What is Elderly Medicine

Question 1

What is ageing?

1 - syndrome making patients more likely to fall
2 - clinical syndrome characterised by inability to deal with stressors
3 - inability to fight infection
4 - progressive generalised impairment of function

Answer 1

4 - progressive generalised impairment of function

• impaired ability to adapt to stressors
• increased risk of disease

Question 2

What is frailty?

1 - syndrome making patients more likely to fall
2 - clinical syndrome characterised by decreased reserve and inability to deal with stressors
3 - inability to fight infection
4 - progressive generalised impairment of function

Answer 2

2 - clinical syndrome characterised by decreased reserve and inability to deal with stressors

• patients are more vulnerable to everything

Question 3

What is geriatrics?

1 - branch of medicine concerned with patients in old age
2 - clinical syndrome characterised by inability to deal with stressors
3 - inability to fight infection
4 - progressive generalised impairment of function

Answer 3

1 - branch of medicine concerned with patients in old age

• treatment is concerned with prevention, remedial and social aspects

Question 4

What is the most common cause of >75 y/o patients attending hospital and common cause of injury related to death?

1 - infection
2 - falls
3 - cardiovascular
4 - respiratory

Answer 4

2 - falls

Question 5

When assessing a patients falls, we should look at postural hypertension. The patient should lie on a bed for how long before having the BP measured?

1 - 10 minutes
2 - 8 minutes
3 - 5 minutes
4 - 3 minutes

Answer 5

3 - 5 minutes

• patient then stands and BP read immediately
• patient remains standing for 3 minutes and BP is measured again

Question 6

Elderly patients are often difficult to diagnose and present with non-specific symptoms, and can be caused by a range of diseases/conditions. These groups of condition are called the geriatric giants. Which of the following is NOT a geriatric giant?

1 - intellectual impairment
2 - instability and falls
3 - impaired vision
4 - incontinence
5 - immobility
6 - iatrogenic

Answer 6

3 - impaired vision

• called the 5 I’s
• common multiple causation, chronic course, deprivation of independence and NO simple cure
• iatrogenic = medically caused condition

Question 7

Intellectual impairment is one of the geriatric giants, but what is it?

1 - abnormal mental state
2 - pre-dementia
3 - delirium
4 - acute depression

Answer 7

1 - abnormal mental state

• also described as confused, muddled or patient is not themselves

Question 8

Intellectual impairment is one of the geriatric giants, and is when patients are have an abnormal mental state, or is confused or muddled. What are the 2 most common acute causes for this in hospitals?

1 - ischaemia and delirium
2 - delirium and dementia
3 - delirium and encephalitis
4 - dementia and pseudo-dementia

Answer 8

3 - delirium and encephalitis

• encephalitis = inflammation of the brain

Question 9

Intellectual impairment is one of the geriatric giants, and is when patients are have an abnormal mental state, or is confused or muddled. What are the 2 most common chronic causes for this in hospitals?

1 - ischaemia and delirium
2 - delirium and dementia
3 - delirium and encephalitis
4 - dementia and pseudo-dementia

Answer 9

4 - dementia and pseudo-dementia

Question 10

Intellectual impairment is one of the geriatric giants, and is when patients are have an abnormal mental state, or is confused or muddled. Delirium is one of the most common acute causes of this. What % of cases of intellectual impairment account for in hospitals?

1 - 1-3%
2 - 5-10%
3 - 20-30%
4 - 50-70%

Answer 10

3 - 20-30%

Question 11

Intellectual impairment is one of the geriatric giants, and is when patients are have an abnormal mental state, or is confused or muddled. Delirium is one of the most common acute causes of this. What % of surgical patients experience delirium leading to intellectual impairment in hospitals?

1 - 1-5%
2 - 10-15%
3 - 10-50%
4 - 10-70%

Answer 11

3 - 10-50%

Question 12

Falls is the most common presenting complaint in over 75s. One of the major causes of this is postural hypotension. How is this best assessed?

1 - 24h BP recording
2 - 12h BP recording
3 - supine to standing recordings
4 - standing BP repeats

Answer 12

3 - supine to standing recordings

• record BP with patient supine for few minutes
• patient stands and record BP
• patient stands for 3 minutes and record BP again

Question 13

What is the comprehensive geriatric assessment (CGA)?

1 - test performed by primary care and repeated in secondary care
2 - tests performed by geriatricians
3 - assessment approach used for elderly patients
4 - assessment used for patients who are frail regardless of age

Answer 13

3 - assessment approach used for elderly patients

• includes a multidisciplinary team

Question 14

What are the the 2 most common reasons why the elderly population continues to increase?

1 - reduced infant mortality and better medication
2 - reduced infant mortality and better clinical treatment
3 - increased infant mortality and better clinical treatment
4 - increased infant mortality and poorer clinical treatment

Answer 14

2 - reduced infant mortality and better clinical treatment

Question 15

What is the fastest growing section of our population?

1 - >50s
2 - >65s
3 - >75s
4 - >85s

Answer 15

4 - >85s

Question 16

Which of the following are not pivotal in increasing longevity?

1 - reduced infant mortality
2 - improved standard of living
3 - improved vaccinations
4 - improvements in public health
5 - reduced birth rates

Answer 16

3 - improved vaccinations

Question 17

Is ageing defined as a disease?

Answer 17

• no

Question 18

Strehlers concepts of ageing are a definition of what ageing is, and how it is distinguishable from disease. Which of the following are NOT one of these concepts?

1 - Universal
2 - Extrinsic
3 - Intrinsic
4 - Progressive
5 - Deleterious

Answer 18

2 - Extrinsic

Question 19

Strehlers concepts of ageing are a definition of what ageing is, and how it is distinguishable from disease. The 4 concepts are?

1 - Universal
2 - Intrinsic
3 - Progressive
4 - Deleterious

What does universal relate to?

1 - restricted to changes of endogenous origin
2 - a process that is present in all members of a species
3 - generalised impairment in function
4 - loss of adaptive response to stressors

Answer 19

2 - a process that is present in all members of a species

• basically means that there is no 1 pathology that causes ageing in all species

Question 20

Strehlers concepts of ageing are a definition of what ageing is, and how it is distinguishable from disease. The 4 concepts are?

1 - Universal
2 - Intrinsic
3 - Progressive
4 - Deleterious

What does Intrinsic relate to?

1 - restricted to changes of endogenous origin
2 - a process that is present in all members of a species
3 - generalised impairment in function
4 - loss of adaptive response to stressors

Answer 20

1 - restricted to changes of endogenous origin

• basically ageing is not restricted to things in the body

Question 21

Strehlers concepts of ageing are a definition of what ageing is, and how it is distinguishable from disease. The 4 concepts are?

1 - Universal
2 - Intrinsic
3 - Progressive
4 - Deleterious

What does Progressive relate to?

1 - restricted to changes of endogenous origin
2 - a process that is present in all members of a species
3 - generalised impairment in function
4 - loss of adaptive response to stressors

Answer 21

3 - generalised impairment in function

• no sudden change, happen throughout life

Question 22

There are many theories of ageing. What is the wear and tear theory?

1 - accumulation of physical damage and oxidative stress
2 - genes predisposed to ageing for adaptive purposes
3 - antagonist pleiotropy
4 - deleterious mutations

Answer 22

1 - accumulation of physical damage and oxidative stress

• Osteoarthritis, Ageing skin and teeth are examples

Question 23

There are many theories of ageing. The wear and tear theory is that accumulation of physical damage and oxidative stress leads to ageing. But based on Strehler’s concepts, which of the following is NOT a flaw in this theory?

1 - humans can regenerate (liver)
2 - life span is variable between species
3 - animals don’t live as long as humans

Answer 23

3 - animals don’t live as long as humans

Question 24

There are many theories of ageing. What is the adaptive evolutionary model?

1 - model that we have evolved beyond ageing
2 - theory that we have adapted to evade ageing
3 - theory that cells are adapted to age naturally
4 - theory that cells are able to resist ageing

Answer 24

3 - theory that cells are adapted to age naturally

• genes are predisposed to ageing to help with natural selection

Question 25

There are many theories of ageing. What is the non-adaptive evolutionary model?

1 - model that we have evolved beyond ageing
2 - theory that we have adapted to evade ageing
3 - theory that cells are adapted to age naturally
4 - theory that single genes can be good and bad

Answer 25

4 - theory that single genes can be good and bad

• Antagonistic Pleiotropy = single genes can cause multiple outcomes
• testosterone is good for young males, but increases cancer in ageing men

Question 26

What does the neuroendocrine of ageing relate to?

1 - organs stop producing hormones as we age
2 - hormones have opposite affects as we age
3 - body desensitises to hormones as we age

Answer 26

1 - organs stop producing hormones as we age

• menopause in women
• andropause in men

Question 27

What % of ageing has genetics been associated with?

1 - 5-10%
2 - 15-30%
3 - 40-60%
4 - >75%

Answer 27

2 - 15-30%

Question 28

Which of the following genes has been associated with increased longevity?

1 - apoe alleles
2 - MC4R gene
3 - sirtuline gene
4 - heperin gene

Answer 28

1 - apoe alleles

• genes involved in the producing proteins that carry cholesterol and fat in the blood stream

Question 29

What is Cellular Senescence?

1 - ability of cells to continually divide
2 - ability of cells to evade apoptosis
3 - cessation of cell division
4 - inability of cells to divide appropriately

Answer 29

3 - cessation of cell division

• referred to as the hayflick limit (around 50 times)
• though to be protective against cancers, but contribute to ageing phenotype

Question 30

How do telomeres influence ageing?

1 - telomeres shorten with each cell replication
2 - telomeres lengthen during cell cycles
3 - telomeres replace DNA in chromosomes
4 - telomere’s induce apoptosis

Answer 30

1 - telomeres shorten with each cell replication

• means cells cannot continue to replicate

Question 31

How do telomeres influence ageing?

1 - telomeres shorten with each cell replication
2 - telomeres lengthen during cell cycles
3 - telomeres replace DNA in chromosomes
4 - telomere’s induce apoptosis

Answer 31

1 - telomeres shorten with each cell replication

• means cells cannot continue to replicate
• counteract cellular senescence, but ultimately fail

Question 32

Which of the following is NOT mechanism that contributes to cellular senescence?

1 - DNA damage
2 - Mitochondrial dysfunction
3 - Increase in free radicals
4 - increased telomere length
5 - Accumulation of dysfunctional proteins

Answer 32

4 - increased telomere length

Question 33

Free radicals and reactive oxygen species (ROS) are created and have been shown to contribute to ageing. Where are the majority of ROS produced in the body?

1 - hepatocytes
2 - mitochondria
3 - tubules of kidneys
4 - neurons

Answer 33

2 - mitochondria

• antioxidants can protect, but become lower in ageing and ROS take over