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Chem 2 Exam 3 > Geriatric and Pediatric > Flashcards

Geriatric and Pediatric Flashcards

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1
Q

Since 2010, there has been a 34% increase in population ___ and older.

A

65

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2
Q

Life expectancy decreased in 2021 by ___ year.

A

1

COVID changed the life expectancy for everyone.

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3
Q

Gerontology is the study of

A

aging

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4
Q

Geriatrics is the

A

subspecialty of clinical medicine that focuses on care of the aged

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5
Q

The total body muscle mass ______ with age

A

decreases

-rate and extent have strong genetic component

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6
Q

As Muscle mass decreases with age, total creatinine production _____

A

decreases

as well

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7
Q

Total bone density and mass _____ with age

A

decreases

-much more dramatic of women post-menopause

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8
Q

Total bone density and mass decreases, while serum calcitonin and PTH _______

A

increases

-affects bone metabolism

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9
Q

Atrophic gastritis

A

low gastric acid production can both increase with age

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10
Q

With age, there is a _______ malnutrition, Vit B12 _________, ______ calcium, iron _____, albumin

A

-increased malnutrition
-vitamin b12 deficiency
-decrease calcium
-iron absorption

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11
Q

In the urinary system, number of functional glomeruli _________

A

decreases

-decrease in kidney size and weight

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12
Q

In the urinary system, as we age, GFR ______

A

declines

-renal blood flow is reduced

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13
Q

In the urinary system, as we age, kidneys concentrating ability ______

A

declines

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14
Q

Acid/base, water, and electrolyte levels are ______ under optimal conditions, but physiologic reserve ______

A

normal, diminished

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15
Q

In the urinary system, there is an increased in three things and a decrease in one main analyte

A

-EPO, ANP, and BNP

decreased: renin, responsiveness to ANP

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16
Q

In the Immune System: as we age the
Thymus _____

A

shrinks

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17
Q

In the Immune system, as we age, the ANAs will ______

A

increase

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18
Q

In the immune system, as we age, thymosin, T-cell function, B-cell function, hematopoietic stem cells will all ______

A

decrease

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19
Q

In the Endocrine system, as we age, ACTH levels don’t usually change, epinephrine is ______, and TSH (may also slightly increase)

but overall they are all ______

A

stable

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20
Q

In the Endocrine system, as we age, what increases and what decreases?

A

increases: norepinephrine secretion

decreases: GH, peak melatonin, aldosterone

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21
Q

As for sex hormones, as we age, what decreases?

A

-We see a decrease in estrogen and progesterone due to Menopause
-We also see a decrease in testosterone due to Andropause.

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22
Q

As we age, renal function _____. Creatinine levels correlate to both so may be the same or slightly _______ even when renal function has significantly decreased.

A

decreases, increased

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23
Q

What is Osteoporosis?

A

the lack of sex hormones and hypogonadism

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24
Q

What is needed to maintain bone density ? (two things)

A

We need adequate calcium and vitamin D

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25
Q

True or False: Inadequate calcium absorption leads to low serum calcium and increased PTH, which then increases calcium loss from bones, which increases ALP levels.

A

True

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26
Q

In the Gastrointestinal System, age related changes with the _______ analytes.

A

liver

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27
Q

In the Gastrointestinal System, as we age, what increases?

A

-CRP
-GGT
-fibrinogen

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28
Q

In the Gastrointestinal System, as we age, what decreases?

A

-Ferritin
-transferrin
-albumin
-total protein

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29
Q

In the Urinary system, what is important about the enlargement of the prostrate as we age?

A

increase in prostate specific antigen (PSA), can also cause urinary obstruction

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30
Q

True or False: As age increases, infection-induced morbidity and mortality decreases.

A

False. As age increases, so does infection-induced morbidity and mortality.

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31
Q

In the Endocrine system these hormone levels: ANP, EPO, PTH, TSH (may slightly), ADH/AVP will _______

A

increase

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32
Q

In the Endocrine system these hormone levels: DHEA, IGF-1, GH, aldosterone will _____

A

decrease

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33
Q

Testrone, estrogen, and progesterone are all sex hormones that will _____ with age

A

decrease

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34
Q

The Glucose Metabolism will show insulin sensitivity ________

A

decrease

-increased prevalence of type 2 diabetes

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35
Q

Normal physiological changes with age: so muscle will decrease and the lab value that correlate is ________. This will _______.

A

Creatinine, decrease

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36
Q

Normal physiological changes with age: so mineral content of bone and cartilage will decrease and the lab values that correlate are…

A

PTH (females) will increase and calcitonin will decrease

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37
Q

Normal physiological changes with age: so gastric motility, vitamin absorption, and drug absorption will decrease and the lab value(s) that correlate are…

A

Vitamin B12, calcium, and Fe absorption will decrease

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38
Q

Normal physiological changes with age: so kidney renal filtration will decrease and the lab value(s) that correlate are…

A

Serum ANP, BNP, EPO, and creatinine will increase and
GFR and renin will decrease

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39
Q

Normal physiological changes with age: so immune hematopoietic stem cells, bone marrow activity, thymosin, and Tcell function will decrease and the lab value(s) that correlate are…

A

ANAs will increase

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40
Q

Normal physiological changes with age: so Endocrine gland sensitivity to pituitary and other stimuli will decrease and the lab value(s) that correlate are…

A

aldosterone will decrease and
Norepinephrine will increase

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41
Q

Normal physiological changes with age: so Reproductive sex hormones will decrease and the lab value(s) that correlate are…

A

Testosterone, estrogen, progesterone, DHEA-S and pregnenolone will decrease while
GnRH will increase

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42
Q

True or False: Most laboratory tests have gender-specific references ranges and/or age-specific reference ranges

A

True.

Because the need to establish reference ranges in a healthy population and the increase prevalence of at least one health condition in the aged, there are little data on more appropriated age-specific references ranged fro older adults.

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43
Q

True or False: Currently, most physicians who care for the geriatric population rely on established patient care, frequent routine examinations, and following changes in laboratory values over time as an early indicator of a problem.

A

True

44
Q

What are the top ten common chronic conditions for adults over 65 years of age?

A

-Hypertension
-High cholesterol
-Arthritis
-Heart disease
-Diabetes
-Chronic kidney disease
-heart failure
-depression
-Alzheimer’s disease/Dementia
-Chronic bronchitis/Emphysema

45
Q

What are the leading causes of death in the United States?

A

-SARS-CoV-2 (COVID-19)
-Heart disease
-Cancer
-Alzheimer’s disease
-Cerebrovascular disease
-Chronic lower respiratory disease
-Diabete
-Other respiratory diseases
-Pneumonia and influenza
-Renal failure

46
Q

Age-associated changes in Drug Metabolism: specifically in absorption

A

The rate of drug absorption slows with aging

47
Q

Age-associated changes in Drug Metabolism: specifically in distribution

A

-Highly water-soluble drugs tend to be more concentrated, due to decreased body water

older folks have a harder time drinking water/ staying hydrated and hence the water-soluble drugs tend to be more concentrated.

48
Q

Age-associated changes in Drug Metabolism: specifically in Metabolism

A

-Hepatic blood flow and hepatic mass decrease with age.

-The liver is responsible for the majority of drug metabolism

49
Q

Age-associated changes in Drug Metabolism: specifically in Elimination

A

-Renal blood flow and renal mass decreases with age, results in gradual decline in GFR.

50
Q

True or False: Identification of geriatric syndromes can be made with a specific lab test

A

False: Identification of geriatric syndromes can not be made with a specific test, but some tests may help explore the underlying causes of this ump tomes that lead to patient presentation.

51
Q

Research indicates that _______ _______ can increase the life span and improve the quality of life among geriatric patients

A

regular exercise.

Exercise helps prevent depression as well as other diseases including diabetes, heart diseases, cancer, and osteoporosis.

52
Q

Maintaining physical activity improves physical _________ and fitness, as well as balance

A

strength

53
Q

The successful management of aging requires proper _________ in addition to regular exercise

A

nutrition

54
Q

Developmental changes from neonate to adult: At birth, the normal infant rapidly adapts to respiration and circulation by

A

initiating active respiration

55
Q

A baby delivered at term weighs about ____ kg. A baby whose birth weight is below the ____ percentile for gestational age is considered ______ for gestational age.

A

3.2 kg
10th
small

56
Q

Most organs are not fully developed at birth. Glomerular filtration rate (GFR) of the kidney and renal tubular function mature during the _____ year of life.

A

first

57
Q

Intrauterine development is programmed for a normal 38 to 40 weeks of gestation. Thus if the baby is born less than 38 weeks they are considered …

A

premature

58
Q

Blood collection from infants and young children is complicated by the patient’s …

A

size and frequently by the ability of the patient to communicate

59
Q

Several issues have prevented the introduction of full-scale automation in pediatrics such as…

A

sample in tubes and evaporation of sample from open tube

  • of many different sizes, varying from standard adult tubes to small pediatric tubes or microtainers
60
Q

What is the choice of analyzer for pediatric sample?

A

-careful inspection and choice of analytic systems remain crucial for handing pediatric samples. Until recently, only a few analyzers performed multiple analytic procedures on small sample volumes (5 to 50 uL)

61
Q

Point-of-care testing (POCT), or near-patient testing, plays an important and expanding role in pediatric practice. What are the factors to be considered?

A

-Turnaround Time
-Evaluation of POCT Devices
-Device Limitations for Pediatric Use

–
Typically, analytic performance is not as good as that with the main laboratory analyzer

62
Q

Primary maintenance of blood gas and pH homeostasis following birth requires that the ______ and ______ be sufficiently mature to regulate acid and base metabolism

A

lungs and kidneys

63
Q

At 24 weeks gestation-lung expresses ___ distinct types of cells. What are they?

A

2

-Type 1 pneumocytes
-Type 2 pneumocytes

64
Q

What is Type 1 pneumocytes responsible for ?

A

gas exchange

65
Q

What is Type 2 pneumocytes responsible for?

A

secretion of surfactant (contains the phospholipids lecithin and sphingomyelin)

66
Q

Surfactant is required for the lungs to…

A

to expand and the transfer of blood gases following delivery

67
Q

Respiratory Distress Syndrome (RDS)

A

failure to excrete CO2 and the levels rise causing respiratory acidosis

68
Q

True or False: Metabolic acidosis is more common than Metabolic alkalosis?

A

True

69
Q

________ status can readily be measured using non-invasive transcutaneous monitoring.

A

Oxygen status

-They can also measure carbon dioxide using transcutaneous devices too like a pulse oximeter on finger or toes.

70
Q

Some blood gas analyzers can be adapted to take small _________ samples in pediatric settings.

A

capillary

–
Anaerobic collection is a challenge - must be free flowing from heel stick and sealed quickly. Processed very quickly too.

71
Q

True or False: not many blood gas analyzers can also measure lactate, urea, bilirubin and creatinine.

A

False! Many blood gas analyzers can measure lactate, urea, bilirubin, and creatinine.

72
Q

What would be an advantage and disadvantage of using a blood gas analyzers for regulation of blood gases and pH in Neonates and infants?

A

-Advantage: smaller blood volume needed
-Disadvantage: not being able to tell if the sample is hemolyzed

73
Q

When babies are born, their Glomerular Filtration Rate (GFR) is at _____mL/min, while at about 2 years their GFR is at a normal rate of 115 mL/min.

A

24

This is due to kidney development. It takes about 2 years for the kidney to fully develop after birth for a neonate to have a normal GFR.

74
Q

Disorders affecting electrolytes and water balance must both be treated in order to prevent…

A

seizures

too low or too high sodium can cause seizures

75
Q

Why would blood need to be less than 5 days old to be given to a baby?

A

When blood is needed to be transfused to a baby, the blood needs to be less than 5 days old for the least amount of potassium to be released in the blood product.

If not it could raise the baby’s potassium levels and it can be lethal.

76
Q

The liver is an essential organ for many ________ processes.

A

metabolic

77
Q

Metabolic pathways and the metabolism of exogenous compounds, in particular pharmacologic agents proceed slower in …

A

neonates

78
Q

The most striking effect of an immature liver is the failure to adequately metabolize ______

A

bilirubin

79
Q

Which organ plays an essential role in energy metabolism for the whole body?

A

liver

80
Q

Blood glucose homeostasis and hepatic metabolism of glucose are maintained by

A

the concerted actions of several hormones.

such as: Glucagon, cortisol, epinephrine, insulin-like growth factor.

81
Q

Which type of diabetes was historically called juvenile?

A

Type 1 diabetes

82
Q

Which type of diabetes has cases that have grown tremendously in the last 30 years?

A

Type 2 diabetes

83
Q

Which organ plays a central role in nitrogen metabolism.

A

the liver

84
Q

Which organ is involved with the metabolic interconversions of amino acids and the synthesis of nonessential amino acids?

A

The liver

Proteins such as: albumin, transferrin, complement clotting factors

85
Q

Metabolism of breakdown products of nitrogen turn over:

A

ammonia urea, creatinine, uric acid

86
Q

**True or False: Blood ammonia levels are typically higher in newborns than older children

A

True

87
Q

In contrast to the high neonatal ammonia levels, creatinine and uric acid levels are lower in newborns because

A

Creatinine concentrations increase with muscle mass and as we known baby s don’t have much muscle mass.

–
- Creatinine clearance test not typical – difficult to collect.
- eGFR used - slightly different formula than adults
-Cystatin C is a potential newer test, not routinely used yet.

88
Q

Which organ is responsible for performing a large number of synthetic and catabolic processes and central to maintaining body homeostasis?

A

the liver

89
Q

Norma bone growth, which parallels body growth requires integration of _____, _____. _____ metabolism with endocrine regulation from vitamin D, parathroid hormone (PTH), and calcitonin?

A

-calcium
-phosphate
-magnesium

90
Q

The lack of Vitamin D can cause ….

A

rickets

98% of the total body calcium is in the bone

91
Q

The hypothalamus secretes _______-______ ________, a 3-amino acid peptide, into the portal blood system between the hypothalamus and anterior pituitary.

A

thryotropin-releasing hormone (TRH)

92
Q

This system is essential for regulating mineral and carbohydrate metabolism

A

Hypothalamic-Pituitary-Adrenal Cortex System

93
Q

The hypothalamus secretes _____ regulatory hormones that affect growth, which are..

A

2

-GH inhibiting factor (somatostatin)
-GH releasing hormone

94
Q

The hypothalamus secretes a 10-amino-acid peptide called __________-________ ________ into the portal blood system. This is suppressed in infants and young children

A

gonadotropin-releasing hormone (GnRH)

95
Q

For baby, most of their immune system comes from their

A

mother

96
Q

What are the components of the immune system?

A
  • Skin
  • phagocytes
  • B cells
  • Natural killer cells
  • Acute-phase reactants
  • antibody production
97
Q

The human fetus synthesizes a small amount of ____ and, to a lesser degree, IgA

A

-IgM

98
Q

Transient hypogammaglobulinemia of infancy may occur because of

A

prematurity or in certain infants, may be a results of delayed onset of immunoglobulin production of unknown etiology.

–
When it takes longer than expected for a baby to make their own IgG antibodies, they may have transient hypogammaglobulinemia of infancy. The cause of THI is unknown, but it is thought to be due to B cells taking longer to mature than normal.

99
Q

Severe Combined Immune Deficiency is the lack of both _____ and ____ pathways for killing bacteria and viruses

A

Severe combined immunodeficiency (SCID) is a life-threatening primary immunodeficiency (PI) with a combined absence of T cell and B cell function. (boy in a bubble)

100
Q

Which immunoglobulin class cross the placenta and in breast milk and which is not?

A

IgG can cross the placenta and milk, which IgM does not.

101
Q

This disease is a common genetic disease within the Caucasians population in the United States. The rate of this disease in Western populations is 1 in 2400 live births, which results from recessively inherited mutations in the cystic fibrosis transmembrane regulator (CFTR) gene

A

Cystic fibrosis

102
Q

Newborn screenings for whole populations: certain inherited diseases are sufficiently common in the population to be considered candidates for

A

whole population screening.

-Usually all babies have Phenylketonuria (PKUs) done
-Steroid 21-hydroxylase deficenty
-Sickle cell disease
-CF
-Galactosemia (in some states and countries)

103
Q

What are two super important things to look at for neonate and pediatric clinical chemistry?

A

-Therapeutic Drug Monitoring
-Toxicologic issues in pediatric clinical chemistry

104
Q

Which of the following will lead to decreased serum levels of creatinine in the geriatric patient?

  • Decreased muscle mass
  • Increased GFR
  • Decreased protein intake
  • None of the above
A

Decreased muscle mass

105
Q

Which could account for drug toxicity following a normally prescribed does to the geriatric patient?

  • Decreased renal clearance
  • Slowing of drug absorption
  • Liver impairment
  • All of the above
A
  • All of the above
106
Q

All of the following represent normal physiology of the newborn except:

  • Weight of 2.1 kg
  • Immature liver function and inability to eliminate excess bilirubin
  • Infants normally rapidly adapt by initiating active respiration
  • 4-6 months for the infants body weight to double
A
  • Weight of 2.1kg is not a normal representation of a mature newborn. The actually normal representation of a normal newborn is 3.2 kg.
107
Q

Which is not a test typically included on a newborn screening panel in the U.S.

  • Cystic fibrosis
  • Cholesterol
  • Sickle cell disease
  • Phenylketonuria
A
  • Cholesterol

Babies livers are not fully mature to even make Cholesterol.

Chem 2 Exam 3 (4 decks)

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