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Geriatric Anesthesia > Prodigy- Geriatircs > Flashcards

Prodigy- Geriatircs Flashcards

1
Q

What is the most common cause of hospitalization in patients over the age of 65?

A

Heart failure

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2
Q

T/F: elderly patients don’t respond as well to vasodilators or vasoconstrictors

why or why not

A

true

due to the structural changes in the vessel endothelium (arterial thickening and stiffness)

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3
Q

How are increases in cardiac ouptut achieved in older adults vs younger

A

older adults = increases in end-diastolic volume
younger = increase in HR

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4
Q

The overall alveolar surface area (increases/decreases) with age

A

decreases with age

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5
Q

the ventilaory response to hypercarbia can reduce as much as what % in the elderly population?

A

50%

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6
Q

T/F: ACH levels normally deline with age

A

ture- slighlty

in alzheimers they can decrease as much as 90%

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7
Q

T/F : inthe absence of disease, the liver reserve is maintained even in extremely aged individuals

A

True

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8
Q

what is the main reason for decreased metabolism of drugs metabolized by the liver

A

decrease in hepatic blood flow

hepatic function normally doesnt change with increased age

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9
Q

The mass of the renal cortex decreases by about what % with age

A

25%

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10
Q

by what age is there up to a 50% reduction in the total number of glomeruli present within the kidneys

A

80%

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11
Q

How is the elmination of hydrophilic drugs affected in the elderly and why

A

prolonged elimination

due to decreased GFR and decreased RBF

less drug taken to the kidneys for excretion and decreased ability to excete the amount taken

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12
Q

T/F: elderly patients tend to have higher insulin requirements perioperatively

A

True! even when a diagnosis of diabetes is not present

they exhibit a lower insulin response to glucose loads
+ an increased insulin resistance in skeletal muscle

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13
Q

Elderly patients exhibit a (higher/lower) insulin response t oglucose loads

A

lower

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14
Q

How is ICF affected in the older population and why

A

decreases 10-15% due to a reduction in muscle mass

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15
Q

T/F: older patients are prone to hypothermia primarily due to an inability to produce vasoconstriction effectively

A

True

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16
Q

A one degree reduction in skin temp is equal to how many degree reduction in core body temp

A

1 degree skin = 0.2 degree core

17
Q

body’s first response to a reduction in temp

A

vasoconstriction

18
Q

T/F: elderly patients are at an increased risk for hypothyroidism

A

True

19
Q

Geriatric patients have a (higher/lower) body surface area to body mass ratio

A

higher

just like neonates
get cold faster

20
Q

How is midazolam altered in the geriatric population?

A

clearance is reduced up to 30% due to a decrease i nhepatic perfusion.

it is metabolized to hydroxymidazolam, a pharmacologically active metabolite excreted by the kidneys that can accumulate if renal function is decreased.

21
Q

How should fentanyl be adjusted in the elderly population

A

dose should be reduced s ignficantly

-older patients are more sensitive to the effects of fentanyl
-pts in theri 80s exhibit a 50% greater sensitivty

22
Q

T/F: meperidine is associated with postop delirium in the elderly

A

true

23
Q

Third-space fluid begins to mobilize into the vascular space on postop day….

A

2

24
Q

T/F: The signle greatest predisposing factor for the development of postop deirium is a pre-existing diagnosis of dementia

A

true

25
Q

T/F: the short-term use of haloperiodol has been shown to reduce the symptoms of postop delirium

A

True

26
Q

Which change is principally responsible for the reduction in alveolar surface volume in the elderly?
A. Osteoporosis in the spinal column
B. Decreased pulmonary elastic tissue
C. COPD
D. Inflexibility of the rib cage

A

B

27
Q

Which of the following drugs would not exhibit a smaller volume of distribution in the geriatric patient?
A. Glycopyrrolate
B. Succinylcholine
C. Diazepam
D. Gentamicin

A

C

28
Q

A drug with a high hepatic extraction ratio exhibits a decreased metabolism in elderly patients primarily due to a decrease in
A. hepatic mass
B. hepatic blood flow
C. hepatic enzyme activity
D. transaminase levels

A

B

29
Q

What primarily explains the prolonged duration of midazolam in an elderly patient?
A. decreased renal perfusion
B. decreased protein binding
C. decreased hepatic perfusion
D. increased absorption into the muscle tissue

A

Not A… i think B.. now i think C

30
Q

What is one reason many geriatric patients are more susceptible to hypothermia?
A. They have a higher basal metabolic rate
B. The have a lower body surface area to body mass ratio
C. They have an increase in lean muscle mass
D. They are more prone to hypothyroidism

A

Not B… D i think

31
Q

An elderly patient describes exhaustion, significant weight loss in the past year, weakness, and a low physical activity level. These are all defining characteristics of
A. senile dementia
B. coronary artery disease
C. renal dysfunction
D. frailty

A

D

32
Q

At what age does the MAC value start to decrease?
A. 30
B. 40
C. 50
D. 60

A

B

33
Q

Which of the following respiratory parameters is decreased in elderly patients?
A. Residual volume
B. Both A and B
C. Closing capacity
D. Alveolar surface area

A

D

34
Q

The geriatric population is more susceptible to decreases in core temperature primarily because
A. basal metabolic rate increases with age
B. decreased body fat results in increased heat loss
C. autonomic peripheral vasoconstriction decreases with age
D. they exhibit increased lean body mass

A

C

35
Q

The elimination of hydrophilic agents in the elderly is prolonged primarily because of
A. a decrease in renal clearance
B. a decrease in serum pH
C. a decrease in volume of distribution
D. a decrease in hepatic blood flow

A

A

36
Q

A drug with a high hepatic extraction ratio may exhibit a prolonged elimination half-life in an elderly patient because:
A. Hepatic mass decreases with age
B. Hepatic blood flow diminishes with age
C. Cytochrome P450 activity diminishes with age
D. Hepatic transaminase levels increase with age

A

B

37
Q

Which of the following characteristics do geriatric patients share with neonates?
A. A higher body surface area to body mass ratio
B. Increased skeletal muscle mass
C. Decreased alpha-1 acid glycoprotein levels
D. A higher relative concentration of body water

A

A

38
Q

Which of the following changes would you expect to occur normally in elderly patients?
A. Increased MAC
B. Increased total body water
C. Decreased serum alpha-1 acid glycoprotein
D. Decreased serum albumin

A

D

Geriatric Anesthesia (2 decks)

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