Atypical Presentation Flashcards
What is the major cause of death in adults aged 65 and older?
- A) Cancer
- B) Cardiovascular disease
- C) Infection
- D) Diabetes
- C) Infection
Infections exacerbate which of the following in older adults?
- A) Mobility
- B) Multimorbidities
- C) Cognitive function
- D) Sensory loss
- B) Multimorbidities
What is immune senescence?
- A) Increase in antibody production with age
- B) Decline in immune function with age
- C) Enhancement of immune response in the elderly
- D) Increase in T-cell function with age
- B) Decline in immune function with age
The decline in which immune cell function is a key feature of immune senescence?
- A) Neutrophils
- B) Platelets
- C) T-cells
- D) Red blood cells
- C) T-cells
Which of the following is a risk factor for atypical presentation of illness in older adults?
- A) Multimorbidities
- B) Cognitive impairment
- C) Polypharmacy
- D) All of the above
- D) All of the above
Why are older adults at higher risk for infections?
- A) Increased nutrition
- B) Immune senescence
- C) Higher skin elasticity
- D) Enhanced immune function
B) Immune senescence
. Fever in older adults is typically defined as an oral temperature:
- A) Over 99°F
- B) Over 100°F
- C) Over 101°F
- D) Over 98.6°F
- B) Over 100°F
. What percentage of older adults with serious infections may not present with a fever?
- A) 25%
- B) 50%
- C) 75%
- D) 90%
- B) 50%
The most common organism causing community-acquired pneumonia (CAP) in older adults is:
- A) Haemophilus influenzae
- B) Moraxella catarrhalis
- C) Streptococcus pneumoniae
- D) Klebsiella pneumoniae
- C) Streptococcus pneumoniae
. Which of the following is NOT a risk factor for pneumonia in older adults?
- A) Multimorbidity
- B) Age over 85
- C) Hypothermia
- D) High cholesterol
D) High cholesterol
Outpatient treatment guidelines for CAP in older adults typically recommend:
- A) Amoxicillin only
- B) Beta-lactam with a macrolide
- C) Penicillin alone
- D) Cephalosporin alone
- B) Beta-lactam with a macrolide
Which of the following is an atypical presentation of pneumonia in older adults?
- A) Fever over 101°F
- B) Abdominal pain
- C) Shortness of breath
- D) Productive cough
- B) Abdominal pain
. In older adults, the absence of which symptom is common in serious infections such as pneumonia?
- A) Fever
- B) Cough
- C) Shortness of breath
- D) Chest pain
- A) Fever
Which of the following might indicate a serious illness in an older adult?
- A) Increased confusion
- B) Worsening incontinence
- C) Functional decline
- D) All of the above
- D) All of the above
. An older adult presenting with confusion or delirium may be experiencing which of the following?
- A) Urinary tract infection (UTI)
- B) Pneumonia
- C) Sepsis
- D) All of the above
- D) All of the above
What is an atypical presentation of UTI in older adults?
- A) Dysuria
- B) Fever
- C) Confusion or altered mental status
- D) Urgency
C) Confusion or altered mental status
Which of the following is a reason NOT to treat asymptomatic bacteriuria in older adults?
- A) It reduces antibiotic resistance
- B) There is no clinical benefit
- C) It increases the cost of healthcare
- D) It prevents C. difficile colitis
- B) There is no clinical benefit
In older adults, T-cell function is typically:
- A) Increased
- B) Decreased
- C) Unchanged
- D) Enhanced with age
- B) Decreased
How does aging affect B cells in the elderly?
- A) B-cells produce more antibodies
- B) B-cells produce fewer antibodies with lower affinity
- C) B-cell activity remains unchanged
- D) B-cells become hyperactive
- B) B-cells produce fewer antibodies with lower affinity
What is the common cause of gastrointestinal infections in older adults?
- A) Inhalation of pathogens
- B) Bloodborne transmission
- C) Oral-fecal contamination
- D) Transmission through wounds
- C) Oral-fecal contamination
Which of the following is commonly associated with GI infections in the elderly?
- A) Rotavirus
- B) Streptococcus pneumoniae
- C) Escherichia coli
- D) Mycobacterium tuberculosis
- C) Escherichia coli
Which of the following increases the risk of GI infections in older adults?
- A) Hypochlorhydria
- B) Antibiotic overuse
- C) Achlorhydria
- D) All of the above
- D) All of the above
Which antibiotic regimen is often recommended for treating CAP in older adults?
- A) Amoxicillin-clavulanate (Augmentin)
- B) Ciprofloxacin alone
- C) Macrolide with a beta-lactam
- D) Penicillin alone
- C) Macrolide with a beta-lactam
What is the usual duration of antibiotic treatment for uncomplicated outpatient CAP in older adults?
- A) 3-5 days
- B) 7-14 days
- C) 14-21 days
- D) 1-2 days
- C) 14-21 days
Fever of unknown origin in older adults is defined as:
- A) A temperature above 100°F for 3 days
- B) A fever lasting more than 3 weeks with no diagnosis after one week of medical evaluation
- C) A temperature above 99°F for more than 2 weeks
- D) A fever that resolves with antipyretics
- B) A fever lasting more than 3 weeks with no diagnosis after one week of medical evaluation
Which of the following is a common cause of fever of unknown origin in older adults?
- A) Osteomyelitis
- B) Heart disease
- C) Chronic kidney disease
- D) Hypertension
- A) Osteomyelitis
Which of the following must be considered when prescribing antibiotics to older adults?
- A) Renal function
- B) Drug metabolism
- C) Drug interactions with other medications
- D) All of the above
- D) All of the above
What is a common reason for poor medication adherence in older adults?
- A) Cognitive impairment
- B) Financial constraints
- C) Polypharmacy
- D) All of the above
- D) All of the above
What is the best strategy to prevent pneumonia in older adults?
- A) Annual flu vaccination
- B) Smoking cessation
- C) High-dose pneumonia vaccine
- D) All of the above
- D) All of the above
High-dose flu vaccines are recommended for adults over:
- A) 50 years old
- B) 60 years old
- C) 65 years old
- D) 70 years old
- C) 65 years old
The most common organism responsible for urinary tract infections (UTIs) in older adults is:
- A) Escherichia coli
- B) Klebsiella pneumoniae
- C) Pseudomonas aeruginosa
- D) Streptococcus pneumoniae
A) Escherichia coli
Which of the following interventions can help prevent recurrent UTIs in postmenopausal women?
- A) Antibiotics daily
- B) Intravaginal estrogen
- C) Cranberry juice
- D) Both B and C
- D) Both B and C
What is the first-line treatment for suspected sepsis in an elderly patient?
- A) Immediate surgery
- B) Antibiotics and fluid resuscitation
- C) Pain management
- D) Antiviral medication
- B) Antibiotics and fluid resuscitation
Which of the following increases the risk of sepsis in older adults?
- A) Age over 85
- B) Multimorbidities
- C) Immune senescence
- D) All of the above
- D) All of the above
Why is it important to assess older adults for multimorbidities when evaluating atypical presentations of infections?
- A) Multimorbidities increase the complexity of diagnosis and treatment
- B) They increase the risk of infection
- C) Symptoms may be masked or atypical
- D) All of the above
- D) All of the above
Which of the following is a common atypical presentation of infection in older adults?
- A) High fever
- B) General malaise or confusion
- C) Rash
- D) Severe joint pain
B) General malaise or confusion
What is the primary reason older adults may not present with typical symptoms of infection such as fever?
- A) Lower metabolic rate
- B) Reduced immune response (immune senescence)
- C) Increased hydration
- D) Enhanced B-cell activity
- B) Reduced immune response (immune senescence)
In the elderly, which of the following is a key symptom that may be absent in a pneumonia diagnosis?
- A) Cough
- B) Fever
- C) Fatigue
- D) Shortness of breath
- B) Fever
Which of the following is the most effective preventive measure for reducing community-acquired pneumonia in older adults?
- A) Regular use of antibiotics
- B) Annual vaccination
- C) Increased vitamin intake
- D) Use of antifungals
- B) Annual vaccination
Which symptom is often absent in older adults presenting with a urinary tract infection (UTI)?
- A) Dysuria
- B) Fever
- C) Confusion
- D) Increased frequency
- B) Fever
Which of the following organisms is most commonly responsible for urinary tract infections (UTIs) in older adults?
- A) Streptococcus pyogenes
- B) Staphylococcus aureus
- C) Escherichia coli
- D) Pseudomonas aeruginosa
- C) Escherichia coli
. In older adults, what is a common cause of sepsis related to gastrointestinal infections?
- A) Rotavirus
- B) Campylobacter
- C) Bacillus species
- D) Clostridium difficile
- D) Clostridium difficile
Why is it important to use antibiotics judiciously in older adults?
- A) To improve the speed of recovery
- B) To prevent the development of drug-resistant organisms
- C) To increase the efficacy of immunizations
- D) To ensure higher drug tolerance
B) To prevent the development of drug-resistant organisms
Which of the following is an adverse effect of overusing antibiotics in older adults?
- A) Increased immune function
- B) Reduced kidney function
- C) Increased risk of developing Clostridium difficile infection
- D) Increased cognitive function
- C) Increased risk of developing Clostridium difficile infection
- What is the major cause of death in adults 65 years and older?
o A) Cancer
o B) Cardiovascular diseases
o C) Infections
o D) Accidents
C) Infections
- Which of the following describes the age-related decline in immune function?
o A) Immune senescence
o B) Immune hypersensitivity
o C) Immune modulation
o D) Immune adaptation
A) Immune senescence
- What is the primary cause of reduced immune function in older adults?
o A) Overactive T-cells
o B) Depressed T-cell and B-cell response
o C) Enhanced macrophage activity
o D) Increased antibody production
o B) Depressed T-cell and B-cell response
- Which of the following organisms is predominantly found in community-acquired pneumonia (CAP) in older adults?
o A) Staphylococcus aureus
o B) Streptococcus pneumoniae
o C) Klebsiella pneumoniae
o D) Moraxella catarrhalis
B) Streptococcus pneumoniae
- What percentage of older adults die from infections?
o A) 10%
o B) 25%
o C) 40%
o D) 50%
o C) 40%
- What is a significant risk factor for developing pneumonia in older adults?
o A) Physical exercise
o B) Multimorbidity
o C) High hydration
o D) Regular flu vaccination
o B) Multimorbidity
- Which of the following is a primary method of pneumonia prevention in older adults?
o A) Regular use of broad-spectrum antibiotics
o B) Immunizations
o C) Strict bed rest
o D) Using antifungal medications
B) Immunizations
- What role does skin integrity play in infection susceptibility in older adults?
o A) Thicker skin increases the risk of infection
o B) Thinner skin increases susceptibility to infection
o C) No effect on infection risk
o D) Skin integrity enhances immunity
B) Thinner skin increases susceptibility to infection
- What is the strongest independent predictor of mortality in older adults with pneumonia?
o A) Smoking
o B) Multimorbidity
o C) Obesity
o D) Dehydration
o B) Multimorbidity
- What is the primary organism responsible for pneumonia in long-term care facilities?
o A) Streptococcus pneumoniae
o B) Gram-negative bacilli
o C) Staphylococcus aureus
o D) Respiratory viruses
o B) Gram-negative bacilli
- How often do nursing home residents develop pneumonia within two years?
o A) 10%
o B) 20%
o C) 30%
o D) 50%
o C) 30%
- Which of the following is a risk factor for urinary tract infections (UTI) in older adults?
o A) Decreased kidney function
o B) Increased protein intake
o C) Frequent hydration
o D) Regular exercise
A) Decreased kidney function
- Which is the most common pathogen causing UTIs in older adults?
o A) Klebsiella pneumoniae
o B) Enterococcus species
o C) Escherichia coli
o D) Pseudomonas aeruginosa
C) Escherichia coli
- Why is asymptomatic bacteriuria often left untreated in older adults?
o A) It is a mild infection
o B) No clinical benefit and potential adverse effects from treatment
o C) It leads to faster recovery without treatment
o D) Antibiotics cannot treat it effectively
B) No clinical benefit and potential adverse effects from treatment
- Which medication is contraindicated in older adults with chronic kidney disease when treating UTIs?
o A) Bactrim
o B) Nitrofurantoin
o C) Amoxicillin
o D) Cephalexin
o B) Nitrofurantoin
- What percentage of older women in long-term care facilities are affected by asymptomatic bacteriuria?
o A) 10% to 20%
o B) 25% to 50%
o C) 60% to 80%
o D) Over 90%
o B) 25% to 50%
- What is the recommended first-line treatment for uncomplicated cystitis in older adults?
o A) Amoxicillin
o B) Fluoroquinolones
o C) Bactrim or Nitrofurantoin
o D) Doxycycline
C) Bactrim or Nitrofurantoin
- Which condition in older adults is often caused by oral fecal contamination?
o A) Respiratory infections
o B) Gastrointestinal infections
o C) Skin infections
o D) Bone infections
o B) Gastrointestinal infections
- Which viral organism is commonly responsible for gastrointestinal infections in older adults?
o A) Staphylococcus aureus
o B) Bacillus species
o C) Norwalk virus
o D) Escherichia coli
C) Norwalk virus
- Which gastrointestinal condition can result from antibiotic overuse in older adults?
o A) Bacillus infection
o B) C. difficile colitis
o C) Rotavirus
o D) Traveler’s diarrhea
B) C. difficile colitis
- What is a significant factor leading to infections in long-term care facilities?
o A) Dehydration
o B) Overuse of antiviral medications
o C) Poor staff compliance with infection control practices
o D) Overnutrition
C) Poor staff compliance with infection control practices
- What is the most effective preventive measure for reducing influenza infections in older adults?
o A) Annual flu vaccination, especially with high-dose vaccines
o B) Quarantine during flu season
o C) Use of antivirals year-round
o D) Increasing hydration levels
A) Annual flu vaccination, especially with high-dose vaccines
- What is the most common side effect of Tamiflu (oseltamivir) in older adults?
o A) Severe headache
o B) Gastrointestinal issues, such as nausea and vomiting
o C) Rash
o D) Difficulty breathing
B) Gastrointestinal issues, such as nausea and vomiting
- What percentage of deaths from influenza occur annually in the United States, especially among older adults?
o A) 10,000
o B) 20,000
o C) 40,000
o D) 60,000
o C) 40,000
- What is the primary management strategy for sepsis in older adults?
o A) Rapid administration of fluids and antibiotics
o B) Immediate surgery
o C) High-dose vitamin therapy
o D) Pain management
A) Rapid administration of fluids and antibiotics
o D) Pain management
26. Which of the following changes in the immune system is commonly observed in older adults?
o A) Increased production of T-cells
o B) Depressed T-cell and B-cell function
o C) Increased production of antibodies
o D) Enhanced macrophage response
o B) Depressed T-cell and B-cell function
- What is a typical sign of upper urinary tract infection (pyelonephritis) in older adults?
o A) Increased frequency of urination
o B) Fever, chills, and flank pain
o C) Abdominal distention
o D) Dry cough
B) Fever, chills, and flank pain
- What percentage of older adults suffer from under-nutrition on an outpatient basis?
o A) 5%
o B) 10%
o C) 11%
o D) 20%
o C) 11%
- Which of the following is an important measure to reduce the risk of hospital-acquired pneumonia?
o A) Giving all patients prophylactic antibiotics
o B) Performing chest X-rays regularly
o C) Keeping patients upright prior to feeding
o D) Administering cough suppressants frequently
C) Keeping patients upright prior to feeding
- What is the treatment for gastrointestinal infections caused by Clostridium difficile in older adults?
o A) IV vancomycin
o B) Oral vancomycin
o C) Oral penicillin
o D) Topical antibiotics
o B) Oral vancomycin
