Atypical Presentations - Exam 1 Flashcards
What is an atypical presentation?
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.
What are the 3 features of an atypical presentation?
vague presentation of illness
altered presentation of illness
non-presentation of illness (underreporting)
What are the risk factors of an atypical presentation?
Increasing age (especially >85 years)
Multiple medical conditions
Multiple medications (polypharmacy)
Cognitive or functional impairment
What is the atypical presentation of acute coronary syndrome?
Mild pain or asymptomatic
Absence of dyspnea
New-onset fatigue, dizziness, or confusion
Predominant GI symptoms: pyrosis / dyspepsia / nausea
What is the atypical presentation of pneumonia?
Absence of cough
General fatigue / malaise
Confusion
What is the atypical presentation of hyperthyroidism? What is it called?
Chronic thyrotoxicosis that presents with cardiac disease, weakness of proximal muscles, and depression
Apathetic thyrotoxicosis
What is the atypical presentation of hypothyroidism?
Confusion
Agitation
What are the MC causes of abdominal pain in geriatric pateints?
Cholecystitis
Bowel obstruction
Diverticular disease
Complications of cancer
Medication side effects
What are the common diseases for each quadrant?
What are the common dz in the epigastric region?
What are the common dz for the peri-umbilical region?
What is the atypical presentation of acute abdomen?
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
Why do geriatric patients have reduced rebound tenderness?
Secondary to decreased abdominal wall musculature
What are risk factors for dehydration in the elderly?
Infection
Tube feedings
Medication – related side effects
Delirium
Mobility disorders
Medications such as _____ may mask the usual tachycardic response seen in volume depletion dehydration.
beta-blockers
_____ sign of dehydration is often unreliable in the elderly. and _______ may be misleading.
skin turgor
Oral dryness
What are 2 PE findings for dehydration in the elderly?
constipation or slight orthostatic hypotension
How does an infectious disease commonly present in the elderly? What is an atypical presentation of an infectious disease?
fever and leukocytosis
Vague
No fever
No elevation in WBCs
No localizing signs
Older adults generally have a (lower/higher) basal body temperature. Why? What body temperature can indicate infection?
lower basal body temperature due to reduced muscle mass
> 99.1°F (37.3°C)
Change in _____ and ______ is sometimes the only sign of underlying infection in the elderly
functional status
mental status
What are some s/s to look for to clue you in to atypical presentation?
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)
