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Geriatrics > Lecture 3 - common systemic diseases > Flashcards

Lecture 3 - common systemic diseases Flashcards

1
Q

what is the most common cause for hospitalization and is the leading cause of death in the elderly?

A

cardiovascular conditions = HTN, coronary artery disease, calcified aortic stenosis, atrial fibrillation, congestive heart failure and anemia

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2
Q

what are normal cardiovascular aging changes?

A

decrease in cardiac functional reserve capacity, limited physical activity, and less ability to tolerate stress

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3
Q

what are abnormal cardiovascular aging changes?

A

hypercholesterolemia, HTN, coronary artery disease, carotid artery disease, vertebrobasilar insufficiency, peripheral vascular disease, heart failure, atrial fibrillation, and valvular heart disease

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4
Q

what are the cardiovascular lab tests?

A

lipid profile (total cholesterol, HDL, LDL, triglycerides), CBC, CBC with differential, ESR and CPR

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5
Q

what does a CBC with differential measure?

A

percentage of WBC components - maker of inflammation, immune response, allergic reaction and hematologic

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6
Q

what does ESR measure?

A

non-specific inflammation, infection and neoplasm (elevated in GCA, vasculitis, waldenstrom macroglobulinemia, metastatic cancer and chronic infection)

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7
Q

what does CRP measure?

A

general marker of inflammation and inflammation secondary to infection (also lymphoma, immune system diseases and GCA) - significant association with cardiovascular disease (atherosclerosis and risk of cardiovascular events)

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8
Q

what is atherosclerosis the leading cause of?

A

heart disease, stroke, and renal failure

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9
Q

what causes atherosclerosis?

A

blood vessel stenosis, thrombus and emboli

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10
Q

what are some risk factors for atherosclerosis?

A

high blood lipid levels, DM dyslipidemia, HTN, low HDL, central fat retention, elevated homocysteine levels, tobacco and male gender

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11
Q

what are the symptoms of atherosclerosis?

A

none initially - later affects the organs

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12
Q

what is the location of atherosclerosis?

A

intima of blood vessels - often at bifurcations

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13
Q

what is an atheroma?

A

an accumulation of lipoproteins (cholesterol) and cellular debris - center becomes necrotic and forms foam cell and has a fibrous cap

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14
Q

what is the composition of an atheroma?

A

necrotic core, abnormal smooth muscle cells, immune cells (monocytes, macrophages, mast cells), fibrous cap

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15
Q

what is the composition of a thrombus or embolus?

A

fibrin, platelet, red blood cells

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16
Q

how does a thrombus form from an atheroma?

A

the atheroma starts to cause stenosis/thinning and causes more stress on the endothelial cells = fibrous cap bursts creating a thrombus

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17
Q

what are the 3 types of emboli?

A

blood (thromboembolism), cholesterol pieces, and calcium pieces

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18
Q

how do you diagnose atherosclerosis?

A

blood cholesterol levels

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19
Q

what is the management for atherosclerosis?

A

prevention (modify risk factors), control lipid levels (statins, fibrates, nicotinic acid, fish oil, folic acid), lifestyle changes (weight loss, exercise, reduce fat/sugar, stop smoking/alcohol)

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20
Q

what are 2 causes of hypertension?

A

lifestyle factors and comorbidities

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21
Q

what are the 2 types of hypertension?

A

essential (idiopathic/primary) and secondary (renal disease, aldosteronism, cushing’s, pheochromocytoma, pre-eclampsia)

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22
Q

what is the definition of hypertension?

A

systolic BP of 120mmHg or greater and/or diastolic BP of 80mmHg or greater (measured on 2 or more clinical occasions after initial screen)

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23
Q

what are some risk factors for HTN?

A

age, genetics, obesity, race, male gender, hypercholesteremia, DM, physical inactivity, salt sensitivity, smoking, excessive alcohol and low vitamin D levels

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24
Q

what organs are affected in HTN?

A

heart (increases workload), brain, kidney, and retina

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25
Q

what are the symptoms of HTN?

A

none

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26
Q

what are the JNC 8 guidelines for patients under 30-60?

A

diastolic less than 90mmHg

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27
Q

what are the JNC 8 guidelines for patients over age 60?

A

systolic less than 150 and diastolic less than 90 unless (tolerating treatment at lower level, has chronic kidney disease, or has DM)

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28
Q

what is the clinical approach to treating HTN?

A

diuretics - if no improvement add beta-blocker/ACE inhibitor/angiotensin receptor agonist
if cannot tolerate diuretic use calcium channel blocker - if calcium channel blocker doesn’t work add ACE inhibitor or beta-blocker

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29
Q

what are the 2 types of coronary artery disease?

A

atherosclerosis of coronary arteries = ischemic heart disease and acute myocardial infarction

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30
Q

what are the risk factors for coronary artery disease?

A

atherosclerosis, HTN, smoking and anemia

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31
Q

what are the characteristics of ischemic heart disease?

A

chronic, caused by atherosclerosis, symptomatic, risk for MI, normal EKG and treatment is prevention of vessel ischemia

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32
Q

what are the characteristics of acute myocardial infarction?

A

acute, caused by atherosclerosis/thrombosis/embolism, may be asymptomatic, at risk for another MI, abnormal EKG, treatment is to open vessels and break thrombus down

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33
Q

what is the work-up for ischemic heart disease?

A

electrocardiogram, stress tests, echocardiogram, coronary arteriography

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34
Q

what is the treatment of ischemic heart disease?

A

treat atherosclerosis, medications (vasodilators/nitrates, beta-blockers, ASA) and surgery (CABG)

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35
Q

what are the symptoms of MI?

A

pain in center of chest, nausea/vomiting, anxiety, shortness of breath, feelings of impending doom

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36
Q

what is the work-up for MI?

A

appearance (pale skin, sweating, cool extremities), physical (pulse/BP normal, positive heart sounds), ECG-ST elevation with production of Q waves, echocardiogram

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37
Q

what is the treatment for MI?

A

defibrillation, ASA, nitroglycerin (pain), medications (antithrombolytic agents, beta-blockers, ACE inhibitors, long-term ASA, heparin, plavix) or surgery (angioplasty or CABG)

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38
Q

what is carotid artery disease?

A

blockage of the carotid artery - high risk for transient ischemic attack, stroke, CRAO = caused by atherosclerosis or thrombus

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39
Q

what is the work-up for carotid artery disease?

A

carotid duplex scan and cerebral antiography

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40
Q

what is the treatment for carotid artery disease?

A

atherosclerosis management, medication (anti-platelet agents = ASA, plavix) and surgical (carotid endarterectomy or carotid stent)

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41
Q

what is vertebrobasilar insufficiency?

A

atheroma or occlusion may block basilar and/or vertebral artery = causes TIA or CVA

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42
Q

what is peripheral vascular disease?

A

segmental occlusion of the medium/large arteries, including aorta, iliac, femoral, popliteal, tibial, peroneal

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43
Q

what causes peripheral vascular disease?

A

atherosclerosis, DM, HTN, hyperlipidemia, smokers, and elderly

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44
Q

what are the symptoms of peripheral vascular disease?

A

pain/fatigue in leg muscles (intermittent claudication) worse with exercise, relieved by rest

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45
Q

what is the work up for peripheral vascular disease?

A

absent pulses distal to the obstruction, may be bruit over site of obstruction, hair loss, thickened nails, doppler flow studies, duplex ultrasound and stress test

46
Q

what is the treatment for peripheral vascular disease?

A

treatment of underlying conditions, ASA, revascularization with stents, and bypass

47
Q

what causes heart failure?

A

DM, coronary artery disease, HTN, myocardial infarction, aortic valve stenosis, smoking

48
Q

what is the diagnostic test for heart failure?

A

echocardiogram

49
Q

what is the treatment for heart failure?

A

treat underlying condition

50
Q

what causes atrial fibrillation?

A

electrophysiological changes in the heart (tachycardia = >100bpm - causes decreased ejection of the atrial chamber of the heart

51
Q

what are people with atrial fibrillation at greater risk for?

A

stroke or ocular embolism

52
Q

what are the signs/symptoms of atrial fibrillation?

A

angina, syncope, embolization, fatigue, palpitations, and anxiety

53
Q

how do you diagnose atrial fibrillation?

A

ECG (3 or more abnormal readings)

54
Q

what is the treatment for atrial fibrillation?

A

treat underlying factors, restore normal sinus rhythm by electrical cardioconversion, slow ventricular rate (beta-blockers, calcium channel antagonists) and anticoagulants to prevent clots (warfarin, ASA)

55
Q

what are bradyarrhythmias?

A

caused by electrophysiological changes in the heart (bradycardia =

56
Q

what causes bradyarrhythmias?

A

drugs (sympathetic decreased - beta-adrenergic receptors or parasympathetic increased - muscarinic receptors) = can cause heart block or death

57
Q

what are the symptoms of bradyarrhythmias?

A

dizziness, fatigue, syncope

58
Q

what is the treatment for bradyarrhythmias?

A

IV atropine, isoproterenol, pacemaker

59
Q

what is valvular heart disease?

A

calcification of the valves (common) and endocarditis from mitral valve prolapse (rare)

60
Q

what can valvular heart disease cause?

A

MI, CVA, ocular embolism

61
Q

what are the diagnostic tests for valvular heart disease?

A

echocardiogram and CT scan

62
Q

what is the treatment for valvular heart disease?

A

surgical, if infectious give antibiotics

63
Q

what are the diagnostic tests for cardiovascular disease?

A

BP, heart rate, electrocardiogram, echocardiogram, carotid doppler

64
Q

what is an ECG (electrocardiogram)?

A

provides graphical representation of electrical impulses that the heart generates during the cardiac cycle = used to determine cardiac electrical problems

65
Q

when is an ECG (electrocardiogram) used?

A

arrhythmias (MI, conduction problems, pulmonary embolis)

66
Q

what is an echocardiogram?

A

heart ultrasound to evaluate structure and function of heart = used to determine if structural problems are present

67
Q

when is an echocardiogram used?

A

valve problems, thrombi present, chamber problems

68
Q

what is a carotid doppler?

A

ultrasound of the carotid arteries

69
Q

when is a carotid doppler used?

A

to diagnose carotid plaques or stenosis

70
Q

if a patient is taking 81mg ASA what should you ask about?

A

if they have had a stroke or heart attack = common for prevention or for maintenance after MI/CVA

71
Q

how is cancer related to aging?

A

increase in prevalence with age = cancer biology directly linked to cellular aging (genetic mutations/instability, telomere shortening, chemical mutations, radiation exposure, free radical development, reduced immune response, chronic inflammation, virus exposure)

72
Q

what is a major cause of mortality and morbidity in the elderly?

A

cardiovascular accident (CVA/stroke)

73
Q

what are the 2 types of cardiovascular accidents?

A

ischemic (2/3) = lack of blood flow to area (thrombus/emboli)
hemorrhagic (1/3) = bleed in brain

74
Q

what are the risk factors for cardiovascular accidents?

A

HTN, hyperlipidemia, atrial fibrillation, DM, carotid stenosis, smoking, temporal arteritis

75
Q

what are the sudden signs of a stroke?

A

FAST = face drooping, arm weakness, speech difficulty, and time to call 911 (time is very important)

76
Q

what is a transient ischemic attack (TIA)?

A

episode that indicates a stroke but only lasts 30 minutes - if recur it is likely brain thrombosis, if recur but different symptoms likely extracranial (heart) emboli

77
Q

what is the work up for an acute stroke?

A

stroke work up, urgent CT or MRI, lab tests

78
Q

what is the treatment for an acute stroke?

A

immediate fibrinolytic therapy

79
Q

what is the secondary preventative therapy for a stroke?

A

antiplatelet therapy (ASA, plavix, dipyridamole)

80
Q

what is the cause if the transient vision loss is monocular during a stroke/TIA?

A

carotid disease

81
Q

what is the cause if the transient vision loss is binocular during a stroke/TIA?

A

vertebrobasilar insufficiency

82
Q

what are the causes of ocular signs during a stroke/TIA?

A

any condition that causes an emboli to go to the brain/centers of vision, atherosclerosis = vascular insufficiency, cardiac arrhythmia

83
Q

what are the diagnostic tests for a stroke/TIA that causes ocular signs?

A

blood work if suspect GCA, blood work to rule out other causes, carotid doppler scan, echocardiogram
diagnostic testing then eye exam

84
Q

what is the cause of the stroke/TIA if there is diplopia present?

A

verebrobasilar insufficiency

85
Q

what is the difference between a mass and a stroke?

A

both are acute - stroke is sudden and has clear signs vs. a mass which is gradual with unclear signs
both need imaging and a neurology consult

86
Q

what is the most common lung disease in the elderly?

A

COPD = inflammation of the airways - mucous plugs obstruct airway

87
Q

what is the symptom of COPD?

A 
dyspnea = shortness of breath
advanced = weight loss, muscle loss, decreased strength
88
Q

what is the difference between emphysema and chronic bronchitis?

A

emphysema = permanently enlarged airspaces

chronic bronchitis = productive, persistent cough

89
Q

what are the causes of COPD?

A

dust, smoking, air pollution, toxic gases, pulmonary infections, reduced antioxidant intake, genetic predisposition

90
Q

what are the treatments for COPD?

A

smoking cessation, bronchodilators, inhaled corticosteroids, rarely systemic corticosteroids, oxygen supplementation

91
Q

what is obstructive sleep apnea?

A

recurrent collapse of the airway during sleep = cessation of airflow (apnea/hyponea), intermittent disturbances in gas exchange, fragmented sleep

92
Q

what are the risk factors for sleep apnea?

A

older age, male, obesity, craniofacial or upper airway soft tissue abnormalities, daytime congestion problems, cardiovascular problems, metabolic syndrome

93
Q

what is the treatment for sleep apnea?

A

weight loss, CPAP machine

94
Q

why should you be worried if the PPD test is negative in the elderly?

A

most causes of TB are elderly and the PPD test is less sensitive - if high suspicion, retest in 2 weeks (signs may be different)

95
Q

how does penumonia/influenza cause mortality in the elderly?

A

usually due to secondary complications = other infections, worsening of other chronic disease (congestive heart failure or COPD)

96
Q

what are the symptoms of pneumonia?

A

fever, cough, dyspnea

97
Q

how do you diagnose pneumonia? what is the treatment?

A

chest x-ray, sputum culture, blood cultures

antibiotics

98
Q

what is metabolic syndrome?

A

obesity, impaired glucose tolerance, high BP, high triglycerides, risk of developing DM

99
Q

what are the symptoms of DM in the elderly?

A

no polyuria or polydipsia (increased threshold for glucose in kidney), falls, failure to thrive, urinary incontinence, delerium

100
Q

what does the initial presentation of DM look like in the elderly?

A

often based on lab work - concurrent with other findings (MI/stroke, vision changes, retinal hemes in routine eye exam)

101
Q

what are some complications in untreated hypothyroidism?

A

heart problems, thyroid eye disease

102
Q

what are some complications in untreated hyperthyroidism?

A

congestive heart failure, stroke, infection, thyroid eye disease

103
Q

what are some symptoms of thyroid disease in the elderly?

A

fatigue, muscle weakness, weight loss and atrial arrhythmias (not = heat intolerance, sinus tachycardia, sweating, tremor)

104
Q

what tests are included in thyroid panel?

A

THS - T4 (total or free) - T3 (total or free), anti-thyroid antibodies

105
Q

what are the treatments for thyroid disease?

A 
hypothyroid = levothyroxine 
hyperthyroid = beta-blockers or thionamides
106
Q

what is osteoporosis?

A

low bone mass as a result of aging - higher rates in women after menopause

107
Q

how do you diagnose osteoporosis and what is the treatment?

A 
diagnosis = bone density scan (DEXA)
treatment = exercise, calcium, bisphosphates, estrogen, calcitonin
108
Q

what is osteoarthritis?

A

degenerative joint disease - idiopathic or secondary

109
Q

what is the treatment for osteoarthritis?

A

palliative not curative = exercise, weight loss, patient education, acetaminophen, NSAID, capsaicin, glucocorticoid injections

110
Q

what is the treatment for benign prostate hyperplasia (BPH)?

A

alpha-1 antagonists = relax neck of bladder
5-alpha-reductase inhibitors
PDE-5 inhibitors or antimuscarinics

111
Q

what are the risk factors for BPH?

A

age, smoking, co-morbidities

Geriatrics (3 decks)

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