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Geriatrics > Atypical Presentations > Flashcards

Atypical Presentations Flashcards

1
Q

When an older adult presents with a disease state that is missing some of the traditional core features of the illness that are usually seen in younger patients.
what is this called?

A

Atypical Presentations

Common in elderly population

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2
Q

Atypical Presentations
usually includes one of the three features

A
  1. Vague presentation of illness
  2. Altered presentation of illness
  3. Non-presentation of illness (underreporting)
    - SOB walking up stairs (think it’s just “old age”)
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3
Q

prevalence with Atypical Presentations increases with what?

A

age
With the aging of the world’s population, atypical presentation of illness will represent an increasingly large portion of illness presentations

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4
Q

risk factors for atypical presentations

A

Age (especially >85 years)
Multiple medical conditions
Polypharmacy
Cognitive impairment
Functional impairment

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5
Q

classic sx of Acute Coronary Syndrome (ACS)

A

Crushing substernal chest pain
Shortness of breath
Nausea
Diaphoresis

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6
Q

atypical sx of ACS

A
  1. Dyspnea
  2. Mild pain, or even no pain
  3. New-onset fatigue, dizziness, or confusion
  4. Predominant GI sx
    - Pyrosis (heart burn) / Dyspepsia / Nausea
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7
Q

The proportion of MI patients who have chest pain and diaphoresis declines with ?

A

age
less than 50% of MI patients older than 80 years complain of chest pain

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8
Q

what is the most common initial symptom in persons older than 80 years old

A

Dyspnea

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9
Q

Up to 20% of patients older than 85 have what type of complaints

A

neurologic

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10
Q

what initial testing is often nondiagnostic in older adults because of preexisting conduction system disease

A

ECG

Other nondiagnostic reasons include:
LBBB
presence of ventricular pacemaker
prior infarct
left ventricular hypertrophy
metabolic abnormalities
drug effects (ex: loop diuretics can cause hypokalemia)

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11
Q

Definitive Diagnosis of STEMI or NSTEMI requires what?

A
  1. abnormal cardiac biomarker elevation - Troponins I & T (gold standard)
    - more sensitive and specific compared to CK-MB
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12
Q

Guidelines state that older patients receive the same treatment for ACS as younger patients but with addition of what?

A

with close monitoring for adverse events

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13
Q

Pneumonia in older adults can be what types?

A
  1. Community acquired
  2. Nosocomial acquired
  3. Skilled nursing facility acquired - MC infection in skilled nursing facility
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14
Q

what type of pneumonia is common among the geriatric that is Associated with oropharyngeal dysphagia, Regurgitation of gastric contents

A

aspiration pneumonia

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15
Q

presentation of pneumonia

A
  1. Can present with:
    - General malaise
    - Confusion
    - Loss of appetite
    - Functional decline
  2. May be absent
    - Fever / chills
    - Pleuritic chest pain
    - cough
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16
Q

scoring assessment for pneumonia?
what does each final result mean?

A

CURB65

  1. Predicts mortality
  2. Death risk at 30 d increases as score increases
    - Confusion
    - Urea - >7 mmol/L
    - Respiratory rate - >30
    - Blood pressure - <90/60
    - Age > 65

Scoring

  • 0 (.6%)
  • 1 (3.2%)
  • 2 (13%)
  • 3 (17%)
  • 4 (41.5%)
  • 5 (57.5%)
17
Q

Cardinal features of Apathetic thyrotoxicosis

A
  1. apathy and depression (opposite of a younger patient)
  2. Chronic - fatigue and slowing down
  3. Cardiac dz
  4. Weakness of proximal muscles

Thyroxine levels are not elevated

18
Q

Subclinical Hypothyroidism presentation

A
  1. may present with few to no complaints
  2. sx akin to the normal aging process
  3. Confusion/agitation/reduced cognitive function
  4. May see increased intestinal transit
  5. Increased IOP
  6. Higher LDL
  7. changes in cardiac performance, including CHF
  8. High TSH and normal free T4
  9. +/- tx with Levothyroxin – may improve LDL, but not known to dec. CV or all-cause mortality
19
Q

presentation of overt hypothyroidism? tx?

A
  1. Subclinical can become overt hypothyroidism
  2. High TSH and low free T4
  3. Treat with Levothyroxin
    - Start with low initial dose
    - Increase q 4-6 weeks until normalization of TSH levels
20
Q

are Acute Abdomen problems in older adults recognizable?

A

Often under recognized
As much as 40% of older adults are misdiagnosed

21
Q

MCC of abd pain? (5)

A

Cholecystitis
Bowel obstruction
Diverticular disease
Complications of cancer
Medication side effects

22
Q

presentation of acute abdomen

A
  1. Pain may be diffuse and mild OR asx
  2. May lack fever
    - Sometimes present with hypothermia
  3. May lack elevated WBC
  4. May have reduced rebound tenderness
    - Due to decreased abdominal wall musculature
23
Q

why is the mortality rate and complications of the acute abdomen much greater in older adults?

A

Because of these delayed presentations and difficult diagnoses
A wide ddx needs to be considered with vague abdominal complaint in an elderly patient

24
Q

The most common fluid and electrolyte problem in older adults

A

dehydration

25
Q

dehydration is a result from what?

A
  1. normal age-related physiologic changes
    - Decrease in total body water
    - Alterations in thirst perception
    - Reduced renal function leading to decreased urine-concentrating ability
26
Q

risk factors of dehydration

A

Infection
Tube feedings
Medication – related side effects
Delirium
Mobility disorders

27
Q

presentation of dehydration

A
  1. vague or even absent
  2. VS may not be helpful
  3. Skin turgor is not reliable
  4. Intake – output charts likely inaccurate in the setting of incontinence
  5. Oral dryness may be misleading
    - mouth breathing
    - meds with anticholinergic properties
28
Q

meds such as ? may mask usual tachycardic response seen in volume depletion

A

BB

29
Q

dehydration May manifest only as _____ or slight ___

A

constipation
orthostatic hypotension

30
Q

new infection typically presents with what?

A

fever, leukocytosis

even in older adults

31
Q

commonly, the presentation of an infection in the elderly population may be:

A

Vague symptoms
No fever
No elevation in WBCs
No localizing signs

32
Q

why do Older adults generally have a lower basal body temperature?

A

Due to reduced muscle mass
Temperature of >99.1°F (37.3°C) may be more likely to be indicative of infection

33
Q

Change in ____ and _____ is sometimes the only sign of underlying infection

A

functional
mental status

34
Q

Delay in recognizing acute illness can lead to

A

Adverse health outcomes
Prolonged hospitalization
Iatrogenesis/negligence
Increased risk of death

35
Q

for Atypical Presentations – Symptoms to look for…

A

Acute confusion (delirium)
Anorexia (change in appetite)
Absence of pain, or pain in alternate location
Generalized weakness
Fatigue
New urinary incontinence
New functional decline (change in mobility)

Geriatrics (12 decks)

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