3 Flashcards
Four visual factors providing evidence for falls** (CPPV)
1-contrast sensitivity
2-poor VA
3-poor depth perception/stereo
4-VF impairment
Relative to 20/20, the risk of falling is doubled, tripled, and quadrupled based on which VA ranges?
DOUBLED: 20/30-20/40
TRIPLED: 20/50-20/70
QUADRUPLED: worse than 20/70
What condition do you assume until proven otherwise if you have a male 10-30Y/O, with a central VF defect and optic atrophy? What’s the vision likely to hover around?
LEBER’S hereditary optic neuropathy
-painless, sequential vision loss, unaffected eye is affected w/i wks-months, mitochondrial DNA mutation - thanks mom.
20/200 (or worse)
What is the biggest potential comorbidity in the elderly, and is both the #1 cause of death due to unintentional injury, AND the #1 cause of TBI in the elderly population?
FALLS!!
What are the six steps to breaking bad news?***
SPIKES
S - Setting/Starting
P - patient’s perspective (what they know, fears)
I - Invitation (your role in their care)
K - Knowledge - BREAK THE NEWS HERE, small chunks
E - Emotions/Empathy
S - Summary/Strategy - mgmt plan
Of the tests to assess mental function, which lacks sensitivity to mild/progressive changes?
-Which is available for blind individuals? Which is very reliable but has the disadvantage of being self-administered?
- MMSE - no sensitivity to mild/prog changes (Alzheimer’s)
- MoCA - montreal cognitive assess - blind people, sensitive to mild & Alz, but “too sensitive”, takes LONG to administer
- SAGE - (self-admin gerocog exam) - very sensitive to mild/Alz, available in many languages, NOT avail for blind ppl
What two services/living arrangements will medicare NOT cover?
1) assisted living
2) long-term (extended) nursing home care
What are three POWERFUL visual predictors increasing the risk of a patient’s first fall?
1) VF loss (-5dB or worse)
2) decreased VA (20/25 or worse)
3) decreased CS (risk rises every 0.1 log; one letter = -0.4)
Average amt of time doctor listens to pt before interrupting:
18 seconds!
