Geriatric/Pediatric Flashcards
Notable growth in ____ y/o population and shrinking in __ ___ y/o population
- 65+
- 14
Gerontology
Study of aging
Geriatrics
Subspecialty of clinical medicine focusing on caring for the aged
How does CRP change with age?
Increases
How does albumin change with age?
Decreases
How do muscle mass and total creatinine production change with age?
- Both decrease
- Rate and extent of muscle mass loss have strong genetic component
How does total bone density change with age?
Decreases
Much more dramatic for women post-menopause
How do serum calcitonin and PTH change with age (bone metabolism)?
Both increase
Which GIT issues increase with age?
- Atrophic gastritis
- Low gastric production
- Increased malnutrition
Which vitamin/mineral/protein deficiencies worsen with age?
- Vit B12 deficiency
- Decreased calcium
- Decreased iron absorption
- Decreased albumin
How do the following change with aging?
Number of functional glomeruli
GFR/renal blood flow
Kidney concentrating ability
Acid/base, water, electrolyte levels
All decrease!!
Which urinary system hormones increase with age?
EPO, ANP (atrial natriuretic peptide), and BNP (b-type natriuretic peptide)
Which urinary system hormones decrease with age?
Renin and responsiveness to ANP
What happens to the thymus with age?
Shrinks
What immune substance increases with age?
ANAs (anti-nuclear antibodies)
What immune substances decrease with age?
- Thymosin
- T-cell and B-cell function
- Hematopoietic stem cells
Which endocrine system hormones usually remain stable with age?
- ACTH
- Epinephrine
- TSH (but may slightly increase)
Which endocrine system hormones usually increase with age?
- Norepinephrine secretion
- ANP
- PTH
- ADH/AVP
Which endocrine system hormones usually decrease with age?
- GH
- Peak melatonin
- Aldosterone
- DHEA
- IGF-1
How does glucose metabolism change with age?
- Insulin secretion does not change BUT insulin sensitivity decreases
- People with genetic predisposition to Type 2 diabetes more likely to manifest illness (increasing age, BMI, lack of exercise)
What are some factors that impact interpretation of lab results for elderly population?
- Exercise type/duration
- Meds
- Mobility
- Nutritional status
- Personal habits
- Presence of chronic/subclinical disorders
What factor correlate with muscle mass and renal function?
Creatinine levels
Osteoporosis due to
lack of sex hormones and hypogonadism
Inadequate calcium absorption leads to ____________________________
low serum calcium and increased PTH, which then increases calcium loss from bones -> increases ALP
Which GIT substances increase with age?
CRP, GGT, and fibrinogen
Which GIT substances decrease with age?
Ferritin, transferrin, albumin, and total protein
Enlargement of prostate leads to
Increase in prostate specific antigen (PSA), which can cause urinary obstruction
How doe sex hormones (testosterone, estrogen, and progesterone) change with age?
All decrease
How does increase in age affect drug absorption, distribution, metabolism, and elimination?
- Absorption=rate slows
- Distribution=highly water-soluble drugs tend to be more concentrated due to decreased body water
- Metabolism=hepatic blood flow/mass decrease
- Elimination=renal blood flow/mass decrease -> decline in GFR
Which factor was emphasized to have a big impact on increased lifespan and quality of life in geriatrics?
Exercise
A baby delivered at term weighs about __
3.2 kg
A baby whose birth weight is below the ___ percentile for gestational age is considered small
10th
Organ development at birth
Most organs are not fully developed
GFR and renal tubular function at birth
Both mature during the first year of life
Normal intrauterine development time period
38-40 weeks of gestation
Infant phlebotomy complicated by which factors?
- Patient size
- Inability for patient to communicate
Which type of testing plays an important/expanding role in pediatric practice?
Point-of-care testing (POCT) aka near-patient testing
POCT factors to be considered
- Turnaround time
- Evaluation of POCT devices
- Device limitations for pediatric use
Primary maintenance of blood gas and pH homeostasis following birth requires what to regulate acid-base metabolism?
Sufficiently mature lungs and kidneys
Which cells does the lung express at 24 wk of gestation and what are their functions?
- Type 1 pneumocytes = gas exchange
- Type 2 pneumocytes = secrete surfactant containing lecithin and sphingomyelin
Why is surfactant important for the lungs?
Necessary for the lungs to expand and transfer blood gases after delivery
Respiratory Distress Syndrome (RDS)
Failure to excrete CO2 and the levels rise -> causing respiratory acidosis
Blood gas measurement in neonates
- Non-invasive transcutaneous devices measure oxygen and CO2 status
- Some analyzers take small capillary samples in pediatric settings
Anaerobic collection from neonates
Must be free-flowing from heelstick and sealed/processed fast
What other analytes can blood gas analyzers measure for neonates?
- Lactate
- Urea
- Bilirubin
- Creatinine
Advantages and disadvantages of blood gas analyzer measuring lactate, urea, bilirubin, and creatinine?
- Advantage = smaller blood volume needed
- Disadvantage = can’t tell if sample is hemolyzed
Disorders that cause hypernatremia and hyponatremia must be treated in neonates to prevent ___
Seizures
Cause of physiologic jaundice in neonates
Failure of immature liver to properly metabolize bilirubin
Which organ plays an essential role in energy metabolism for the whole body?
Liver
Blood glucose homeostasis/hepatic metabolism of glucose are maintained by which hormones?
- Glucagon
- Cortisol
- Epinephrine
- IGF
Type 1 diabetes previously called ___
juvenile
Type 2 diabetes cases ____
have grown tremendously in the last 30 years
Which organ plays a central role in nitrogen metabolism?
Liver
Liver synthesizes which proteins?
- albumin
- transferrin
- complement clotting factors
Liver metabolism of breakdown products turn into ___
- ammonia
- urea
- creatinine
- uric acid
Blood ammonia levels are typically higher in which age group compared to which other age group?
Higher in newborns than older kids
Which is a potential new test, not routinely used yet, for testing renal function in neonates?
Cystatin C
Creatinine and uric acid levels in newborns
Lower
Lack of Vit D can cause
Rickets
Normal bone growth requires integration of which elements?
- calcium
- phosphate
- magnesium
Normal bone growth requires endocrine regulation from which hormones?
- Vit D
- PTH
- Calcitonin
Hypothalamus secretes which hormone in the thyroid system?
TRH
Adrenal cortex system regulates
Mineral and carb metabolism
Hypothalamus secretes which two regulatory hormones that affect growth?
- GH-inhibiting factor (somatostatin)
- GHRH
Hypothalamus secretes which sexual maturation hormone?
GnRH (suppressed in infants and young children)
Human fetus synthesizes which Ab?
Small amount of IgM and IgA to lesser extent
How does prematurity affect infant immunity?
Transient hypogammaglobinemia
Severe combined immune deficiency (SCID)
Lack both humoral and cellular immunity (boy in bubble)
Common genetic disease within Caucasian population in the US
Cystic fibrosis
Newborn screening tests
- PKU
- Steroid 21-hydroxylase deficiency
- Sickle cell disease
- CF
- Galactosemia (some states/countries)
Theophylline is metabolized to ___ in neonates but not adults
Theophylline