Potpourri 1

Question 1

Age-related macular degeneration

Answer 1

Leading cause adult blindness in developed countries

Loss of central vision is usually primary complaint

Amsler grid to detect progression

Question 2

Dry Macular Degeneration

Answer 2

Atrophic - ischemic, retinal cell apoptosis/inflammation

Bright yellow drusen, atrophy w/ depigmentation or increased pigmentation

Treatment: none

-antioxidants, beta carotene (not in smokers), zinc, copper

Question 3

Wet Macular Degeneration

Answer 3

Neovascular/exudative with vascular endothelial growth factor (VEGF), abnormal blood vessels

Subretinal fluid, hemorrhage risk from neovascularization

Fluorescein angiogram to assess

Treatment: VEGF inhibitor, photocoagulation surgery

Question 4

Glaucoma

Answer 4

Leading cause irreversible blindness worldwide

Primary open-angle is most common form

• Optic neuropathy with elevated IOP and cupped disk (>50%)
• Peripheral then central vision lost

Secondary glaucoma - uveitis, trauma, steroid therapy

Angle closure glaucoma either anatomical or secondary caused

Question 5

Cataract

Answer 5

Leading cause of blindness in the world

Risk: smoking, DM, ETOH, sunlight, systemic corticoid use

Painless, progressive - night driving, fine print, lens opacity, darkened red reflex, ocular fundus

Tx: Surgery #1, HTN needs controlled

Warfarin and ASA are low risk

Complications: endophthalmitis, retinal detachment

Question 6

Presbycusis

Answer 6

Age-related hearing loss

Sensorineural, bilateral, high-frequency range first

Screen >60 yo

Can cause social isolation

Tx: Hearing aids - do not restore normal hearing

Question 7

Presbycusis unilateral or hearing pulsatile sounds

Answer 7

Unilateral: r/o TIA or CVA

Pulsatile: assess w/ MRA/MRI to r/o glomus tumor or AV malformation

Question 8

COPD - Chronic Bronchitis v Emphysema

Answer 8

Chronic Bronchitis: daily cough for >3 months in 2 years

-overweight and cyanotic w/ peripheral edema, rhonchi/wheezing

Emphysema: permanent enlargement and destruction of airspaces distal to the terminal bronchiole

-Thin, dyspneic with flattened diaphragm

Question 9

COPD PFTs

Answer 9

FEV1 and Vital capacity decreased

TLC, FVC, RV increased

CO2 diffusing capacity decreased

Not reversible

Question 10

Only med to prolong life w/ COPD

Answer 10

Oxygen

Question 11

Community-acquired pneumonia

Answer 11

Uncomplicated - Azithr

Complicated (comorbidities/recent abx) - Augmentin 1st line

CURB-65 for hospitalization

Question 12

Factors for drug resistance w/ community-acquired pneumonia

Answer 12

>65 yo

Antibiotics w/in 3-6 months

Alcoholism

Medical comorbidities

Immunosuppression

Question 13

CURB-65

Answer 13

Confusion

BUN >7

RR >30

BP <90/<60

>65 years old

0-1 = outpatient

2 = hospitalization

3-4 = ICU

Question 14

Chronic Pain

Answer 14

Tylenol is 1st line for mild pain, can move up to opioids/adjuvant if necessary

Do not use amitriptyline, propoxyphene

Neuropathic pain - use Neurontin, Lyrica, Cymbalta

Question 15

30% adverse drug reaction hospitalizations due to…

Answer 15

ASA and NSAIDs

Increased risk change of toxicity in >65 yo

Renal, GI, cardiotoxic

May get interactions between ASA and Warfarin

Question 16

Subclinical Hypothyroidism Treatment Guidelines

Answer 16

Normal T4 with elevated TSH

Treat all pts w/ TSH >10 or symptomatic

Treating pts >70 yo increases risk cardiovascular disease and heart failure - evaluate before treatment w/ THS >10

>70 yo w/ TSH 4-8 should not be treated due to complications and unknown efficacy