GERIATRICS

Question 1

What two important changes in the autonomic nervous system (ANS) take place with aging?

Answer 1

A decrease in response to Beta- receptor stimulation and an increase in sympathetic nervous system activity.

Question 2

Why do geriatric patients have a decrease response to beta antagonists?

Answer 2

In the geriatric patient, the beta receptor has a reduced affinity for beta adrenergic receptors antagonists. Beta-adrenergic receptor agonists also show a reduced affinity for the beta-adrenergic receptor in the elderly.

Question 3

An elderly patient is supine. This position changes to sitting or standing. Blood pressure decreases but heart rate remains unchanged. Why?

Answer 3

Gravity causes blood to pool in dependent extremities when going from the recumbent to the sitting or standing position. Heart rate does not change because autonomic responses that maintain cardiovascular and metabolic homeostasis are progressively impaired in the elderly. known as AUTONOMIC DYSFUNCTION

Question 4

What is the most significant risk factor for developing cancer?

Answer 4

Old age

Question 5

1 MET is equal to

Answer 5

3.5 mLO2/kg/min

Question 6

2 questions to assess cardiac status

Answer 6

Can you walk up a flight of steps without stopping?

Are you able to walk 4 blocks without stopping?

Question 7

When does physiologic function begins to wane?

Answer 7

As early as 30

Question 8

Walking 2 blocks slowly is how many mets?

Answer 8

2

Question 9

How do you calculate metabolic equivalent?

Answer 9

Metabolic rate of specific physical activity / metabolic rate at rest.

Question 10

What happens to the response to hypercarbia and hypoxia in elderly

Answer 10

Decrease
because the central, carotid and aortic chemoreceptors are less sensitive to alternations in pH, PaCo2, PaO2 leading to increase risk for respiratory failure.

Question 11

What happens to protective airway reflexes an upper airway tone in the elderly?

Answer 11

Decreased

Question 12

Lung elasticity in the elderly is

Answer 12

Decreased

Question 13

What happens with RV in the older patient?

Answer 13

Increased

Question 14

Closing capacity surpasses FRC at ____in the supine and ______when standing

Answer 14

45 sit; 65 stand (At 45 you sit and listen at 65 you stand and raise hell)

Question 15

Why does the TLC remains unchanged in the elderly?

Answer 15

IBecause of the increase in RV and reduction in VC

Question 16

3 main respiratory changes in the elderly the increase? FRC

Answer 16

FRC
RV
Closing capacity

Question 17

Main respiratory changes in the elderly the decrease?

Answer 17

Decrease Vital capacity

Question 18

FEV & FEV 1 in the elderly

Answer 18

Decrease (loss of lung elastic recoil favors airway collapse during forced exhalation)

Question 19

Most common coexisting disease in the elderly

Answer 19

Cardiac disease

Question 20

4 most common condition in the elderly

Answer 20

HTN
CAD
CHF
MI

Question 21

What is the best indicator of cardiac Reserve?

Answer 21

Exercise tolerance

Ability to perform physical ADLs

Question 22

What is the most common cause of death in the postop period?

Answer 22

MI

Question 23

What happens to collagen in the elderly ? What about elastin?

Answer 23

Collagen INCREASES

Elastin is lost

Question 24

What happens to arterial compliance and venous compliane?

Answer 24

They are both decrease

Question 25

Arterial compliance decreases , what does that cause?

Answer 25

increase SVR and afterload

Question 26

Venous compliance decreases , what does that cause?

Answer 26

Changes in blood volume cause drastic changes in preload.

Question 27

What happens to BP with aging?

Answer 27

Increase

Question 28

Systolic FUCTION in the elderly***

Answer 28

NO CHANGE

Question 29

How is Maximal HR is calculated

Answer 29

220 - age

Question 30

SV in the elderly

Answer 30

Diminish ability to increase SV

Question 31

Heart, SV and CO in the elderly

Answer 31

Decrease

Question 32

What happens to the circulation time with the elderly? why?

Answer 32

Decrease; decreased CO

Question 33

ANS : What process is associated with the NORMAL aging process

Answer 33

Autonomic dysfunction

Question 34

NE concentration in the plasma, SNS tone?

Answer 34

Higher NE concentration in the plasma

Question 35

Elderly response to catecholamines

Answer 35

Decrease

Question 36

Autonomic function in the elderly is

Answer 36

Decrease

Question 37

Few things that increase risk of hypothermia?

Answer 37

Shivering increases VO2 Increased blood loss impaired drug metabolism Vasoconstriction increase afterload.

Question 38

MAC and aging: % and age

Answer 38

MAC decreases 6% for every decade after 40

Question 39

IV induction dosage with the elderly

Answer 39

Doses should be reduced 30-40%

Question 40

Alzheimer's disease is a disease associated with

Answer 40

decrease Act

Question 41

Parkinson's disease is a disease associated with

Answer 41

Decrease dopamine in the BASAL GANGLIA

Question 42

Brain mass and aging

Answer 42

Reduced but does not affect mental capacity

Question 43

Most common CNS complication in the elderly during preoperative period?

Answer 43

Postoperative Delirium

Question 44

Postoperative delirium vs Postoperative cognitive dysfunction onset

Answer 44

Delirium - Early onset | POCD- Wks to months after surgery.

Question 45

Postoperative delirium vs Postoperative cognitive dysfunction Presentation

Answer 45

Delirium - Easy to identify (disordered behavior, perception, memory, psychomotor skills. POCD: Subtle and difficult to pinpoint (impaired concentration , comprehension , psychomotor skills)

Question 46

Risk FACTORS of POST Op Delirium: | DELIRIUM

Answer 46

``` Drugs (anesthetic agents) Electrolyte imbalance Lack of drugs (Withdrawal) Infection Reduced sensory input Intracranial dysfunction Urinary retention and fecal impaction Myocardial event, male gender ```

Question 47

What is the most important risk factor for POCD?

Answer 47

Advanced Age

Question 48

What is the top 3 risk factors for Post operative cognitive dysfunction?

Answer 48

Advanced age pre-existing cognitive deficit cardiac surgery Long duration surgery

Question 49

Treatment of delirium vs treatment of POCD?

Answer 49

Delirium Treatment: Treat underlying cause, antipsychotics , minimize polypharmacy POCD: no specific treatment, mild cases resolve in about 3 months.

Question 50

Elderly and sensitivity of nerve tissue to LA

Answer 50

Increased

Question 51

Sensitivity of elderly to intrathecal anesthetics

Answer 51

Decrease CSF volume --> greater spread of LA so decrease the dose.

Question 52

Sensitivity of elderly to epidural anesthetics

Answer 52

Decrease epidural space volume --> greater spread of LA so decrease the dose.

Question 53

Serum creatinine level in the elderly ***

Answer 53

NO CHANGE

Question 54

Na+ handling and the elderly

Answer 54

Na+ handling is impaired.

Question 55

GFR and aging

Answer 55

GFR decreases with age

Question 56

Creatinine does NOT CHANGE in elderly why?

Answer 56

GFR decreases, which should cause an increase in creatinine. But muscle mass decreases with age and that means less creatinine is produced. The 2 processes cancel each other out.

Question 57

What is POOR indicator of renal function in the elderly?

Answer 57

Serum Cr.

Question 58

What happens to Creatinine clearance in the elderlY?

Answer 58

Decreased

Question 59

What is the most sensitive indictor of renal function and drug clearance in the elderly>

Answer 59

Creatinine Clearance

Question 60

Renal mass in the elderly and its impact?

Answer 60

Loss of mass = loss of functioning glomeruli = loss of nephrons.

Question 61

GFR decrease with aging, what is the rate

Answer 61

Decrease by 1 ml/min/year after age 40

Question 62

Elimination of hydrophillic drugs and elderly

Answer 62

Decrease elimination of hydrophilic drugs

Question 63

Elimination of hydrophillic drugs metabolites and elderly

Answer 63

decrease

Question 64

At what age should you consider dosage adjustments

Answer 64

Age > 60

Question 65

Aldosterone in the elderly; response to acid load in the elderly

Answer 65

Both Decrease

Question 66

ADH in the elderly

Answer 66

Decrease, surgical stress increase ADH but the elderly have a reduced response to ADH.

Question 67

Hepatocellular function in the elderly is

Answer 67

NORMAL no changes

Question 68

Hepatic Mass in the elderly and its impact

Answer 68

Less hepatic mass = less total enzyme produced.

Question 69

Hepatic blood flow in the elderly and its impact

Answer 69

Decrease meaning that less drug or toxin is delivered to the liver per unit of time.

Question 70

Preoperative hepatic function of the elderly>

Answer 70

Reduced as a RESULT OF DECREASE BLOOD FLOW AnD LIVER MASS not because of impaired hepatocellular function .

Question 71

Alpha 1 acid glycoprotein production in the elderly is

Answer 71

Increased

Question 72

Albumin production in the elderly is

Answer 72

Decreased

Question 73

Pseudocholinesterase production is _____What is the significance of that?

Answer 73

Decreased | Prolonged duration of succinylcholine and ester LA.

Question 74

Phase I reactions in the elderly is ______and phase II reactions are

Answer 74

Decrease; no change in phase 2 reactions

Question 75

First pass metabolism in the elderly and its significance?

Answer 75

Due to reduced hepatic mass and liver blood flow Increase concentration of drugs with HIGH PASS metabolism Decrease concentration of drugs that require LIVER FOR ACTIVATION.

Question 76

Circulation time in the elderly is decreased; how does that affect IV induction and inhalation induction?

Answer 76

IV induction slowed | Inhaled induction fast

Question 77

Surface area to body mass ratio in the elderly?

Answer 77

Reduced lean body mass

Question 78

Total body fat in the elderly

Answer 78

Increased Vd of lipophilic drugs -> larger reservoir prolong their elimination

Question 79

Free fraction of drugs that binds to albumin (acidic drugs) is

Answer 79

InCREASED

Question 80

Free fraction of drugs that binds to basic drugs is s

Answer 80

DECREASED

Question 81

Why is the rate of recovery for volatile anesthetic decrease in the elderly?

Answer 81

Increased total body fat Decreased gas exchanged Decrease hepatic metabolism

Question 82

In the elderly, the decrease in Beta-receptor responsiveness is secondary to both

Answer 82

decreased receptor affinity and alterations in signal transduction

Question 83

In the elderly patient, total body water ______while total body fat ______

Answer 83

decreases ; increases.

Question 84

Thus, the volume of distribution for water-soluble drugs such as glycopyrrolate, succinylcholine, and gentamicin

Answer 84

decreases

Question 85

While the volume of distribution for lipid-soluble drugs such as barbiturates, benzodiazepines, and volatile anesthetics

Answer 85

increases.

Question 86

The duration of action of midazolam is increased in the elderly. The clearance of the drug is reduced by as much as

Answer 86

30 percent due to a decrease in hepatic mass and perfusion.

Question 87

The duration of action of midazolam is _____ in the elderly.

Answer 87

increased

Question 88

Liver and kidney function in the elderly

Answer 88

Decreased renal function and decreased hepatic function

Question 89

Hepatic function in the elderly is

Answer 89

decreased

Question 90

Write an equation that shows how the Pa02can be estimated for a given age. Predict the Pa02 of a 78-year-old patient

Answer 90

Pa02 =102-Age/3.

Question 91

How does the arterial blood-alveolar partial pressure C02 difference (Pa- COrPAC02) change with age? Why?

Answer 91

Increase in V/Q mismatching with age.

Question 92

Will muscle relaxants that are eliminated by renal or hepatic mechanisms have a shortened or prolonged elimination half· life in the geriatric patient?

Answer 92

Prolonged, because ofreduced renal and hepatic function

Question 93

About the postoperative fluid status of an elderly patient with a history of congestive heart failure. On what postoperative day would you expect third space fluid to mobilize into the vascular system?

Answer 93

Day 2 . Third-space fluid begins to mobilize into the vascular space on postoperative day two. It is important to evaluate the elderly patient for signs of fluid volume excess such as rales, crackles, tachypnea, and orthopnea.

Question 94

Elderly signs of fluid volume excess

Answer 94

Rales, crackles, tachypnea, and orthopnea.

Question 95

The decrease in total body water that occurs with aging is primarily due to

Answer 95

A decrease in muscle mass

Question 96

Which of the following alterations would you expect to see in a patient treated with acetylcholinesterase inhibitors for Alzheimer's disease?

Answer 96

They will exhibit a resistance to nondepolarizing muscle relaxants due to the use of acetylcholinesterase inhibiting drugs as part of their medical management. They will also exhibit a longer duration of action with succinylcholine.

Question 97

What primarily explains the prolonged duration of midazolam in an elderly patient?

Answer 97

decreased hepatic perfusion

Question 98

By age 80, the number of functioning nephrons has decreased by. Bone density decreases significantly with age, increasing the risk for fractures. Although hepatic mass decreases significantly, baseline hepatic function remains well preserved with age.

Answer 98

50 percent

Question 99

Lean muscle mass and aging

Answer 99

decreases with age

Question 100

With age, renal cortical mass decreases by as much as

Answer 100

Renal cortex lowers by 20-25 percent with age.