geri COPY Flashcards
1
Q
what does congo red stain allow us to see in alzheimer’s disease?
A
staining of the blood vessels
2
Q
what does the silver stain allow us to see in patients with alzheimer’s disease?
A
neuretic plaques
3
Q
definition of subdural haemaatoma
A
atrophy of cerebal hemisphere
= slow venous bleeding
= slow mental impairment
4
Q
prostate (BPH) - what is the impact on renal function?
A
obstruct opening of uretrha
= fluid build up
= impact renal parenchyma
= hydronephrosis + atrophy of renal cortex
5
Q
what is this
A
bladder works extra hard to push the urine out
= thickened bladder wall
= increase bends (prominent trabeculations on mucosal surface) of muscularic mucosae
hydronephrosis
atrophy of renal parenchyma
= chronic renal failure
= decrease GFR
6
Q
A
nodular hyperplasia of glands
diasstromal hyperplasia
7
Q
what does senile osteoporis do?
A
senile osteoperosis: loss of bone matter due to ageing
thinning of cortical bone (eg. fracture of femoral neck)
8
Q
when does bone density start to decrease?
A
starts to decrease before menopause
**loss of bone density inevitable with age
9
Q
A
10
Q
identify the titles of the pictures
A
11
Q
tell me more about OA
A
OA
= cartildge does not act as a smooth lubricating surface anymore + thinning of trabeculae bone
= pain when moving
common locations
1. hands
- heberden nodes
- osteophytes at DIPJs
2. knee
prevlance directly increases with age
12
Q
describe the histology of OA
A
13
Q
identify the histology of RAd
A
14
Q
describe the histology of GA (gouty arthritis)
A
deposition of urate crystal
= tophus
= reaction to presence of crystals
= multinucleated giant cell present
15
Q
describe the histology of pseudogout arthritis
A
16
Q
tell me more about the
- causes of COPD
- what happens in patients who have COPD
A
patients have emphysema + chronic bronchitis
most common type of emphysema: centrilobular emphysema
17
Q
tell me more about emphysema
A
proximal aveoili affected, distal aveoli spared
18
Q
what can chronic sun exposure lead to
A
dermal elastosis
= epidermis can become progresively dysplastic (acttinic keratosis)
= pre malignant condition
19
Q
what are malignanies associated with chronic sun exposure
A
basal cell carcinoma
squamous cell carcinoma
melanoma
20
Q
what are seborrheic keratoses
A
21
Q
what actinic keratosis
A
22
Q
what are the 2 most common chronic diseases in singapore
A
- diabetes mellitus
- hypertension
= affects multiple organ systems
**control is impt, compliance is a major issue
23
Q
compare type 1 vs 2 DM
A
24
Q
describe the condition of diabeties
A
25
what is the clinical syndrome associated with diabetic glomerulosclerosis?
1. diabetic retinopathy
2. diabetic neuropathy
26
what are the complications of hypertension
1. intracerebal haemorrage
2. concentric hypertrophy of LV
3. nephrosclerosis
27
fine granular scarring on cortical surface
28
where does cancer usually spread to?
extramural venous invasion = spread to liver
common organs for mets: liver, lungs, breast
29
interstatial fibrosis = chronic renal failure
Hyaline arteriolosclerosis is a common vascular lesion characterized by the accumulation of various serum proteins in the subendothelial space often extending into the media.
30
EGFR receptor (+) respond very well to certain forms of chemotherapy
31
are these patients candidates for surgical ressection?
no, since the cancer spreads too wuickly
32
what are the complications of atherosclerosis
deposition of cholesterol crystals for arterosclerosis
underlying thrombus
= narrow lumen/ total occlusion of lumen
= acute MI
33
compare acute vs healed MI
- gross appearance
34
compare acute vs healted MI
35
what is the relevance of watershed areas?
ischemic collitis
= necrosis of entire musosa
= entire wall of intestines becomes necrotic
36
describe the histology and gross patho of ischemic colitis
37
tell me about an inguinal hernia in the elderly
- definition
- what predisposes them to it
- complications
38
tell me about diverticular disease
39
type 1 vs 2 respiratory failure
type 1: resp system cannot adequately provide oxygen to the body
= impaired alveolar capillary unit
= hypoxemia
type 2:
impaired ventilation
= resp system cannot remove CO2 from body
= hypercapnia (too much CO2 in the blood)
40
what is the temporal hierarchy of 3 aging metrics
1. biological aging
2. phenotypic aging
3. functional aging
41
what are the 3 phrases in aging and decline in acpacity
42
**HIGH YIELD MCQ
what is healthy aging?
43
definition of frailty
frailty: complex, multidimensional, cyclical state of diminished psyiologic reserve
= increase vulnerability to adverse clinical outcomes
*is a DYNAMIC process, maybe reversible
44
what is sarcopenia?
skeletal muscle loss with aging
45
what is the difference in management for patients who are frail?
46
what are the signs of cushing's syndrome
47
**high yield MCQ
what is the disease cascade in older adults?
disease --> pathophysiology --> symptoms --> treatment
*patient centered biopsychosocial approach
48
what is the approach to falls?
internal vs external factors ffor fall
49
**HIGH YIELD MCQ
how does madopa precipitate falls?
postural HYPOtension
defined as >20 drop for systolic, >10 drop for diastolic BPM
50
*mid yield MCQ
what is the disease presentation in older adults?
1. diseases present atypically in old age
2. late presentation and altered clinical course
3. typical presentation
51
what are the hazards of hospitalisation in older adults?
1. unfamiliar environment = insomnia
2. sensory deprivation, immobility, restraints
3. polypharmacy
4. malnutrition
52
**high yield MEQ part 1 question
what is the definition of polypharmacy
what are the pros and cons of it?
Polypharmacy, defined as the regular use of 5 or more medications at the same time, is common in older adults and at-risk younger individuals.
53
what is the physiology of aging?
54
what are the changes in body composition with aging?
55
why do the elderly not want
56
why do elderly people tend to not have a fever during viral infections?
57
why are vaccines less effacious in the elderly?
58
why do some elderly patients with pneumonia or AMI not complain of breathlessness?
59
what are the most common cause of death in elderly?
1. AMI
2. pneumonia
60
**high yield MCQ
why does metformin cause weight loss?
if patient has weight loss on metformin, change to glucoziade
Reduced Gluconeogenesis in the Liver:
Metformin inhibits hepatic gluconeogenesis (glucose production) by activating the enzyme AMP-activated protein kinase (AMPK).
This reduces circulating glucose levels, improving insulin sensitivity and lowering fat storage.
Improved Insulin Sensitivity:
By increasing insulin sensitivity in peripheral tissues, metformin reduces fat deposition and promotes the utilization of glucose for energy rather than storage as fat.
Increased Fat Oxidation:
Metformin promotes fat breakdown by enhancing AMPK activity, leading to greater reliance on fat as an energy source.
Appetite Suppression:
Metformin affects gut hormones like glucagon-like peptide-1 (GLP-1), which can reduce appetite.
It may also reduce cravings and hunger, leading to a lower caloric intake.
Effects on Gut Microbiota:
Metformin alters gut microbiota composition, increasing beneficial bacteria that might contribute to weight loss by improving metabolism and reducing systemic inflammation.
Mild Gastrointestinal Side Effects:
Common side effects, such as nausea, diarrhea, and bloating, can result in decreased food intake, indirectly contributing to weight loss.
61
*low yield
what is the geriatric depression scale, and what is it used for?
62
**HIGH YIELD
what are the risk factors for cognitive and behavioural disorders?
1. non modifiable (60%)
- age = brain mass decrease with time
- female gender
- genetic factors
- down syndrome
- family history
2. modifiable (40% of all dementias)
- education
- smoking
- air pollution
- midlife obesity
- hypertension
63
(don't need to memorise)
what are the genetic factors in alzheimer's disease?
early onset: AD gene mutations = rare, but deterministic
- amyloid precursor protein
- usually include mood syndromes
late onset: AD gene mutations = common, but non-deterministic
- neurotoxic APOE E4 allele
64
**MCQ
what is the definition of 'cognitive resrve'
capacity beyond what is needed for daily functioning, so as to be more resilient./ adaptive to brain pathology
65
how to prevent dementia?
decrease putative factors, increase protective factors
putative factors:
1. neuropathological damage
- tau mediated damage
-
protective:
1. cognitive reserve
66
**high yield
what parameters to use to assess dementia?
1. risk of cognitive decline
2. risk for functional decline
3. health related QoL
67
what to eat/ do to prevent dementia
medication: antihypertensives
diet: mediterranean diet
68
**high yield
what exactly is the definition of dementia?
- progressive and disabling decrease in mental functions
1. memory
2. thinking
3. language
4. behaviour
5. mood and personality
- clinically diagnosed
- gross anatomy of brain with dementia/ AD
1. increased space between gyri
2. brain atrophy = ventricular widening
69
what are the reversible causes of dementia
70
what does excessive alchol result in?
cerebellar degeneration
71
**HIGH YIELD
what are the most common types of dementia?
72
tell me about alzheimer's disease
- alzhimers dementia have better prognosis than those with vascular dementia
- most common presentation of AD: AMNESIA, apraxia,
what to look for in brain imaging:
1. medial temporal lobe atrophy
2. small hippocampal volumes (hippocampus: for memory to be stored at the cortex, just imagine hippocampus as the gatekeeper for memory to enter the cortex, or for memory to be drawn out from the cortex)
histology
1. amyloid plaques
2. neurofibrillary tangles
73
**HIGH YIELD
what is the potential differential diagnosis for AD
lewy body dementia: EPS (extra pyramidal), hallucinations
frontotemporal dementia: issues with semantics, behaviour, language
74
**high yield
what are the clinical features of dementia?
ABC
Activites of daily living = loss of independence
Behaviour
Cognitive = memory deficit (short term memory loss worse than long term), disorientation, impaired judgement, visuospatial
75
**mid yield
what are the effects of dementia on caregivers?
cascade of caregiver burdern:
caregiver burden --> burnout --> institutionalisation
1. role strain
2. personal strain
76
what is depression?
2 signs:
1. low mood
2. lack of interest
77
**HIGH YIELD
what are the cellular mechanisms that lead to depression?
1. monoamine hypothesis
2. cytokines (eg. IL-1b)
3. neuropeptides
78
what is the continuum of depression?
approximately 15% of the whole population is struggling with either syndromal or subsyndromal depression
79
*mid yield
how to classify the risk factors ffor depression?
1. biological
2. social
3. physical
4. psychological
80
what are the 3Ds in dementia?
.
delecium
81
what is the most impt slide for the presentation
82
what are the causes of delerium?
83
how to diagnose delerium
84
what is the confusion assessment method
85
what is the definition of 'brain plasticity'
ability of the brain to form new neuronal connections and synapses in response to new learning and injury
*usually stops at 30yo
86
**potential MCQ
what is aging?
1. decline in physiologic reserve of major body organs
= most organs lose function from 30 years old onwards
87
functional decline
- definition
- strategies to prevent it
-
definition:
decrease physical and cognitive function = decrease ability to perform everyday tasks
preventive strategies:
- be mindful of likelihood
- comprehensively assess (general and body system specific) then identify high risk indicators
- implement preventive management strategies
- management
88
8 possible causes of acute functional decline
condition
1. worsening condition
2. new condition
medication
3. poor compliance
4. new medications
electrolyte disturbances
5. dehydration
6. metabolic/ electrolyte disturbances
7. hypoglycemia
others
8. underlying dementia
9. poor caregiver support
89
4 important aspects of history to
