Flashcards in Geriatrics Potpourri 3 Deck (51):
What is the leading cause of adult blindness in the developing world?
Age-Related Macular Degeneration (AMD)
Impacts of Age-Related Macular Degeneration (AMD) on the elderly?
1. Ability to drive
2. Increased rates of falls
3. Ability to live independently
1. What is AMD?
2. Early AMD usually presents how?
3. Results in the loss of what?
1. Degenerative disease of the central portion of the retina (macula)
2. Early AMD is often asymptomatic
3. Results in loss of central vision primarily
Classifications of AMD? 2
1. Dry (atrophic)*
2. Wet (neovascular or exudative)
Describe the following types of AMD:
1. Dry (atrophic)*? 2
2. Wet (neovascular or exudative)?
1. Dry (atrophic)*
-Retinal epithial cell apoptosis/activating inflammation
2. Wet (neovascular or exudative)
-Balance between substances that promote or inhibit blood vessel development
-Vascular endothelial growth factor (VEGF)
AMD Risk factors?
6. Cataract surgery?
7. Possibly alcohol
AMD Hx questions? 4
Vision loss occurring over days or weeks requires what?
1. Rate of vision loss
2. Whether one or both eyes involved
3. Loss near or far vision or both
4. Acute distortion of loss of central vision—may be wet AMD
urgent ophthalmic referral
for Dry? 3
For wet? 3
1. Drusen appears as bright yellow spots
2. Atrophy appears as areas of depigmentation
3. There may be increased pigmentation
1. Subretinal fluid/and or hemorrhage
2. Neovascularization—appears as grayish-green discoloration
3. Often require fluorescein angiogram
Treatment for dry? 1
-To slow progression? 3
Tool for detecting AMD?
2. For slowing the progression:
-Antioxidants with Vitamin C, E;
-zinc & copper (in smokers NO beta carotene)
1. VEGF inhibitors
Tool for detecting disease progression: Amsler Grid
What are the types of glaucoma?
1. Acute angle glaucoma
2. Secondary glaucoma
3. Congenital glaucoma
4. Primary open-angle glaucoma: most common
Subtypes of secondary glaucoma?
: many subtypes
2. Old trauma
3. Steroid therapy
Characteristics of POAG?
Disease must be screened for
1. Optic neuropathy—optic disc described as “cupping”
2. Peripheral visual field loss followed by central field loss—cannot be recovered
3. No symptoms initially
Disease must be screened for
1. Elevated IOP:
2. Increasing age w/ increased risk of blindness
3. African Americans have 4-5 times greater risk
4. Family history
What is a normal IOP?
Normal range 8-22 mg Hg
Exact relationship between elevated IOP & cupping not well understood
1. POAG screening?
-Done by who?
2. Tx? 3
-Generally done by specialist with specialized equipment
-Can examine optic disc for cupping—cup > then 50% of the vertical disc diameter is suspicious
-Topical and systemic medications
What is the difference between primary and secondary?
-patients anatomically predisposed
-No identifiable secondary cause
-Secondary process responsible for closure of the anterior chamber angle
Examples of secondary angle closure glaucoma? 2
1. A fibrovascular membrane grows over the angle
2. A mass or hemorrhage in the posterior segment pushes the angle closed
1. Family history
2. Age older then 40-50 years
4. Hyperopia (farsightedness)
What races are most at risk for ACG? 2
1. Highest in Inuit and Asian populations
2. Lower in African and European origins
1. Pressure rising acutely: symptoms? 5
2. Signs? 4
-Halos around lights
-Severe eye pain
-Corneal edema or cloudiness
-Shallow anterior chamber
-Mid-dilated pupil (4-6mm); reacts poorly to light
3. In how long or else what?
4. Guided by what?
5. Tx aimed at doing what?
1. Ophthalmologic emergency
2. Immediate referral for further evaluation and definitive treatment:
3. If there is an hour or more delay to treatment empiric therapy should be started
4. This should be guided by the consultant
5. It is aimed at lowering IOP
What is the leading cause of blindness in the world?
1. Age: predominant
2. Smoking: two-fold increase
4. Sunlight exposure
5. Metabolic syndrome
7. Systemic corticoid steroid use*
Cataract presentation? 3
PE findings? 2
1. Painless, progressive process
2. Patients usually complain of problems w/ night driving, reading road signs or difficulty w/ fine print
3. Often increase in nearsightedness (myopic shift)
1. Lens opacity can be confirmed by fundoscopic exam
2. May see darkening of the red reflex, opacities or obscuration of ocular fundus detail
Cataract Surgery Pre-op evaluation should include? 3
Pre-op: Extensive evaluation not necessary
1. HTN should be controlled
2. Endocarditis prophylaxis not needed
3. Risk of bleeding w/ aspirin or warfarin (coumadin) is low so meds can usually be taken
2. Retinal detachment
Hearing Loss in the Elderly
Most common presentation presbycusis?
3. Beginning in the high frequency range (4000-8000Hz)
1. Lifetime exposure to noise
4. Older age
6. Cerebrovascular disease
9. White race
Associated symptoms? 2
-Complain of inability to hear/understand speech in crowded or noisy environment
-Difficulty understanding consonants
-Inability to hear high pitched voices or sounds
2. Associated symptoms:
-If hearing a pulsatile noise in one ear should further assess w/ MRA or MRI to R/O glomus tumor or AV malformation
Screening for Hearing loss should begin when?
Screening for hearing loss > age 60
1. Should be done through who?
2. Describe the efficiency of hearing aids?
1. Should be done through a licensed audiologist!
2. Hearing aids do not restore hearing to normal!
-For example a 60 dB loss could be improved to a 30 dB range
Sometimes two hearing aids are better, sometimes one
Data link subclinical hypothyroidism w/ what? 2
1. Defined as a normal T4 with a elevated TSH
2. atherosclerosis and MI
Subclinical Hypothyroidism: Tx Recommendations?
1. TSH =/> 10 mU/L treat
2. TSH between 4.5 – 10 mU/L in persons less than/= 65YO with sx suggestive of hypothyroidism
3. Treating persons >/= 65YO increase risk of cardiac arrhythmias
4. 4.5 to 8 in those over 70 then they should not be treated
1. What is it?
2. Periodic exacerbations are characterized by what?
1. Slow progressive irreversible airway obstruction:
2. Periodic exacerbations:
Pathophysiology—Air Flow Obstruction: from what? 3
1. Increased mucous in bronchioles
3. Decreased ciliary movement
What is the definition of chronic bronchitis?
Chronic bronchitis is when a cough with mucus persists for most days of the month, for at least three months, and at least two years in a row.
Characteristics of Chronic Bronchitis?
1. Overweight and cyanotic
2. Elevated Hemoglobin
3. Peripheral edema
4. Rhonchi and wheezing
What is Emphysema?
Pathologic dx, permanent enlargement and destruction of airspaces distal to the terminal bronchoiles
Characteristics of Emphysema? 4
1. Older and thin
2. Severe dyspnea
3. Quiet chest
4. On x-ray, hyperinflation and flattened diaphragm
COPD: Air flow obstruction leads to? 3
1. Increase residual volume and functional capacity
2. Total lung capacity often increased
3. Vital capacity decreased
What is the main tx for COPD?
Treatment additions for COPD? 3
-Short acting beta-agonists
-Short acting anti-cholinergics
1. Cor Pulmonale
Chronic Therapy for COPD
Usually involves what?
long term inhaled glucocorticoids
Long term inhaled glucocorticoids:
1. Local deposition effects? 3
2. Systemic SE? 3
3. Cough/throat irritation/reflex bronchoconstriction
2. Adrenal suppression
3. Increase intraocular pressure/cataracts
Signs of Worsening COPD
1. Decrease in BMI
2. Decrease in FEV1
3. Increased dyspnea on exertion
4. Need for O2
End Stage COPD
What should be involved in management? 5
2. Control any pain
3. Usually bedridden
4. Support family
5. Get living will in ADVANCE from patient—don’t want to put them on a ventilator they can’t come off of!
Community Acquired Pneumonia: Predisposing conditions?
2. Alcohol consumption
3. Pulmonary edema
5. Administration of immunosuppressive agents
6. Being >/= 65 years of age **
8. Previous episode of pneumonia
Risk factors for drug resistance? 5
Complicated—comorbidities/recent antibiotic use? 2
1. Strep Pneumo
2. H. influenzae
4. Viruses 10-31%
Risk factors for drug resistance:
1. Age > 65 years
2. Antibiotic therapy within the last 3-6 months
4. Medical comorbidities
5. Immunosuppressive illness or therapy
-Respiratory fluoroquinolones (minimum of 5 days)
CAP: Indications for hospitalization?
2. Respiratory rate > 30
3. BP (systolic less than 90 mmHg or diastolic less than 60 mmHg)
4. Age >65 years
0-1—treated as outpatient
3-4—consider ICU care
Residents of LTCF w/ pneumonia have a higher mortality then elderly patients in the community
Patients in LTCF have underlying factors? 4
2. Left heart failure
4. Use of sedating medications