Geriatrics Quiz 1
Selective M3 antimuscarinics Bladder Relaxants
- solifenacin (Vesicare) - darifenacin (Enablex)
Non-selective anticholinergics Bladder relaxants
-oxybutynin (Ditropan) -tolterodine (Detrol) -trospium (Sanctura) doesn't cross B/B barrier - fesoterodine (Toviaz)
3 Anatomical/functional parts of hearing:
1) peripheral - modulation of sound to nerve impulses; 2) brainstem - binaural; source location; 3) cortical - sound and speech discrimination and interpretation
Five I's of Geriatric Problems
1. Immobility/ Instability- arthritis, strokes, hip fracture, osteoporosis, neurologic dis. 2. Incompetence- dementia, delirium, depression, intellectual impairment 3. Incontinence/Impotence- urinary, fecal 4. Impaired homeostasis- immunosenescence, dysautonomia, sensory loss, insomnia 5. Iatrogenesis or Inanition- falls, infection, polypharmacy, malnutrition, failure to thrive, isolation,
Readmissions are now "Hot topic" due to 20% of hospitalizations occurring within ___ days of discharge
30 days
Greatest growth of population will be in the percentage of those in what age group?
85 and older
More than one-third of health care spending goes toward those in what age group?
> 65 years of age
A 54-year-old male initially presents with gross painless hematuria. He is found to have lowgrade, nonmuscular invasive bladder cancer. Which of the following is the most appropriate treatment option? a. Intravesical immunotherapy with Bacillus Calmette-Guerin (BCG) b. Systemic chemotherapy with gemcitabine and cisplatinum c. Radical cystectomy d. Radiation therapy
A
A 65 year-old male with a 60 pack-year smoking history presents with painless hematuria for two days. He also complains of frequency and dysuria. He denies a history of recent upper respiratory tract infection. Which of the following is the most likely diagnosis? A. Bladder cancer B. Wegener's granulomatosis C. IgA nephropathy D. Benign prostatic hypertrophy
A
A 66 year-old male patient has both hypertension and benign prostatic hypertrophy. Which of the following medications would most likely benefit both conditions? A. Prazosin (Minipress) B. Finasteride (Propecia) C. Verapamil (Calan) D. Propranolol (Inderal)
A
A 68-year-old female with 40 pack-years of tobacco use presents for evaluation of gradual painless loss of central vision bilaterally. She also describes distorted images in the lower fields. Which of the following funduscopic examination findings is most consistent with the likely diagnosis? a. haphazardly distributed hard drusen with sharply defined edges b. hyperemic, swollen optic disc with blurred margins c. rings and crescents along the temporal border of the optic disc d. venous tapering, flame-shaped hemorrhages, copper wiring
A
A 71-year-old female presents to the emergency department with acute severe back pain. She states the pain started suddenly while she was shopping. Examination reveals a kyphotic spine with tenderness in the thoracic area. Radiology confirms a fracture of T10. What is the next step in the work-up of this patient? A. Bone density B. Bone Scan C. Vitamin D level D. Adjusted calcium level E. MRI of spine
A
A 72 year-old female presents with vulvar pruritus for the last nine months, which has progressively worsened over the last two months. She states that she went through menopause at age 54 and has been on estrogen and progesterone therapy since that time. Physical examination reveals red lesions with white plaques on the vulva. What should the next course of management include? a. Refer to a gynecologist for biopsy b. Refer to a dermatologist for antifungal therapy c. Treat with topical steroid d. Treat with estrogen cream
A
A 80 y/o WF is brought to family practice by her daughter with complaints of forgetfulness. The daughter states that her mom has been driving and forgets where she is going. This has happened on numerous occasions. The daughter also reports that her mom can't remember something she told her 5 mins before. She states this has been occurring for months and is steadily getting worse. The patient does admit frustration with her memory because it is affecting her life. She is often missing appointments and social engagements. The physical exam is WNL. MMSE is 24/30. The presence of which of the following on autopsy would confirm your diagnosis? a. Beta Amyloid Plaques b. Frontotemporal lobar degeneration c. Lewy's bodies d. Degeneration of the nigrostriatal dopaminergic system e. Effacement of the ventricles
A
Patients with recurrent urinary stone disease should be educated to maintain a diet restricted in? A. sodium and protein B. carbohydrates and fat C. Bran D. Fluids
A
The most effective preventive strategy to prevent recurrence of renal lithiasis is which of the following? A. Increase in hydration B. Early Treatment of UTI C. Limitation of Calcium intake D. Probenecid
A
A 52 year-old obese patient with persistent heavy menses undergoes an endometrial biopsy and is diagnosed with atypical adenomatous hyperplasia. What is the next step in the management of this patient? a. Total abdominal hysterectomy b. Observation and endometrial biopsy in 3 months c. Endometrial curettage followed by progesterone daily d. Oral progesterone days 16-25 of the month for 6 months and repeat biopsy
A. Atypical adenomatous hyperplasia contains cellular atypia and mitotic figures in addition to glandular crowding and complexity. This has a 20-30% risk of progression to endometrial cancer and the recommendation is hysterectomy
Transient Monocular Blindness
AKA Amaurosis Fugax (TIA of retina) Vision (usually only one eye) fades rapidly like "a curtain descending" over all or part of the visual field
ADLs vs IADLs
Activities of Daily Living - refers to basic self care abilities Instrumental Activities of Daily Living - refers to tasks required to maintain independent household; IADLs apply to activities requiring higher levels of function
AAO Recommendations for Eye exams
Adults with no signs or risk factors: a baseline comprehensive eye evaluation at age 40 Individuals without risk factors: --aged 40 to 54: examined every 2 to 4 years --aged 55 to 64: examined every 1 to 3 years 65 years old or older: examined every 1 to 2 years
Most common cause of legal blindness in the elderly
Age-Related Macular Degeneration (ARMD)
A 53-year-old female comes to the office complaining of vaginal dryness, itchiness, and irritation. She also states that sexual intercourse is painful. She says she previously enjoyed intercourse with her husband, and would like to have pleasurable sex with him again. The patient is postmenopausal and has vaginal atrophy. She was previously given topical estrogen vaginal creams, but she did not like the "messiness" of them. What alternative treatment would you suggest to help relieve her vaginal atrophy? a. Oral estrogen and progesterone b An estrogen vaginal ring c. Over-the-counter vaginal lubrication products d. Estrogen vaginal suppositories e. Abstinence from sexual intercourse
B
A 67-year-old presents with ear pain. Examination reveals edema of the external auditory canal producing an anterior and inferior displacement of the auricle with percussion tenderness posteriorly. What is the most likely diagnosis? a. Acute otitis externa b. Mastoiditis c. Otitis media d.Malignant otitis externa
B
A 68 y/o WM presents to family practice as a new patient. He recently obtained insurance coverage and states he hasn't seen a doctor in over 10 years. He has no past medical history that he knows of. He does not know his immunization status and states he knows he hasn't had any shots in over 10 years but he does remember getting shots as a child. For his age, which of the following immunizations are recommended for him to receive today? a. Influenza, Herpes Zoster vaccine (Shingrix), Tdap b. Influenza, Tdap, Herpes Zoster vaccine (Shingrix), PCV13 c. Herpes Zoster vaccine (Shingrix), Tdap, PPSV23, MMR d. Tdap and PCV13 e. Influenza, Herpes Zoster vaccine (Shingrix), Tdap, PPSV23
B
A 88 y/o AA male presents to the clinic for his 6 month check up and lab work. While evaluating the patient you hear a systolic crescendo-decrescendo murmur in the second right interspace. This murmur is accompanied with a brisk carotid upstroke. Pt denies any CP, SOB, palpitations, peripheral edema, diaphoresis, or N/V. What is the patients most likely diagnosis? a. Mitral regurgitation b. Aortic sclerosis c. Aortic stenosis d. Mitral valve prolapse (MVP) e. Mitral stenosis
B
A postmenopausal female presents with vaginal bleeding. Which of the following is the next best step in the evaluation of this patient? a. CA-125 b. Endometrial biopsy c. Pelvic ultrasound d. Hysterosalpingography e. Abdominal paracentesis
B
An 80 yo WM is establishing care as a new pt in your primary care office. After obtaining the patient's medical hx you begin the geriatric screener to determine the patient's functional limitations, if any. When asking the patient about his vision he remarks that he has difficulty performing his activities of daily living due to a decline in his eyesight. In addition to this positive finding, what visual acuity per the Snellen chart would pt have to exhibit for it to be considered a positive vision screening (meaning they have functional impairment)? a. >20/30 b. >20/40 c. >20/50 d. >20/100 e. >20/200
B
An elderly male presents with unilateral hearing loss for 1 day. He denies URI symptoms, fever, or ear pain or discharge. He further denies any dizziness or headaches. Physical exam reveals normal balance, negative Romberg, but evidence of conductive hearing loss in the affected ear. What is the most likely diagnosis? a. barotrauma b. cerumen impaction c. eustachian tube dysfunction d. otitis media
B
An elderly patient with diabetes mellitus type 2 presents with mouth irritation. Exam reveals creamy white, curd-like patches which are easily scraped off revealing erythematous buccal mucosa. What is the most appropriate treatment? a. acyclovir b. fluconazole c. penicillin d. prednisone
B
Which of the following is diagnosed by use of the cover/uncover test? a. Adie's pupil b. Strabismus c. Glaucoma d. Myopia
B
Which of the following lab studies best demonstrates menopause findings: a. High estradiol and low FSH and LH b. Low estradiol and high FSH and LH c. High estradiol and high FSH and LH d. Low estradiol and low FSH and LH
B
You are doing rounds in an assisted living facility and a nurse approaches you with concerns about one of the patients who has been experiencing dizziness, blurred vision, and balance disturbances upon getting out of bed in the morning. Based on blood pressure readings in the supine and standing positions that the nurse took, she is worried that the patient may have orthostatic hypotension. What blood pressure reading from supine to standing would concern you most for orthostatic hypotension? a. Supine: 120/80mmHg Standing: 110/80mmHg b. Supine: 120/80mmHg Standing: 99/70mmHg c. Supine: 120/80mmHg Standing: 115/72mmHg d. Supine: 120/80mmHg Standing 110/73mmHg e. Supine: 120/80mmHg Standing: 111/75mmHg
B
You're evaluating a 67-year-old man who was involved in a motor vehicle accident. On physical examination, you notice a significant restriction of right eye movement. Which of the following would you order next? a. Radiograph of the orbit b. CT scan of the orbit c. MRI of the head without gadolinium d. Skull radiograph e. PET scan
B
You're treating a 62-year-old man for benign prostatic hyperplasia (BPH). He has an American Urological Association (AUA) symptom score of 7, denoting mild BPH symptoms. He also has hypertension, so you elect to start terazosin (Hytrin). What would you advise this patient concerning potential side effects of this medication? A. There are no side effects he needs to be aware of. B. He should get up slowly and notify you if he has lightheadedness or dizziness. C. He should call you if his blood pressure increases. D. He needs blood work to monitor potassium levels. E. He needs to watch for edema and constipation.
B
Most common cause of acute vertigo
BPPV
A 50 y/o WF comes to your clinic complaining of recent upper respiratory infection to include fever, malaise, and rhinorrhea x 5 days. Patient states the symptoms resolved with OTC Nyquil at night and Tylenol during the day. Today the patient is complaining of pain in her left eye with reduced vision and sensitivity to light for the last 24 hrs. Patient denies wearing contacts, exposure to ocular debris, injury to the eye or excessive rubbing. VS within normal limits, afebrile. After visual inspection of the sclera, conjunctiva, and fundoscopic you rule out global cause. Next, you complete fluorescein instillation bilaterally to her eyes. The right eye is without concern. The left eye presents with a dendritic branching brightly lit area midline involving the cornea. What is your diagnosis and what is your next step in treatment? a. Corneal Ulcer, ophthalmic antibiotics b. Corneal Abrasion, lubricating eye drops c. Herpes Simplex Infection, Ophthalmology consultation d. Cataract, reassure patient e. Papilledema, Ophthalmology consultation
C
A 52 y/o woman returns to your office 2 weeks postoperatively. She initially presented with a 12cm pelvic mass and an elevated CA-125 (300 U/mL). She underwent an uncomplicated total abdominal hysterectomy, bilateral salpingo-oophorectomy and omentectomy. Outside of the ovary, the only apparent disease at the time of surgery was a 4cm implant on the distal omentum. At the completion of surgery, there was no visible residual disease and the final pathology revealed a high-grade serous ovarian carcinoma with metastatic disease in the omental implant. Her postoperative course has been without complications thus far and she is otherwise healthy and without medical comorbidities. In speaking with her about adjuvant therapy, she expresses that she is willing to accept increased treatment related toxicity if it may result in a survival advantage. Based on the patient's preferences, surgical stage and clinical characteristics, what is the MOST appropriate adjuvant treatment? a. Whole abdominal radiation b. Intravenous (IV) cisplatin and IV paclitaxel c. Intraperitoneal (IP) cisplatin and IV/IP paclitaxel d. IV carboplatin and IV docetaxel e. Single-agent carboplatin
C
A 52-year-old male presents complaining of urinary frequency, with hesitancy, and nocturia for the past few months. During his physical examination, you note a nontender, non-enlarged prostate with an isolated right posterior lobe nodule. Which of the following options is most appropriate? A. Order a serum acid phosphatase level B. Initiate prazosin and schedule a follow-up appointment in 6 weeks C. Refer the patient for an ultrasound of the prostate and order a PSA level D. Reassure the patient and schedule a follow-up appointment in six months E. Initiate norfloxacin therapy for 7 days and schedule follow-up in two weeks
C
A 59-year-old male complains of "flashing lights behind my eye" followed by sudden loss of vision, stating that it was "like a curtain across my eye." He denies trauma. He takes Glucophage for his diabetes mellitus, and atenolol for his hypertension. He has no other complaints. On fundoscopic exam, the retina appears to be out of focus. Which of the following is the most likely diagnosis? a. Central retinal vein occlusion b. Retinal artery occlusion c. Retinal detachment d. Hyphema
C
A 62-year-old elementary school teacher returns to clinic for reevaluation of a severe sore throat. She was seen earlier in the week, diagnosed with tonsillitis, and prescribed amoxicillin. Today, she reports she is still febrile and has malaise, odynophagia, dysphagia, and otalagia. She speaks with a "hot potato" voice and is drooling. Physical exam reveals tonsillar displacement, palatal edema, and uvular deviation. What additional intervention is most appropriate at this time? a. Addition of oral steroids b. Change of antibiotic to clindamycin c. Emergent ENT referral for abscess drainage d. Immediate intubation for airway maintenance
C
A 64-year-old woman complains of headache and left eye pain for about a day. She says it started yesterday as a dull ache and now is throbbing. She also complains of nausea and vomiting, which she attributes to the popcorn she ate at the movie theater yesterday afternoon. On exam, the left pupil is mid dilated and nonreactive. The cornea is hazy. A ciliary flush is noted. Which of the following is the most likely diagnosis? a. Migraine headache b. Temp oral arteritis c. Acute glaucoma d. Retinal artery occlusion
C
A 66 yo AA male presents to your clinic with complaints of worsening vision x 1 year. He has past medical hx of HTN and diabetes mellitus type 2. Current vitals are normal except for BP being at 144/92. He describes his vision as having become blurrier than before, especially his peripheral vision. He states that he hates going to the doctor so he hasn't had it checked by anyone in a number of years. On PE you notice clear conjunctiva, PERRLA, and intact EOMs. Fundoscopic exam reveals cupping of the optic disc and an increased cup-to-disc ratio. Based upon the history and presentation what is the likely etiology of the patient's symptoms? a. Macular degeneration b. Acute narrow angle glaucoma c. Primary open angle glaucoma d. Retinal detachment e. Cataracts
C
A 67-year-old artist presents to the ER c/o pain and swelling around her left eye that started 2 days ago but is now severe. Pt states that she came to the ER because the pain worsened and now hurts when she tries to look from side to side. Pt is also c/o symptoms of sinus congestion that has been going on for 2 weeks now. On exam, pt has fever, tenderness over her sinuses, severe swelling and redness to the left eye, and pain with EOM's. What aspect of the history and physical exam would rule out pre- septal cellulitis compared to orbital cellulitis? a. age b. History of sinus congestion c. Pain with EOM's d. Fever e. Swelling and redness to the eye
C
A 68 year-old woman comes to the office for evaluation of urinary incontinence. For the past few months, she has had an intense urgency to urinate, followed by leakage of urine. Which of the following is the most appropriate intervention for this patient? A. Intravaginal estrogen cream (Premarin cream) B. Terazosin (Hytrin) C. Oxybutynin (Ditropan) D. Intravaginal miconazole cream (Monistat cream)
C
A 70-year-old woman with a history of congestive heart failure and diabetes mellitus is seen in your clinic because of frequent episodes of incontinence. She says that these episodes happen without warning, usually in the context of coughing or sneezing. Which of these interventions is the most likely to help with her incontinence? A. Tolterodine B. Topical estrogen C. Pelvic muscle exercises D. Tamsulosin E. Augmentation cystoplasty
C
A 73-year-old with a history of moderate emphysema is brought to the emergency department with fever and obtundation. Examination reveals a thin woman with dry mucous membranes, tachypnea, and scattered rhonchi and wheezes. Abdomen is soft, bowel sounds are hyperactive, she winces with deep palpation of the suprapubic area. Remainder of the exam is unremarkable. What is the most likely diagnosis? A. Cerebral vascular accident B. Encephalitis C. Pneumonia D. Rupture abdominal viscus E. Urinary tract infection
C
A 75 y/o WM presents to the clinic for routine physical exam and refill of medications. He states he is doing well but does mention complaints of a bump on his nose. Past medical history includes hypertension, hyperlipidemia, and peripheral vascular disease. Patient is a farmer and is outside often. On physical exam, there is a translucent nodule with a depressed center and a firm elevated border on the patient's nose. What is the most likely diagnosis? a. Squamous cell carcinoma b. Melanoma c. Basal cell carcinoma d. Aktinic keratosis e. Seborrheic keratosis
C
Which of the following is the most appropriate intervention for a stage I testicular seminoma? A. Watchful waiting B. Chemotherapy initially C. Orchiectomy and radiation D. Orchiectomy and chemotherapy
C
Which one of the following is a risk factor for vulvar cancer? a. anorexia b. Vitamin B12 deficiency c. Human papillomavirus d. Epstein-Barr virus e. adenovirus
C
You're evaluating a 65-year-old woman who presents with abdominal distention and bloating. An abdominal ultrasound confirms the presence of ascites. Which one of the following is she most likely to have? a. adrenal cancer b. renal cell carcinoma c. Ovarian carcinoma d. Cervical cancer e. Liver cancer
C
A 60 y/o BM comes to your Emergency Department. He has a history of cataract extraction last year (no complications), nearsightedness, and use of glasses for 40 years. Patient denies history of Diabetes, hypertension, atherosclerosis, hyperlipidemia, or cardiac disease. His chief complaint is visual changes with sudden onset. His visual field loss is described as starting low and expanding upward. Upon reviewing his history, he does admit to seeing new "floaters" over the past week. Upon physical exam, central vision is intact at this time, fundoscopic exam reveals a retinal gray cloud with visual identification of tears in the lower retina. What is your diagnosis and what position should the patient be placed in immediately? a. Papilledema, face down to promote blood flow to the area b. Optic neuritis, sitting straight up c. Acute Narrow Angle-Closure Glaucoma, supine and resting to decrease IOP d. Retinal Detachment, head elevated back with nose to the ceiling e. Central Retinal Artery Occlusion, supine position to promote revascularization
D
A 60-year-old male presents with complaints of irritation and a white plaque on his tongue. He denies pain. During physical exam you are unable to remove the white plaque from the mucosa with a tongue depressor. What is the most likely diagnosis, represented as follows? a. Glossitis b. Geographic tongue c. Lichen Planus d. Oral leukoplakia
D
A 68 year old female describes myalgias and arthalgias that have interfered with her ability to ambulate. She has fallen twice in the past month but denies any loss of consciousness or injuries. She lives alone and spends most of her day inside. She avoids caffeine but has a shot of whiskey each evening. She is thin and prefers not to eat meat more than once per week. A deficiency of which of the following is most likely present? A. Calcium B. Parathyroid Hormone C. Vitamin B12 D. Vitamin D E. Zinc
D
A 70-year-old male presents to his primary care physician with complaints of urinary frequency, urgency and nocturia. Physical exam shows an enlarged, rubbery, non-tender and firm prostate without discrete nodules or masses. Which of the following treatments for this condition is matched with its most common side effect? A. Prazosin - Hypertension B. Finasteride - Hair Loss C. Transurethral electrovaporization (TUEVP) - Urinary incontinence D. Transurethral resection of the prostate (TURP) procedure - Retrograde ejaculation
D
A patient with prostate cancer has a nonpalpable, focal lesion, and the patient is reluctant to have surgery at this time. Which of the following would best monitor disease progression? A. Periodic rectal exams B. Transrectal ultrasonography C. Measurements of serum acid phosphatase D. Measurements of prostate-specific antigen
D
The use of tamoxifen increases the risk of which type of cancer? a. Breast b. Ovarian c. Cervical d. Endometrial e. Liver
D
Which of the following is a common characteristic of menopause? a. Slow bone demineralization b. increased vaginal secretions c. decreased LDL Cholesterol d. Genital atrophy e. Headache
D
Which of the following is the most common cause of death in postmenopausal women a. cerebral vascular accident b. ovarian cancer c. breast cancer d. heart disease e. diabetes
D
Which of the following is the treatment of choice for a nursing home patient who has asymptomatic bacteriuria with no history of diabetes or structural abnormalities of the genitourinary tract? A. Ciprofloxacin B. Sulfamethoxazole-trimethoprim (Bactrim) C. Cephalexin D. No treatment needed
D
Which one of the following would be a cause of sensorineural hearing loss? a. Cerumen impaction b. Flying in a plane at high altitude c. Otitis externa d. Ménière's disease e. Otitis media
D
While undergoing your monthly evaluation of your 81 y/o patient in the long-term care facility, you notice two well-demarcated vividly purple macules/patches on the patient's left posterior forearm. The most proximal lesions measure approximately 2x1 cm and the other measures approximately 0.5 cm by 1.5 cm. You did not notice such lesions last month during your evaluation and the patient along with their chart deny any recent injuries. Patient is WDWN with no other acute changes on physical exam. What is the most likely diagnosis and treatment option? a. Squamous cell carcinoma (SCC)—Biopsy the lesion and send the sample to the lab for histologic evaluation. b. Elderly abuse—Follow the proper protocols to report these PE findings as suspected abuse because there is no other explanation for such findings on your elderly patient. c. Actinic Lentigines—Simply make note of findings and observe as these are normal PE findings known as "liver spots" d. Actinic purpura—Note findings and reevaluate at the next monthly visit. Watch for fading of the lesions over the next several weeks. e. Melanoma—Biopsy the lesion and send the sample to the lab for STAT histologic evaluation as these lesions are likely cancerous and dangerous.
D
Which of the following women is most likely to develop breast cancer? a. 30-year-old Japanese woman with a history of menarche at age 14 b. 40-year-old African American woman currently on birth control pills c. 50-year-old Indian woman who had her first pregnancy at age 17 d. 60-year-old white woman whose mother had breast cancer
D The strongest risk factors in developing breast cancer are increasing age, white race, and a first-degree relative (mother, sister, daughter) with a history of the disease.
A 52-year-old presents for evaluation of decreased visual acuity, which he describes as a general burring which has progressed over the past few months. Further questioning reveals increased difficulty driving at night due to glaring lights. Which of the following pieces of historical information would lead to a consideration of cataracts as the cause of the visual changes? a. History of rubella at 5yoa b. Contact lens use for 25y c. Family history of senile cataracts d. Inhaled corticosteroid use for asthma
D. The risk factors for developing cataracts include *congenital* rubella, trauma, systemic disease such as diabetes, systemic or inhaled corticosteroid use, uveitis, and excessive sun exposure
Causes of Acute or Reversible UI
DIAPPERS Delirium Infection Atrophic urethritis or vaginitis Pharmaceuticals Psychological factors Excess urinary output Restricted Motility Stool Impaction
List some geriatric syndromes
Dementia, Delirium, Urinary Incontinence, Falls, Gait Disturbances, Dizziness, Syncope, Hearing Impairment, Visual Impairment, Osteopenia, Malnutrition, Eating and Feeding Problems, Pressure Ulcers, Sleep Problems
Acute closed angle glaucoma
Develops over hours; freq. + FmHx Painful, red eye with vision loss Pupil tends to be fixed, mid-sized
Factors That Place Older Adults at Risk for Malnutrition
Drugs (eg, reserpine, digoxin, antitumor agents) Chronic disease (eg, congestive heart failure, renal insuiciency, chronic gastrointestinal disease) Depression Dental and periodontal disease Decreased taste and smell Low socioeconomic level Physical weakness Isolation Food fads
Keratoconjunctivitis sicca (KCS)=
Dry eyes
95% of cataract surgery is:
Extracapsular cataract extraction (ECCE) with I-O lens implant
Refers to incontinence associated with the inability or lack of motivation to reach the toilet in time; single episode is not a diagnosis
Functional Incontinence
Common readmit conditions:
Heart failure COPD Pneumonia Acute MI CABG PTCA (now more stents, fewer PTCAs) Other Vascular disease
Type of incontinence seen in women with atrophic vaginitis; in men with strictures or treated for stricture
Intrinsic Sphincteric Weakness
Common cause of incontinence in frail pts
Involuntary bladder contractions (detrusor muscle); Less upper brain (cortex) inhibition of detrusor muscle, so ↑'d contractions
Cause of amaurosis fugax
Ischemia of retina; i.e. ASCVD plaque in carotid or aorta, thrombosis or embolism of retinal artery; or temporal arteritis (giant cell arteritis, GCA, which can affect the optic nerve; ESR very high; HA common)
Anti-Muscarinic Side Effects
M1 & M4: impaired cognition (if cross Blood/Brain barrier) M2: cardiac (tachycardia, prolongation of Q-T interval, arrhythmias) M3: Dry mouth, constipation, blurred vision (dilated pupil, can ↑ intraocular press, so relative contraindication in Open angle Glaucoma; definite contraindication in narrow angle Glauc.; must consult ophthalmologist*)
Loss of central vision
Macular Degeneration
How would polyneuropathy/balance disturbance affect Immobility/Falls?
May interfere with proprioception, cause muscle weakness & balance issues
Detrusor Muscle Overactivity may result from
May result from impaired function of inhibitory centers- w. aging*, neurologic disease (MS, Parkinson, stroke)*, sedation, hypoxia May also result from irritative causes within the bladder (inflammation) which cause over-stimulation of contractions- UTI, bladder stones or cancer, atrophic vaginitis
Mirabegron
New class of medication; agonist of the human beta-3 adrenergic receptor (AR); Relaxes the detrusor smooth muscle, which increases bladder capacity, inhibits bladder contractions
Loss of peripheral vision associated with?
OAG
Optic disk changes are associated with what?
OAG, temporal arteritis
Which glaucoma is more common?
Open angle
Chronic open angle glaucoma
Peripheral vision loss first, then central vision loss*; but slow progression; insidious onset
Healthy Aging refers to effective actions taken to:
Prevent or lessen disease, avoid/minimize disuse, and adapt to, and cope with events of normal aging disease + disuse + normal aging
Acute closed angle glaucoma treatment
Requires urgent treatment- lower IOP: Miotics, (b-block, pilocarpine); acetazolamide (diamox) Ophthalmology referral immediately because is surgical disease (laser iridectomy); risk of blindness if delay
Defined as involuntary loss of urine with increases in intra-abdominal pressure
Stress Incontinence
Frailty phenotype- must have at least 3 of these 5:
Unintentional wt. loss =/> 10lb. Sense of exhaustion Poor grip strength Slow walking speed Poor physical activity
Inability to delay voiding after bladder fullness perceived; need to "go now"
Urge Incontinence
Unconscious Incontinence
Urge incontinence without warning
Meniere's Disease Triad
Vertigo, Tinnitus, Hearing Loss
Fixed pupil is associated with what?
angle-closure glaucoma
Red eyes are associated with what?
angle-closure glaucoma, conj, FB, subconjunctiva hemorrhage
#1 presenting symptom for urosepsis in elderly is ________
confusion
Which of the following can be used to treat chronic bacterial prostatitis? A. Penicillin B. Cephalexin (Keflex) C. Nitrofurantoin (Macrobid) D. Levofloxacin (Levaquin)
d
Frailty
dysregulation of multiple organ systems, with ↓ in physiologic reserves, & ↑ in vulnerability to stressors
Concept of Functional reserve
gradual sens. loss→ cardinal event→ intervention, or surg., or ↓activity
Overflow Incontinence Hallmark
increased post voiding residual volume (PVR)
Ocular change that increases with age
intraocular pressure
Retinal exudates are associated with what
macular degeneration, diabetic retinopathy
Caffeine effects on bladder
↑'s detrusor contractions (causes ↑'d intracellular Calcium, is irritant*)
