Geriatrics

Question 1

Age related changes to cardiovascular system

Answer 1

• Unchanged cardiac output and cardiac index at rest
• Increased myocardial hypertrophy
• Decreased arterial elasticity
• Reduced HR responsiveness to stress and respiration

Question 2

Age related changes to respiratory system

Answer 2

• Reduced lung volume due to loss of elastic recoil
• Reduction in FEV1 and FVC
• Increased RV
• Increased V/Q mismatch
• Decreased ventilatory response to hypoxia and hypercapnia
• Reduced mucociliary clearance

Question 3

Age related changes to GI system and liver

Answer 3

• Decreased oesophageal peristalsis
• Delayed gastric emptying
• Decreased pancreatic enzyme secretion
• Reduced liver volume, weight and blood flow
• No changes to LFTs

Question 4

Age related changes to endocrine system

Answer 4

• Increased insulin resistance
• Increased incidence of AI thyroiditis
• Increased vasopressin with increased risk of hyponatraemia
• Decreased basal renin level
• Decreased aldosterone and increased risk of hyperkalaemia
• Increased FSH/LH

Question 5

Age related changes to immune system

Answer 5

• Immunoglobulin levels remain stable
• Diminished antibody response
• Impaired T cell response, especially to viral infections

Question 6

Features of renal artery stenosis

Answer 6

Resistant hypertension
Flash pulmonary oedema

Young women –> fibromuscular hyperplasia
Advanced age –> atherosclerotic disease of renal artery

Question 7

Patients at risk of refeeding syndrome

Answer 7

• poor oral intake > 5 days
• exisiting electrolyte disturbance
• low BMI
• recent unintentional significant weight loss
• history of alcohol abuse

Question 8

What is fludrocortisone not recommended for?

Answer 8

Synthetic mineralocorticoid
Increased blood volume and improved blood vessel sensitivity to pressor agents
Not recommended for patients with nocturnal hypertension and CCF

Question 9

MOA of midodrine

Answer 9

a1-adrenergic agonist
Increases BP by stimulating arterial and venous adrenoceptors to increase peripheral resistance

Question 10

Risk associated with HRT

Answer 10

Breast cancer
VTE (no risk with transdermal HRT)
Cardiovascular disease and stroke risk (higher in those who start after 60 years old or 10 years after onset of menopause)

Question 11

Management of venous ulcers

Answer 11

Compression is mainstay - graded multi-component > single component ones
Should be modified if ABI 0.6-0.9
Contraindicated if ABI < 0.6 (severe PVD)
Surgery can be done to promote healing