Geriatrics

Question 1

A 70-kg patient can walk up two flights of stairs without stopping. How much oxygen is consumer per minute during this activity?
a. 250 mL
b. 500 mL
c. 1,000 mL
d. 1,500 mL

Answer 1

c. 1,000 mL

Question 2

Walking up two flights of stairs without stopping is equal to ____ METS

Answer 2

4

Question 3

One MET corresponds to oxygen consumption of

Answer 3

3.5 mL/kg/min.

Question 4

__________ are classified as geriatric or elderly.

Answer 4

Patients 65 years of age or older

Question 5

A bedside tool that allows us to measure functional reserve and identify those who are at greater perioperative risk is known as

Answer 5

metabolic equivalents or METs

Question 6

Inability to achieve 4 METs is associated with

Answer 6

increased perioperative risk

Question 7

Examples of activities that meet 4 METs levels include

Answer 7

climbing a flight of stairs without stopping and raking leaves

Question 8

The subjective nature of METS makes it

Answer 8

a poor predictor of postoperative morbidity and mortality

Question 9

_____________ is characterized by a decreased reserve coupled with reduced resistance to stress (physiologic, physical, or psychosocial).

Answer 9

Frailty

Question 10

Frail patients are more likely to

Answer 10

suffer poor outcomes when exposed to perioperative stressors

Question 11

The most significant risk factor for developing cancer is

Answer 11

getting older

Question 12

For every MET a patient can achieve, mortality decreases by

Answer 12

11%

Question 13

Answering “yes” to the following questions indicates the patient is ok for surgery without the need for additional cardiac testing.

Answer 13

1. Can you walk up a flight of steps without stopping?
2. Are you able to walk four blocks without stopping?

Question 14

Activities that are equal to 1 METs include

Answer 14

self-care activities
working at computer
walking 2 blocks slowly

Question 15

Which factor increases in the elderly?
a. dead space
b. lung elasticity
c. PaO2
d. chest wall compliance

Answer 15

a. dead space

Question 16

What happens to minute ventilation as we age?

Answer 16

increased

Question 17

What happens wot upper airway tone as we age?

Answer 17

decreased

Question 18

What happens to protective airway reflexes as we age?

Answer 18

decreased

Question 19

What happens to lung compliance as we age?

Answer 19

increased

Question 20

What happens to chest wall compliance as we age?

Answer 20

decreased

Question 21

What happens to the response to hypercarbia and hypoxia as we age?

Answer 21

decreased

Question 22

What happens to lung elasticity as we age?

Answer 22

decreased

Question 23

Older adults have ___________ related to decreased upper airway tone

Answer 23

increased risk of respiratory failure and upper airway obstruction

Question 24

Older adults have ____________ related to decreased protective airway reflexes

Answer 24

reduced efficiency of cough and swallowing
higher risk of aspiration

Question 25

Due to their decreased response to hypercarbia and hypoxia, older adults have

Answer 25

higher risk of hypoventilation
higher risk of apnea
higher risk of respiratory failure

Question 26

Older adults have an increased __________ which requires an increased ___________ to maintain a normal PaCO2

Answer 26

dead space; minute ventilation

Question 27

Which volumes and capacities are increased in the 70-year-old patient? (select 3)
a. closing capacity
b. residual volume
c. total lung capacity
d. vital capacity
e. expiratory reserve volume
f. functional residual capacity

Answer 27

a. closing capacity
b. residual volume
f. functional residual capacity

Question 28

Closing capacity surpasses FRC at _____________ in the _________ position and _____________ when ________

Answer 28

45 in the supine; 65 when standing

Question 29

As closing capacity surpasses FRC, this means that the small airways

Answer 29

will collapse during tidal breathing which sets the stage for V/Q mismatch, increased dead space, and decreased PaO2

Question 30

What happens to FRC as we age?

Answer 30

increased

Question 31

What happens to total lung capacity as we age?

Answer 31

no change

Question 32

What happens to vital capacity as we age?

Answer 32

decreased

Question 33

What happens to closing capacity as we age?

Answer 33

increased

Question 34

What happens to inspiratory and expiratory reserve volume as we age?

Answer 34

decreased

Question 35

What happens to residual volume as we age?

Answer 35

increased

Question 36

What happens to FEV & FEV1 as we age?

Answer 36

decreased

Question 37

The following changes occur in the cardiovascular system in response to aging EXCEPT:
a. diastolic dysfunction
b. loss of elastin in arterial wall
c. fibrosis of the cardiac conduction system
d. increased venous capacitance

Answer 37

d. increased venous capacitance

Question 38

The most common coexisting disease in the elderly is

Answer 38

cardiac disease

Question 39

The four most common cardiac conditions in the elderly are

Answer 39

HTN
CAD
CHF
myocardial ischemia

Question 40

The best indicators of cardiac reserve are

Answer 40

exercise tolerance & the ability to perform daily living activities

Question 41

What happens to myocardial mass in the elderly patient?

Answer 41

increased

Question 42

What happens to arterial & venous compliance in the elderly patient?

Answer 42

decreased

Question 43

What happens to myocardial compliance and conduction in the elderly patient?

Answer 43

decreased

Question 44

In the postoperative period, _______________ is the most common cause of death.

Answer 44

myocardial infarction

Question 45

Because of their decreased cardiac conduction, elderly patients are at an increased likelihood of

Answer 45

dysrhythmias such as atrial fibrillation, 1st degree block, 2nd degree block and sick sinus syndrome

Question 46

_________ increases with age due to Virchow’s triad

Answer 46

The risk of DVT

Question 47

Virchow’s triad includes

Answer 47

venous stasis
hypercoagulability
endothelial dysfunction