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88 Cards in this Set
- Front
- Back
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mcc cause of vision loss in > 65 years old
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age-related macular degeneration (ARMD)
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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) |
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define: exudative ARMD
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less common, more severe vision loss
secondary to leakage of serous fluid into retina -> neovascularization |
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define: nonexudative ARMD
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atrophy/degeneration of central retina
(w/ yellow-white deposits called drusen) |
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characteristics of glaucoma (3)
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1) incr. IOP secondary to impaired outflow of aqueous humor
2) damage to the optic nerve 3) irreversible vision loss |
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define: open-angle glaucoma
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decreased aq. humor outflow
- 90% of all cases - visual field loss (central sparing) - silent progression - painless |
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define: closed-angle glaucoma
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acute outflow obstruction
- precipitated by dilation (movie theater) - blurred vision ("halos") - red painful eye - N/V/HA - pupil dilated and NR |
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how do you determine the cause of glaucoma?
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gonioscopy is used to visualize the anterior chamber (and determine cause)
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how do you measure IOP in glaucoma pts?
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tonometry, to be performed regularly in pts with (or at risk for) glaucoma
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what is the txt of open-angle glaucoma? (4)
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(1) of or combo:
- beta-blocker - alpha-agonist - carbonic anhydrase inhibitor - prostaglandin analog |
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what is the txt of closed-angle glaucoma? (3:1)
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medical txt:
- pilocarpine drops - IV acetazolamide - oral glycerin surgical txt (definitive): - iridectomy |
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define: cataracts
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opacification of the lens -> loss of visual acuity + glare when driving at night
- (half of of >75 yo population) |
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what is the txt for cataracts?
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surgery - implantation of an artificial lens (definitive)
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what is "second sight"?
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pts with cataracts become increasingly near-sighted, no longer requiring reading glasses
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mcc of red eye?
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conjunctivitis
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define: subconjunctival hemorrhage
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rupture of small conjunctival vessels
- usually secondary to Valsalva - focal unilateral blotchy redness |
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define: keratoconjunctivitis sicca
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"dry eye"
- foreign body sensation - txt artificial tears (day)/lubricant (night) - txt occlude tear puncta |
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define: blepharitis
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inflammation of the eyelid
- assd w/ staphylococcus spp. - eyelid edge crusting/inflamm - txt warm compress (topical antibx for severe cases) |
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define: episcleritis
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inflamm of vessels lining the episclera
- autoimmune process - red, irritate, ache - blotchy sclera - NSAIDS |
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define episclera
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vascular plexus between the conjunctiva and the sclera
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define: scleritis
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inflamm of the sclera assd with systemic immunologic dz
- severe eye pain - refer to optho for corticosteroids |
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acute anterior uveitis (iritis)
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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 |
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define: herpes simplex keratitis
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- HSV-1
- occular irritation + photophobia dendrite on cornea of fluorescein staining - topical antiviral drops + optho referal |
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mcc of conjunctivitis?
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viral (adenovirus)
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mcc of bacterial conjunctivitis?
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s. pneumoniae (also gram-negatives)
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what are the (2) types of chlamydial conjunctivitis?
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1) Trachoma (serotype A/B/C)
- mcc of blindness worldwide 2) Inclusion conjunctivitis (D-K) - genital-hand-eye transmission - does not cause blindness |
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what is the txt for acute bacterial conjunctivitis?
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broad-spectrum topical antibx:
- erythromycin - ciprofloxacin - sulfacetamide |
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what is the txt for hyperacute bacterial conjunctivitis (gonococcal)?
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ceftriaxone 1g IM
- (one time dose) |
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what is the txt for chlamydial conjunctivitis?
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2 weeks of either:
- tetracycline - doxycycline - erythromycin |
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obstructive sleep apnea can cause what hematologic disorder?
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polycythemia
(incr RBCs secondary to hypoxia) |
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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) |
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define: narcolepsy
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involuntary REM sleep at random times
- inherited (variable penetrance) |
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narcolepsy txt?
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methylphenidate (ritalin)
+ naps |
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define: exostoses
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bony outgrowths of ext. auditory canal secondary to repeated exposure to cold water
(causes conductive hearing loss) |
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define: otosclerosis
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bony fusion of the stapes to the oval window.
- autosomal dominant - corrected with surgery (causes conductive hearing loss) |
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mcc of sensorineural hearing loss
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prebycusis - degeneration of sensory/nerve fibers leading to loss at high frequencies, assd with aging
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define: noise-induced hearing loss
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prolonged exposure to > 85 dB leading to damage of the hair cells in the organ of Corti
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what medications cause hearing loss? (5)
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- aminoglycosides (antibx)
- furosemide (diuretic) - ethacrynic acid (diuretic) - cisplatin (chemo) - quinidine (antiarrhytmic) |
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define: Meniere's dz
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caused by an increase in volume and pressure of the endolymph of the inner ear
- unilateral (sensorineural) hearing loss - vertigo - txt: salt restriction + meclizine |
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what are some of the clinical differences between conductive and sensorineural hearing loss?
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conductive loss:
- decreased LOW-frequency perception - can hear loud noises well sensorineural loss: - decreased HIGH-frequency perception - difficulty hearing loud noises - tinnitus often present |
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Rinne and Weber tests in conductive hearing loss?
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Rinne: bone conduction > air conduction (abnormal)
Weber: sound lateralizes to affected side |
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Rinne and Weber tests in sensorineural hearing loss?
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Rinne: air conduction > bone conduction (normal)
Weber: sound lateralizes to UNaffected side |
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how do beta-blockers affect urinary incontinence?
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diminish sphincter tone, worsening it
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how do CCB's affect urinary incontinence?
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decrease detrusor contraction
(narcotics also do this) |
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define: urge incontinence
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detrussor instability (involuntary contraction) characterized by a sudden urge.
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what is the treatment for urge incontinence? (3)
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- anticholinergics (oxybutynin)
- TCAs (imipramine) - bladder retraining |
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define: stress incontinence
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(usually in women)
weakening of the pelvic floor -> decr bladder support -> descent of prox urethra - involuntary urine loss when intra-abdominal pressure incr |
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what is the treatement for stress incontinence? (3)
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- Kegels
- estrogen replacement - surgery (urethropexy) |
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define: overflow incontinence
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inadequate bladder contraction -> retention -> overdistention -> leakage
features: - nocturnal wetting - large postvoid residual (>100 mL) |
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what is the treatement for overflow incontinence? (3)
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- self-catheterization
- cholinergic agents (bethanechol) - alpha-blockers (terazosin, doxazosin to decr sphincter resistance) |
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define: reflex incontinence
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pt cannot sense the need to urinate
(usually secondary to sc injury) |
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Postvoid urine volume greater than ___ mL may indicated obstruction or hypotonic bladder.
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50 mL
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MOA of sildenafil citrate
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(viagra) is a phosphodiesterase inhibitor which promotes smooth muscle relaxation in the vasculature.
(contraindicated with nitrates -> hypotension) |
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what are the CAGE questions?
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screening for alcoholism (1 or more suggests)
1) Cut down (ever felt the need?) 2) Annoyed 3) Guilty 4) Eye-opener (morning drink) |
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what is the MAST questionare?
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the Michigan Alcholism Screening Test (25 questions that helps id alcoholism
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what is Wernicke's encephalopathy?
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thiamine deficiency
- nystagmus/(opthalmoplegia) - ataxia - confusion (reversible) |
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what is Korsakoff's psychosis?
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thiamine deficiency
- amnestic disorder - affects short term memory - confabulation is common (irreversible) |
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what are common nutritional deficiencies in alcoholics? (3)
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- thiamine
- magnesium - folate |
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why does alcoholism cause peripheral neuropathy?
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thiamine deficiency
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best treatment for alcoholism? (3)
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1) alcoholics anonymous (AA)
2) disulfram (antabuse) - sympathetic rxn to EtOH) 3) naltrexone (trexan) - reduces cravings |
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what is the prefered treatment for alcohol withdrawal?
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benzodiazepines
- best to use long-acting, ie diazepam (valium) |
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what does the USPSTF stand for?
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United States Preventative Services Task Force
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what is the USPSTF recommendation for HTN screening?
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- adults >18 years old
- every 2 years |
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what is the USPSTF recommendation for hyperlipidemia screening?
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- adults >20 years old
- non-fasting total cholesterol + HDL - every 5 years (less w/ risk factors) |
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what is the USPSTF recommendation for colorectal cancer screening for average-risk pts?
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average risk - pts >50 w/ no GI sxs
either: - FOBT annually + flex sigmoidoscopy Q5 yrs - FOBT annually + colonoscopy Q10 yrs - |
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what is the USPSTF recommendation for colorectal cancer screening for moderate-risk pts?
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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) |
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what is the USPSTF recommendation for colorectal cancer screening for high-risk pts?
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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 |
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what is the USPSTF recommendation for prostate cancer screening?
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not sufficient evidence that benefits outweight harms/cost
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what is the USPSTF recommendation for breast cancer screening?
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- self exam Qmonthly >20 yo
- physician exam Q3years til 40, Qyearly - mammogram annually >40 (if famhx, start 10 years younger than youngest case) |
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what is the USPSTF recommendation for cervical cancer screening?
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- 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 |
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what is the USPSTF recommendation for STD screening?
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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 |
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what is the USPSTF recommendation for depression screening?
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all adults
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who gets the influenza vaccine and how often?
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- 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) |
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who gets the pneumococcal polysaccharide vaccine and how often?
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- adults >65
- pts with sickle cell (or asplenia) - one-time dose - (5 year booster for high risk pts) |
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who gets the tetanus/diphtheria (Td) vaccine and how often?
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- 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 |
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who gets the hepatitis B vaccine and how often?
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- primary series to all infants
- 3 doses (0, 1, 6mo) |
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who gets the hepatitis A vaccine and how often?
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- travelers
- pts with chronic liver dz - 2 doses (6mo apart) |
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who gets the MMR (measles-mumps-rubella live) vaccine and how often?
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- 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) |
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who gets the varicella (live) vaccine and how often?
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- primary series in children
- those who've never had it - 2 doses - (2nd dose within 4-8 wks) |
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who gets the shingles vaccine and how often?
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- adults >60
- once |
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who gets the polio (inactivated) vaccine and how often?
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- primary series in children
- adults who travel |
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who gets the meningococcus (A, C, W-125, Y) vaccine and how often?
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- asplenic
- travelers - college/military - single dose |
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who gets the HPV vaccine?
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recommended for females age 9-26
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drug of choice for cluster headaches?
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sumatriptan (imitrex) is the drug of choice
(O2 is beneficial as well, combo of both is ideal) |
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what is the medication used for prophylactic treatment of cluster headaches?
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verapamil (CCB), Qdaily
(cluster HAs are the MOST responsive to prophylactic txt) |
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migrane HA's have been linked to ____________ as a likely cause regarding pathogenesis
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serotonin depletion
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what are common migrane treatments?
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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 |
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what are prophylactic medications used for migrane prevetion?
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1) first line agents:
- TCA's (amitriptyline) - B-blockers (propranolol) 2) second-line agents - CCBs (verapamil) - anticonvulsants (valproic acid/methysergide) |
