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MC II > MC III Exam 1 > Flashcards

MC III Exam 1 Flashcards

1
Q

What was the affect of >10 days spent in bed rest for healthy older adults?

A

substantial loss of LE strength, power and aerobic capacity. NO statistical difference in physical performance tests

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2
Q

Are older adults who develop new functional deficits likely to recover lost function?

A

no- less likely that they will regain that function

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3
Q

factors included w/ physiologic changes due to aging

A 
decreased muscle strength and aerobic capacity
vasomotor instability
decreased bone density
decreased ventilation 
decreased sensory continence
altered thirst and nutrition
fragile skin
tendency to urinary incontinence
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4
Q

factors occurring due to deconditioning

A

decreased strength/endurance
orthostatic hypotension/syncope
decreased aerobic capicty= decreased HR/SV/CO
accelerated bone loss leading to osteopenia/osteoporosis
decreased lung volumes and gas exchange leading to increased WOB
sensory deprivation/isolation leads to altered MS/delirium

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5
Q

What is a negative statistic associated w/ delirium in the hospital?

A

have 3x more likely chance that they will die in the hospital

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6
Q

What is the leading complication of hospitalization for the elderly

A

functional decline: occurs in 34-50% of hospitalized older adults and often occurs by day 2

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7
Q

does the functional decline experienced by older adults during hospitalization improve?

A

less likely to recover lost function- about 25% reduction in VO2 within 20 days in 1966- never reached point of initial oxygen uptake function- clearly demonstrates reversibility of training

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8
Q

what happens to CO during bed rest?

A

CO is decreased due to overall decrease in SV. HR increases to compensate for decrease in SV

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9
Q

changes in blood volume/viscosity

A

overall decreased plasma volume
increased blood viscosity
replenishing plasma volume alone does not immediately lead to improvements

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10
Q

bed rest effect on barorecptors?

A

for a given reduction in arterial pressure, there is smaller compensatory increase in heart rate after adaptation in microgravity

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11
Q

what is the effect of bed rest on postural sway?

A

for a given condition, there is resultant increase in postural sway after adaptation to microgravity

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12
Q

what are the main CV changes?

A 
CO decreases
HR increases-limits HR reserve
SV decreases
decreases plasma volume
orthostatic hypotension
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13
Q

neurologic changes w/ bedrest

A 
decreased parasympathetic activity
increased sympathetic activity
alterations i baroreceptor sensitivity and sympathetic activity
risk of peripheral nerve compression
decreased balance and coordination
sensory deprivation
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14
Q

What are the main factors altered by neurologic changes following bed rest?

A

orthostatic intolerance, fall risk and mental status changes

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15
Q

definition of orthostatic hypotension

A

gradual, sustained decrease in SBP >20 or DBP>10

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16
Q

POTS

A

increased HR >30 during 1st 10 sec up; no decrease in BP

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17
Q

reflex syncope

A

sudden decrease in BP and HR

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18
Q

pulmonary changes w/ bed rest

A

diaphragm moves cephalad and decreases thoracic volume, TV, minute volume and maximal breathing capacity
RR increases
gas exchange declines

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19
Q

Possible developments secondary to pulmonary changes w/ bed rest

A

atelectasis
oxygen desaturation
may contribute to development of pneumonia

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20
Q

peripheral adaptation of bone w/ bedrest/deconditioning

A

decreased BMD
increased hypercalcemia
increased fx risk

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21
Q

muscle changes w/ deconditioning

A

decrease CSA and muscle atrophy
fiber type transitions
increase type II muscle fibers and decrease type I
strength can decrease as much as 20-30% during only a week to nine days of bed rest

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22
Q

integumentary changes w/ bed rest

A

pressure ulcer or decubitus ulcer
tissues compressed, blood vessels compressed, blood flow diverted
cell respiration is impaired and cells die

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23
Q

renal complications

A

calciuria- kidney/urinary tract stone formation

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24
Q

GI complications

A

decreased motility

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25
Q

psychiatric complications w/ bed rest

A

altered MS, depression, delirium

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26
Q

key to avoiding deconditionin?

A

early mobilization and rehabilitation/preention

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27
Q

main reasons why people fall

A 
orthostatic hyptotension
neurlogical changes
MSK changes (strength, decreased BMD)
poor nutrition
medication
surgery
dementia
baseline sarcopenia
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28
Q

What number decreases significantly after the age of 30?

A

FEV1

RV increases, therefore expiratory reserve volume and inspiratory reserve volume decrease

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29
Q

change in RV?

A

increases

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30
Q

change in expiratory reserve volume and inspiratory reserve volume?

A

decrease

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31
Q

TLC change?

A

no- stays the same

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32
Q

vital capacity change?

A

decreases

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33
Q

functional residual capacity change?

A

increases

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34
Q

what condition presents similar to older adults?

A

patients w/ COPD

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35
Q

alveolar-arterial gradient

A

difference between the alveolar concentration of oxygen and the arterial concentration of oxygen
used in diagnosing hypoxemia source

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36
Q

A-a gradient change w/ age

A

increases-therefore PaO2 declines w/ age

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37
Q

what is the expected decline in PaO2 w/ age?

A

for every year over60, subtract 1 mmHg for PaO2

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38
Q

what is the relationship between respiratory muscle function and age?

A

inspiratory muscles AND expiratory muscles have a decrease force production w/ increasing age
maximal voluntary ventilation also decreases
decreased diaphragm strength/decreased force generation

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39
Q

what decreases due to decrease in diaphragm strength?

A

maximal inspiratory pressures
maximal expiratory pressures
maximum voluntary ventilation

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40
Q

changes in the chest wall w/ age

A

decrease in chest wall compliance due to calcification of intercostal cartilage and arthritis of CV joints
decreased contribution of intercostal muscle to effective ventilation

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41
Q

what are the functional consequences of the above mentioned decrease in diaphragm strength and changes in chest wall compliance?

A

increased use of accessory muscles
increased energy expenditure of breathing
increased WOB
decreased gas exchange efficiency
increased risk of hypoxemia
increased ventilation for younger at same work loads
diminished cough reflex

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42
Q

what happens within arteries w/ age that leads to decreased compliance?

A

arterial stiffening
lose dilatory response
contractibility becomes impaired

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43
Q

two main components leading to dysfunction of arteries w/ aging?

A

decreased endothelial function

increased arterial stiffness

44
Q

what is aortic pulse wave velocity?

A

a measure of aortic stiffness
greater in healthy postmenopausal compared w/ premenopausal sedentary
regular aerobic exercise lessens aortic stiffness w/ agin in health adults

45
Q

carotid artery compliance?

A

better in young controls, however aerobically exercising adults have greater compliance than non-exercising peers

46
Q

collagen effect on artery compliance?

A

collagen increases w/ age

this appears to be reversible w/ mice trials w/ added wheel running

47
Q

change to artery dilation w/ aging

A

large arteries dilated

48
Q

arterial stiffness w/ aging?

A

increased stiffness

49
Q

HTN and aging?

A

Increased HTN- increased TPR

50
Q

LV changes w/ aging

A

increased LV after load leads to LV hypertrophy and possible HF

51
Q

cardiac muscle changes

A

LV wall thickness increase
decreased myocyte number
increased lipid deposition
decreased heart compliance

52
Q

cardiac valve changes

A

increased thickness and calcification

changed filling and ejection

53
Q

conduction system changes

A

decreased number of SA node pacemaker cells
increased atrophy and fibrosis of conduction pathways
increased risk of dysrhthmias

54
Q

Pupulation of people over the age of 70 w/ a-fib?

A

10-15%

55
Q

HR changes w/ age

A

HR max declines w/ age- NO change at rest

HR at submax workloads IS reduced w/ training

56
Q

CO changes

A

NO change of CO at rest
CO max declines w/ age
CO max CAN be increased w/ exercise training

57
Q

SV changes?

A

SV decreases w/ aging

SV at submax workloads is increased w/ exercise training

58
Q

age predicted Max HR

A

220-age +/-10-15 bpm
tends to underestimate
208-.7xage

59
Q

HRR equation

A

HRR=HR max-HR rest

60
Q

sympathetic changes

A

sympatheticNS activity increases- increased NE/E release

61
Q

parasympathetic change?

A

activity decreases

62
Q

B adregnergic responsiveness?

A

decreased- blunted responses

63
Q

a-adrenoreceptor responsiveness?

A

increases

64
Q

baroreceptor sensitivity?

A

decreases

65
Q

% of physician visits for patients w/ CVD, DM, HLD including counseling/education regarding exercise?

A

13%

66
Q

starvation

A

pure protein energy deficiency- reduction of both fat and fat-free mass

67
Q

cachexia

A

severe wasting axxompanysing disease states such as cancer or immunodeficiency0 reduction of both fat and fat free mass

68
Q

sarcopenia

A

observed age related decline in muscle mass- reduction of fat-free mass, but increase in fat mass

69
Q

anorexia nervosa

A

self-induced weight loss- typically 85% of normal weight, duration greater than 3 months, intense drive for thinness, irrational fear of fat, body image distortion

70
Q

malnourishment/malabsorption

A

abnormality in absorption of food nutrients across GI tract. Can be single or multiple nutrients

71
Q

refeeding syndrome

A

syndrome consisting of metabolic disturbances that occur as a result of reinstitution of nutrition to patients who are starved or severely malnourished

72
Q

complications of RFS

A

patients develop fluid and electrolyte disorders, especially hypophosphatemia, hypokalemia and a hypomagnesemia- delirium, ataxia, peripheral edema, cardiac hypotension, dysrthmias

73
Q

lab values that are less than normal w /starvation

A 
albumin
c-reactive protein
serum transferrin
hemoglobin
phosphorus\_\_skip
74
Q

cachexia

A

loss of weight, muscle atrophy, fatigue, weakness and significant loss of appetite in someone who is not actively trying to lose weight
cancer, AIDS, ets

75
Q

contributing factors to cachexia

A

anorexia/malnourishment
immune overactivity and systemic inflammation
endocrine disorders

76
Q

how does increase immune activity lead to weight loss?

A

up-regulation of pro-inflammatory cytocines elades to increased c-reactive protein, and chronic inflammation leads to anemia of chronic diseases and decreased weight

77
Q

how can endocrine disorders play a role in cachexia?

A

anabolic/catabolic imbalance- decline and resistance to GH, IGF-1, decline in sex steroid, hyperthyroidism

78
Q

two primary factors causing physical function impairment in elderly?

A

sarcopenia and frailty

79
Q

3 factors in diagnostic alorith for sarcopenia?

A

gait speed (

80
Q

definition of frailty

A

clinical syndrome in which 3 or more of following are present
unintentional weight loss (10lbs in last year)
self reported exhaustion
weakness
slow walking speed
low physical activity

81
Q

what can frailty predict?

A

falls
ED visitys/hospitalization
entry to residential care
death

82
Q

single best predictor of institutionalization

A

impaired funcitonal status

83
Q

can frailty and mobility disability be successfully treated ?

A

yes- using an interdisciplinary multifaceted treatment program

84
Q

location of non-steroid hormone receptors vs steroid receptors

A

steroid within the cell’s cytoplasm or in the cell nucleus; non-steroid hormones located on cell membrane

85
Q

steroid hormone- long or short half life?

A

long half life (also lipophyllic)

86
Q

examples of steroid hormones

A

cortisol, aldosterone, testosterone, estrogen

87
Q

examples of non-steroid hormones

A

thyroid, parathyroid, vasopressin, GH, insulin, glucagone, E

88
Q

5 basic physiological needs met by the hypothalamus

A 
controls BP
Energy metabolism
regulates body temperature
regulates reporoduction
Influences blood flow
89
Q

hypothalamus effect on posterior pituitary

A

synthesizes oxytocin and vasopressin which are then stored in posterior pituitary

90
Q

hypothalamus effect on anterior pituitary

A

secretes releasing hormones to ant. pituitary hormones

releases inhibitory hormones to inhibit release of hormones from ant. pituitary

91
Q

What are the initial factors with pituitary infarction or pituitary disorders?

A

visual changes, sudden headache

92
Q

acromegaly

A

excessive secretion of GH in adults- most often in 4th decade
soft tissue and bony hypertrophy, carpal tune, OA, severe headache, HTN, DM, sleep apnea, visual changes

93
Q

gigatism

A

excessive secretion of GH in children- epiphyseal plate not yet closed

94
Q

apnea

A

cessation of airflow >10 seconds

95
Q

hypopnea

A

decreased airflow = 10 seconds associated w/ arousal, oxyhemoglobin desaturation

96
Q

outcome of GH deficiency in children vs adults

A

children: dwarfism, overweight, delayed milestones
adult: adiposity, reduced muscle mass, osteoporosis

97
Q

role of vasopressin

A

regulates blood volume and salt concentration in response to reduced plasma volume (baroreceptors) or increase plasma osmotic pressure (osmoreceptors)

98
Q

two physiological changes the release of vasopressin leads to

A

vasoconstriction of blood vessels and increased reabsorption of water at the kidneys

99
Q

two causes of diabetes insipidus

A
  1. posterior pituitary doesn’t secrete ADH/vasopressin (central/neurogenic DI)
  2. Insensivitiy of kidney to ADH (nephrogenic DI)
100
Q

syndrome of inappropriate Antidiuretic hormone secretion

A

excessive release of ADH
leads to water retention and expansion of ECF volume
fluid overload- HTN

101
Q

common s/s of SIAHS

A

muscle aches, weakness, tremor
lethargy, confusion,
treat through H2O restriction, correct hyponatremia

102
Q

role of adrenal medulla

A

secrete E/NE- bind to adrenergic receptors

103
Q

general rule of alpha receptors

A

generally stimulatory

beta generally inhibitory except stimulatory at heart

104
Q

hyper function of adrenal gland disorders

A

cushing’s syndrome: excessive cortisol
hyperaldosteronism
pheochromocytoma

105
Q

hypo function adrenal gland

A

addison’s disorder

106
Q

common functions of cortisol

A

counter regulatory insulin
decreases bone formation
acts as diuretic
controls immune function

107
Q

difference between ACTH-dependent and ACTH independent

A

ACTH dependent- Cushing’s disease- pituitary adenoma secreting ACTH
ACTH independent-syndrome- adrenal adenoma- hypersecretion cortisol- most common, decreased ACTH

MC II (3 decks)

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