Atypical Presentations in the Elderly Flashcards
What is an atypical presentation in elderly?
Vague presentation of illness
Altered presentation of illness
Non-presentation of illness (underreporting)
SOB walking up stairs (think it’s just “old age”)
change in behavior, functional ability as well
What are the risk factors of atypical presentations?
Age (especially >85 years)
Multiple medical conditions
Polypharmacy
Cognitive impairment
Functional impairment
What is acute coronary syndrome in elders?
Classically: Crushing substernal chest pain
Shortness of breath
Nausea
Diaphoresis
But in elders sometimes just dyspnea, GI, heart burn, or nausea
What is the deinitive diagnosis of ACS?
Troponin
EKG is not specific
What is the presentation of pneumonia in elderly?
Abscence of fever and chills
What is the curb criteria for pneuomina?
Predicts mortality
Death risk at 30 days increases as the score increases
Confusion
Urea
Respiratory rate
Blood pressure
Age > 65
If all 5, then
A 73 y/o male is brought to the ER by his wife with new onset confusion. She states it started about 2 hours ago. At first, she was not concerned, but it started to be constant. He was not aware of where he was, who he was, and what year it was. She denies he has had any cough, congestion, or fever. She did note that he did not eat much for dinner last night and did not have much for breakfast today. His vitals show a RR of 34, BP of 86/56, and a HR of 106. All other lab work is WNL. What could be at the top of your differential diagnosis?
What are some of the s/sx that led you this way?
What is this patient’s CURB65 30-day mortality risk?
.6%
3.2%
13%
17%
41.5% (this)
57.5%
What usually is the case for thyroid disease in elderly?
Normally not elevated thyroxine
What are the causes of acute abdomen
Most common causes of abdominal pain in older adults
Cholecystitis
Bowel obstruction
Diverticular disease
Complications of cancer
Medication side effects
. A patient presents to the ER and is diagnosed with acute abdomen. Which of the following is true about acute abdomen?
It can present with a lack of an elevated WBC count
It will present with an increased rebound tenderness
Will have a high fever
The pain will be localized
A
Where do you check turgur in a patient?
sternum
What are the s/s of dehydration in elderly?
vague or even absent
Why do patients have lower basal body temperature and what should we be aware of as a result?
reduced muscle mass, meaning that they may have an infection if at >99.1 F
You have a patient that you have diagnosed with dehydration, however, their vitals show a heart rate of 88, which is WNL. What could be the reason for this?
T/F: Constipation may be one of the only signs of dehydration?
Why does the geriatric population have a lower basal body temperature?
- BB use
- True
- Lower muscle mass
Ms. Mills is an 83 y/o woman who began living with her son following her husband’s recent death. She is active and independent. Medical history includes diet-controlled diabetes mellitus and HTN. She takes HCTZ 25mg daily and ASA 81mg daily. You have seen her once in your office to check her BP and refill medication. Today you receive a call from her son, who sounds anxious. He states that his mother has become increasingly short of breath over the preceding 24 hours and is mildly confused. You ask to speak to her. She has some difficulty being attentive to your questions, but she denies chest pain, fever, or sputum production. You ask her to go to the ER for evaluation.
- What is your Differential Dx?
- What Labs / tests do you want to order?
Suspect MI
Troponin
