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WEEK 7 SEM 4 > Homeostasis and disease presentation > Flashcards

Homeostasis and disease presentation Flashcards

1
Q

What needs to be maintained in homeostasis?

A

temperature, pH, glucose, water, electrolytes, oxygen, carbon dioxide

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2
Q

What is homeostenosis?

A

less ability to maintain homeostasis under stress because there is a decline in reserve capacity of an organ

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3
Q

What is frailty?

A

when a person can no longer manage homeostasis

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4
Q

For what conditions can a person be delirious/confused?

A

UTI
GI bleed
MI

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5
Q

Why can conditions cause delirium?

A

things like UTI, GI bleed and MI can cause delirium because they involve the release of catecholamines and inflammation mediators which can confuse the brain

also the anti-confusion reserves in the brain are being used up and are now available in less quantities.

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6
Q

What does the drug bendroflumethazide do?

A

thiazide diuretic acting on DCT blocking reabsorption of Na+/Cl-

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7
Q

What does the drug digoxin do?

A

Na+/K+ ATPase inhibitor= used for heart

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8
Q

What is the mechanism of aspirin?

A

COX inhibitor

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9
Q

What is ramipril?

A

ACE inhibitor

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10
Q

In kidney failure, what happens to the K+ levels?

A

increases

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11
Q

When you are dehydrated what happens to the blood volume?

A

it falls

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12
Q

When you are dehydrated what does the pituitary gland do?

A

produce ADH

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13
Q

How does ADH work?

A

aquaporins in the collecting duct
more water reabsorbed from the kidney
produce more concentrated urine in smaller volumes

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14
Q

What is the feedback loop for ADH

A

when water rises again there is negative feedback so ADH decreases

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15
Q

What are the structural changes in an ageing kidney?

A

kidney mass reduces (mainly from cortex)
more renal fat
fibrosis
sclerosis (stiffen bc of extra CT) in cortical nephrons

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16
Q

What are the functional changes of the kidney?

A

less blood flow to kidneys bc of fibrosis of the intima layer of vessels
impaired sodium excretion and conservation
less ability to concentrate or dilute the urine
less renin and aldosterone production
impaired recovery after kidney injury
reduced GFR
high creatinine in urine

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17
Q

What happens to the thirst response in people?

A

reduced response to thirst

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18
Q

How do geriatric patients present?

A 
instability
immobility
intellectual impairment
incontinence
iatrogenic
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19
Q

What are the consequences of immobility?

A

pressure ulcers

pneumonia

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20
Q

Why can immobility cause pneumonia?

A

lie flat all day- lungs not inflated to max capacity- person at higher risk of infection

21
Q

What are the causes of instability?

A

drugs, alcohol
age related changes- sarcopenia, visual impairment
medical problems
environment

22
Q

What is delirium?

A

clinical syndrome characterised by disturbed consciousness, cognitive function or perception that has an acute onset and fluctuating course.

23
Q

What is an osborn wave?

A

comes up in ECG after QRS complex

24
Q

Why is the osborn wave on an ECG seen?

A

hypothermia

25
Q

What is hypothermia?

A

impairment in balance between heat production and heat loss

26
Q

What is mild hypothermia?

A

core temp between 32 to 35 degrees

27
Q

What can mild hypothermia lead to?

A

Tachypnoea
tachycardia
ataxia
impaired judgement

28
Q

What is moderate hypothermia?

A

28-32 degrees

29
Q

What does moderate hypothermia cause?

A 
less pulse rate
less cardiac output
loss of reflexes
decreased renal flow
no shivering
cardiac problems- AF, bradycardia
30
Q

What is severe hypothermia?

A

below 28 degrees

31
Q

What does severe hypothermia cause?

A 
Pulmonary oedema
oliguria (low pee output)
no reflexes
coma 
hypotension
heart problems
32
Q

How is heat lost?

A

in the skin and lungs by:

radiation, conduction, convection, evaporation

33
Q

What does the body do in response to cold?

A

shiver, more thyroid, catecholamine, adrenal activity

34
Q

Why do elderly people have high risk of hypothermia?

A

less fat under their skin
not much shiver bc of sarcopenia
socially isolate selves
cognitive impairment

35
Q

What is elderly hypothermia treated with?

A

Medications like beta blockers, neuroleptics, alcohol and sedatives interfere with the physiological response to cold, for example it can stop the increase in CO and vasoconstriction

36
Q

What fraction of adults over 65 who live at home have at least 1 fall a year?

A

1/3rd of adults AND 1/2 of these will have more frequent falls

37
Q

What are the causes of falling and instability?

A

Drugs and alcohol
Age-related changes (e.g. gait changes, sarcopenia, visual impairment etc.)
Medical causes
Environmental causes

DAME

38
Q

What are the reversible causes of incontinence?

A

DIAPERS:

Delirium
Infection
Atrophic urethritis and vaginilitis
Pharmaceuticals
Psychiatric disorders esp. depression
Excessive urine output (e.g. due to heart failure or hyperglycaemia)
Restricted mobility
Stool impaction
39
Q

Where is heat generated from?

A

heart and liver = cellular metabolism

40
Q

Which of these organs control thermoregulation?

a) Kidney
b) Hypothalamus
c) Skin
d) Pancreas
e) Skeletal muscle

A

B,C,E

41
Q

Which of these problems can cause delirium?

a) Infection
b) Change in environment
c) Change in medication
d) Constipation
e) Ruptured Abdominal Aortic Aneurysm

A

All

42
Q

With regards to the ageing kidney which of these is correct?

a) The mass of the kidney increases
b) There is decreased renal fat
c) There is dilatation of the larger renal arteries
d) There is decreased aldosterone release
e) There is an increase in GFR

A

D

43
Q

What proportion of adults over 65 have at least one fall per year

a) ¼
b) 1/3
c) ½
d) 2/3
e) ¾

A

B

44
Q

Which of these are the “Geriatric Giants”

a) Immaturity
b) Instability
c) Intellectual impairment
d) Immobility
e) Illogical behaviour

A

B,C,D

45
Q

Which of these are reversible causes of urinary incontinence

a) Constipation
b) Immobility
c) Delirium
d) Depression
e) Heart failure

A

A,B,C,D (e?)

46
Q

What can cause delirium?

A

Precipitants – polypharmacy, illness, constipation, electrolyte or fluid imbalance, change in environment, seizure, pain

47
Q

What are the consequences of delirium?

A

Consequences – instability, immobility, need to stay longer in hospital or in critical care, dependence, death

48
Q

What can ramipril cause and what can you see in blood tests as a result of it?

A

If you are dehydrated and are on Ramipril, it can lead to an acute kidney injury- so will expect urea and creatinine to be high.

49
Q

The mass of kidney decreases mainly fro the cortex. What is within the cortex?

A

glomerulus
bowmans capsule
renal tubule
(EXCEPT LOOP OF HENLE AND COLLECTING DUCT)

WEEK 7 SEM 4 (7 decks)

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