutrient, when given with vitamin D and calcium, may be protective against bone loss?
Mg
87
When supplementing with vitamin K, keep patients on ___ until K wears off.
Heparin
88
S/E of bisphosphonates
Esophagitis, Osteonecrosis of the jaw, Myalgias
89
Bisphosphonates have been shown to reduce the risk of ___.
Spinal/hip fractures
90
HRT and bone fractures
Decreased bone fractures
| Increased heart disease
91
Example of SERM
Raloxifine
92
S/E of Raloxifine
Increased risk for development of DVT/PE
93
Raloxifine did not cause a decrease in ___.
Non-vertebral fractures
94
Which drugs for osteoporosis are used for treatment only?
Calcitonin, Calcimar
95
Which drugs for osteoporosis are used for treatment and prevention?
Raloxifine, Fosamax
96
Intermittent administration of low-dose PTH causes ___
increased bone remodeling and bone density
97
What should you do with a patient before starting them on Denosumab therapy?
Establish suficient vitmain D and calcium levels
98
Contraindications: Denosumab
Hypocalcemia -> inc. risk for jaw osteonecrosis
99
What sign may be absent in pneumonia in the elderly?
fever
100
Compared to younger patients, elderly patients with pneumonia are more likely to ___
be bacteremic
develop complications
die
101
What symptom is less common in UTIs in the elderly?
Dysuria
102
Urosepsis frequently manifests as ___ when systemic signs are absent (fever/chills).
confusion, altered mental status
103
What is a common presentation for cardiac ischemia in the elderly?
Dyspnea
104
When anginal pain is present in cardiac ischemia in the elderly, what is unique about it?
May occur in the back of shoulders or epigastric area
105
What % of elderly patients with MIs present with "silent MIs"?
>25%
106
What are some atypical presentations of MI in the elderly?
```
V w/ or w/o abdominal pain
Vertigo
Confusion
Syncope, near-syncope
Falling
```
107
Renal failure in the elderly? Think __.
MI
108
What % of elderly patients with PUD have "silent" form?
30-50%
109
What is a good motto to remember difference between peptic and duodenal ulcers?
Starve a peptic, feed a duodenal
110
What is the MC clinical presentation of geriatric pts hospitalized with duodenal ulcer?
Melena
111
Atypical SSx: PUD in the elderly
Anorexia, weight loss, confusion, GI bleeding/perforation
112
Which is more likely to perforate: anterior or posterior ulcer?
Anterior
113
What should you suspect in any elderly pt w/ unexplained abdominal pain w/ sepsis or GI bleeding?
PUD
114
SSx: Fecal impaction
Anorexia, N/V
Paradoxical D, stool incontinence
Abdominal pain
Bladder sxs
115
SSx: Hypothyroid
```
Failure to thrive
Wt loss
Constipation
Falling
Muscle weakness
CHF
Anemia
Depression
Carpal tunnel syndrome
```
116
What common symptoms of hyperthyroidism are present in less than 50% of elderly pts?
tachycardia, tremulousness, sweating
117
SSx: Hyperthyroidism
Apathy, inactivity
118
>65? What 3 tests do they need?
Carotid artery US, TSH, abdominal aorta US
119
Don't increase thyroid meds by more than ___.
25 mcg
120
SSx: Hyperparathyroidism
```
GI complaints (N/V, wt loss, dyspepsia, C, anorexia)
Depression, anxiety, dec. memory, personality change, delirium
```
121
Causes: delirium
```
Medications
Pneumonia
CHF
MI
PE
Sepsis (esp. urosespsis)
Dehydration
Hypoxemia
```
122
Diagnosis of dementia requires at least two of these must be affected:
```
Memory
Language
Personality
Emotion
Motor skills
```
123
Levels of SHBG (increase/decrease) with age.
Increase
124
T -> ? -> DHT
5-alpha reductase
125
T -> ? -> E2
Aromatase
126
What is andropause?
Hormonal changes and subsequent mental/physical/emotional changes that occur in aging men
127
E2 interacts with ___ to cause an 8-fold increase in ___, causing ___
SHBG
cAMP
Increased growth of prostate tissue
128
SSx: Andropause
Dec. libido, disturbed sleep, depression, fatigue, irritability, hot flashes, thinning skin, inc. osteoporosis/atherosclerosis/ht disease
129
Routes: Testosterone
Injection, Patch, Gel, Oral
130
Bioavailability of oral testosterone
Limited unless bioengineered, which can cause LV disease/CA
131
S/E: Testosterone
Acne, breast tenderness/enlargement, Erythrocytosis, Sleep apnea, Led edema, Worsening of ht dz, cardiac hypertrophy, prostate CA
132
What is a natural aromatase inhibitor extracted from Passionflower?
Chrysin
133
Contraindications: Testosterone
Presence of PrCA or PMHx of PrCA
Presence of BrCA or PMHx of BrCA
134
DHEA levels peak at age ___
25
135
MOA: Viagra
Inc. NO level
136
What are organic causes of impotency?
DM, hypothyroidism
137
What AA is a precursor to NO?
L-arginine
138
Drug classes for BPH
5-alpha reductase inhibitor
| Alpha-1 blocker
139
What is a natural 5-alpha reductase inhibitor?
Saw palmetto
