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Flashcards in Potpurri 2 Deck (21)
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1

Age-related Macular Degeneration:
-what is this?
-types
-sx
-risk factors

What: degenerative dz of central portion of the retina (macula)

Types:
-Dry (atrophic) = ischemic, retinal epithial cell apoptosis
-Wet (neovascular or exudative) = Vascular Endothelial Growth Factor?

Sx: may often be asymptomatic and results in central vision loss.

Risk factors:
-age, smoking, genetics, CVD, heavy alcohol use, caucasians

2

Age Related Macular degeneration:
-what are some good hx questions to ask?
-PE findings in both wet and dry ARMD

Hx questions:
-rate of vision loss; vision loss occurring over days or weeks requires urgent ophthalmic referral!
-whether one or both eyes are involved.

PE:
-Dry = drusen bodies (bright yellow spots), atrophy (depigmentation)
-Wet = subtretinal fluid and/or hemorrhage, neovascularization (gray/green), fluoresein angiogram lights up the vessels

3

Age-related Macular Degeneration:
-tx of dry and wet
-dx

Tx:
-Dry = none, slow progression with antioxidants with Vit C and E, beta carotene, zinc, and copper.
*no beta carotene in smokers

Wet:
-VEGF inhibitors
-photocoagulation
-surgery

Dx: Amsler grid

4

Glaucoma:
-types
-Which type is MC?
-risk factors
-pathophys

Types:
-acute angle glaucoma

-Primary open-angle glaucoma (MC)

-secondary:
--uveitis
--old trauma
--steroid therapy

-congenital glaucoma

Risk factors :
-FHx
-age greater than 40-50YO
-female
-hyperopia
-pseudoexfoliation
-race; highest in inuit and asains

Pathophys: schlemms canal becomes blocked.
*In acute angle closure glaucoma the iris root occludes the trabecular meshwork completely obstructing drainage of aqueous fluid from the anterior chamber

5

Primary angle closure glaucoma:
-signs and sx
-cauuse
-tx

signs and sx:
-no sx initially
-optic disc described as cupping (increased cup:disk ratio)
-peripheral visual field loss followed by central field loss.
-increased IOP (normal is 8-22)
Cause:
-pts anatomically predisposed
-no identifiable secondary cause

Tx:
-topical and systemic medications: carbonic anyhdrase inhibitors
-laser therapy
-surgery

6

Secondary Angle-closure glaucoma:
-cause

Cause:
-fibrovascular membrane grows over the angle
-mass or hemorrhage in posterior segment pushes the angle closed

7

Angle closure glaucoma:
-presentation
-tx

Presentation:
-decreased vision
-halos around lights
-HA
-severe eye pain
-N/V

-conjunctival redness
-corneal edema or cloudiness
-shallow anterior chamber
-mild-dilated pupil; reacts poorly to light.

Tx:
-immediate referral to ophtho, if there is an hour or more delay to tx then empiric therapy should be started
-treatment is aimed at lowering IOP.

8

Cataract:
-risk factors
-presentation
-PE findings
-tx

Risk:
-age*
-smoking
-alcohol
-sunlight exposure
-metabolic syndrome
-DM
-systemic corticoid steroid use*

Presentation
-painless
-c/o trouble with night driving, reading road signs, or difficulty with fine print
-increase in nearsightedness

PE findings:
-lens opacity can be confirmed by fundoscopic exam
-may see darkening of red reflex, opacities or obscuration of ocular fundus

Tx:
-surgery

Complications:
-endophthalmitis
-retinal detachment

9

Presbycusis:
-what is this?
-MC type
-Risk factors
-presentation
-Tx

What; hearing loss d/t aging

MC type: sensorineural

Risk factors:
-lifetime exposure to noise
-genetics
-medications
-age
-DM
-Cerebrovascular dz
-smoking
HTN
-white race

Presentation:
-inability to hear/understand speech in a crowded or noisy environment
-difficulty understanding consonants
-inability to hear high pitched voices or sounds
-tinnitus

Tx: hearing amplification
-hearing aids by audiologist

10

Subclinical Hypothyroidism:
-definition
-recommendations for tx

Definition: normal T4 with an elevated TSH.

Recommendations fort Tx:
-TSH greater than 10mU/L
-pts who have sx of hypothyroidism
-DO NOT treat if older 70 and TSH 4.5-10.
-consider tx for patients less than 70 with TSH 4.5-10 who have high titers of thyroid peroxidase abys.

11

COPD
-what is this?
-sx of exacerbations
-risk factors
-pathophys

What; slow progressive irreversible airway obstruction: chronic bronchitis, emphysema

Sx:
--increased dyspnea
-infection
-respiratory failure

Risk factors:
-smoking
-alpha-1 antitrypsin

Pathophys:
-increased mucus production leading to obstruction
-decreased ciliary transport
-inflammation of bronchioles
-air trapping in alveoli...leading to less surface area for gas exchange

12

Chronic Bronchitis:
-definition
-what do these pts look like

Emphysema:
-definition
-what do these pts look like?

def: daily productive cough for 3mo or more in at least 2 consecutive years

Looks:
-overweight & cyanotic
-elevated Hgb
-peripheral edema
-rhonchi & wheezing
-blue bloaters

Emphysema:
- def: permanent enlargement and destruction of airspaces distal to the terminal bronchiole

Looks:
-older and thin
-severe dyspnea
-quiet chest
-pink puffers
-pursed lips

13

With COPD is lung total lung capacity increased or decreased? vital capacity?

What are some common findings on CXR in COPD?

total lung capacity is often increased while vital capacity is decreased.

CXR:
-elongated heart and chest cavity, flattened diaphragm

14

Acute COPD exacerbations:
-cause
-tx
-long term tx
-complications
-what is the only tx that prolongs life?

Cause:
-infections (majority are viral but may be bacterial)
-environmental pollution or unknown

Tx:
-Short acting beta agonists
-short acting anti-cholinergics
-glucocorticosteroids

Long term: inhaled glucocorticoids

Complications:
-Cor pulmonale
-pna
-pneumothorax
-polycythemia
-arrhthymias

OXYGEN is the only tx that prolongs life!

15

COPD:
-worsening signs of this dz
-COPD will kill you.

Worsening signs:
-decrease BMI
-decrease in FEV1
-increased dyspnea on exertion
-need for O2

16

Community Acquired Pneumona:
-predisposing conditions
-pathogens
-tx uncomplicated and complication
-indications for hospitilization

Predisposing conditions:
-smoking
-ETOH
-pulm edema
-malnutrition
-administration of immunosuppressive agents
-being greater than 65YO**
-COPD
-previous episodes of PNA

Pathogens;
-H. flu, chlamydia, strep pneumo
-viruses

Tx:
-uncomplicatied: macrolide

-complicated: resp FQ such as levoquin or amoxacillin-clavulanate (Augmentin)

Indications for hospitilization:
-CURB-65
--Confusion
--Blood urea nitrogen greater than 7
--RR greater than 30
--BP (Systolic) less than 90 or diastolic less than 60

*Scores: 0-1 = treat outpatient, 2= hospitalize, 3-4= consider ICU

17

T/F, residents in long term care facilities w/ pna have a higher mortality than elderly pts iin the community?

True.

18

Common causes of pain in the elderly?

What are the WHO guidelines for treating
-mild
-moderate
-severe
pain in the elderly.

WHat medications are we certain not to use?

osteoarthritis and other joint dz

night time leg cramps

claudication

Neuropathies: diabetic, herpetic, idiopathic

Cancer

Mild pain: nonopioid +/- adjuvant

Moderate: nonopioid or opioid or adjuvant

Severe: nonopioid, stronger opioid, or adjuvant

**DO NOT USE amitriptyline or propoxyphene

19

NSAIDS and the elderly:
-may be toxic to which organ systems?

Toxic:
-renal toxicity
-GI
-cardiotoxicity (interacts with aspirin and warfarin)

20

Tx of chronic pain in the elderly.

Tx of neuopathic pain

What are some of the adjuvant therapies that can be used in tx?

first line: tylenol

Neuropathic pain: neurontin, lyrica, cymbalta

*be careful with opioids, start low and slow

Adjuvants;
Exercise: PT/OT/Stretching/stregnthening
-TENS
-Ice, heat, massage
-CBT
-chiropractic therapy
-acupuncture
-relaxation & guided imagery
-biofeedback

21

Osteoporosis:
-what is this?
-what is a fragility fx?
-risk factors for osteoporosis independt of BMD.
-Tx

What; dz characterized by low bone mass w/ microarchitectural disruption & skeletal fragility

Fragility fx: fx that occurs from standing height or less or with no trauma.

independent Risk factors:
-advanced age*
-previous fx*
-long term steroids
-low body weight (127)
-FHx of hip fx
-smoking
-excess alcohol intake

Tx:
-Hip: surgery
-Vertebral fx: analgesics, calcitonin, vertebroplasy and kyphoplasty