Lecture 7

Question 1

What are the 3 features of an atypical presentation?

Answer 1

• Vague presentation
• Altered
• Non-presentation of illness (underreporting)

Question 2

At what age do atypical presentations really start to appear?

Answer 2

> 85yo

Question 3

What are the atypical symptoms of ACS?

Answer 3

• Dyspnea
• Mild pain to no pain
• New-onset fatigue, dizziness, or confusion
• Predominant GI symptoms

Question 4

What is the MC symptom in ACS pts older than 80?

Answer 4

Dyspnea

Question 5

What is the gold standard lab test for diagnosing STEMI?

Answer 5

Troponins I and T.

Question 6

How does treatment for an older pt with ACS differ from a younger pt?

Answer 6

It does not.
Same treatment, but much closer monitoring.

Question 7

What is the MC causative organism for CAP and the tx?

Answer 7

• Strep pneumo
• Amoxicillin, Augmentin, cephalosporins

Question 8

What pneumonia variant should we wary about with elderly?

Answer 8

Aspiration pneumonia

Question 9

What is the CURB-65 criteria?

Answer 9

• Confusion (new onset)
• Urea (>= 19mg/dL or 7 mmol/L)
• Respiratory rate (>30)
• Blood Pressure (< 90 SBP or <= 60 DBP)
• Older than 65

2 puts you into moderate risk

Question 10

What is apathetic thyrotoxicosis?

Answer 10

Apathy and depression that is a result of hyperthyroidism

Often presents with cardiac disease

Question 11

How does apathetic thyrotoxicosis often present in geriatric patients?

Answer 11

• Apathy and depression are the cardinal symptoms.
• Fatigue and slowing down in chronic
• Cardiac disease often present
• Weakness of proximal muscles
• Thyroxine is usually NORMAL

Question 12

How does subclinical hypothyroidism present in geriatric patients?

Answer 12

• Confusion, agitation, reduced cognitive function
• Increased IOP
• Increased LDL

Question 13

What are the MCC of acute abdominal pain in older adults?

Answer 13

• Cholecystitis
• Bowel obstruction
• Diverticular disease
• Complications of cancer
• Medication side effects

Question 14

How does acute abdomen pain typically present in elderly patients?

Answer 14

• Diffuse/no pain
• Lack fever sometimes
• May lack leukocytosis
• Reduced rebound tenderness

Question 15

What is the MC fluid and lyte problem in elderly pts?

Answer 15

• Dehydration.
• Decreases in body water
• Alterations in thirst perceptions
• Reduced renal function

Question 16

How should we check for dehydration in an elderly patient on PE?

Answer 16

• Skin on sternum or back
• Oral mucosa (tongue), but careful of anticholinergics.
• Tachycardia (can be masked by a BB)

Question 17

How does infection sometimes present in elderly pts?

Answer 17

• Vague symptoms
• No fever
• No leukocytosis
• No localized signs

Question 18

What is a fever in an elderly patient?

Answer 18

Usually > 37.3C may be infection due to a lower basal body temperature.

Question 19

Where should we start our lung exam for elderly patients?

Answer 19

Bases of the lungs!!!