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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
psychiatric complications w/ bed rest
altered MS, depression, delirium
26
key to avoiding deconditionin?
early mobilization and rehabilitation/preention
27
main reasons why people fall
``` orthostatic hyptotension neurlogical changes MSK changes (strength, decreased BMD) poor nutrition medication surgery dementia baseline sarcopenia ```
28
What number decreases significantly after the age of 30?
FEV1 | RV increases, therefore expiratory reserve volume and inspiratory reserve volume decrease
29
change in RV?
increases
30
change in expiratory reserve volume and inspiratory reserve volume?
decrease
31
TLC change?
no- stays the same
32
vital capacity change?
decreases
33
functional residual capacity change?
increases
34
what condition presents similar to older adults?
patients w/ COPD
35
alveolar-arterial gradient
difference between the alveolar concentration of oxygen and the arterial concentration of oxygen used in diagnosing hypoxemia source
36
A-a gradient change w/ age
increases-therefore PaO2 declines w/ age
37
what is the expected decline in PaO2 w/ age?
for every year over60, subtract 1 mmHg for PaO2
38
what is the relationship between respiratory muscle function and age?
inspiratory muscles AND expiratory muscles have a decrease force production w/ increasing age maximal voluntary ventilation also decreases decreased diaphragm strength/decreased force generation
39
what decreases due to decrease in diaphragm strength?
maximal inspiratory pressures maximal expiratory pressures maximum voluntary ventilation
40
changes in the chest wall w/ age
decrease in chest wall compliance due to calcification of intercostal cartilage and arthritis of CV joints decreased contribution of intercostal muscle to effective ventilation
41
what are the functional consequences of the above mentioned decrease in diaphragm strength and changes in chest wall compliance?
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
42
what happens within arteries w/ age that leads to decreased compliance?
arterial stiffening lose dilatory response contractibility becomes impaired
43
two main components leading to dysfunction of arteries w/ aging?
decreased endothelial function | increased arterial stiffness
44
what is aortic pulse wave velocity?
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
carotid artery compliance?
better in young controls, however aerobically exercising adults have greater compliance than non-exercising peers
46
collagen effect on artery compliance?
collagen increases w/ age | this appears to be reversible w/ mice trials w/ added wheel running
47
change to artery dilation w/ aging
large arteries dilated
48
arterial stiffness w/ aging?
increased stiffness
49
HTN and aging?
Increased HTN- increased TPR
50
LV changes w/ aging
increased LV after load leads to LV hypertrophy and possible HF
51
cardiac muscle changes
LV wall thickness increase decreased myocyte number increased lipid deposition decreased heart compliance
52
cardiac valve changes
increased thickness and calcification | changed filling and ejection
53
conduction system changes
decreased number of SA node pacemaker cells increased atrophy and fibrosis of conduction pathways increased risk of dysrhthmias
54
Pupulation of people over the age of 70 w/ a-fib?
10-15%
55
HR changes w/ age
HR max declines w/ age- NO change at rest | HR at submax workloads IS reduced w/ training
56
CO changes
NO change of CO at rest CO max declines w/ age CO max CAN be increased w/ exercise training
57
SV changes?
SV decreases w/ aging | SV at submax workloads is increased w/ exercise training
58
age predicted Max HR
220-age +/-10-15 bpm tends to underestimate 208-.7xage
59
HRR equation
HRR=HR max-HR rest
60
sympathetic changes
sympatheticNS activity increases- increased NE/E release
61
parasympathetic change?
activity decreases
62
B adregnergic responsiveness?
decreased- blunted responses
63
a-adrenoreceptor responsiveness?
increases
64
baroreceptor sensitivity?
decreases
65
% of physician visits for patients w/ CVD, DM, HLD including counseling/education regarding exercise?
13%
66
starvation
pure protein energy deficiency- reduction of both fat and fat-free mass
67
cachexia
severe wasting axxompanysing disease states such as cancer or immunodeficiency0 reduction of both fat and fat free mass
68
sarcopenia
observed age related decline in muscle mass- reduction of fat-free mass, but increase in fat mass
69
anorexia nervosa
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
malnourishment/malabsorption
abnormality in absorption of food nutrients across GI tract. Can be single or multiple nutrients
71
refeeding syndrome
syndrome consisting of metabolic disturbances that occur as a result of reinstitution of nutrition to patients who are starved or severely malnourished
72
complications of RFS
patients develop fluid and electrolyte disorders, especially hypophosphatemia, hypokalemia and a hypomagnesemia- delirium, ataxia, peripheral edema, cardiac hypotension, dysrthmias
73
lab values that are less than normal w /starvation
``` albumin c-reactive protein serum transferrin hemoglobin phosphorus__skip ```
74
cachexia
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
contributing factors to cachexia
anorexia/malnourishment immune overactivity and systemic inflammation endocrine disorders
76
how does increase immune activity lead to weight loss?
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
how can endocrine disorders play a role in cachexia?
anabolic/catabolic imbalance- decline and resistance to GH, IGF-1, decline in sex steroid, hyperthyroidism
78
two primary factors causing physical function impairment in elderly?
sarcopenia and frailty
79
3 factors in diagnostic alorith for sarcopenia?
gait speed (
80
definition of frailty
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
what can frailty predict?
falls ED visitys/hospitalization entry to residential care death
82
single best predictor of institutionalization
impaired funcitonal status
83
can frailty and mobility disability be successfully treated ?
yes- using an interdisciplinary multifaceted treatment program
84
location of non-steroid hormone receptors vs steroid receptors
steroid within the cell's cytoplasm or in the cell nucleus; non-steroid hormones located on cell membrane
85
steroid hormone- long or short half life?
long half life (also lipophyllic)
86
examples of steroid hormones
cortisol, aldosterone, testosterone, estrogen
87
examples of non-steroid hormones
thyroid, parathyroid, vasopressin, GH, insulin, glucagone, E
88
5 basic physiological needs met by the hypothalamus
``` controls BP Energy metabolism regulates body temperature regulates reporoduction Influences blood flow ```
89
hypothalamus effect on posterior pituitary
synthesizes oxytocin and vasopressin which are then stored in posterior pituitary
90
hypothalamus effect on anterior pituitary
secretes releasing hormones to ant. pituitary hormones | releases inhibitory hormones to inhibit release of hormones from ant. pituitary
91
What are the initial factors with pituitary infarction or pituitary disorders?
visual changes, sudden headache
92
acromegaly
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
gigatism
excessive secretion of GH in children- epiphyseal plate not yet closed
94
apnea
cessation of airflow >10 seconds
95
hypopnea
decreased airflow = 10 seconds associated w/ arousal, oxyhemoglobin desaturation
96
outcome of GH deficiency in children vs adults
children: dwarfism, overweight, delayed milestones adult: adiposity, reduced muscle mass, osteoporosis
97
role of vasopressin
regulates blood volume and salt concentration in response to reduced plasma volume (baroreceptors) or increase plasma osmotic pressure (osmoreceptors)
98
two physiological changes the release of vasopressin leads to
vasoconstriction of blood vessels and increased reabsorption of water at the kidneys
99
two causes of diabetes insipidus
1. posterior pituitary doesn't secrete ADH/vasopressin (central/neurogenic DI) 2. Insensivitiy of kidney to ADH (nephrogenic DI)
100
syndrome of inappropriate Antidiuretic hormone secretion
excessive release of ADH leads to water retention and expansion of ECF volume fluid overload- HTN
101
common s/s of SIAHS
muscle aches, weakness, tremor lethargy, confusion, treat through H2O restriction, correct hyponatremia
102
role of adrenal medulla
secrete E/NE- bind to adrenergic receptors
103
general rule of alpha receptors
generally stimulatory | beta generally inhibitory except stimulatory at heart
104
hyper function of adrenal gland disorders
cushing's syndrome: excessive cortisol hyperaldosteronism pheochromocytoma
105
hypo function adrenal gland
addison's disorder
106
common functions of cortisol
counter regulatory insulin decreases bone formation acts as diuretic controls immune function
107
difference between ACTH-dependent and ACTH independent
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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