HEENT/Resp Flashcards
1
Q
All of the following are age-related changes of the auditory system EXCEPT:
A) Cochlear hair cells in organ of Corti degenerate
B) Neurons innervating the cochlear and auditory centers in brain are lost
C) Degeneration, stiffening and calcification of basiliar membrane of cochlea
D) Increased vascularity of cochlea, capillaries of stria vascularis thicken
E) Degeneration of ossicular joints
A
C) Decreased vascularity of cochlea, capillaries of the stria vascularis (source of endolymph) thicken
2
Q
Which of following are possible age-related changes of the auditory system: (multiple answers)
A) Inability to hear high-frequency sounds
B) Inability to hear low-frequency sounds
C) Inability to disseminate localization of sound
D) Increased risk of cerumen impaction
A
A) Inability to hear high-frequency sounds
C) Inability to disseminate localization of sound
D) Increased risk of cerumen impaction
3
Q
True/False
Hearing loss is an inevitable consequence of aging
A
False
4
Q
Most common cause of age-related hearing loss in older adult
A
Presbycusis
5
Q
Describe characteristics of presbycusis (ie. laterality, SNHL, CHL, onset, frequency affected)
A
Insidious onset, symmetrical SNHL affecting high frequency tones
6
Q
Which of the following are risk factors for hearing loss: A) older age B) Male sex C) Dark complexion D) Education level E) Exposure F) Medications
A
ALL except C)
7
Q
Which exam that can be conducted in any primary care office has high specificity and sensitivity for hearing loss?
A
Whisper test
8
Q
At age __, all people should have routine hearing tests every ___ years
A
60 years old
every 2 years
9
Q
List common medications/classes that are ototoxic. Hint:
A
Don’t Loop and Snag My Plate Christine Quinn
Loop Diuretics Salicylate NSAIDs Antibiotics Amino-glycosides VancoMYcin Plate - cisplatin, carboplatin Cristine - vincristine Quin - Quinine
10
Q
True/False
Antidepressants can cause tinnitus
A
True
11
Q
What medications have reversible ototoxicity when stopped?
A
NSAIDs
Loop diuretics
Antimalarials (usually)
12
Q
What is the gold standard exam to diagnose cataracts?
A
Slit lamp
13
Q
Name that condition: Decreased visual acuity - blurry/foggy Sensitivity to light/glare Decreased color perception Decreased night vision/halos
A
Cataracts
14
Q
Leading cause of blindness in the world
A
Cataracts
15
Q
List 3 risk factors for cataracts
A
DM Long-term use steroids Prior intra-ocular surgery Myopia Age Family hx Smoking HTN
16
Q
3 types of cataracts
A
Nuclear
Cortical
Posterior subscapular
17
Q
Name that condition:
Most common type of cataract that develops over years
A
Nuclear sclerotic cataracts
18
Q
Type of cataracts that is highest risk in DM
A
Cortical Cataracts
19
Q
Type of cataracts that you are at risk for if you have DM or extreme nearsightedness or use steroids
A
Posterior subscapular cataracts
20
Q
Cataract that develops quickly over months, NOT years
A
Posterior subscapular cataracts
21
Q
Type of cataracts where you first notice your night vision changing and difficulty reading
A
Posterior Subcapsular Cataracts
22
Q
True/False
Age related macular degeneration is reversible
A
False
23
Q
Which of the following are risk factors for AMD?
- HTN
- DM
- Smoking
- ETOH
- Family Hx
- Male sex
- Age >65
- European descent
A
HTN Smoking Diabetes Family History of AMD Age >60 European decent Female sex
24
Q
What home monitoring tool can be used for macular degeneration?
A
Amsler grid
25
Leading cause of irreversible vision loss
AMD
26
Two forms of AMD
Atropic/dry
| Neovascular/wet
27
Type of AMD that is slow to progress, limited night vision and difficulty reading
Atropic/Dry/Non-exudative
28
characterized by large drusen and pigmentary abnormalities in the macula
early stage of dry age-related macular degeneration
29
What type of vision loss?
AMD - Center vision may appear blurry because parts of the macula have begun to die, leaving blank spots in vision. Straight lines may look wavy. Side or “peripheral” vision is rarely affected.
30
Mgmt of dry macular degeneration
BP control
Smoking cessation
Daily eye vitamins (C, E, letin, zinc, etc.)
31
All these medications have in common is:
sedatives, antipsychotics, antianginal agents, antidepressants, antihistamines, antihypertensives, antiparkinsonian agents, diuretics, anticholinergics
SE of Xerostoma
32
____ inhibits demineralization of the tooth surface and enhances remineralization
Saliva
33
What components are included in history of xerostoma?
Xerostoma Inventory questionnaire
Med -
PMHx - infections, diabetes, Alzheimer’s disease, RA, HTN, Bell's Palsy, depression and anxiety, sjogrens, chemo, irradiation of head/neck
Surgical Hx -
34
Most common opportunisitc infection with xerostoma
oral candidiasis
35
Tx for xerostoma
First line:
Mechanical - lozenges
Chemical - artificial saliva (ex. biotene)
Dental care
Second line:
Antimuscarinics
36
rise in intraocular pressure (IOP) that causes damage to the optic nerve
Glaucoma
37
Normal IOP between ___ and ___ mm Hg.
IOP is typically between 10-21mmHg
38
True/False
| Initial diagnosis and treatment of glaucoma is done by NPs
False
39
Patient presents with the following symptoms. What do you suspect and what is your next step?
```
41 year old with:
Aching eye and brow pain
Deep dull, periocular headache
Reduced visual acuity
Eye redness
Corneal edema
Fixed dilated pupil
```
primary closed angle glaucoma
Referral to ophthalmologist for tonometry
Note: Fixed dilated pupil. Iris ischemia may cause the pupil to remain permanently fixed and dilated.
40
the IOP rises rapidly as a result of relatively sudden blockage of the trabecular meshwork by the iris via papillary block mechanism
Angle-closure glaucoma (ACG)
41
First line treatment of POAG
Prostaglandin analogues that increase uveoscleral outflow.
Ex. Latanoprost, Bimatoprost
42
Laser iridotomy is required for definitive treatment of what condition?
Closed-angle glaucoma
43
Open-angle glaucome with eye pressure within normal range.
Normal-Tension Glaucoma
44
Black and white dots on the tympanic membrane
Fungal infection
45
T/F- Tinnitus is a ringing, crackling, or buzzing sound that comes from within a person
True
46
T/F- Normal age related changes to ears include pendulous earlobes due to the loss of elasticity, and a more weight, doll, opaque Tympanic membrane
True
47
Ulcerated crusting Lesions on the pinna, that bleed, are slow to heal, have indurated base ——?
Think- carcinoma!
48
A 70-year-old patient complains of hearing that is getting worse, sounds are garbled and difficult to locate. What’s your response?
Normal age to changes in hearing – presbycusis
49
What cranial nerve transmits nerve impulses from the organ of Corti to the brain
VIII- Vestibulocochlear
50
Spinning sensations are due to what ear structure
Labyrinth
51
A form of hearing loss when sounds cause pain as volume increases
Recruitment
52
Movement of the extraocular muscles is controlled by what cranial nerves
III, IV, VI
| Oculomotor, trochlear, abducens
53
The outer layer of the eye is made up of what structures?
Cornea and the sclera, sensitive to touch
54
Structures in the middle layer of the eye-
| Inner layer lf the eye-
Middle- choroid
| Inner- retina
55
Stimulation of the sympathetic branch of the autonomic nervous system does what to a pts eye?
Elevates the eye lid and dilates the pupil
56
Parasympathetic nervous system stimulation does what to the pupil?
Constricts pupil
57
The ciliary body controls what
Thickness of the lens
58
Intraocular pressure is determined by what
The balance between the amount of aqueous produced and the resistance to its outflow at the angle of the anterior chamber
59
Does accommodation cause-
pupillary constriction when looking at a near object, or
pupillary dilation when looking at a far object?
Constriction- near
| Muscles in iris contract pupil in bright light and accomodate for near vision
60
What physiological changes responsible for presbyopia
The lens loses its elasticity and decreases its ability to change shape to accommodate for near vision
61
What causes floaters?
Condensed vitreous fibers, often insignificant
62
Snellen eye chart result is 20\30, what does that mean?
The patient reads at 20 feet what someone with normal vision can read at 30 ft
63
Normal findings of the diagnostics positions test?
Parallel tracking of the object with those eyes
64
T/F- In older adults pupils are small, pupillary light reflex is slowed, pupillary constriction is symmetric.
True- pupillary assymetry is not normal in older age!
65
What is Anisocoria?
Unequal pupils size
66
Person has shadows are diminished vision in one quadrant or 1/2 of the visual field
Retinal detachment
67
Differentiate hordeolum , chalazion, dacryocystitis, blepharitis
Hordeolum - painful, red, lid margin
chalazion- nontender, firm , nodule on eyelid
Dacryocystitis- lacrimal sac inflammation
Blepharitis- inflammation of the eyelids
68
Common presentation of macular degeneration
Lots of central vision but preserved peripheral vision, most common cause of blindness
69
Most common type of glaucoma, involves a gradual loss of peripheral vision
Chronic open-angle glaucoma
70
Older adults with tears rolling down face from left eye, lower lid is loose and rolling outward, complaints of dry and itchy Eye=
Ectropion
71
Normal ageing results in the progressive loss of elastic recoil of the lung parenchyma and conducting airways.
This results in reduced vital capacity + increased residual volume- and what breathing pattern?
Shallow breathing
72
Theophyline levels are at risk of toxic levels with what behaviour?
Smoking
73
Early signs of a respiratory problem in older adult
Change in mental status ie. increased irritability
74
Why should the patient with peripheral arterial disease not use nicotine in any forms
Cause vasoconstriction
75
T/F- Carbohydrates should not make up more than 50% of the daily intake of calories in pts sith COPD- because they break down into carbon dioxide, worsening breathing
True
76
Heparin infusion per treatment of pulmonary embolism serves what purpose?
Prevents clot from getting bigger
77
Asthma can be exacerbated by what 2 medication classes
Beta blockers, NSAIDS
78
```
All of the following are examples of what?
Aspiration
Atelectasis
Bronchiectasis
MG
Pulmonary fibrosis
Pulmonary effusion
```
Restrictive lung diseases
79
Diagnostic test results for COPD
Spirometry FEV1/FVC < 70%
80
Diagnostic test results asthma
Spirometry - reversible airflow, 12% or greater improvement in FEV1 or FEV1 > 200 ml from baseline after bronchodilator
OR
+ methylcholine test
81
What does bibasilar crackles and finger clubbing indicate?
Pulmonary fibrosis
82
Diagnostic test results for Pulmonary Fibrosis
PFT - decreased FVC, normal FEV1/FVC ratio
CXR
High resolution CT
Bronchoscopy/lung biopsy if unable to diagnose by other means
83
CT can be used for screening for people at low risk of lung cancer. T/F?
False
84
What are high risk criteria for lung cancer?
Age -
Social -
Age 55-74
30 pack year history of smoking
Smoking within last 15 years
85
< 55 year old lose hearing @ ____ dB/decade
3
86
> 55 lose hearing at ___ dB/decade
9
87
According to Laurie Barnhart, what do all of the following medications have in common?
Aminoglycosides Gentamicin or Tobramycin.
Other antibiotics: erythromycin and tetracycline - more pronounced with renal impairment
Many chemotherapy drugs - notably cisplatin
Phosphodiesterase 5 inhibitors – limited evidence
High dose aspirin/salicylates - reversible upon cessation of drug
High dose NSAIDs (reversible)
Loop diuretics (reversible)
Antimalarial drugs: quinine and chloroquine (usually reversible)
Antidepressants - tinnitus
meds that were not ototoxic, but could cause irritating symptoms such as tinnitus.
88
Visual acuity and visual feild changes should be assessed how often after the age of 80 for driving?
Q 2 years
89
Eye exams are covered if < ___ years old or > ___ years old
< 18 or >65
90
Leading cause of severe vision loss in > 50 year old people
Age related macular degeneration
91
What is the most common type of glaucoma?
Primary open angle glaucoma
92
```
all of the following are risk factors for what condition:
> 40 years
0.5 cup to disc ratio or larger
African heritage
+ family history
diseases affecting vasculature (ie. DM)
```
Primary open angle glaucoma
93
Lung diseases that prevent exhalation of air effectively
Obstructive
94
Lung diseases that prevent lungs from expanding fully
Restrictive
95
If CT + for lung cancer, what is your next step
Referral for management and biopsy
96
chest x-ray can be used screen for lung cancer, with or without sputum cytology. T/F?
False
97
What are the determined ages for asymptomatic screening for lung cancer and risk factors? What test is ordered? How many times can it be repeated?
55-74 years
RF - 30 pack year history or quit within last 15 years
Order CT with contrast
Can be repeated 3 times (CTF)
98
```
All of the following are risk factors for what?
age >/= 70
smoking
exposure (occupational or other)
fhx
radiation
```
Lung cancer
99
hyperopia
farsightedness
100
myopia
nearsightedness
101
presbyopia
increased age causes changes in lens curvature, decrease in elasticity of lens and decrease in strength of ciliary muscle
Impaired accommodation/focussing on near objects
102
Mneumonic to remember congenital cataracts causes
```
Toxoplasma
Other (syphillis)
Rubelle
Cytomegalovirus
Herpes
```
103
S&S of acute angle closure glaucoma
```
Sudden onset
Painful
Red eye
Vision blurriness
Dilated non-reactive pupil
Seeing haloes
frontal headache
nausea/vomiting
EMERGENCY!!
```
104
T/F
| All alpha agonists are contraindicated in closed angle glaucoma.
True
105
Leukocoria
sign of congenital cataracts, white red reflex
106
Characterized by yellowish extracellular deposits of waste materials, known as "drusen"
Dry macular degeneration
107
Characterized by metamorphopsia (stright objects appear curved) or scotomas
dry macular degeneration
108
Rapid central vision loss over few weeks of months
Wet Age-related macular degeneration
109
Characterized by AV nicking, flame shaped retinal hemmorhages and macular stars in addition to cotton wool spots and microanyeruisms on fundoscopy
hypertensive retinopathy
110
Is your vision blurry or foggy?
Do you have decreased night vision or see halos around lights?
Do colours appear dull or muted?
Are your glasses no longer working?
Does sunlight or other light seem overly bright or glaring?
What would you be suspecting with the following questions?
Cataracts
111
Type of cataracts that is most common in diabetics
Cortical cataracts
112
most common type of cataract
Nuclear
113
Type of cataracts that people with DM, extreme nearsightedness or use of steroids are at higher risk for
Posterior subcapsular cataracts
| * Develops over months NOT years
114
True/False
| Age-related macular degeneration is reversible with some therapies
False, there is no reversibility of this condition.
115
CI to dix hallpike
Absolute contraindications:
cervical instability
vascular problems like vertebrobasilar insufficiency
carotid sinus syncope
acute neck trauma
cervical disc prolapse
116
What type of hearing loss is present with menieres disease?
low frequency SNHL
117
All of the followig conditions are considered risk factors for what oral condition:
infections, diabetes, Alzheimer’s disease, RA, HTN, Bell's Palsy, depression and anxiety
Xerostomia
118
Medications which commonly have a side effect of xerostomia
sedatives, antipsychotics, antianginal agents, antidepressants, antihistamines, antihypertensives, antiparkinsonian agents, diuretics, anticholinergics
119
ICS must always be used with _____ in COPD and is NEVER used as monotherapy
LABA
120
Factors to consider when starting ICS for COPD
Hospitalizations
Exacerbations
Eosinophil level
Hx of concurrent asthma
121
Strong support for ICS in COPD
>/= 1 hospitalization
>/= 2 moderate exacerbations/ year
Eosinophil level >/= 300
Hx of asthma
122
What COPD Group requires LAMA in monotherapy
Group C
123
If CAT > 20 and >/= 1 hospitalization or >/= 2 exacerbations, what medicaiton to add
LABA
124
What two screening tools are used to determine symptoms for COPD initial treatment
mMRC
| CAT
125
mMRC and CAT scores for group A & C
mMRC 0-1
| CAT < 10
126
mMRC and CAT scores for group B&D
mMRC >/=2, CAT >10
127
What medication for COPD for EXACERBATIONS is indicated if eos <100 and not controlled with LAMA+ LABA
Roflumilast, FEV1 < 50% or chronic bronchitis
OR
Azithromycin for chronic smokers
128
Secondary Glaucoma causes:
```
Idopathic
Uveitis
Trauma
Keratoplasty or surgery
Pseudoexfoliation occurs when deposits of unknown origin and composition are seen on the lens surface
```
129
Uncomplicated corneal abraision treatment
Polymyxin B sulfate drops or erythromycin ophthalmic ointment 0.5% QID for 3-5 days.
130
When to reassess corneal abraisions
24 hours
131
Treatment of corneal abraision for contact wearer
ciprofloxacin 0.3%, gentamycin 0.3%, or tobramycin ointment or drops.
132
When to refer to opthamology for corneal abrasision
if symptoms persist > 48 hours
*Immediate referral to an ophthalmologist is required for large or central lesions, deep or penetrating wounds, open globe, or hyphema
133
The acronym RULE and what it is used for
Can help with lesions that at greater than 3 weeks in duration to determine if should be biopsied
●Red or red and white lesion
●Ulcer
●Lump
●Especially when in combination or if indurated (firm on palpation)
134
Name that condition
Pre-malignant leukoplakia
Ranges from slightly raises, white translucent areas to dense, white opaque plaques
Benign condition but may develop into oral cancer
135
Erythroplakia/ premalignant
Fiery red, sharp, demarcated patch, non-blanchable
Floor of mouth ventral tongue, or soft palate
High risk of malignant transformation
136
Oral Lichen Planus
Variable presentation: lacelike on the buccal mucosa to erosions on the gingival margin, tongue or mucosa
Potentially malignant condition
137
Where are melanomas commonly found in the mouth?
hard palate
138
Canadian cancer society recommends adults >40 are screened ______ for oral lesions
annually
139
Outline component of CURB 65
140
How to interpret CURB 65
141
Treatment based on CURB 65
142
```
True/False
Bronchoalveolar lavage (BAL) fluids in healthy older subjects have consistently shown an increased proportion of neutrophils and lower percentage of macrophages compared with younger adults.
```
True
143
RF for narrow angle (closed)
female
Asian
hyperopia
144
RF for wide angle glaucoma (open)
male
african
myopia
