S/S of Corneal Ulcers
Eye redness, pain, decreased vision, corneal infiltrate
S/S of Uveitis
Photophobia, eye redness, decreased vision
S/S of Herpes Zoster Ophthalmicus and tx
Eye redness/pain/burning/rash/Dec vision/light sensitivity/skin lesion
Tear drops
Refer to ophtho immediately if there are lesions on tip of nose. (Hutchinson sign indicates intracranial mass)
Chalazion treatment
Cyst of eyelid
Blocked gland
-warm compresses, may refer for excision if persistent (goes away comes back)
What is myopia?
nearsightedness, have trouble seeing objects at a distance
when to screen for hearing
The American Speech-Language-Hearing Association recommends that adults be screened by an audiologist once per decade and every 3 years after age 50 years or more frequently in those with known exposures or risk factors associated with hearing loss.
When to refer to otolaryngologist?
-consult for asymmetrical hearing loss (may indicate tumor of posterior pharynx blocking Eustachian tube or auditory nerve tumor)
-cerumen impaction not responsive to cerumenolytics, irrigation, or manual extraction, or in pt w/ a hx of TM surgery or perforation
-Otorrhea: acute hearing loss or hearing loss with vertigo
when to refer to audiologist?
determining presence and type of hearing loss, recommend and fit hearing aids, and provide auditory rehab
-assessment: evaluation of pure-tone thresholds for both air and bone conduction, speech-recognition thresholds, speech discrimination, and middle-ear function
No lateralization on Webber test?
If a patient has unilateral conductive hearing loss, the tuning fork sound would be heard loudest in the affected ear. Where hearing loss is bilateral and symmetrical of either type, Weber’s test would be normal.
presbycusis hearing loss
Notmal age related change
Sensorineural hearing loss; usually symmetrical may have central components
When cochlear mediated— patho (sensory/neural/strial/cochlear conductive/combined or indeterminate)
Amplification often helps
Factors caused by hearing loss in the elderly
External ear canal/middle/inner ear/auditory
Nerve/central auditory pathways or combo
Tinnitus can be an early sign of hearing loss
age related changes in the elderly that can interfere with hearing
walls thin in external ear canal
-cerumen becomes drier/stubborn and inc risk for impaction
-eardrum thickens and appears duller
-cochlea: hair cells and fibrocytes in organ of corti are lost, basilar membrane stiffens, auditory structure calcify, cochlear neurons lost
-stria vacularis: capillaries thicken, endolymph production decreases, Na/K ATPase activity Dec
sensorineural hearing loss causes
most often from age, noise damage, or ototoxicity (meds)
-cochlear disease (most common and most often from noise damage)
Genetics/vascular dz/autoimmune dz/auditory nerve tumors/occupation/env chemical exposure
Infection/presbycusis/meniere/myxedema
treatment of hearing loss
hearing aids, cochlear implants
REM sleep
Rapid eye movement sleep, a recurring
vigorous sleep behaviors assoc w/vivid dreams. Can cause injury to patient or bed partner. Aka paradoxical sleep, because the muscles are relaxed (except for minor twitches) but other body systems are active.
Excessive motor activities during sleep, lack of normal muscle atonia (brain shuts off stimulation to large muscles).
Polysomnography needed to establish dx
Insomnia (DSM5)
difficulty initiating or maintaining sleep
-waking up too early
-associated with day time impairment (fatigue, poor concentration, daytime sleepiness, concerns about sleep)
-symptoms must occur at least 3x per week
-Chronic insomnia = sx for atleast 3 months
Sleep medication use in relation to gender
Women (10.2%) were more likely than men (6.6%) to take medication for sleep, and the use of medication increased with increasing age.
epidemiology of sleeping difficulty
in older people insomnia generally occurs comorbidly with other psychiatric, medical, or neurologic illness
Changes in sleep with aging
decreased sleep efficacy (time spent asleep divide by total time in bed)
stable or decreased total sleep time
increased sleep latency (time to fall asleep)
earlier bedtime and earlier morning awakening
more awakenings and wakefulness at night, more daytime napping
Decreases in deeper stages of sleep (rem sleep gets less)
Circadian rhythm
Disturbances in the sleep wake cycle more common with advanced age
the physical, mental and behavior changes incurred in our daily cycle and is influenced by light (primary motivator)
3 phases: advanced sleep, delayed, irregular
To dx: sleep logs/wrist actigraphy
Referred to sleep specialist when sx don’t respond to initial mgmt, dx unclear, another sleep disorder suspected
non-pharmacologic treatments for chronic insomnia
stimulus control (& chronic insomnia) (no eating/tv in bed/get off bed when unable to sleep/return when sleepy/up at same time every morning/no daytime nap)
-sleep restriction
-cognitive interventions (educate to change false beliefs/attitude)
-relaxation techniques (teach tense/relax each muscle group. give feedback, meditate/imagery to relieve racing thought/anxiety)
-bright light (sun or light box exposure)
-CBT for insomnia longer foreplay
Vaginal atrophy treatment
moisturizers,
water soluble lube
oral SERM ospemifene: long-term safety data, lacking)
estrogen suppositories
Regular intercourse , longer foreplay
Low-dose topical estrogen (cream-can be difficult to administer) estradiol ring/tablet better tolerated because easy to use and comfy
Advanced sleep phase
Delayed sleep
Fall asleep early Wake up early, common in older people. Tx: evening exposure to bright light
D: fall asleep late, awaken late
Tx: morning exposure to bright light or evening melatonin
Irregular sleep week cycles
More common with dementia and nursing home residents
