1. What would your next step be for a patient you suspect has a diagnosis of acute angle glaucoma?
For a patient that a practitioner suspects having an acute angle glaucoma, an immediate referral for a complete ophthalmic examination to an ophthalmologist should be performed. Permanent visual loss...
1. What would your next step be for a patient you suspect has a diagnosis of
acute angle glaucoma?
For a patient that a practitioner suspects having an acute angle glaucoma,
an immediate referral for a complete ophthalmic examination to an
ophthalmologist should be performed. Permanent visual loss occurs within 2
to 5 days if the condition is not treated. Treatment includes peripheral
iridectomy or laser iridotomy. The use an osmotic diuretic IV or orally and
miotic eye drops may be used to
lower intraocular pressure preoperatively. The practitioner must communicate
to the specialist medical conditions that need monitoring using the said
agents.
2. What education would you give your older patients about the preventable
causes of hearing loss?
Education on older patients regarding preventable causes of hearing loss would include the use of protective devices
to guard against occupational or recreational hearing loss, equalize ear pressure when diving, chew gums or use
decongestants in airplanes, avoid flying or diving if the patient has upper respiratory infection, and to
avoid ototoxic medications. It is also important to educate the patient on the proper technique for cerumen removal,
avoiding Q-tip type ear swabs and other foreign bodies in the ear. Any sign if hearing difficulty in elder patients
would require hearing screening tests.
3. How often should an older adult be screened for hearing loss?
Hearing screening tests for patients over 65 years old and persons who report hearing difficulty
are recommended. Periodic screening for hearing loss is not recommended in asymptomatic
adults as recently revised by USPSTF. The American Speech-Language-Hearing Association
recommends screening every 3 years for adults more than 50years old. For those patients
residing in long-term care facilities, screening for hearing loss is recommended on admission .
4. Martin is an 82-year-old with a history of smoking and alcohol use, which are
known risk factors in developing oral cancers. List another risk factor for oral
cancer for developing oral cancer.
Besides tobacco and alcohol use, other risk factors for developing oral cancer include ill-fitting
dentures; however, the duration of denture use, in general, is not. For Asians like myself,
several genetic polymorphisms, in addition to environmental carcinogens like betel quid
chewing have been associated with oral cancer development. Pipe smoking and sun exposure
are also implicated in lip cancer. Leukoplakia and erythroplasia are also precursors to oral
cancer.
5. What other diagnostic testing would you perform to evaluate for cataracts?
Diagnostic testing to evaluate cataracts includes visual acuity and examination of
the eye. After initial screening, a referral to an ophthalmologist for a complete
evaluation is recommended. Pupillary dilation and slit lamp exam would reveal
white, gray, or brownish opacities if a patient developed a cataract. Small cataracts
indicate dark areas on the red reflex in a dilated eye while for large cataracts, the
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