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NUNP 547 - Older Adult > HEENT/Resp > Flashcards

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

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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

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3
Q

True/False

Hearing loss is an inevitable consequence of aging

A

False

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4
Q

Most common cause of age-related hearing loss in older adult

A

Presbycusis

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5
Q

Describe characteristics of presbycusis (ie. laterality, SNHL, CHL, onset, frequency affected)

A

Insidious onset, symmetrical SNHL affecting high frequency tones

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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)

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7
Q

Which exam that can be conducted in any primary care office has high specificity and sensitivity for hearing loss?

A

Whisper test

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8
Q

At age __, all people should have routine hearing tests every ___ years

A

60 years old

every 2 years

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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
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10
Q

True/False

Antidepressants can cause tinnitus

A

True

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11
Q

What medications have reversible ototoxicity when stopped?

A

NSAIDs
Loop diuretics
Antimalarials (usually)

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12
Q

What is the gold standard exam to diagnose cataracts?

A

Slit lamp

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13
Q 
Name that condition:
Decreased visual acuity - blurry/foggy
Sensitivity to light/glare
Decreased color perception
Decreased night vision/halos
A

Cataracts

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14
Q

Leading cause of blindness in the world

A

Cataracts

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15
Q

List 3 risk factors for cataracts

A 
DM
Long-term use steroids
Prior intra-ocular surgery
Myopia
Age
Family hx
Smoking
HTN
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16
Q

3 types of cataracts

A

Nuclear
Cortical
Posterior subscapular

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17
Q

Name that condition:

Most common type of cataract that develops over years

A

Nuclear sclerotic cataracts

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18
Q

Type of cataracts that is highest risk in DM

A

Cortical Cataracts

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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

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20
Q

Cataract that develops quickly over months, NOT years

A

Posterior subscapular cataracts

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21
Q

Type of cataracts where you first notice your night vision changing and difficulty reading

A

Posterior Subcapsular Cataracts

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22
Q

True/False

Age related macular degeneration is reversible

A

False

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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
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24
Q

What home monitoring tool can be used for macular degeneration?

A

Amsler grid

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25
Q

Leading cause of irreversible vision loss

A

AMD

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26
Q

Two forms of AMD

A

Atropic/dry

Neovascular/wet

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27
Q

Type of AMD that is slow to progress, limited night vision and difficulty reading

A

Atropic/Dry/Non-exudative

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28
Q

characterized by large drusen and pigmentary abnormalities in the macula

A

early stage of dry age-related macular degeneration

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29
Q

What type of vision loss?

A

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.

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30
Q

Mgmt of dry macular degeneration

A

BP control
Smoking cessation
Daily eye vitamins (C, E, letin, zinc, etc.)

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31
Q

All these medications have in common is:
sedatives, antipsychotics, antianginal agents, antidepressants, antihistamines, antihypertensives, antiparkinsonian agents, diuretics, anticholinergics

A

SE of Xerostoma

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32
Q

____ inhibits demineralization of the tooth surface and enhances remineralization

A

Saliva

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33
Q

What components are included in history of xerostoma?

A

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 -

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34
Q

Most common opportunisitc infection with xerostoma

A

oral candidiasis

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35
Q

Tx for xerostoma

A

First line:
Mechanical - lozenges
Chemical - artificial saliva (ex. biotene)
Dental care

Second line:
Antimuscarinics

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36
Q

rise in intraocular pressure (IOP) that causes damage to the optic nerve

A

Glaucoma

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37
Q

Normal IOP between ___ and ___ mm Hg.

A

IOP is typically between 10-21mmHg

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38
Q

True/False

Initial diagnosis and treatment of glaucoma is done by NPs

A

False

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39
Q

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
A

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.

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40
Q

the IOP rises rapidly as a result of relatively sudden blockage of the trabecular meshwork by the iris via papillary block mechanism

A

Angle-closure glaucoma (ACG)

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41
Q

First line treatment of POAG

A

Prostaglandin analogues that increase uveoscleral outflow.

Ex. Latanoprost, Bimatoprost

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42
Q

Laser iridotomy is required for definitive treatment of what condition?

A

Closed-angle glaucoma

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43
Q

Open-angle glaucome with eye pressure within normal range.

A

Normal-Tension Glaucoma

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44
Q

Black and white dots on the tympanic membrane

A

Fungal infection

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45
Q

T/F- Tinnitus is a ringing, crackling, or buzzing sound that comes from within a person

A

True

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46
Q

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

A

True

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47
Q

Ulcerated crusting Lesions on the pinna, that bleed, are slow to heal, have indurated base ——?

A

Think- carcinoma!

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48
Q

A 70-year-old patient complains of hearing that is getting worse, sounds are garbled and difficult to locate. What’s your response?

A

Normal age to changes in hearing – presbycusis

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49
Q

What cranial nerve transmits nerve impulses from the organ of Corti to the brain

A

VIII- Vestibulocochlear

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50
Q

Spinning sensations are due to what ear structure

A

Labyrinth

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51
Q

A form of hearing loss when sounds cause pain as volume increases

A

Recruitment

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52
Q

Movement of the extraocular muscles is controlled by what cranial nerves

A

III, IV, VI

Oculomotor, trochlear, abducens

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53
Q

The outer layer of the eye is made up of what structures?

A

Cornea and the sclera, sensitive to touch

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54
Q

Structures in the middle layer of the eye-

Inner layer lf the eye-

A

Middle- choroid

Inner- retina

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55
Q

Stimulation of the sympathetic branch of the autonomic nervous system does what to a pts eye?

A

Elevates the eye lid and dilates the pupil

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56
Q

Parasympathetic nervous system stimulation does what to the pupil?

A

Constricts pupil

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57
Q

The ciliary body controls what

A

Thickness of the lens

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58
Q

Intraocular pressure is determined by what

A

The balance between the amount of aqueous produced and the resistance to its outflow at the angle of the anterior chamber

59
Q

Does accommodation cause-
pupillary constriction when looking at a near object, or
pupillary dilation when looking at a far object?

A

Constriction- near

Muscles in iris contract pupil in bright light and accomodate for near vision

60
Q

What physiological changes responsible for presbyopia

A

The lens loses its elasticity and decreases its ability to change shape to accommodate for near vision

61
Q

What causes floaters?

A

Condensed vitreous fibers, often insignificant

62
Q

Snellen eye chart result is 20\30, what does that mean?

A

The patient reads at 20 feet what someone with normal vision can read at 30 ft

63
Q

Normal findings of the diagnostics positions test?

A

Parallel tracking of the object with those eyes

64
Q

T/F- In older adults pupils are small, pupillary light reflex is slowed, pupillary constriction is symmetric.

A

True- pupillary assymetry is not normal in older age!

65
Q

What is Anisocoria?

A

Unequal pupils size

66
Q

Person has shadows are diminished vision in one quadrant or 1/2 of the visual field

A

Retinal detachment

67
Q

Differentiate hordeolum , chalazion, dacryocystitis, blepharitis

A

Hordeolum - painful, red, lid margin
chalazion- nontender, firm , nodule on eyelid
Dacryocystitis- lacrimal sac inflammation
Blepharitis- inflammation of the eyelids

68
Q

Common presentation of macular degeneration

A

Lots of central vision but preserved peripheral vision, most common cause of blindness

69
Q

Most common type of glaucoma, involves a gradual loss of peripheral vision

A

Chronic open-angle glaucoma

70
Q

Older adults with tears rolling down face from left eye, lower lid is loose and rolling outward, complaints of dry and itchy Eye=

A

Ectropion

71
Q

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?

A

Shallow breathing

72
Q

Theophyline levels are at risk of toxic levels with what behaviour?

A

Smoking

73
Q

Early signs of a respiratory problem in older adult

A

Change in mental status ie. increased irritability

74
Q

Why should the patient with peripheral arterial disease not use nicotine in any forms

A

Cause vasoconstriction

75
Q

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

A

True

76
Q

Heparin infusion per treatment of pulmonary embolism serves what purpose?

A

Prevents clot from getting bigger

77
Q

Asthma can be exacerbated by what 2 medication classes

A

Beta blockers, NSAIDS

78
Q 
All of the following are examples of what?
Aspiration
Atelectasis
Bronchiectasis
MG
Pulmonary fibrosis
Pulmonary effusion
A

Restrictive lung diseases

79
Q

Diagnostic test results for COPD

A

Spirometry FEV1/FVC < 70%

80
Q

Diagnostic test results asthma

A

Spirometry - reversible airflow, 12% or greater improvement in FEV1 or FEV1 > 200 ml from baseline after bronchodilator
OR
+ methylcholine test

81
Q

What does bibasilar crackles and finger clubbing indicate?

A

Pulmonary fibrosis

82
Q

Diagnostic test results for Pulmonary Fibrosis

A

PFT - decreased FVC, normal FEV1/FVC ratio
CXR
High resolution CT
Bronchoscopy/lung biopsy if unable to diagnose by other means

83
Q

CT can be used for screening for people at low risk of lung cancer. T/F?

A

False

84
Q

What are high risk criteria for lung cancer?
Age -
Social -

A

Age 55-74
30 pack year history of smoking
Smoking within last 15 years

85
Q

< 55 year old lose hearing @ ____ dB/decade

A

3

86
Q

> 55 lose hearing at ___ dB/decade

A

9

87
Q

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

A

meds that were not ototoxic, but could cause irritating symptoms such as tinnitus.

88
Q

Visual acuity and visual feild changes should be assessed how often after the age of 80 for driving?

A

Q 2 years

89
Q

Eye exams are covered if < ___ years old or > ___ years old

A

< 18 or >65

90
Q

Leading cause of severe vision loss in > 50 year old people

A

Age related macular degeneration

91
Q

What is the most common type of glaucoma?

A

Primary open angle glaucoma

92
Q 
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)
A

Primary open angle glaucoma

93
Q

Lung diseases that prevent exhalation of air effectively

A

Obstructive

94
Q

Lung diseases that prevent lungs from expanding fully

A

Restrictive

95
Q

If CT + for lung cancer, what is your next step

A

Referral for management and biopsy

96
Q

chest x-ray can be used screen for lung cancer, with or without sputum cytology. T/F?

A

False

97
Q

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?

A

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
Q 
All of the following are risk factors for what?
age >/= 70
smoking
exposure (occupational or other)
fhx
radiation
A

Lung cancer

99
Q

hyperopia

A

farsightedness

100
Q

myopia

A

nearsightedness

101
Q

presbyopia

A

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
Q

Mneumonic to remember congenital cataracts causes

A 
Toxoplasma
Other (syphillis)
Rubelle
Cytomegalovirus
Herpes
103
Q

S&S of acute angle closure glaucoma

A 
Sudden onset
Painful
Red eye
Vision blurriness
Dilated non-reactive pupil
Seeing haloes
frontal headache
nausea/vomiting
EMERGENCY!!
104
Q

T/F

All alpha agonists are contraindicated in closed angle glaucoma.

A

True

105
Q

Leukocoria

A

sign of congenital cataracts, white red reflex

106
Q

Characterized by yellowish extracellular deposits of waste materials, known as “drusen”

A

Dry macular degeneration

107
Q

Characterized by metamorphopsia (stright objects appear curved) or scotomas

A

dry macular degeneration

108
Q

Rapid central vision loss over few weeks of months

A

Wet Age-related macular degeneration

109
Q

Characterized by AV nicking, flame shaped retinal hemmorhages and macular stars in addition to cotton wool spots and microanyeruisms on fundoscopy

A

hypertensive retinopathy

110
Q

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?

A

Cataracts

111
Q

Type of cataracts that is most common in diabetics

A

Cortical cataracts

112
Q

most common type of cataract

A

Nuclear

113
Q

Type of cataracts that people with DM, extreme nearsightedness or use of steroids are at higher risk for

A

Posterior subcapsular cataracts

* Develops over months NOT years

114
Q

True/False

Age-related macular degeneration is reversible with some therapies

A

False, there is no reversibility of this condition.

115
Q

CI to dix hallpike

A

Absolute contraindications:

cervical instability

vascular problems like vertebrobasilar insufficiency

carotid sinus syncope

acute neck trauma

cervical disc prolapse

116
Q

What type of hearing loss is present with menieres disease?

A

low frequency SNHL

117
Q

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

A

Xerostomia

118
Q

Medications which commonly have a side effect of xerostomia

A

sedatives, antipsychotics, antianginal agents, antidepressants, antihistamines, antihypertensives, antiparkinsonian agents, diuretics, anticholinergics

119
Q

ICS must always be used with _____ in COPD and is NEVER used as monotherapy

A

LABA

120
Q

Factors to consider when starting ICS for COPD

A

Hospitalizations
Exacerbations
Eosinophil level
Hx of concurrent asthma

121
Q

Strong support for ICS in COPD

A

> /= 1 hospitalization
/= 2 moderate exacerbations/ year
Eosinophil level >/= 300
Hx of asthma

122
Q

What COPD Group requires LAMA in monotherapy

A

Group C

123
Q

If CAT > 20 and >/= 1 hospitalization or >/= 2 exacerbations, what medicaiton to add

A

LABA

124
Q

What two screening tools are used to determine symptoms for COPD initial treatment

A

mMRC

CAT

125
Q

mMRC and CAT scores for group A & C

A

mMRC 0-1

CAT < 10

126
Q

mMRC and CAT scores for group B&D

A

mMRC >/=2, CAT >10

127
Q

What medication for COPD for EXACERBATIONS is indicated if eos <100 and not controlled with LAMA+ LABA

A

Roflumilast, FEV1 < 50% or chronic bronchitis
OR
Azithromycin for chronic smokers

128
Q

Secondary Glaucoma causes:

A 
Idopathic
Uveitis
Trauma
Keratoplasty or surgery
Pseudoexfoliation occurs when deposits of unknown origin and composition are seen on the lens surface
129
Q

Uncomplicated corneal abraision treatment

A

Polymyxin B sulfate drops or erythromycin ophthalmic ointment 0.5% QID for 3-5 days.

130
Q

When to reassess corneal abraisions

A

24 hours

131
Q

Treatment of corneal abraision for contact wearer

A

ciprofloxacin 0.3%, gentamycin 0.3%, or tobramycin ointment or drops.

132
Q

When to refer to opthamology for corneal abrasision

A

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
Q

The acronym RULE and what it is used for

A

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
Q

Name that condition

A

Pre-malignant leukoplakia

Ranges from slightly raises, white translucent areas to dense, white opaque plaques

Benign condition but may develop into oral cancer

135
Q
A

Erythroplakia/ premalignant

Fiery red, sharp, demarcated patch, non-blanchable

Floor of mouth ventral tongue, or soft palate

High risk of malignant transformation

136
Q
A

Oral Lichen Planus

Variable presentation: lacelike on the buccal mucosa to erosions on the gingival margin, tongue or mucosa

Potentially malignant condition

137
Q

Where are melanomas commonly found in the mouth?

A

hard palate

138
Q

Canadian cancer society recommends adults >40 are screened ______ for oral lesions

A

annually

139
Q

Outline component of CURB 65

A
140
Q

How to interpret CURB 65

A
141
Q

Treatment based on CURB 65

A
142
Q 
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.
A

True

143
Q

RF for narrow angle (closed)

A

female
Asian
hyperopia

144
Q

RF for wide angle glaucoma (open)

A

male
african
myopia

NUNP 547 - Older Adult (19 decks)

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