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PMP > Week 5--lecture slides > Flashcards

Week 5--lecture slides Flashcards

1
Q

what is pseudohypertension

A

seen in older patients

when blood vessel wall becomes more rigid with aging because of hyaline degeneration and endothelial hyperplasia

this increases the impedance to blood flow–> exacerbated by presence of atherosclerosis

result–> BP measures in elderly may be overestimated

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2
Q

what does a positive osler’s sign suggest

A

pseudoHTN

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3
Q

what is osler’s sign

A

suggests pseudo HTN

is a palpable brachial artery well when the BP cuff is inflated above sBP with disappearance of korotkoff-I sounds

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4
Q

definition of orthostatic BP

A

drop of sPB by at least 20 mmHg and/or dBP by at least 10 mmHg when changes from supine to standing

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5
Q

ddx orthostatic BP

A

meds

autonomic dysfunction

depleted intravascular volume

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6
Q

how do you make the definitive diagnosis of aortic stenosis vs sclerosis

A

by echo or angio

increased aorto-ventricular pressure gradient

decreased cross-sectional aortic valve area

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7
Q

what are some clinical findings in aortic sclerosis

A

narrow pulse pressure

pulsus parvus et tardus (uncommon in elderly due to rigid carotid artery wall)

*intensity and pattern of AS murmur NOT helpful

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8
Q

how do you manage patient with new AS murmur but otherwise no sx

A

watchful waiting

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9
Q

how do cardiac myocytes changes as we age

A

increased oxidative stress

decreased cell renewal capacity

accumulation of metabolic wastes in myocytes leads to increased risk of apoptosis

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10
Q

even in absence of disease, what % of myocytes in the aging heart are lost to apoptosis

A

30%

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11
Q

cardiac causes of palpitations

A
  1. arrhythmias
  2. acute CHF
  3. cardiomyopathy
  4. valvular disease
  5. pericarditis
  6. prosthetic materials
  7. previous MI
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12
Q

non cardiac causes of arrhythmias

A
  1. drugs
  2. aortic aneurysm
  3. high cardiac output states (anemia, fever)
  4. metabolic diseases (thyrotoxicosis, hypoglycemia)
  5. pheochromocytoma
  6. psychiatric
  7. lifestyle (alcohol)
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13
Q

what types of drugs can cause palpitations

A

anticholinergic drugs

adrenergic drugs

amphetamines

caffeine/theophylline

nicotine

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14
Q

symptoms of apathetic thyrotoxicosis

A

can present in older people

palpitations
tremor
diarrhea
depression/anxiety
delirium
falls

*dx of biochemical hyperthyroidism with TSH is important

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15
Q

what impact does spironolactone have in the treatment of CHF

A

REDUCES MORTALITY

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16
Q

usual dose of spironolactone

A

25-50 mg daily or BID

17
Q

what is the risk of spironolactone when combined with ACEi or K supplement or in renal failure

A

hyperkalemia

18
Q

ECG changes of hyperkalemia

A

prolonged PR

wide QRS

tall T

sinusoidal wave

VF

19
Q

describe physiological cardiac changes associated with aging

A
  1. decrease in early diastolic filling
  2. late diastolic filling due to atrial contraction is VITAL to maintaining normal cardiac output–> CHF in older adults is usually due to diastolic dysfunction
  3. decreased ventricular compliance
  4. left ventricular muscle hypertrophies
  5. increased peripheral vascular resistance –> increased incidence of systolic HTN
  6. baro-reflex sensitivity reduced–> increased likelihood of orthostatic hypotension
  7. exercise response reduced older adults less adaptive to hemodynamic stress
20
Q

three common cardiac findings in the elderly patient

A
  1. orthostatic BP changes
  2. S4
  3. aortic sclerosis
21
Q

sx of heart failure

A

elevated JVP

+ hepatojugular reflex

S3 gallop

crackles

dependent edema

  • occur less frequently in older adults –> may instead have:
  • tender or anorexic abdo
  • confusion/lethargy, anxiety /agitation
  • peripheral cyanosis
22
Q

what % of people with ACS have angina

A

less than 50%

23
Q

in older adults, what are some more common sx of ACS than what we usually learn

A 
weakness
syncope
confusion
abdo pain
pulm edema

*therefore, investigations are important!!! i.e ecg/trop

24
Q

what % of aortic sclerosis develops into aortic stenosis

A

15%

25% of people over 65 have aortic sclerosis–no impediment to hemodynamic flow like in stenosis

25
Q

what % of people over 75 have afib

A

10%

26
Q

mnemonic for working safely in an authority gradient (i.e disagreeing or speaking up about an unsafe practice)

A

PACE

Probe–> I was wondering why…

Alert–> I was noticing…/I am uncomfortable with…

Challenge–> Are you sure…

Emergency–> Stop, please, to double check….

27
Q

how does multi-morbidity affect risk of mobility disability

A

more likely to have a mobility disability if you have both heart disease AND arthritis than just one or the other (odds ratio 13.6 vs 2.3 or 4.6 for each alone)

28
Q

what % of over 75 year olds have 5 or more medical conditions

A

25%

29
Q

is palliative care all about end of life

A

no–it is associated with improved survival and the earlier it starts the better

in the hospital, compared to conventional care, palliative care treatments were associated with significant improvements in pain, non pain sx, patient and family satisfaction, hospital length of stay, reduction of in hospital visits

30
Q

what is the palliative approach to care

A

focuses on symptoms rather than disease entities

focus on quality of life rather than preventing death

make medical decisions based on–medical evidence for benefit, prognostic awareness, patient preference and feasibility

31
Q

what conditions must be met for the federal government to supply money to provinces for their health care systems

A
  1. public administration
  2. universality–> excludes WCB, armed forces, those who do not meet residency requirements
  3. comprehensiveness–> provincial gov only has to pat for “insured health benefits” which are “medically required services” provided by physicians
  4. portability
  5. accessibility
32
Q

when can a physician charge privately for a procedure/service

A

if it is not medically required and they can perform it

i.e wart removals, family planning counselling, cosmetic surgery

33
Q

does evidence show that denial of private health insurance ensures quality public care?

A

no–chaoulli vs quebec

PMP (9 decks)

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