Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Geriatrics > Geriatrics Potpourri 3 > Flashcards

Geriatrics Potpourri 3 Flashcards

1
Q

What is the leading cause of adult blindness in the developing world?

A

Age-Related Macular Degeneration (AMD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Impacts of Age-Related Macular Degeneration (AMD) on the elderly?

A
  1. Ability to drive
  2. Increased rates of falls
  3. Ability to live independently
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q
  1. What is AMD?
  2. Early AMD usually presents how?
  3. Results in the loss of what?
A
  1. Degenerative disease of the central portion of the retina (macula)
  2. Early AMD is often asymptomatic
  3. Results in loss of central vision primarily
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Classifications of AMD? 2

A
  1. Dry (atrophic)*

2. Wet (neovascular or exudative)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Describe the following types of AMD:
1. Dry (atrophic)*? 2

  1. Wet (neovascular or exudative)?
    2
A
  1. Dry (atrophic)*
    - Ischemia

-Retinal epithial cell apoptosis/activating inflammation

  1. Wet (neovascular or exudative)
    - Balance between substances that promote or inhibit blood vessel development

-Vascular endothelial growth factor (VEGF)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

AMD Risk factors?

7

A
  1. Age
  2. Smoking
  3. Genetics
  4. CVD
  5. Diet?
  6. Cataract surgery?
  7. Possibly alcohol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

AMD Hx questions? 4

Vision loss occurring over days or weeks requires what?

A
  1. Rate of vision loss
  2. Whether one or both eyes involved
  3. Loss near or far vision or both
  4. Acute distortion of loss of central vision—may be wet AMD

urgent ophthalmic referral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Ophthalmologic Evaluation
for Dry? 3

For wet? 3

A

Dry:

  1. Drusen appears as bright yellow spots
  2. Atrophy appears as areas of depigmentation
  3. There may be increased pigmentation

Wet:

  1. Subretinal fluid/and or hemorrhage
  2. Neovascularization—appears as grayish-green discoloration
  3. Often require fluorescein angiogram
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Treatment for dry? 1
-To slow progression? 3

Wet? 3

Tool for detecting AMD?

A

Dry:

  1. None
  2. For slowing the progression:
    - Antioxidants with Vitamin C, E;
    - beta carotene,
    - zinc & copper (in smokers NO beta carotene)

Wet:

  1. VEGF inhibitors
  2. Photocoagulation
  3. Surgery

Tool for detecting disease progression: Amsler Grid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the types of glaucoma?
4

Most common?

A
  1. Acute angle glaucoma
  2. Secondary glaucoma
  3. Congenital glaucoma
  4. Primary open-angle glaucoma: most common
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Subtypes of secondary glaucoma?

3

A

: many subtypes

  1. Uveitis
  2. Old trauma
  3. Steroid therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Characteristics of POAG?
3

Disease must be screened for

A
  1. Optic neuropathy—optic disc described as “cupping”
  2. Peripheral visual field loss followed by central field loss—cannot be recovered
  3. No symptoms initially

Disease must be screened for

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

POAG—Risk Factors

4

A
  1. Elevated IOP:
  2. Increasing age w/ increased risk of blindness
  3. African Americans have 4-5 times greater risk
  4. Family history
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is a normal IOP?

A

Normal range 8-22 mg Hg

Exact relationship between elevated IOP & cupping not well understood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q
  1. POAG screening?
    - Done by who?
    - How?
  2. Tx? 3
A
  1. Screening:
    - Generally done by specialist with specialized equipment
    - Can examine optic disc for cupping—cup > then 50% of the vertical disc diameter is suspicious
  2. Treatment:
    - Topical and systemic medications
    - Laser therapy
    - Surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Angle-Closure Glaucoma

What is the difference between primary and secondary?

A
  1. Primary:
    - patients anatomically predisposed
    - No identifiable secondary cause
  2. Secondary:
    - Secondary process responsible for closure of the anterior chamber angle
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Examples of secondary angle closure glaucoma? 2

A
  1. A fibrovascular membrane grows over the angle

2. A mass or hemorrhage in the posterior segment pushes the angle closed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

ACG—Risk Factors

6

A
  1. Family history
  2. Age older then 40-50 years
  3. Female
  4. Hyperopia (farsightedness)
  5. Pseudoexfoliation
  6. Race:
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What races are most at risk for ACG? 2

Least? 2

A
  1. Highest in Inuit and Asian populations

2. Lower in African and European origins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

ACG—Presentation
1. Pressure rising acutely: symptoms? 5

  1. Signs? 4
A
    • Decreased vision
    • Halos around lights
    • Headache
    • Severe eye pain
    • N/V
  2. Signs:
    - Conjunctival redness
    - Corneal edema or cloudiness
    - Shallow anterior chamber
    - Mid-dilated pupil (4-6mm); reacts poorly to light
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

ACG

  1. Severity?
  2. Management?
  3. In how long or else what?
  4. Guided by what?
  5. Tx aimed at doing what?
A
  1. Ophthalmologic emergency
  2. Immediate referral for further evaluation and definitive treatment:
  3. If there is an hour or more delay to treatment empiric therapy should be started
  4. This should be guided by the consultant
  5. It is aimed at lowering IOP
22
Q

What is the leading cause of blindness in the world?

A

Cataract

23
Q

Cataract—Risk Factors

7

A
  1. Age: predominant
  2. Smoking: two-fold increase
  3. Alcohol
  4. Sunlight exposure
  5. Metabolic syndrome
  6. DM
  7. Systemic corticoid steroid use*
24
Q

Cataract presentation? 3

PE findings? 2

A

Presentation:

  1. Painless, progressive process
  2. Patients usually complain of problems w/ night driving, reading road signs or difficulty w/ fine print
  3. Often increase in nearsightedness (myopic shift)

PE:

  1. Lens opacity can be confirmed by fundoscopic exam
  2. May see darkening of the red reflex, opacities or obscuration of ocular fundus detail
25
Q

Cataract Treatment?

A

Surgery

26
Q

Cataract Surgery Pre-op evaluation should include? 3

Complications? 2

A

Pre-op: Extensive evaluation not necessary

  1. HTN should be controlled
  2. Endocarditis prophylaxis not needed
  3. Risk of bleeding w/ aspirin or warfarin (coumadin) is low so meds can usually be taken

Complications:

  1. Endophthalmitis
  2. Retinal detachment
27
Q

Hearing Loss in the Elderly
Most common presentation presbycusis?
3

A
  1. Sensorineural
  2. Bilateral
  3. Beginning in the high frequency range (4000-8000Hz)
28
Q

Presbycusis—Risk Factors

9

A
  1. Lifetime exposure to noise
  2. Genetics
  3. Medications
  4. Older age
  5. DM
  6. Cerebrovascular disease
  7. Smoking
  8. HTN
  9. White race
29
Q

Presbycusis
Presentation? 3

Associated symptoms? 2

A
  1. Presentation:
    - Complain of inability to hear/understand speech in crowded or noisy environment
    - Difficulty understanding consonants
    - Inability to hear high pitched voices or sounds
  2. Associated symptoms:
    - Tinnitus
    - If hearing a pulsatile noise in one ear should further assess w/ MRA or MRI to R/O glomus tumor or AV malformation
30
Q

Screening for Hearing loss should begin when?

A

Screening for hearing loss > age 60

31
Q

Hearing Amplification
1. Should be done through who?

  1. Describe the efficiency of hearing aids?
A
  1. Should be done through a licensed audiologist!
  2. Hearing aids do not restore hearing to normal!
    - For example a 60 dB loss could be improved to a 30 dB range

Sometimes two hearing aids are better, sometimes one

32
Q

Subclinical Hypothyroidism
Defined how?

Data link subclinical hypothyroidism w/ what? 2

A
  1. Defined as a normal T4 with a elevated TSH

2. atherosclerosis and MI

33
Q

Subclinical Hypothyroidism: Tx Recommendations?

3

A
  1. TSH =/> 10 mU/L treat
  2. TSH between 4.5 – 10 mU/L in persons less than/= 65YO with sx suggestive of hypothyroidism
  3. Treating persons >/= 65YO increase risk of cardiac arrhythmias
  4. 4.5 to 8 in those over 70 then they should not be treated
34
Q

COPD

  1. What is it?
    - two types?
  2. Periodic exacerbations are characterized by what?
A
  1. Slow progressive irreversible airway obstruction:
    - Chronic bronchitis
    - Emphysema
  2. Periodic exacerbations:
    - Increased dyspnea
    - Infections
    - Respiratory failure
35
Q

Pathophysiology—Air Flow Obstruction: from what? 3

A
  1. Increased mucous in bronchioles
  2. Inflammation
  3. Decreased ciliary movement
36
Q

What is the definition of chronic bronchitis?

A

Chronic bronchitis is when a cough with mucus persists for most days of the month, for at least three months, and at least two years in a row.

37
Q

Characteristics of Chronic Bronchitis?

4

A
  1. Overweight and cyanotic
  2. Elevated Hemoglobin
  3. Peripheral edema
  4. Rhonchi and wheezing
38
Q

What is Emphysema?

A

Pathologic dx, permanent enlargement and destruction of airspaces distal to the terminal bronchoiles

39
Q

Characteristics of Emphysema? 4

A
  1. Older and thin
  2. Severe dyspnea
  3. Quiet chest
  4. On x-ray, hyperinflation and flattened diaphragm
40
Q

COPD: Air flow obstruction leads to? 3

A
  1. Increase residual volume and functional capacity
  2. Total lung capacity often increased
  3. Vital capacity decreased
41
Q

What is the main tx for COPD?

Treatment additions for COPD? 3

A
  1. O2
    • Short acting beta-agonists
  • Short acting anti-cholinergics
  • Glucocorticosteroids
42
Q

Complications COPD

5

A
  1. Cor Pulmonale
  2. Pneumonia
  3. Pneumothorax
  4. Polcythemia
  5. Arrhthymias
43
Q

Chronic Therapy for COPD

Usually involves what?

A

long term inhaled glucocorticoids

44
Q

Long term inhaled glucocorticoids:
1. Local deposition effects? 3

  1. Systemic SE? 3
A
  1. Dysphonia
  2. Thrush
  3. Cough/throat irritation/reflex bronchoconstriction
  4. Osteoporosis
  5. Adrenal suppression
  6. Increase intraocular pressure/cataracts
45
Q

Signs of Worsening COPD

4

A
  1. Decrease in BMI
  2. Decrease in FEV1
  3. Increased dyspnea on exertion
  4. Need for O2
46
Q

End Stage COPD

What should be involved in management? 5

A
  1. Hospice
  2. Control any pain
  3. Usually bedridden
  4. Support family
  5. Get living will in ADVANCE from patient—don’t want to put them on a ventilator they can’t come off of!
47
Q

Community Acquired Pneumonia: Predisposing conditions?

8

A
  1. Smoking
  2. Alcohol consumption
  3. Pulmonary edema
  4. Malnutrition
  5. Administration of immunosuppressive agents
  6. Being >/= 65 years of age **
  7. COPD
  8. Previous episode of pneumonia
48
Q

CAP
Pathogens? 4

Risk factors for drug resistance? 5

Tx?

Complicated—comorbidities/recent antibiotic use? 2

A

Pathogens?

  1. Strep Pneumo
  2. H. influenzae
  3. Chlamydia
  4. Viruses 10-31%

Risk factors for drug resistance:

  1. Age > 65 years
  2. Antibiotic therapy within the last 3-6 months
  3. Alcoholism
  4. Medical comorbidities
  5. Immunosuppressive illness or therapy

-Azithro

  • Respiratory fluoroquinolones (minimum of 5 days)
  • Amoxacillin-clavulanate
49
Q

CAP: Indications for hospitalization?

4

A

Use CRB-65:

  1. Confusion
  2. Respiratory rate > 30
  3. BP (systolic less than 90 mmHg or diastolic less than 60 mmHg)
  4. Age >65 years

Scores:
0-1—treated as outpatient
2—hospitalized
3-4—consider ICU care

50
Q

Residents of LTCF w/ pneumonia have a higher mortality then elderly patients in the community

Patients in LTCF have underlying factors? 4

A
  1. COPD
  2. Left heart failure
  3. Aspiration
  4. Use of sedating medications
51
Q

Parameters for clinical tx in LTCF rather then hospitalization?
6

A
  1. Able to eat and drink
  2. Pulse less than/= 100
  3. Respiratory rate less than/= 30
  4. Systolic BP >/= 90 or decrease of less than/=20 from baseline if /=92% or if pt has 6. COPD >/= 90%

Geriatrics (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions