Other- ENT, derm, gero Flashcards
What is ageing
=Gradual development of changes in structure and function that are not due to preventable disease or trauma
-Associated with decreased functional capacity (reduced muscle, cardio-resp reserve, cognitive capacity, bladder capacity)
- increased probability of death
-Reduced homeostatic reserve and become more frail: more at risk of severe deterioration from minor insult, poorer recovery and resilience
-less independence
Old age >65 years old
Difference between 1) impairment, 2) disability and 3) handicap. And examples of solutions for these
-the physical damage caused by the disease process (e.g. Paralyzed left arm from stroke=physio strengthening exercises)
-the tasks that cannot be performed as a result of the impairment (e.g. Unable to get dressed properly due to paralyzed arm= aids and appliances to help
–how it affects the individual’s lifestyle (e.g. Lost ability to enjoy hobbies, loneliness =carers, social activities
The Geriatric giants (6 Is)
-Instability – falling easier
-Immobility – unable to walk
-Incontinence = peeing/ pooing uncontrollably
-Intellectual impairment – dementia, delirium
-Isolation - loneliness
-Iatrogenesis – medically induced problems
What is age discrimination and give examples
-Demeaning Attitudes, language and behavior for older people
-Prioritising younger people for services (eg for cateracts or hip surgery as it limits them more because of their job)
-Age-restriction of services or procedures i.e. SEDATION
-Lack of accessibility – transport, lifts, ramps
-Neglect/Physical/ emotional/ financial/ sexual abuse
Reasons for poor compliance for old people taking their meds and ways to overcome
-Poor explanation by doctor
-Side effects
-No noticeable benefit
-Scared by package insert
-Poor mental function – cannot remember
-Poor physical function – manual dexterity, vision (cannot read small print)
-Explain things carefully, leaflets, speak to carer or relative, communicate with GP, dosing boxes, supervision by carers
How drug action differs in old patients
-Different pharmacokinetics=reduced GI absorption, reduced excretion in liver/kidney, altered protein binding, increased sensitivity of drugs
-Altered drug action
-Drug interactions= polypharamcy, co-morbidities
-Adverse effects =increased sensitivity to side effects
Common side effects in old people of opioids, clindamycin, sedatives, NSAIDs, anticholinergics
-Opioids – constipation and confusion
-clindamycin/ clarithromycin- diarrhea
-Sedatives – confusion & falls
-NSAIDs – peptic ulceration, fluid retention, renal impairment
-Anticholinergic – CONFUSION, CONSTIPATION, URINE RETENTION, BLURRED VISION & DRY MOUTH
How central nervous system changes with old age
-neurones lost as you age=reduced coordination, slower reaction time, reduced learning
-increased amyloid protein deposition=poorer short term memory
-decreased dopamine =parkinson’s, depression
-confusion
-altered taste, smell
Changes in the cardiovascular system that occur with ageing
-Vascular changes: Atherosclerosis – hypertension - stroke
-Reduced baroreceptor response =postural hypotension
-Pathology - need artificial valves, transplants
-reduced nitric oxide=delayed angiogenesis
- thickening of heart ventricles as heart has to pump at higher force
-Reduced cardiac function
-Cardiac conductive system: arrhythmia, lower max HR
-Increased systolic blood pressure (but diastolic remains stable)
How the following hormones change with age and their effects: 1)melatonin, 2) dopamine, 3) thyroxine, 4) PTH, 5) insulin, 6) aldosterone
1) decreases -sleep disturbances
2) decreases - parkinson’s, depression
3) decreases- lower core temp, reduced metabolic rate, fatigue, constipation
4) high- more Ca in blood causing reduced bone density
5) decreases- increased diabetic risk
6) decreases-drop in blood pressure - postural hypotension
Changes in eyes with ageing
-Anatomical changes around eyelids
-decreased tear production and drainage
-Presbyopia -dense less flexible lens = inability to focus on nearby objects
-Ophthalmic dysfunction: retinopathy, macular degeneration, cataracts, glaucoma
-Pupillary diameter decreases and ability for diameter to change reduces- night vision problems
Hearing changes that occur with ageing
-Loss of hair cells and cochlear neurons
-Impaired conduction and amplification = Conductive hearing loss
-Reduced ear wax=increased risk of infection
-Pressure imbalance in middle ear
-Presbycusis -age-related hearing loss
-Inability to hear high frequencies, struggle with background noise
-Loss of balance, dizziness
-Tinnitus
Respiratory changes that occur in ageing
-reduced volume of rib cage, reduced muscle strength
-Reduced coughing reflex =higher risk of infection and choking.
-Breakdown of alveolar structure and its elasticity (emphysema and COPD)
-Diminished aerobic capacity
-Aspiration: due to reduced ciliary escalator, dementia, being fed by tubes
GIT changes that occur with ageing. Why peptic ulcers are common
-Reduced apatite
-Altered gastric and oesophageal motility=reflux, dysphagia, heart burn
-Reduced goblet cells so less mucin, and decreased bicarbonate: affects bioavailability of drugs, peptic ulcers
-Reduced drug absorption
-Altered hepatic / renal function and hence drug metabolism
-Artificial bits and transplants
Skin changes that occur with ageing (intrinsic and extrinsic)
-Intrinsic: reduced fibroblasts and collagen=fine wrinkles, pale, less elastic, dry, smooth, thinner
-Extrinsic: smoking, UV, diet= deep wrinkles, rough, pigmentation, lost elasticity
Musculoskeletal changes during ageing
-Reduced protein synthesis, muscle growth, ability to repair
-Reduced size and number of muscle fibres
-Replacement of active muscle fibres by collagen-rich non-contractile fibrous tissue
-Reduced muscle mass associated with changes in hormone levels
-Reduced Flexibility - due to reduction in cartilage
-Reduced motor neurones
-Increased fat deposition at the expense of lean muscle
-Less efficient metabolism particularly in fast-twitch fibres – reduced blood flow
-Decreased vitamin D and blood calcium = decreased bone density = increased risk of fracture, osteoarthritis, joint changes, osteoporosis
How saliva changes with ageing
-reduced stimulated and unstimulated salivary flow
-Modest decrease in the concentration of mucins and some saliva electrolytes.
-decreased antimicrobial factors
-due to reduced salivary gland function, medication, disease
-wake up with dry mouth, feels dry a lot of the time, takes sips of water when chewing and speaking
Types of medications and diseases that cause Xerostomia
-Anti-cholinergic
-ACEI
-Diuretics
-Ca channel blockers
-b-adrenergic blockers
-chemo and radiotherapy
-Carbemazepine
-antidepressants
-anxiolytics
-antiparkisnonians
-Sjögren’s syndrome
-Diabetes
-Dehydration
Changes that occur to our teeth and mucosa with ageing
-Enamel: thinner, darker, reduced translucency, cracks
-Darker: dentine showing through, staining, less water content (can cause cracking), sclerosis (tubule occlusion), tertiary dentine
-Pulp: smaller, calcifications, reduced space (tertiary dentine), degeneration of pulpal neurons, more fibrous, less cellular
-Cementum: thicker, widening of the major apical foramen, decreased vascularity, more fibrous, decreased cellularity, non-patent canals
-Physiological and pathological TSL
-Periodontium: more fibrous, less cellular, less proteoglycans/protein/collagen, little attachment loss, buccal recession
-Mucosa: reduced microvasculature, delayed wound healing, less elastic
Anatomy of the external, middle and internal ear
-External =pinna, external auditory meatus, auditory canal, tympanic membrane
-Middle=conduction of sound by the ossicles- Incus, malieus, stapes. Petrous part of temporal bone. Eustachian tube
-Inner =labyrinth- vestibule and cochlea. Deepest part of petrous temporal bone. Balance
What is conductive and sensory deafness. Types of tests to assess it
-Conductive deafness – air not transported through the ear = usually due to wax
-Sensory neural deafness – due to CNVIII (vestibulocochlear), inner ear hair cell damage, brain processing
-Tune fork tests: Rinne and Weber
-Pure tone audiometry
-Electric response audiometry
Explain the Rinne test. Does it test conductive or sensory hearing deafness
-A tune fork test to assess conductive hearing.
-Compares air and bone conduction
-Hit fork against object, place on mastoid process (BC) and compare this to 3cm in front of ear (AC)
-Normally: AC better than BC
-Conductive deafness: BC>AC
Explain the Weber test. Does it investigate conductive or sensory hearing deafness
Investigates if it is conductive or sensory
-Tune fork put in middle of back of head and ask which side patient hears the sound
-If louder in deaf ear= conductive
-If louder in normal ear=sensory
What is 1) pure tone and 2) electric response audiometry. When are they used
1) Exposed to a range of sounds with varying decibels. In soundproof booth and special headphones
-Both air and bone conduction tested
-If abnormality of Rinne’s or Weber’s test
-Subjective
2) Used in patients/children that you can’t get a reliable answer from
-Objective score for somebody’s hearing
What is otitis external. Causes, symptoms, treatment
-inflammation of external ear
-Infection, Irritants, skin disorders, trauma, otitis media spreading outwards
-very painful with serous discharge. Inflamed red ear drum. Blockage.
-Tx- GENTAMICIN & STEROID (OTIMIDE) EAR DROPS. ANTI-FUNGAL if fungal infection
What is Perichondritis. Causes and symptoms
-Inflammation of the perichondrium- connective tissue which surround cartilage of the external ear
-can be due to auricular haematoma due to trauma (multiple haematomas can cause cauliflower ear)
Types of benign and malignant external ear neoplasms
1) Benign
-osteoma -bony overgrowth
-Ceruminoid adenoma - wax glands
2) Malignant
-Basal cell carcinoma
-SCC
-Ceruminous adenocarcinoma
What is acute Otitis media: symptoms, cause, tx, complications
-Infection of middle ear usually in childhood (<5)
-Blockage of underdeveloped Eustachian tube so secretion from middle ear to pharynx get infected
-painful, discharge, fever, or may be oblivious
-Complications: otitis external, scarring if recurrent, perforation, mastoiditis, intracranial spread
-Progression to chronic otitis media with effusion (GLUE EAR) where fluid builds up, prone to infection. Conductive hearing loss
-Tx=Antipyretics, antibiotics, decongestants, surgery
What is acoustic neuroma. Symptoms
-Benign tumour of the VESTIBULOCHCOLEAR nerve in cerebellum pons
-doesn’t take much enlargement to cause problems
-unilateral deafness, vertigo, unsteadiness, facial palsy
What is benign paroxysmal positional vertigo. Symptoms
-causes 20% of dizziness. Triggered by different head positions (lying down, looking up)
-age related or post head injury
-Sudden recurrent episodes <1 hour: world feels like its spinning, feel sick, no vomitting, disorientation
-conservative management, surgery rare
