Geriatrics

Question 1

1 met corresponds to an oxygen consumption of _____

Answer 1

3.5ml/kg/min

Question 2

Walking up two flightsd of stairs without stopping is equivalent to ___ mets and consumes ____

Answer 2

4
1L/ min

Question 3

For every MET a patient can achieve, mortality decreases by ____

Answer 3

11%

Question 4

Examples of 1 MET

Answer 4

Self car activities
Working at a computer
Walking 2 blocks slowly

Question 5

Examples of 4 METS

Answer 5

Walking up a flight of stairs without stopping
Walking FOUR blocks without stopping
Walking up a hill >1-2 blocks
Light housework
Gardening

Question 6

What respiratory factors INCREASE with age?

Answer 6

Lung compliance
Dead space
FRC
RV
CC

Question 7

What respiratory factors decrease with age?

Answer 7

VC
ERV

Question 8

How is TLC changed in the elderly?

Answer 8

Unchanged

Question 9

What is virchows triad?

Answer 9

Marker for venous thromboembolism
Venous stasis
Hypercoaguable
Endothelial dysfunction

Question 10

What are some changes to the cardiovascular system?

Answer 10

Increase SBP and PP
No change in systolic function
Decrease SV
Decrease HR
Thus, decrease CO
Decrease lusitropy
Decreased diastolic function

Question 11

Aging and the ANS

Answer 11

Increase SNS, decrease PNS
Increased Norepi
So, decreased responsive to catecholamines

Question 12

MAC decreases by ___ each decade after 40 years old

Answer 12

6%

Question 13

A decrease in Ach will cause

Answer 13

Alzheimers

Question 14

A decrease in DA will cause ___

Answer 14

Parkinsons

Question 15

___ anesthesia is associated with a higher degree of LA spread

Answer 15

Epidural and Spinal

Question 16

Neuraxial anesthesia

Answer 16

Increased sensitivity to LA, intrathecal, epidural, spinal, and difficulty of blocks
Decreased response to test dose epi

Question 17

Kidney changes (GFR, cr, Cr cl, aldosterone)

Answer 17

Serum creatinine stays the same- muscle mass decreases, but so does Cr Cl, so it balances out
GFR decreases by 1 ml/min after 40
Cr Cl decreases
Aldosterone decreases

Question 18

How is RBF affected?

Answer 18

Decrease 10% per decade

Question 19

How are proteins affected?

Answer 19

Albumin (which binds acidic drugs) DECREASES
Alpha 1 glycoprotein (binds basic drugs) INCREASES

Question 20

How is liver function affected?

Answer 20

NO change!!!
Decreased blood flow, mass, and periop function though
The decrease of blood flow and size will, however, decrease function, but not cellular changes

Question 21

How are induction times affected?

Answer 21

Slower IV (low CO)
Faster inhalation (larger lungs from frc, air trapping?), but slower recovery

Question 22

How are NMBs affected? Which are most stable?

Answer 22

Steroid based are prolonged
Roc, vec, panc
Stable: nimbex, atracurium

Question 23

___ is the most sensitive test of renal function and drug clearance in the elderly

Answer 23

Cr cl

Question 24

What drugs exacerbate parkinsons?

Answer 24

reglan
Droperidol
Chlorpromazine
BENADRYL IS OK

Question 25

When does CC exceed FRC while supine?

Answer 25

45

Question 26

When does CC exceed FRC while standing?

Answer 26

65