Atypical Presentations - Exam 1

Question 1

What is an atypical presentation?

Answer 1

When a geriatric patient presents with a disease state that is missing some of the traditional core features of the illness usually seen in younger patients.

Question 2

What are the 3 features of an atypical presentation?

Answer 2

vague presentation of illness

altered presentation of illness

non-presentation of illness (underreporting)

Question 3

What are the risk factors of an atypical presentation?

Answer 3

Increasing age (especially >85 years)

Multiple medical conditions

Multiple medications (polypharmacy)

Cognitive or functional impairment

Question 4

What is the atypical presentation of acute coronary syndrome?

Answer 4

Mild pain or asymptomatic

Absence of dyspnea

New-onset fatigue, dizziness, or confusion

Predominant GI symptoms: pyrosis / dyspepsia / nausea

Question 5

What is the atypical presentation of pneumonia?

Answer 5

Absence of cough

General fatigue / malaise

Confusion

Question 6

What is the atypical presentation of hyperthyroidism? What is it called?

Answer 6

Chronic thyrotoxicosis that presents with cardiac disease, weakness of proximal muscles, and depression

Apathetic thyrotoxicosis

Question 7

What is the atypical presentation of hypothyroidism?

Answer 7

Confusion
Agitation

Question 8

What are the MC causes of abdominal pain in geriatric pateints?

Answer 8

Cholecystitis
Bowel obstruction
Diverticular disease
Complications of cancer
Medication side effects

Question 9

What are the common diseases for each quadrant?

Answer 9

Question 10

What are the common dz in the epigastric region?

Answer 10

Question 11

What are the common dz for the peri-umbilical region?

Answer 11

Question 12

What is the atypical presentation of acute abdomen?

Answer 12

Pain may be more diffuse and mild
vs rather than localized to specific
quadrant

May lack fever
Sometimes present with hypothermia

May lack elevated WBC

May have reduced rebound tenderness
Secondary to decreased abdominal wall musculature

Question 13

Why do geriatric patients have reduced rebound tenderness?

Answer 13

Secondary to decreased abdominal wall musculature

Question 14

What are risk factors for dehydration in the elderly?

Answer 14

Infection
Tube feedings
Medication – related side effects
Delirium
Mobility disorders

Question 15

Medications such as _____ may mask the usual tachycardic response seen in volume depletion dehydration.

Answer 15

beta-blockers

Question 16

_____ sign of dehydration is often unreliable in the elderly. and _______ may be misleading.

Answer 16

skin turgor

Oral dryness

Question 17

What are 2 PE findings for dehydration in the elderly?

Answer 17

constipation or slight orthostatic hypotension

Question 18

How does an infectious disease commonly present in the elderly? What is an atypical presentation of an infectious disease?

Answer 18

fever and leukocytosis

Vague
No fever
No elevation in WBCs
No localizing signs

Question 19

Older adults generally have a (lower/higher) basal body temperature. Why? What body temperature can indicate infection?

Answer 19

lower basal body temperature due to reduced muscle mass

> 99.1°F (37.3°C)

Question 20

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

Answer 20

functional status

mental status

Question 21

What are some s/s to look for to clue you in to atypical presentation?

Answer 21

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