Case 7: Harry Souza Flashcards
What are some common causes of falls in the elderly?
Cardiac: arrhythmias Neurologic: Dementia, Parkinsons Musculoskeletal: arthritis, weak Vascular: orthostatic hypotension Metabolic: Hypoglycemia Sensory deficit: balance, vision Medication
What is osteoarthritis?
-Progressive erosion of articular cartilage that results in structural & functional failure of synovial joints
What’s the pathophysiology of osteoarthritis?
Usually insidious (no apparent cause) as aging phenomenon
EARLY OA
Chondrocyte injury
Chondrocyte proliferation
Secrete proinflammatory mediators, collagens, proteoglycans, and proteases
Remodel cartilaginous matrix and initiate secondary infl. changes in synovium/subdchondral bone
LATE OA
Repetitive injury/Chronic inflam.
Chondrocytes die (degradation>synthesis
Marked loss of cartilage
Exposed subchondral bone plate becomes new articular surface
Friction against bone
Sclerosis + fractures
Synovial fluid can enter subchondral regions
Physical findings of osteoarthritis
Early OA: asymptomatic
Late OA: deep achy pain in joints aggravated by use, morning stiffness, limited range of motion, Heberden’s nodes (swelling in distal interphalangeal joints)
Treatment of OA
No cure, focus on pain management and prevent further exacerbation
- Avoid activity that cause pain
- Physical therapy
- Resistance training
- Redistribute/remove load (cane)
- Pain meds
- Surgery
What are cataracts?
Risk factors?
Clinical findings?
Treatment?
Opacification of lens that causes it to become cloudy & distort rays of light, prevent focusing on retina
- Caused by chemical changes in protein of lens
- Risk factors: Age*, smoking, UV
- Distorted vision, less acuity, sensitive to glare
- Lens removal & phacoemulsification
What is glaucoma?
Findings?
Treatment?
- Increased intraocular pressure due to abnormality in flow of aqueous fluid from ant. chamber that causes optic nerve damage
- IOP pushes lens backward, push vitreous humor back, pressure on choroid vascular layer, retinal ischemia
- Loss of PERIPHERAL vision, degeneration of optic disc
- Laser therapy/surgery
What is age-related macular degeneration?
Findings?
Treatment?
- Atrophic: atrophy/degeneration of retinal epithelium
- Neovascular: New vessels grow in retinal epithelium, causing hemorrhage/fibrosis
- Lose CENTER OF VISUAL FIELD, wavy images, lose contrast sensitivity
- None, Can only slow progression
What is diabetic retinopathy?
Findings?
Nonproliferative: dilation of veins, micro aneurysms, retinal hemorrhage, ischemia of macula
Proliferative: neovascularization
-Decreased/missing visual field
What is presbyopia?
-Age-related progressive loss of focusing power of lens (due to lens hardening and decreased ciliary muscle movement)
Pharmacology of HCTZ
Thiazide diuretic used for HTN, edema, Diabetes insipidus, and hypercalcuria
MOA:
-Inhibit Cl- portion of NaCl cotransporter at early DCT
-Increase NaCl in lumen
-Increase H2O in lumen via isosmotic movement
-Osmotic diuresis
-Decrease blood vol, SV, CO, BP
Common Side Effects of HCTZ
Decrease NaCl & K (hyponatremia, hypochloremia, hypokalemia)
Increase Ca2+, uric acid (Hypercalcemia, hyperuricemia)
Ankle sprain
Inversion** (damage to lateral ligaments) vs. Eversion (damage to medial ligaments)
Definition of a sprain
Grading
Sprain: stretch/torn ligament (most common in knees, ankles, fingers, wrists)
Grade 1) Microscopic tear in ligament, no lengthening, usually only anterior talofibular lig
Grade 2) Partial tear/stretching, some laxity, ant/post talofibular lig
Grade 3) Completely torn lig
What is the role of the mini-mental status exam?
Geriatric depression scale?
MMSE: determines cognitive function, assess orientation/memory/attention
GDS: Detect (but not diagnose) depressive symptoms in elderly. Helps distinguish between depression & somatic complaints
