Metabolism & Diseases Of Aging

Question 1

Acute attacks of porphyria are most commonly precipitated by events that decrease _____ and increase activity of _______ and stimulate production of porphyrinogens

Answer 1

Heme concentration; ALA synthase

Question 2

The most important tirggers in the development of acute porphyria

Answer 2

Enzyme-inducing drugs

Question 3

Patients at known risk of porphyria but perviously asymptomatic (silent or latent porphyria) may experience their first symptoms in response to?

Answer 3

Administration of tirggering drugs during the perioperative period

Question 4

Which drugs are okay to give with porphyrias? Which are bad?

Answer 4

All inhalational drugs ok;

Toradol, ketamine, etomidate, thiopental, & amio = Bad

Question 5

Particular attention myst be given to _______ and ________ since these signs may predict impending respiratory failure and an increased risk of pulmonary aspiration

Answer 5

Skeletal muscle strength; cranial nerve function

Question 6

Drug of choice for management of acute gouty arthritis

Answer 6

Colchicine (lacks any effect on purine metabolism)

Question 7

Self-mutilation often involves trauma to ______ with Lesch-nyhan syndrome

Answer 7

Perioral tissues

Question 8

The mainstay treatment of hemochromatosis

Answer 8

Phlebotomy to physically remove iron from the body

Question 9

Brown rings around the rim of the cornea seen with wilson’s dz

Answer 9

Kayser-fleischer rings

Question 10

Hallmark of atherosclerosis

Answer 10

Inflammation, with inceased cholesterol as a cofactor

Question 11

Any systolic dysfunction in the elderly should be considered abnormal, especially if it is accompanies by _________

Answer 11

Wall motion abnormality

Question 12

Cardiovascular changes with aging:

Answer 12

LA chamber size ⬆️;
The electrical system declines with age;
The number of pacemaker cells is reduced by 90% by age 70;
Prolongation of PR interval, QRS duration, & QT interval;
Slowere resting HR

Question 13

A state of reduced physiologic reserve that is a/w increased susceptibility to disability

Answer 13

Frailty

Question 14

_______ is an independent predictor of in-hospital mortality

Answer 14

Frailty

Question 15

One of the early hallmarks of dementia

Answer 15

Intellectual decline

Question 16

MAC values decrease by about _____ per decade after age 40 for volatile anesthetics and about ____ per decade for nitrous oxide

Answer 16

6%; 8%

Question 17

The ________ of neuromuscular blocking drugs are not significantly altered by age

Answer 17

Pharmacodynamics

Question 18

Which patients are considered to be at severe nutritional risk?

Answer 18

Unintentional weight loss > 10% - 15% over the last 6 mos;
BMI < 18.5;
Or serum albumin below 3g/dL

Question 19

A 3 item recall and clock drawing test that efficiently screens for cognitive impariment; 1 point is awarded for each item recalled and 2 points for a normal-appearing clock

Answer 19

The mini-cog

Question 20

The strongest predisposing factor for postop delirium

Answer 20

Preexisting dementia