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88 Cards in this Set

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mcc cause of vision loss in > 65 years old
age-related macular degeneration (ARMD)
define: age-related macular degeneration (ARMD)

what are the 2 types?
- loss of central vision
(peripheral vision spared and complete loss is rare)

- exudative/nonexudative ARMD

(txt does not exist)
define: exudative ARMD
less common, more severe vision loss

secondary to leakage of serous fluid into retina -> neovascularization
define: nonexudative ARMD
atrophy/degeneration of central retina
(w/ yellow-white deposits called drusen)
characteristics of glaucoma (3)
1) incr. IOP secondary to impaired outflow of aqueous humor

2) damage to the optic nerve

3) irreversible vision loss
define: open-angle glaucoma
decreased aq. humor outflow
- 90% of all cases
- visual field loss (central sparing)
- silent progression
- painless
define: closed-angle glaucoma
acute outflow obstruction
- precipitated by dilation (movie theater)
- blurred vision ("halos")
- red painful eye
- N/V/HA
- pupil dilated and NR
how do you determine the cause of glaucoma?
gonioscopy is used to visualize the anterior chamber (and determine cause)
how do you measure IOP in glaucoma pts?
tonometry, to be performed regularly in pts with (or at risk for) glaucoma
what is the txt of open-angle glaucoma? (4)
(1) of or combo:
- beta-blocker
- alpha-agonist
- carbonic anhydrase inhibitor
- prostaglandin analog
what is the txt of closed-angle glaucoma? (3:1)
medical txt:
- pilocarpine drops
- IV acetazolamide
- oral glycerin

surgical txt (definitive):
- iridectomy
define: cataracts
opacification of the lens -> loss of visual acuity + glare when driving at night

- (half of of >75 yo population)
what is the txt for cataracts?
surgery - implantation of an artificial lens (definitive)
what is "second sight"?
pts with cataracts become increasingly near-sighted, no longer requiring reading glasses
mcc of red eye?
conjunctivitis
define: subconjunctival hemorrhage
rupture of small conjunctival vessels
- usually secondary to Valsalva
- focal unilateral blotchy redness
define: keratoconjunctivitis sicca
"dry eye"
- foreign body sensation
- txt artificial tears (day)/lubricant (night)
- txt occlude tear puncta
define: blepharitis
inflammation of the eyelid
- assd w/ staphylococcus spp.
- eyelid edge crusting/inflamm
- txt warm compress (topical antibx for severe cases)
define: episcleritis
inflamm of vessels lining the episclera
- autoimmune process
- red, irritate, ache
- blotchy sclera
- NSAIDS
define episclera
vascular plexus between the conjunctiva and the sclera
define: scleritis
inflamm of the sclera assd with systemic immunologic dz
- severe eye pain
- refer to optho for corticosteroids
acute anterior uveitis (iritis)
inflamm of the iris and ciliary body
- mc in young to middle aged
- assd w/ connective tissue dz
- circumcorneal injection, blurred vision, pain, constricted pupil
define: herpes simplex keratitis
- HSV-1
- occular irritation + photophobia
dendrite on cornea of fluorescein staining
- topical antiviral drops + optho referal
mcc of conjunctivitis?
viral (adenovirus)
mcc of bacterial conjunctivitis?
s. pneumoniae (also gram-negatives)
what are the (2) types of chlamydial conjunctivitis?
1) Trachoma (serotype A/B/C)
- mcc of blindness worldwide

2) Inclusion conjunctivitis (D-K)
- genital-hand-eye transmission
- does not cause blindness
what is the txt for acute bacterial conjunctivitis?
broad-spectrum topical antibx:
- erythromycin
- ciprofloxacin
- sulfacetamide
what is the txt for hyperacute bacterial conjunctivitis (gonococcal)?
ceftriaxone 1g IM
- (one time dose)
what is the txt for chlamydial conjunctivitis?
2 weeks of either:
- tetracycline
- doxycycline
- erythromycin
obstructive sleep apnea can cause what hematologic disorder?
polycythemia
(incr RBCs secondary to hypoxia)
what is the difference between mild/moderate vs severe sleep apnea?

txt?
mild/moderate < 20 apneic episodes
severe > 20

txt options
mild/moderate:lifestyle changes
severe:
- CPAP
- uvulopalatopharyngoplasty
- tracheostomy (for life-threatening cases)
define: narcolepsy
involuntary REM sleep at random times
- inherited (variable penetrance)
narcolepsy txt?
methylphenidate (ritalin)
+
naps
define: exostoses
bony outgrowths of ext. auditory canal secondary to repeated exposure to cold water

(causes conductive hearing loss)
define: otosclerosis
bony fusion of the stapes to the oval window.
- autosomal dominant
- corrected with surgery

(causes conductive hearing loss)
mcc of sensorineural hearing loss
prebycusis - degeneration of sensory/nerve fibers leading to loss at high frequencies, assd with aging
define: noise-induced hearing loss
prolonged exposure to > 85 dB leading to damage of the hair cells in the organ of Corti
what medications cause hearing loss? (5)
- aminoglycosides (antibx)
- furosemide (diuretic)
- ethacrynic acid (diuretic)
- cisplatin (chemo)
- quinidine (antiarrhytmic)
define: Meniere's dz
caused by an increase in volume and pressure of the endolymph of the inner ear
- unilateral (sensorineural) hearing loss
- vertigo
- txt: salt restriction + meclizine
what are some of the clinical differences between conductive and sensorineural hearing loss?
conductive loss:
- decreased LOW-frequency perception
- can hear loud noises well

sensorineural loss:
- decreased HIGH-frequency perception
- difficulty hearing loud noises
- tinnitus often present
Rinne and Weber tests in conductive hearing loss?
Rinne: bone conduction > air conduction (abnormal)

Weber: sound lateralizes to affected side
Rinne and Weber tests in sensorineural hearing loss?
Rinne: air conduction > bone conduction (normal)

Weber: sound lateralizes to UNaffected side
how do beta-blockers affect urinary incontinence?
diminish sphincter tone, worsening it
how do CCB's affect urinary incontinence?
decrease detrusor contraction

(narcotics also do this)
define: urge incontinence
detrussor instability (involuntary contraction) characterized by a sudden urge.
what is the treatment for urge incontinence? (3)
- anticholinergics (oxybutynin)
- TCAs (imipramine)
- bladder retraining
define: stress incontinence
(usually in women)
weakening of the pelvic floor -> decr bladder support -> descent of prox urethra
- involuntary urine loss when intra-abdominal pressure incr
what is the treatement for stress incontinence? (3)
- Kegels
- estrogen replacement
- surgery (urethropexy)
define: overflow incontinence
inadequate bladder contraction -> retention -> overdistention -> leakage

features:
- nocturnal wetting
- large postvoid residual (>100 mL)
what is the treatement for overflow incontinence? (3)
- self-catheterization
- cholinergic agents (bethanechol)
- alpha-blockers (terazosin, doxazosin to decr sphincter resistance)
define: reflex incontinence
pt cannot sense the need to urinate
(usually secondary to sc injury)
Postvoid urine volume greater than ___ mL may indicated obstruction or hypotonic bladder.
50 mL
MOA of sildenafil citrate
(viagra) is a phosphodiesterase inhibitor which promotes smooth muscle relaxation in the vasculature.
(contraindicated with nitrates -> hypotension)
what are the CAGE questions?
screening for alcoholism (1 or more suggests)
1) Cut down (ever felt the need?)
2) Annoyed
3) Guilty
4) Eye-opener (morning drink)
what is the MAST questionare?
the Michigan Alcholism Screening Test (25 questions that helps id alcoholism
what is Wernicke's encephalopathy?
thiamine deficiency
- nystagmus/(opthalmoplegia)
- ataxia
- confusion

(reversible)
what is Korsakoff's psychosis?
thiamine deficiency
- amnestic disorder
- affects short term memory
- confabulation is common

(irreversible)
what are common nutritional deficiencies in alcoholics? (3)
- thiamine
- magnesium
- folate
why does alcoholism cause peripheral neuropathy?
thiamine deficiency
best treatment for alcoholism? (3)
1) alcoholics anonymous (AA)
2) disulfram (antabuse) - sympathetic rxn to EtOH)
3) naltrexone (trexan) - reduces cravings
what is the prefered treatment for alcohol withdrawal?
benzodiazepines
- best to use long-acting, ie diazepam (valium)
what does the USPSTF stand for?
United States Preventative Services Task Force
what is the USPSTF recommendation for HTN screening?
- adults >18 years old
- every 2 years
what is the USPSTF recommendation for hyperlipidemia screening?
- adults >20 years old
- non-fasting total cholesterol + HDL
- every 5 years (less w/ risk factors)
what is the USPSTF recommendation for colorectal cancer screening for average-risk pts?
average risk - pts >50 w/ no GI sxs

either:
- FOBT annually + flex sigmoidoscopy Q5 yrs
- FOBT annually + colonoscopy Q10 yrs
-
what is the USPSTF recommendation for colorectal cancer screening for moderate-risk pts?
pts with polyps or PMH of CRC - colonoscopy; repeat at 3 years - if nl colonoscopy every 5 yrs

pts with famhx of CRC or adenomatous polyps in 1st degree relatives
either:
- colonoscopy at age 40
- colonoscopy 10 yrs younger than youngest case in family
(repeat in 3-5 yrs if normal)
what is the USPSTF recommendation for colorectal cancer screening for high-risk pts?
pts with famhx of FAP: genetic testing at age 10
- if positive, consider colectomy
- if negative, annual colonoscopy beginning at puberty

pts with famhx of HNPCC: genetic testing at 21
- if positive, colonoscopy every 2 years til 40, then annually
what is the USPSTF recommendation for prostate cancer screening?
not sufficient evidence that benefits outweight harms/cost
what is the USPSTF recommendation for breast cancer screening?
- self exam Qmonthly >20 yo
- physician exam Q3years til 40, Qyearly
- mammogram annually >40
(if famhx, start 10 years younger than youngest case)
what is the USPSTF recommendation for cervical cancer screening?
- PAP within 3 years of first sexual activity or age 21
- 2 consecutive (-) smears, repeat every 3 years til 35, then every 5 years til 65
what is the USPSTF recommendation for STD screening?
at risk women* should be screened for chlamydia and gonorrhea
(all sexually active women <25 for chlamydia

- at risk men and women for HIV on a periodic basis
what is the USPSTF recommendation for depression screening?
all adults
who gets the influenza vaccine and how often?
- adults >50 or younger w/ chronic medical problems
- pregnant women (2nd-3rd trimester during flu season)

- annually
- give October to November (or anytime during flu season Oct-May)
who gets the pneumococcal polysaccharide vaccine and how often?
- adults >65
- pts with sickle cell (or asplenia)

- one-time dose
- (5 year booster for high risk pts)
who gets the tetanus/diphtheria (Td) vaccine and how often?
- primary series for everyone
- when indicated for wounds
- travel to places with diphtheria

- primary series is 3 doses (1, 1-2, 6-12mo)
- booster q10 years
who gets the hepatitis B vaccine and how often?
- primary series to all infants

- 3 doses (0, 1, 6mo)
who gets the hepatitis A vaccine and how often?
- travelers
- pts with chronic liver dz

- 2 doses (6mo apart)
who gets the MMR (measles-mumps-rubella live) vaccine and how often?
- primary series (those born after 1957)
- childbearing age women without proof of rubella immunity

- given as 1 or 2 doses
- (2nd must be >4 wks after 1st)
who gets the varicella (live) vaccine and how often?
- primary series in children
- those who've never had it

- 2 doses
- (2nd dose within 4-8 wks)
who gets the shingles vaccine and how often?
- adults >60

- once
who gets the polio (inactivated) vaccine and how often?
- primary series in children
- adults who travel
who gets the meningococcus (A, C, W-125, Y) vaccine and how often?
- asplenic
- travelers
- college/military

- single dose
who gets the HPV vaccine?
recommended for females age 9-26
drug of choice for cluster headaches?
sumatriptan (imitrex) is the drug of choice
(O2 is beneficial as well, combo of both is ideal)
what is the medication used for prophylactic treatment of cluster headaches?
verapamil (CCB), Qdaily
(cluster HAs are the MOST responsive to prophylactic txt)
migrane HA's have been linked to ____________ as a likely cause regarding pathogenesis
serotonin depletion
what are common migrane treatments?
1) NSAIDS/acetominophen for mild migranes
2) DHE - a serotonin-r agonist
- SC, IM, IV
3) sumatriptan - a more selective serotonin-r agonist
- rapid (within 1 hr)
- don't use more than 2/week
what are prophylactic medications used for migrane prevetion?
1) first line agents:
- TCA's (amitriptyline)
- B-blockers (propranolol)

2) second-line agents
- CCBs (verapamil)
- anticonvulsants (valproic acid/methysergide)