Potpurri 2 Flashcards
Age-related Macular Degeneration:
- what is this?
- types
- sx
- risk factors
What: degenerative dz of central portion of the retina (macula)
Types:
- Dry (atrophic) = ischemic, retinal epithial cell apoptosis
- Wet (neovascular or exudative) = Vascular Endothelial Growth Factor?
Sx: may often be asymptomatic and results in central vision loss.
Risk factors:
-age, smoking, genetics, CVD, heavy alcohol use, caucasians
Age Related Macular degeneration:
- what are some good hx questions to ask?
- PE findings in both wet and dry ARMD
Hx questions:
- rate of vision loss; vision loss occurring over days or weeks requires urgent ophthalmic referral!
- whether one or both eyes are involved.
PE:
- Dry = drusen bodies (bright yellow spots), atrophy (depigmentation)
- Wet = subtretinal fluid and/or hemorrhage, neovascularization (gray/green), fluoresein angiogram lights up the vessels
Age-related Macular Degeneration:
- tx of dry and wet
- dx
Tx:
- Dry = none, slow progression with antioxidants with Vit C and E, beta carotene, zinc, and copper.
- no beta carotene in smokers
Wet:
- VEGF inhibitors
- photocoagulation
- surgery
Dx: Amsler grid
Glaucoma:
- types
- Which type is MC?
- risk factors
- pathophys
Types:
-acute angle glaucoma
-Primary open-angle glaucoma (MC)
- secondary:
- -uveitis
- -old trauma
- -steroid therapy
-congenital glaucoma
Risk factors :
- FHx
- age greater than 40-50YO
- female
- hyperopia
- pseudoexfoliation
- race; highest in inuit and asains
Pathophys: schlemms canal becomes blocked.
*In acute angle closure glaucoma the iris root occludes the trabecular meshwork completely obstructing drainage of aqueous fluid from the anterior chamber
Primary angle closure glaucoma:
- signs and sx
- cauuse
- tx
signs and sx: -no sx initially -optic disc described as cupping (increased cup:disk ratio) -peripheral visual field loss followed by central field loss. -increased IOP (normal is 8-22) Cause: -pts anatomically predisposed -no identifiable secondary cause
Tx:
- topical and systemic medications: carbonic anyhdrase inhibitors
- laser therapy
- surgery
Secondary Angle-closure glaucoma:
-cause
Cause:
- fibrovascular membrane grows over the angle
- mass or hemorrhage in posterior segment pushes the angle closed
Angle closure glaucoma:
- presentation
- tx
Presentation:
- decreased vision
- halos around lights
- HA
- severe eye pain
- N/V
- conjunctival redness
- corneal edema or cloudiness
- shallow anterior chamber
- mild-dilated pupil; reacts poorly to light.
Tx:
- immediate referral to ophtho, if there is an hour or more delay to tx then empiric therapy should be started
- treatment is aimed at lowering IOP.
Cataract:
- risk factors
- presentation
- PE findings
- tx
Risk:
- age*
- smoking
- alcohol
- sunlight exposure
- metabolic syndrome
- DM
- systemic corticoid steroid use*
Presentation
- painless
- c/o trouble with night driving, reading road signs, or difficulty with fine print
- increase in nearsightedness
PE findings:
- lens opacity can be confirmed by fundoscopic exam
- may see darkening of red reflex, opacities or obscuration of ocular fundus
Tx:
-surgery
Complications:
- endophthalmitis
- retinal detachment
Presbycusis:
- what is this?
- MC type
- Risk factors
- presentation
- Tx
What; hearing loss d/t aging
MC type: sensorineural
Risk factors: -lifetime exposure to noise -genetics -medications -age -DM -Cerebrovascular dz -smoking HTN -white race
Presentation:
- inability to hear/understand speech in a crowded or noisy environment
- difficulty understanding consonants
- inability to hear high pitched voices or sounds
- tinnitus
Tx: hearing amplification
-hearing aids by audiologist
Subclinical Hypothyroidism:
- definition
- recommendations for tx
Definition: normal T4 with an elevated TSH.
Recommendations fort Tx:
- TSH greater than 10mU/L
- pts who have sx of hypothyroidism
- DO NOT treat if older 70 and TSH 4.5-10.
- consider tx for patients less than 70 with TSH 4.5-10 who have high titers of thyroid peroxidase abys.
COPD
- what is this?
- sx of exacerbations
- risk factors
- pathophys
What; slow progressive irreversible airway obstruction: chronic bronchitis, emphysema
Sx:
- -increased dyspnea
- infection
- respiratory failure
Risk factors:
- smoking
- alpha-1 antitrypsin
Pathophys:
- increased mucus production leading to obstruction
- decreased ciliary transport
- inflammation of bronchioles
- air trapping in alveoli…leading to less surface area for gas exchange
Chronic Bronchitis:
- definition
- what do these pts look like
Emphysema:
- definition
- what do these pts look like?
def: daily productive cough for 3mo or more in at least 2 consecutive years
Looks:
- overweight & cyanotic
- elevated Hgb
- peripheral edema
- rhonchi & wheezing
- blue bloaters
Emphysema:
- def: permanent enlargement and destruction of airspaces distal to the terminal bronchiole
Looks:
- older and thin
- severe dyspnea
- quiet chest
- pink puffers
- pursed lips
With COPD is lung total lung capacity increased or decreased? vital capacity?
What are some common findings on CXR in COPD?
total lung capacity is often increased while vital capacity is decreased.
CXR:
-elongated heart and chest cavity, flattened diaphragm
Acute COPD exacerbations:
- cause
- tx
- long term tx
- complications
- what is the only tx that prolongs life?
Cause:
- infections (majority are viral but may be bacterial)
- environmental pollution or unknown
Tx:
- Short acting beta agonists
- short acting anti-cholinergics
- glucocorticosteroids
Long term: inhaled glucocorticoids
Complications:
- Cor pulmonale
- pna
- pneumothorax
- polycythemia
- arrhthymias
OXYGEN is the only tx that prolongs life!
COPD:
- worsening signs of this dz
- COPD will kill you.
Worsening signs:
- decrease BMI
- decrease in FEV1
- increased dyspnea on exertion
- need for O2
Community Acquired Pneumona:
- predisposing conditions
- pathogens
- tx uncomplicated and complication
- indications for hospitilization
Predisposing conditions:
- smoking
- ETOH
- pulm edema
- malnutrition
- administration of immunosuppressive agents
- being greater than 65YO**
- COPD
- previous episodes of PNA
Pathogens;
- H. flu, chlamydia, strep pneumo
- viruses
Tx:
-uncomplicatied: macrolide
-complicated: resp FQ such as levoquin or amoxacillin-clavulanate (Augmentin)
Indications for hospitilization:
- CURB-65
- -Confusion
- -Blood urea nitrogen greater than 7
- -RR greater than 30
- -BP (Systolic) less than 90 or diastolic less than 60
*Scores: 0-1 = treat outpatient, 2= hospitalize, 3-4= consider ICU
T/F, residents in long term care facilities w/ pna have a higher mortality than elderly pts iin the community?
True.
Common causes of pain in the elderly?
What are the WHO guidelines for treating -mild -moderate -severe pain in the elderly.
WHat medications are we certain not to use?
osteoarthritis and other joint dz
night time leg cramps
claudication
Neuropathies: diabetic, herpetic, idiopathic
Cancer
Mild pain: nonopioid +/- adjuvant
Moderate: nonopioid or opioid or adjuvant
Severe: nonopioid, stronger opioid, or adjuvant
**DO NOT USE amitriptyline or propoxyphene
NSAIDS and the elderly:
-may be toxic to which organ systems?
Toxic:
- renal toxicity
- GI
- cardiotoxicity (interacts with aspirin and warfarin)
Tx of chronic pain in the elderly.
Tx of neuopathic pain
What are some of the adjuvant therapies that can be used in tx?
first line: tylenol
Neuropathic pain: neurontin, lyrica, cymbalta
*be careful with opioids, start low and slow
Adjuvants; Exercise: PT/OT/Stretching/stregnthening -TENS -Ice, heat, massage -CBT -chiropractic therapy -acupuncture -relaxation & guided imagery -biofeedback
Osteoporosis:
- what is this?
- what is a fragility fx?
- risk factors for osteoporosis independt of BMD.
- Tx
What; dz characterized by low bone mass w/ microarchitectural disruption & skeletal fragility
Fragility fx: fx that occurs from standing height or less or with no trauma.
independent Risk factors:
- advanced age*
- previous fx*
- long term steroids
- low body weight (127)
- FHx of hip fx
- smoking
- excess alcohol intake
Tx:
- Hip: surgery
- Vertebral fx: analgesics, calcitonin, vertebroplasy and kyphoplasty
