990
U N I T 1 0
Nervous System
6.
A granddaughter is worried that her grandfather
is “losing his hearing.” Lately, he has been staying
away from social gatherings that he always
enjoyed, saying everybody mumbles. He is defiant
in maintaining that there is nothing wrong with his
hearing. However, he does complain that his ears
have been ringing a lot lately.
A.
What are common manifestations of hearing
loss in the elderly?
B.
What type of evaluation would be appropriate
for determining if this man has a hearing loss,
and the extent of his hearing loss?
C.
What are some things the granddaughter might
do so that her grandfather could hear her better
when she is talking to him?
7.
A 70-year-old man complains that he gets this
terrible feeling “like the room is moving around”
and becomes nauseated when he rolls over in
bed or bends over suddenly. It usually goes away
once he has been up for a while. He has been
told that his symptoms are consistent with benign
paroxysmal positional vertigo.
A.
What is the pathophysiology associated with
this man’s vertigo?
B.
Why do the symptoms subside once he has been
up for a while?
C.
What methods are available for treatment of the
disorder?
R E F E R E N C E S
1. Lighthouse International. About us [Online]. Available: http://
prevalence-of-vision-impairment/. Accessed August 7, 2013.
2. Ross MH, Pawlina W.
Histology: A Text and Atlas
. 5th ed.
Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams &
Wilkins; 2011:896–919.
3. Nijm LM, Garcio FJ, Schwab IR. Conjunctiva and tears. In:
Riordan-Eva P, Cunningham ET Jr., eds.,
Vaughan & Asbury’s
General Ophthalmology
. 18th ed. New York: Lange Medical
Books/McGraw-Hill; 2011:98–125.
4. Pasternak A, Irish B. Ophthalmologic infections in primary care.
Clin Fam Pract.
2004;6(1):19–33.
5. Cronau H, Kankanala RR, Mauger T. Diagnosis and management
of red eye in primary care.
Am Fam Physician.
2010;81(2):137–144.
6. Rubin E, Strayer DS, eds.
Rubin’s Pathology: Clinicopathologic
Foundations of Medicine
. 6th ed. Philadelphia, PA: Wolters
Kluwer Health/Lippincott Williams & Wilkins; 2012:180–182,
1393–1414.
7. Ono SJ, Abelson MB. Allergic conjunctivitis: Update on
pathophysiology and prospects for future treatment.
J Allergy
Clin Immunol.
2006;115(1):118–122.
8. Biswell R. Cornea. In: Riordan-Eva P, Cunningham ET, eds.,
Vaughan & Ashbury’s General Ophthalmology
. 18th ed.
New York: Lange Medical Books/McGraw-Hill; 2011:120–144.
9. DelMonte DW, Kim T. Anatomy and physiology of the cornea.
J Cataract Refract Surg.
2011;37:588–598.
10. Dargin JM, Lowenstein RA. The painful eye.
Emerg Med Clin
North Am.
2008;26:199–216.
11. Pepose JS, Keadle TL, Morrison LA. Ocular herpes simplex:
changing epidemiology, emerging disease patterns, and
potential of vaccine prevention and therapy.
Am J Ophthalmol.
2006;141:547–557.
12. Shaikh S, Ta C. Evaluation and management of herpes zoster
ophthalmicus.
Am Fam Physician.
2002;66:1723–1732.
13. Dart JKG, Saw VPL, Kilvington S. Acanthamoeba keratitis:
diagnosis and treatment update 2009.
Am J Ophthalmol.
2009;148(4):487–499.
14. Stapleton F, Carnt N. Contact lens-related microbial keratitis:
how have epidemiology and genetics helped us with pathogenesis
and prophylaxis.
Eye (Lond).
2012;26:185–193.
15. Harper RA, Shock JP. Lens. In: Riordan-Eva P, Cunningham ET,
eds.
Vaughan & Asbury’s General Ophthalmology
. 18th ed.
New York: McGraw-Hill Medical; 2011:174–182.
16. Hall JE.
Guyton & Hall Textbook of Medical Physiology
.
12th ed. Philadelphia
,
PA: Elsevier Saunders; 2011:557–631,
633–644.
17. Packer M, Fine H, Hoffman RS. Refractive lens surgery.
Ophthalmol Clin North Am.
2006;19:77–88.
18. Abraham AG, Condon NG, Gower EW. The new epidemiology
of cataract.
Ophthalmol Clin North Am.
2006;19:415–425.
19. James ER. The etiology of steroid cataracts.
J Ocul Pharmacol
Ther.
2007;23(5):403–420.
20. Asbell PA, Dualan I, Mindel J, et al. Age-related cataract.
Lancet.
2005;365:599–609.
21. Chan WH, Susmito B-J A, Lloyd LC. Congenital and infantile
cataract: aetiology and management.
Eur J Pediatr.
2012;
171:625–630.
22. Kandel ER, Schwartz JH, Jessell TM, et al.
Principles of Neural
Science
. 5th ed. New York: McGraw-Hill; 2013:577–601,
639–653, 654–711, 917–935.
23. Fletcher EC, Chong GV, Augsburger JJ, et al. Retina. In:
Riordan-Eva P, Cunningham ET, eds.
Vaughan & Asbury’s
General Ophthalmology
. 18th ed. New York: McGraw-Hill
Medical; 2011:271–313.
24. Riordan-Eva P, Hoyt WF. Neuro-ophthalmology. In: Riordan-
Eva P, Cunningham ET, eds.
Vaughan & Asbury’s General
Ophthalmology
. 18th ed. New York: McGraw-Hill Medical;
2011:190–221.
25. In: Kumar V, Abbas AK, Fausto N, eds.
Robbins and Cotran
Pathologic Basis of Disease
, 8th ed. Philadelphia, PA: Elsevier
Saunders; 2010:1345–1368.
26. Antonetti DA, Klein R, Gardner TW. Diabetic retinopathy.
N Engl J Med.
2012;366(13):1227–1239.
27. Cheung N, Mitchel P, Wong TW. Diabetic retinopathy.
Lancet.
2010;276:124–136.
28. Simó R, Hernández C. Advances in medical treatment of diabetic
retinopathy.
Diabetes Care.
2009;32(8):1556–1562.
29. Wong TY, Mitchell P. Hypertensive retinopathy.
N Engl J Med.
2004;351(22):2310–2317.
30. D’Amico DJ. Primary retinal detachment.
N Engl J Med.
2008;359(22):2346–2354.
31. Michenbaum JW. Geriatric vision loss due to cataracts, macular
degeneration, and glaucoma.
Mt Sinai J Med.
2012;79:276–294.
32. Lim L, Mitchell P, Sheldon JM, et al. Age-related macular
degeneration.
Lancet.
2012;379:1728–1738.
33. Kaufman SR. Developments in age-related macular degeneration:
diagnosis and treatment.
Geriatrics.
2009;64(2):16–19.
34. Salmon JF. Glaucoma. In: Riordan-Eva P, Cunningham ET Jr,
eds.
Vaughan & Asbury’s General Ophthalmology
. 18th ed.
New York: McGraw-Hill Medical; 2011:222–237.
35. Quigley HA. Glaucoma.
Lancet.
2012;377:1367–1377.
36. Kwon YH, Fingert JH, Kuehn MH, et al. Primary open-angle
glaucoma.
N Engl J Med.
2009;360(11):1113–1124.
37. Singh A. Medical therapy of glaucoma.
Ophthalmol Clin North
Am.
2005;18:397–408.
