Sensoty Impairments

Question 1

Normal age-related changes in vision

Answer 1

Typically gradual
Limit functional ability
External changes
Internal changes
Visual acuity 
Light sensitivity

Question 2

Presbyopia

Answer 2

Caused by loss of elasticity of the lens, resulting in decreased ability to see up close.

40-50 years old

Can’t read small print up close

Readers will help

Question 3

Cataracts

Answer 3

Opacity of optic lens

Progressive decrease in visual acuity - appearing 40-50 but not affecting vision until after 60

Painless
May be halos and glares in bright lights

“ i cant see well, things look cloudy, i need more light”

Will have no red reflex on exam

Question 4

Low vision

Answer 4

Age related
Reduced level of vision that can not be fully corrected by conventional glasses

Not a normal part of aging and usually. Associated with underlying eye disease

Difficult recognizing objects at a distance, differentiating colors, seeing well up close

Question 5

Legal blindness

Answer 5

Central visual acuity does not exceed 20/200 in the better eye with correcting lenses or

That the widest diameter of the visual field sub tends on angle no greater than 20 degrees

Question 6

Glaucoma - Primary open angle glaucoma

Answer 6

Most common type type of glaucoma

Progressive loss of peripheral visual fields followed by central field loss

Usually occurs with increased IOP

Risk factors : age, race, fam hx, elevated IOP, common in Asians, eskimos, cauc women

PE: optic disk appears hollowed out “ cupping”

Question 7

Glaucoma treatment

Answer 7

Lowering IOP = #1 therapy

Goal is to prevent loss vision

Refer - eye drops to lower pressure

Question 8

Acute Angle Closure Glaucoma

Answer 8

Sudden onset, severe eye pain, blurred vision, unilateral headache, n/v/ and photophobia

Caused by rapid, sudden increase in IOP, trigged by medications, infections, trauma or surgery

Medical emergency - to prevent damage to the optic nerve and permanent vision loss

Question 9

Macular degeneration

Answer 9

Leading cause of vision loss among people 50 and older

Degenerative disease of the central and most sensitive portion of the retina (the macula)

Results primarily in loss of central vision

Question 10

Dry macular degeneration

Answer 10

Progress more slowly than the wet type
Small white or yellowish deposits called druses form on the retina , beneath the macula causing it to deteriorate over time

Question 11

Wet macular degeneration

Answer 11

More rare, when abnormal vessels begin to grow towards the macula. The blood vessels break, bleed, and leak fluid damaging the macula dm cause it to lift up and pull away

Can cause a rapid and severe loss of central vision

Question 12

Clinical presentation of MG

Answer 12

Gradual loss of vision
Visual distortion
Loss of central vision

Question 13

Amsler Grid

Answer 13

Changes in central vision may cause the lines in the grid to disappear or appear wavy

Question 14

MD dx

Answer 14

Dilated eye exam

Drusen bodies - Dry MD

Round or oval area of increased pigmentation - wet MD

Question 15

MD treatment

Answer 15

Age-related Eye Disease Study - suggests diet may decrease risk of vision loss in patient with MD

Vit C, E, beta carotene, zinc, copper, low vision aids

Refer

Question 16

Retinal detachment

Answer 16

Caused by trauma or traction ( underlying conditions that put pressure on the eye)

Characterized by a sudden visual disturbance

EMERGENCY time is critical , need surgical intervention

Question 17

Diabetic retinopathy

Answer 17

Often asymptomatic can be characterized by “ scotoma like black spots” in central vision, if untreated can lead to blindness

Results from persistent hyperglycemia

Affects both eyes, gradual onse, often not noticed, effects both central and peripheral vision

Involves changes to retinal blood vessels that can cause them to bleed or leak fluid thus distorting vision

Question 18

PE findings

Answer 18

Cotton wool spots, neovasculatization, microaneurysms, edema and exudates

Question 19

Uveitis

Answer 19

Inflammation of the “ uvea” iris/ciliary body/choroid - any part of it

Caused by
Infection or systemic reaction
Increased in immune comprised pt
Autoimmune causes

Anterior iritis most common

Unilateral, red and it is located around the limbus

Question 20

Uveitis s/s

Answer 20

Redness, pain, blurred vision, photophobia, increased tearing, floaters

Question 21

Iris

Answer 21

Colored part of the eye, and controls movement of the pupil

Question 22

Ciliary body

Answer 22

Is a muscle attached to the lens of the eye

Question 23

Choroid

Answer 23

Lies behind the sclera and contains blood vessels to nourish the eye

Question 24

Uveitis eval and treatment

Answer 24

PE: visual acuity may be decreased in affected eye, photophobia

Refer for treatment

Question 25

Corneal abrasion

Answer 25

Painful scratch on cornea Caused by Trauma, contact lens, dust, sand, sharp fingernail Symptoms Foreign body sensation, intense tearing, inability to keep eye open, blurred vision, pain, light sensitivity

Question 26

Corneal abrasion tx

Answer 26

Rinse eye with a ton of water or lubricating eye drops Tylenol, NSAIDS Antibiotic eye ointment - to prevent bacterial super infection Cover eye for comfort Avoid contact lenses until symptoms resolve Follow up in 24 hours

Question 27

Subjunctival hemorrhage

Answer 27

Painless hemorrhage ( broken blood vessels) in the conjunctiva Can occur after sudden sneeze, cough, heavy lifting Should not cause change in vision, itchiness, discharge, photophobia or pain Will resolve in 1 to 2 weeks

Question 28

Subconjunctival hemorrhage PE

Answer 28

Extravasated blood in the inferior conjunctiva

Question 29

Hordeolum (Stye)

Answer 29

Pain, warm, swollen pustule not the eye lid can be wither upper or lower lid - a focal abscess Self limiting , will resolve in 1-2 weeks with warm compress and no eye make up

Question 30

Chalazion

Answer 30

Hard painless eye lid nodule formed by obstruction of sebaceous gland, can be present for weeks to months and they then to reoccur Should not have eye pain, vision changes, fever Treatment : warm moist hear for 15 min , refer is suspect CA or doesn’t resolve in a month

Question 31

Blepharitis

Answer 31

Chronic condition characterized by inflammation of eyelid margin, freq co exist with dry eyes, entropion and ectropion Red swollen or itchy eyes, gritty or burning sensation, excessive tearing, crusting of eyelashes in the morning

Question 32

Entropion

Answer 32

Inward turning of the lower eyelid with eyelashes rubbing against ocular surface

Question 33

Ectropion

Answer 33

Outward turning of the lower lid with increased exposure of the ocular surface as well as disruption of normal tear drainage

Question 34

Conductive hearing loss

Answer 34

Perforated TM Serous Otitis Cerumen

Question 35

Nerve deafness

Answer 35

Presbycusis Vestibular schwannoma ( acoustic neuroma) Meds

Question 36

Central deafness

Answer 36

Infection

Question 37

Screening for hearing loss

Answer 37

Every 10 years until the age of 50 adn then every 3 years

Question 38

Tuning fork tests

Answer 38

Look it up

Question 39

Ototoxic drugs

Answer 39

Aminoglycosides antibiotics ( gentamicin, erythromycin) Antineoplastics Loop diuretics Baclofen Propranolol

Question 40

Tinnitis

Answer 40

High pitched ringing or pulsations in ears Treatment White noises machines, hearing aids, stress reduction, acupuncture, treat underlying cause

Question 41

Ménière’s disease

Answer 41

Disorder of the inner ear that causesL Episode of severe dizziness lasting 20 min and longer ``` Ringing in ears Hearing loss Sensation of fullness or congestion Generally affects one ear Common with ages 40-60 ```

Question 42

Menieres dx causes

Answer 42

Build of fluid in compartments of inner ear that are responsible for balance and hearing which interferes with signals to the brain - vertigo Refer to ENT TX: med, salt restriction, cognitive therapy

Question 43

Benign Paroxysmal Positional Vertigo

Answer 43

Common form of positional vertigo due to presence of calcium debris within the semicircular canal known as the canalithiasis

Question 44

BPPV - s/s

Answer 44

Recurrent episodes of vertigo that last one minute of les Provoked by specific movement - looking up while standing, lying down or getting up from bed - N/V - not associated with hearing loss or other numerological complaints - episodes can last for weeks to months without therapy

Question 45

BPPV - DX

Answer 45

Conformed by presence of nystagmus present during provoking maneuvers Dix - Hallpike Treatment is Epley Maneuver

Question 46

Look up Dix - Hall pike and particle repositioning maneuver

Answer 46

D

Question 47

Gustatory system

Answer 47

Tase - receptors are located in the taste bud on the upper surface of the tong to provide information about the taste of food being eaten

Question 48

Four taste sensations

Answer 48

Sweet, bitter, salty, sour No tongue map

Question 49

Disturbances in the gustatory system effected by

Answer 49

Smell

Question 50

Ageusia

Answer 50

Inability to taste

Question 51

Hypogeusia

Answer 51

Decreased taste

Question 52

Dysgeusia

Answer 52

Distorted ability to taste

Question 53

Drugs affecting taste

Answer 53

``` Antibtiocs Anticonvulsants Antihypertensives Antidepressants Lipid lowering agents Antihistmaines Muscle relaxants Anti- inflammatory agents ```

Question 54

Xerstomia

Answer 54

Dry mouth Caused by salivary gland dysfunction Can increase risk of aspiration

Question 55

Olfactory system

Answer 55

Smell Receptors are located in the olfactory lining of the nasal passages Oldest and most vital parts of the brain