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Geriatrics/Neuro > Geri - Sleep disorders, FTT, Vision and Hearing loss, Skin Lesions > Flashcards

Geri - Sleep disorders, FTT, Vision and Hearing loss, Skin Lesions Flashcards

1
Q

what are the 2 types of sleep states?

A

Nonrapid eye movement (NREM)

REM

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2
Q

what are the 4 stages of sleep?

A

1 and 2: light sleep
-stage 1 is between wakefulness and sleep

3 and 4: deep sleep (REM sleep)
-Deep restorative sleep occurs here

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3
Q

what’s a “Normal Night”?

A

Begins with NREM -> REM sleep after 80 minutes -> cycle continued between NREM and REM with REM getting longer

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4
Q

in what state of sleep does deep restorative sleep occur?

A

REM (stages 3 and 4) - deep sleep

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5
Q

what is insomnia associated with?

A

daytime fatigue, irritability and problems with concentrating

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6
Q

what are the 4 common types of insomnia?

A

(1) Difficulty falling asleep
(2) Mid sleep awakening
(3) Early morning awakening
(4) Non-restorative sleep (don’t get into stage 3 or 4 of sleep)

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7
Q

how long do transient/acute insomnia sx’s last?

A

< 1 week

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8
Q

how long do short/subacute insomnia sx’s last?

A

1 week - 3 months

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9
Q

how long do chronic insomnia sx’s last?

A

3 months

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10
Q

sleep disorder NREM presentation?

A
  • Change in sleep structure (stages of sleep)
  • Change in sleep pattern (amount and timing) - mid sleep awakening
  • Decrease in total sleep time
  • Day time fatigue, irritability
  • Problems with concentration
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11
Q

sleep disorder dx?

A
  • Sleep questionnaires
  • Sleep log
  • Interview of bed partner
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12
Q

polysomnography (sleep study) is NOT indicated for regular evaluation of what?

A

insomnia

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13
Q

how are REM sleep d/o’s dx?

A

polysomnography (ex: sleep apnea)

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14
Q

sleep disorder NREM non-pharmacologic tx

A

Sleep hygiene

Behavioral therapy

Bright light therapy

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15
Q

what is sleep hygiene tx?

A
  • Regular wake up times
  • Limit daytime napping
  • Avoid excess pm fluids, minimize noise, ambient temp
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16
Q

sleep disorder NREM pharmacologic tx?

A

Benzo’s

Non-Benzo’s (Trazadone)

OTC meds (melatonin, APAP, “night cap”)

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17
Q

why caution with short acting Benzo’s?

A

rebound insomnia increased risk of fall, hallucinations

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18
Q

why caution with long acting Benzo’s?

A

can have carryover effects into the day time -> risk of falls

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19
Q

what is sleep apnea caused by?

A

Collapse of the oropharyngeal structures

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20
Q

how long does breathing stop for in sleep apnea?

A

10secs-minutes

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21
Q

what is the MOST IMPORTANT predictor for sleep apnea?

A

Obesity - increased BMI

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22
Q

what are the 2 types of sleep apnea and which one is the M/C?

A

Obstructive (M/C)

Central

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23
Q

what is Obstructive sleep apnea d/t?

A

anatomy or obesity

-collapse of oropharyngeal structures (tongue falls back and blocks airway)

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24
Q

what is Central sleep apnea d/t? examples?

A

brain fails to transmit signals to breathing muscles

Ex:

  • Parkinson’s
  • Stroke
  • CHF
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25
Q

sx’s of sleep apnea?

A
  • Daytime sleepiness (M/C)

- Morning HA (b/c low on O2)

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26
Q

what does the bed partner report in sleep apnea?

A
  • Loud snoring
  • Choking
  • Gasping sounds
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27
Q

how is sleep apnea dx?

A

***Polysomnography (measures NREM and REM)

Vitals - hypoxia
Labs - hypoxia, hypercapnia

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28
Q

tx of sleep apnea?

A
  • ***weight loss
  • avoid alcohol
  • avoid sedatives
  • avoid sleeping supine
  • ***CPAP
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29
Q

what is periodic limb movement disorder? when does it stop?

A

recurring episodes of stereotypic rhythmic movements during sleep, generally involving the legs

doesn’t stop -> occurs during sleep

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30
Q

what is restless leg syndrome? when does it start and stop?

A

uncomfortable irresistible urge to move legs, motor restlessness

occurs just before onset of sleep and stops once asleep

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31
Q

how is PMLD and RLS dx?

A

PMLD dx with Polysomnography

RLS dx based on pt’s sx’s

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32
Q

tx of PMLD and RLS?

A

RLS - stretching and massage

Dopaminergic agents

  • pramipexole
  • ropinirole

Oxy or Clonazepam (but bad adrs in elderly)

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33
Q

what is failure to thrive (FTT)?

A

Deteriorating state characterized by:

  • weight loss
  • decreased appetite, poor nutrition
  • inactivity (not moving around a lot)
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34
Q

what is FTT accompanied by?

A

dehydration, depression, impaired immune function, and low cholesterol

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35
Q

what’s the etiology of FTT?

A

Interaction of 3 components:

(1) Physical frailty
(2) Disability -> difficulty completing tasks for self-care and independent living (ADLs)
(3) Impaired neuropsychiatric function

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36
Q

what neuropsychiatric d/o’s are M/C in FTT?

A

Delirium, depression, and/or dementia

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37
Q

what are some RF’s of FTT?

A
  • Med adrs
  • Comorbidities
  • Psychosocial factors
  • Weight loss of 5% of body weight over 6-12 months
  • Poor food intake
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38
Q

FTT risk factor measurement for Frailty

A

Must have 3 or more of these 5 criteria:

(1) Weight loss (>5% of body weight in 1 year)
(2) Exhaustion (by asking questions related to activity)
(3) Weakness (decreased grip strength)
(4) Slow walking speed (>7 seconds to walk 15 feet)
(5) Decreased physical activity (based on kcals)

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39
Q

FTT risk factor measurements

A

Frailty

Mini nutritional assessment

Subjective global assessment

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40
Q

what’s the subjective global assessment for FTT?

A

Weight, diet, gi symptoms, functional capacity, physical appearance (decrease in muscle mass or fat)

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41
Q

what vital sign should you look for with FTT?

A

Look for orthostatic hypotension

-signs of both autonomic dysfunction and/or dehydration (with this, at risk for falls and FTT)

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42
Q

what’s the best PE test for FTT? how’s it done?

A

Get up and go test

  • Rise from chair not using arms, walk 10 feet, turn and return to the chair and sit
  • Complete in 7-10 sec
  • Increased risk for fall & FTT if >10 sec
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43
Q

FTT dx is based on what?

A

history and PE

order appropriate lab tests

  • screen for infection
  • CMP (LFT, Cr) for organ failure
  • Ca, phosphate
  • TSH
  • B12, folate, vit D
  • albumin
  • total cholesterol
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44
Q

tx for FTT

A

treat underlying condition

consult when appropriate (dietitian, psych, PT, etc.)

***REVIEW MEDS FOR POLYPHARMACY

Appetite stimulants, PT, Growth hormones

Psychostimulants for geriatric depression and FTT (methylphenidate)

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45
Q

what are appetite stimulants?

A

Megestrol - be cautious of edema and DVT

Dronabinol - limit use 2/2 side effects

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46
Q

what med for depression/weight gain in FTT?

A

Mirtazapine

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47
Q

when do you consider hospice for FTT?

A

(must be DNR/DNI) -> life expectancy must be < 6 months

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48
Q

what’s the hospice criteria?

A
  • Weight loss not due to reversible cause
  • Chronic or intractable infection
  • Recurrent aspiration and/or inadequate intake 2/2 pain with swallowing or weakness
  • Progressive dementia
  • Progressive pressure ulcers even with extreme care (stage III or IV)
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49
Q

what is visual impairment defined as?

A

best corrected visual acuity worse than 20/40 & better than 20/200 in better seeing eye

50
Q

what is blindness?

A

when best visual acuity is <20/200

51
Q

Common diseases with visual impairment?

A
  • Cataracts
  • Age related Macular Degeneration
  • Glaucoma
  • ***Diabetes
52
Q

what are cataracts?

A

Lens opacity which causes glare, blurred vision, alterations of color

53
Q

risk factors of cataracts?

A

> 60 y/o

smoking, steroid medication, DIABETES

54
Q

sx’s of cataracts?

A

glare-related vision loss

reduction of visual acuity (trouble focusing)

yellow discoloration of lens

***ABSENT RED REFLEX

55
Q

dx of cataracts?

A

PAINLESS, progressive decline in vision that doesn’t improve with refraction (glasses, contacts)

56
Q

cataracts can be confirmed by?

A

nondilated funds exam showing darkening of red reflex or opacities w/in it

57
Q

tx of cataracts?

A

Surgery if 20/50 vision or worse
-Phacoemulsification of the nucleus

REFER TO OPHTHALMOLOGIST

58
Q

what is macular degeneration?

A

degeneration of the macular retina leading to central vision loss

59
Q

what is the 1st sign of macular degeneration?

A

appearance of yellow-white deposits under the retina in a dilated exam

60
Q

macular degeneration and associated blindness triples at what age?

A

> 70 y/o

61
Q

what’s the leading cause of vision loss in >60 y/o?

A

macular degeneration

62
Q

risk factors of macular degeneration?

A

smoking, family hx, HTN

63
Q

what are the 2 types of macular degeneration?

A

Atrophic (nonexudative) “dry” (M/C)
-***Yellow drusen bodies

Neovascular (exudative) “wet”: 90% of legal blindness
-Growth of abnormal blood vessels; sometimes can see bleeding

64
Q

in what macular degeneration are yellow drusen bodies seen?

A

atrophic (nonexudative) “dry” macular degeneration

65
Q

sx’s of macular degeneration?

A

***Loss of central vision (peripheral vision is spared)

bilateral

dark or empty areas in visual field (scotomas)

distortion of straight lines (b/c only have peripheral vision)

66
Q

dx of macular degeneration?

A

Refer to opthomologist

Fundoscopic exam

67
Q

what are the yellow drusen spots seen in atrophic “dry” macular degeneration?

A

protein material

68
Q

tx of macular degeneration?

A

No effective treatment

Neovascular AMD may benefit from focal photocoagulation or photodynamic therapy

Laser surgery is the main treatment for neovascular AMD

Central vision loss of b/l eyes -> consider referral for low-vision rehabilitation

69
Q

what’s the main treatment for neovascular AMD?

A

laser surgery

70
Q

what’s the definition of Glaucoma?

A

Triad of signs including at least 2 of the following:

(1) Elevated intraocular pressure
(2) Optic disc cupping
(3) Visual field loss

71
Q

what’s the most common type of glaucoma in elderly?

A

Primary open-angle

72
Q

what is 3x as risky for glaucoma occurrence/

A

family hx

73
Q

can vision loss in glaucoma be reversed?

A

NO!!! vision loss in glaucoma can’t be reversed

74
Q

how can you prevent glaucoma?

A

screenings q2-4 years until age 64 then every 1-2 years >65

75
Q

when does vision loss occur in glaucoma?

A

after a significant amount of nerve damage is done

76
Q

Primary open-angle glaucoma sx’s?

A
  • Blurred vision
  • Halos around lights
  • Impaired dark adaption
  • Vision loss starts in nasal field
77
Q

Primary closed-angle glaucoma sx’s?

A
  • Blurred vision
  • HA, N/C
  • Corneal edema
  • Mid-dilated pupil
78
Q

dx of glaucoma?

A

Tonometry – measures the IOP

Optic Disc assessment and gonioscopy (measures anatomic configuration of the anterior chamber angle open vs. closed)

Visual Field Exam

79
Q

what is normal eye pressure on tonometry? pressure in POAG? COAG?

A

-Normal eye 10-21 mm Hg

POAG – may have normal pressure

Closed angle has higher pressure

80
Q

what is seen on Optic DISC assessment and gonioscopy for glaucoma?

A

Enlarged optic disc cup with pallor

Nasal displacement of the retinal vessels on the disc

81
Q

tx of Glaucoma?

A

-Lower the IOP

Medications – lower IOP through reduction on aqueous production or resistance to outflow

  • Beta-adrenergic antagonists
  • Alpha-aderenergic agonists
  • Muscarinic agonists
  • Carbonic anhydrase inhibitors

Surgical Tx – when refractory to medications -> Laser trabeculoplasty

82
Q

what’s the goal of glaucoma tx?

A

to stabilize visual field loss and optic nerve damage

83
Q

when does hearing loss start to decline?

A

Hearing starts to decline by 9dB/decade once you hit age 55

84
Q

what’s the most common type of hearing loss?

A

presbycusis - bilateral high frequency sensorineural hearing loss

-innear ear sensorial hearing loss

85
Q

what is conductive hearing loss due to?

A

external or middle ear problem

M/C is infection, tumor, WAX!!!

86
Q

most common cause of sensorineural hearing loss?

A

inner ear

Presbycusis

87
Q

other causes of sensorineural hearing loss?

A

noise, infection, Meniere’s, trauma

Gentamycin (ototoxic) -> affects CN 8

88
Q

causes of conduction hearing loss?

A

outer/middle ear

  • ***WAX
  • external otitis/otitis media
89
Q

etiology of Presbycusis

A

Pure-tone threshold sensitivity diminishes

both cochlear hair cells and the spiral ganglion cells in the vestibulocochlear nerve can be affected

90
Q

what are the 3 main affected areas of Presbycusis hearing loss?

A

sensory, metabolic, neural

91
Q

what is affected in the sensory area in Presbycusis?

A

loss of hair cells and a high-frequency hearing deficit

92
Q

what is affected in the metabolic area in Presbycusis?

A

loss of stria vascularis and a low-frequency hearing deficit

93
Q

what is affected in the neural area in Presbycusis?

A

loss of ganglion cells and a variable pattern of hearing loss

94
Q

what’s the HALLMARK presentation of Presbycusis?

A

progressive, symmetric loss of high-frequency hearing

bilateral and bilateral tinnitus

95
Q

what is presbyasmasis?

A

loss of vestibular end-organ function

causes dizziness in Presbycusis

96
Q

dx of Presbycusis?

A

based on hx - progressive, bilateral

***Audiologist evaluation

whispered test

***Weber test will be normal

97
Q

when does the ALS hearing association recommendation audiometric testing and for who?

A

recommends anyone older then 50yrs old should complete audiometric testing every 3 years

98
Q

what test will be normal in Presbycusis?

A

Weber test (pt hears sound equally in both ears)

99
Q

Presbycusis tx?

A
  • hearing aid
  • cochlear implant (if hearing aid fails)
  • assisted listening devices
  • auditory rehab
100
Q

syncope is associated with…

followed by…

A

associated with loss of postural tone

followed by complete and quick recovery

101
Q

sharp rise in syncope at what age?

A

70 y/o

102
Q

men often have more what type of syncope?

A

cardiac syncope

103
Q

pathophysiology of syncope?

A

Result of decreased baroreceptor reflex sensitivity
-elderly persons may not be able to maintain cerebral blood flow by increasing HR and vascular tone in the setting of hypotension

Elderly more sensitive to the effects of vasodilators and hypotensive drugs

More sensitive to volume loss, GI bleeding, standing up from sitting

104
Q

what are the 3 types syncope?

A

Reflex (M/C)

Cardiac (Brady/tachy arrhythmia - supraventricular and ventricular)

Unknown

105
Q

what are the 4 types of Reflex syncope?

A

Vasovagal (M/C)

Orthostatic hypotension

Carotid sinus hypersensitivity

Situational

106
Q

what’s vasovagal syncope?

A

Development of inappropriate cardiac slowing and arteriolar dilation from a decrease in sympathetic tone

Originates in the heart

107
Q

vasovagal syncope d/t?

A

Emotional or orthostatic stress:

  • venipuncture/painful stimuli
  • fear
  • prolonged standing
  • heat exposure
  • exertion
108
Q

what is the prodrome that vasovagal syncope is associated with? secondary to?

A
  • Nausea
  • Pallor and sweating

This is secondary to an increase in vagal tone

109
Q

even if think syncope is vasovagal, what do you need to r/o? do what tests?

A

that it is NOT cardiac syncope

-do ECHO, put on heart monitor, test electrolytes, make sure not a stroke BEFORE SAY PT WAS VASOVAGAL

110
Q

what is orthostatic hypotension?

A

Postural decrease in systolic BP of at least 20 mmHg

111
Q

causes of orthostatic hypotension?

A

Decreased intravascular volume: infection, diuretics

Drugs: TCA, HTN
-Beta and alpha blockers, hydralazine, ACEs

Vasodilators: CCB and nitrates (more common in elderly)

Primary autonomic insufficiency: Parkinson’s

Secondary autonomic insufficiency
-DM, ETOH (impairs vasoconstriction)

112
Q

what is carotid sinus hypersensitivity syncope?

A

BP and HR are controlled within the carotid sinus of aortic arch

Increase in BP or pressure applied to the carotid sinus activates vagal efferents -> slows the HR and decreases BP

113
Q

what is situational syncope caused by?

A

Cough, sneeze, BM, postmicturation, post exercise, post prandial

114
Q

sign and sx’s of syncope?

A
  • Abrupt onset
  • Prompt recovery of dull consciousness
  • transient loss of consciousness

-Maybe Prodrome of: sweating, lightheaded, dizzy, nausea

115
Q

get what test done on everyone that presents with syncope?

A

EKG -> could have WPW

116
Q

upright tilt table test diagnostic if? useful to distinguish b/w?

A

syncope is d/t bradycardia and hypotension

Helpful to distinguish between reflex and orthostatic hypotension

117
Q

tx of syncope?

A

Treat finding or underlying condition

118
Q

what are pressure ulcers?

A

Pressure on susceptible tissues causing skin breakdown

Visible evidence of the pathological changes in blood supply to the dermal tissues

119
Q

primary source of pressure ulcers is in what setting?

A

acute hospital

120
Q

pressure ulcer tx?

A

Maintain a moist wound healing environment (heal faster than air-exposed wounds)

Topical dressings
-Hydrogels, Hydrocolloid, Alginates

Growth factors

Surgical Debridement

Geriatrics/Neuro (11 decks)

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