Geriatrics

Question 1

What is the cardiac output at rest?

Answer 1

There is no change to cardiac output (heart rate x stroke volume).

Question 2

What happens to maximum heart rate with exertion in the elderly?

Answer 2

There is an overall reduction in maximum heart rate.

Question 3

What is diastolic dysfunction in elderly individuals primarily caused by?

Answer 3

Reduced left ventricular compliance (stiffness) leads to impaired diastolic filling and stroke volumes.

Question 4

What is the most common valvular abnormality prior to 65 years of age?

Answer 4

Mitral regurgitation.

Question 5

What valvular disease becomes the leading valve disease after age 65?

Answer 5

Aortic stenosis.

Question 6

What does arteriosclerosis promote in elderly patients?

Answer 6

Arterial wall thickening and calcium deposition.

Question 7

What is the leading risk factor for stroke and ischemic heart disease in the elderly?

Answer 7

Hypertension.

Question 8

What structural changes occur in the lungs of the elderly?

Answer 8

Loss of elastic recoil and decrease in vital capacity.

Question 9

What happens to the glomerular filtration rate (GFR) with age?

Answer 9

GFR falls by approximately 10% per year.

Question 10

What is the normal GFR for a 70-year-old person?

Answer 10

Less than 90 mL/min.

Question 11

What effect does aging have on sodium concentration in the kidney?

Answer 11

The kidney loses the ability to concentrate sodium.

Question 12

What is a common result of the loss of estrogen in elderly women?

Answer 12

Uterine and vaginal atrophy.

Question 13

What percentage reduction in liver blood flow occurs with aging?

Answer 13

30% reduction.

Question 14

What happens to blood glucose levels as people age?

Answer 14

Blood glucose levels rise.

Question 15

What is sarcopenia?

Answer 15

Reduced muscle mass due to muscle cell atrophy.

Question 16

What cognitive condition is strongly correlated with frailty?

Answer 16

Dementia.

Question 17

What percentage of elderly people in the community have suffered a fall?

Answer 17

One in three.

Question 18

What are the two major types of falls in the elderly?

Answer 18

• Syncopal falls * Non-syncopal falls.

Question 19

What can increase the risk of non-syncopal falls?

Answer 19

Previous falls, cognitive impairment, visual loss.

Question 20

What is the most effective way to reduce the risk of falls?

Answer 20

Balance and exercise training.

Question 21

What is the most feared complication of falls in the elderly?

Answer 21

Hip fracture.

Question 22

What is the role of the detrusor muscle in the bladder?

Answer 22

Contraction of the muscle forces the bladder to empty.

Question 23

What innervates the external urethral sphincter?

Answer 23

Pudendal nerve (S2-S4) under voluntary control.

Question 24

What neurotransmitter mediates detrusor contraction during bladder emptying?

Answer 24

Acetylcholine.

Question 25

What is the function of the internal urethral sphincter?

Answer 25

Constricts to inhibit outflow during bladder filling.

Question 26

What is a common cause of syncope in the elderly?

Answer 26

Cardiac arrhythmia.

Question 27

What happens to the bioavailability of prodrugs in the elderly?

Answer 27

It is reduced due to decreased hepatic blood flow.

Question 28

What is the effect of aging on first pass metabolism?

Answer 28

There is a reduction in first pass metabolism.

Question 29

What changes occur in total body fat and water with aging?

Answer 29

* Increase in total body fat * Reduction in total body water.

Question 30

What is the Rockwood Frailty Score used for?

Answer 30

To assess the accumulation of deficits in elderly patients.

Question 31

What is the clinical significance of sarcopenia?

Answer 31

It is a key clinical finding associated with frailty.

Question 32

What is the relationship between polypharmacy and falls in the elderly?

Answer 32

Polypharmacy, especially with psychotropics, increases fall risk.

Question 33

What are some complications of falls in elderly populations?

Answer 33

* Neck of femur fracture * High mortality rates.

Question 34

What is the recommended management for patients after a fall?

Answer 34

Address the reason for the fall and manage its consequences.

Question 35

What is the role of the pelvic nerve in detrusor control?

Answer 35

Contraction and urethral relaxation via the pelvic nerve arising from S2-S4 using muscarinic receptors on their target muscle cells.

Question 36

What is the sympathetic control of detrusor relaxation during bladder filling?

Answer 36

Noradrenaline/Beta-0 via the hypogastric nerve from T11-L2.

Question 37

What is the parasympathetic control of detrusor contraction during bladder emptying?

Answer 37

Acetylcholine/M2,M3 via the pelvic nerve.

Question 38

What is the prevalence of urinary incontinence in community-residing elderly people?

Answer 38

15-36%.

Question 39

What are some common risk factors for urinary incontinence?

Answer 39

* Obesity * Constipation * Diabetes * Bladder irritants (tea, coffee, juice, alcohol)

Question 40

What is stress incontinence and who is most affected?

Answer 40

Most common in women following childbirth; men affected after radical prostatectomy.

Question 41

What are the common risk factors for stress incontinence?

Answer 41

* Obesity * Chronic cough * Sneezing * Chronic abdominal straining * Squatting

Question 42

What occurs with a spinal cord lesion above the sacrum in relation to bladder control?

Answer 42

Impairment of the brain-bladder response; loss of somatic control of continence.

Question 43

What are the key investigations for all causes of incontinence?

Answer 43

Exclusion of urinary tract infection and urodynamic studies.

Question 44

What are the components of urodynamic studies considered the gold standard?

Answer 44

* Urinary flowmetry * Electromyography (EMG) of detrusor activity * Pressure measurements * Post void residual volume measurements

Question 45

What is the first line management for urge incontinence?

Answer 45

* Lifestyle modification * Exclusion and treatment of urinary tract infection * Avoidance of bladder irritants * Weight loss

Question 46

What is bladder retraining?

Answer 46

Voiding at set times only, increasing time interval between voiding, focusing on somatic control.

Question 47

What is the role of antimuscarinics in pharmacotherapy for urge incontinence?

Answer 47

Used to decrease bladder contraction stimulated by parasympathetic pelvic nerves.

Question 48

What is the primary risk factor for Alzheimer's Disease (AD)?

Answer 48

Advancing age.

Question 49

What genetic mutations are associated with Alzheimer's Disease?

Answer 49

* Amyloid precursor protein - chromosome 21 * Presenilin 1 and 2 * Alterations in Apolipoprotein E (e4 allele)

Question 50

What are the characteristic pathophysiological features of Alzheimer's Disease?

Answer 50

* Generalized cortical and subcortical neuronal loss * Atrophy of frontal, temporal, and parietal lobes * Amyloid plaques * Neurofibrillary tangles

Question 51

What are amyloid plaques composed of?

Answer 51

Beta-amyloid proteins that fold abnormally and produce plaques outside neuronal cell bodies.

Question 52

What are neurofibrillary tangles made of?

Answer 52

Aggregates of phosphorylated tau protein.

Question 53

What are common clinical features used to diagnose Alzheimer's Disease?

Answer 53

* Impaired memory * Impaired language * Impaired visuospatial skills * Impaired orientation

Question 54

What lifestyle factors may reduce the risk of Alzheimer's Disease?

Answer 54

* Regular exercise * Reading * Intellectually stimulating games * Mediterranean diet

Question 55

What is the role of cholinesterase inhibitors in managing Alzheimer's Disease?

Answer 55

Increase synaptic concentrations of acetylcholine for mild-moderate AD.

Question 56

What are common adverse effects of cholinesterase inhibitors?

Answer 56

* Bradycardia * Hypotension * Diarrhea * Hypersecretion of salivary and lacrimal glands

Question 57

What is the prognosis for Alzheimer's Disease?

Answer 57

Progressive neurodegenerative disorder; average life expectancy from diagnosis is 4-12 years.

Question 58

What are common causes of delirium?

Answer 58

* Infections (e.g., urinary tract infections) * Pain * Hypoxia * Medications * Metabolic derangements * Neurological insults

Question 59

What is the definition of delirium?

Answer 59

A syndrome encompassing a disturbance of cognition, attention, and consciousness that fluctuates over time.

Question 60

What are effective non-pharmacological strategies for managing delirium?

Answer 60

* Family member visits * Providing a single room * Repeated orientation * Optimizing light conditions

Question 61

What are the key characteristics of Lewy Body Dementia?

Answer 61

* Progressive cognitive decline * Hallucinations * Movement disorders (Parkinsonism) * Autonomic dysfunction