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Differential Diagnosis & Med Screening > COMPS:GULICK: Medical Screening in Geriatric Pts > Flashcards

COMPS:GULICK: Medical Screening in Geriatric Pts Flashcards

1
Q

MSK Changes

General….

A
  • DECs In:
    • mm mass & strength
    • motor unit recruitment
    • speed of mvmt (DEC type II (FT) mm fibers)
    • jt flexibility
    • bone mass & strength
  • Cartilage degen.
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2
Q

Neural Changes

General

A
  • DECs in:
    • conduction= altered pain
    • enyzmatic activity
    • reflexes
    • responsiveness
  • INCs in:
    • postural sway
  • Change in sleep patterns
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3
Q

Cardiovascular Changes

General

A
  • INCs In:
    • Vascular resistance
  • DECs In:
    • CO (HR*SV)
    • Lipid catabolism
    • Vascular elasticity==> INC DBP
    • Response to postural stress
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4
Q

Pulmonary Changes

General

A
  • DECs In:
    • Recoil w/in lung
    • PO2 from 20-70yrs
    • VO2 max
    • Pulmonary blood flow==> DEC O2sats
  • INCs In:
    • RV (residual volume)
  • Calcification of soft tissue in chest wall
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5
Q

Integumentary Changes

General

A
  • DECs In:
    • vascularity== altered thermoreg.
    • SubQ tissue== INC risk for hypOthermia
    • thickness w/ INC risk breakdown
  • Uneven pigmentation
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6
Q

GI Changes

General

A
  • DECs In:
    • peristalsis
    • enzymatic activity
    • motility
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7
Q

Urogenital/Renal Changes

General

A
  • DECs In:
    • bladder capacity, bladder elasticity
    • kidney mass
    • GFR
    • creatinine clearance*
  • Prostate hyperplasia (BPH)
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8
Q

Special Senses Changes

General

A
  • DECs In:
    • visual acuity
    • hearing
    • smell&taste
    • Thymus function* (HUGE role in immunity)
    • Ca++ control
    • sweating*
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9
Q

Immune Changes

General

A
  • DECs In:
    • function/resistance
    • T-cells
    • Temp regulation
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10
Q

Psychosocial Changes

General

A
  • INCs In:
    • depression
    • fatigue
  • Cognitive deficits
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11
Q

Medications

Rule of Thumb

A

DEC meds w/ INC age

Due to DEC liver & DEC kidney metabolism

  • Polypharmacy→ adverse effects, interactions***
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12
Q

Keeping Track of Medications

*USE Medscape Interaction Checker

All suffixes you will need to KNOW @ some point!!!

SAVE THIS!!!!

A
  • -caine= local anasthetic
  • -cillin= antibx
  • -dine= anti-ulcer agent
  • -done= opioid analgesic
  • -ide= oral hypoglycemic
  • -iam= anti-anxiety agent
  • -micin= diuretic
  • -mycin= antibx
  • -nium= NM blocking
  • -olol= beta blocker
  • -oxacin= antibx
  • -pam= anti-anxiety
  • -pril= ACE inhibitory
  • -sone= steroid
  • -statin= anti-lipemic (Cholesterol meds)
  • -vir= anti-viral
  • -zide= diuretic
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13
Q

Risk of Falls

The Vicious Cycle

  • >2.5 mill falls end up in ER
  • >13K
  • 52% Am’s >65yo fall/yr
A

FALLS→ DEC function→Fear→Isolation→ Inactivity→Weakness→FALLS

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14
Q

Risk of Falls

Some great Outcome Measures

A

Berg, Tinetti, TUG, Gait Abnorm Rating Scale, Gait Velocity (5th Vital Sign?), 5xSTS, DGI, Activity-Specific Balance Confidence (ABC) Scale

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15
Q

TUG

*Get up, walk 3m, go around obj, walk back and sit down

A

see pics for #’s

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16
Q

TUG-Cog

*Dual-Tasking

A
  • Stand, walk 3m, return & sit
  • Perform phys task while subtracting 3 for any given # from 66-100
    • OR serial 7’s, days of week, etc…
  • Cut-Off is 15s***
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17
Q

Gait Velocity

Gait Speed as a Predictor of Hospitalization

A

see pics

Slow walkers 4x MORE LIKELY have hospitalization w/in 12-mos

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18
Q

5xSTS

Description + Norm Values

A

see pics

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19
Q

“Balance” Borg Scale

Like RPE for BALANCE*

A

SEE PICS

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20
Q

Questionnaire to Calculate Falls Risk

A

jscalc.io/calc/Y53w0rSwoRCx0fuE

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21
Q

Warning Signs of Elder Abuse

A

see pics***

YOU MUST SAY SOMETHING!!!

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22
Q

TOP Reasons for ER Visits in Elderly…

A
  • Injuries→ Falls/Accidents
  • PNA
  • Comps after Sx
  • Chest pain
  • SEs from meds
  • Dehydration
  • Stroke
  • Back/Abdominal pain
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23
Q

Systems Review: MSK

Arthritis

Osteoporosis

A
  • Arthritis→ see pics for loc’s
  • Osteoporosis
    • ~12% women 50-70 have vertebral compression fx’s
    • ~20% >70yo
  • NOTE: Ginger + Cinnamon for OA*** ½ tsp, 2-3x/day
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24
Q

Systems Review: MSK Patho

Patellar-Pubic Percussion Test (Geriatrics) → Screening Test

A

Sn= 94 (-LR)=0.06 Sp= 95 (+LR)= 20.4

  • Technique: Pt in SUPINE, scope on symphysis pubis & tuning fork on patella; listen for change in sound qual w/ both LEs
  • (+)= Osseous problem, i.e. fx, cx
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25
Q

Tech. for Fx ID

A

Use of 128-Hz vibrating tuning fork & stethoscope to ID Fx’s

Dx accuracy= 81%

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26
Q

Systems Review: MSK

Influence of Fluoroquinolone (FQ): Gram (-) antibx for Resp, Uro, GI Infx’s

A
  • HIGH affinity for connective tissue
  • FQ toxic to type I collagen synthesis (esp. Achilles) & promotes collagen degen.
    • Risk is dose dependent
  • “Black Box Warning”== Severe SEs, but still on market bc value
  • Mean onset== 6d
  • Look for→ Heel pain, Calf pain, Heel lifts
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27
Q

Influence of Fluoroquinolone (FQ):

Risk of Tendon Damage INCs if:

A
  • >60yo
  • Concurrent corticosteroid use (46-fold INC)*
  • Renal failure
  • DM
  • Hx of tendon rupture
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28
Q

Influence of FQ:

On tendons and esp. Achilles Tendon

A
  • 89.9% Achilles Tendon
  • S/S:
    • Pain 2-3cm prox. to calcaneal attach.
    • Swelling/inflammation
    • “Snap”, “Pop” w/ bruise
    • (+) Thompson Sign
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29
Q

Influence of FQ:

Avoiding ruptures

A

S/S can occur up to 2wks BEFORE rupture

  • Avoid rupture:
    • tendon protected from WB
    • Heel lift used
    • Crutches/Bracing
  • May need to protect tendon up to 6mos
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30
Q

Systems Review: Neuromuscular

These 2 pathos have Bi-Modal Distribution:

A

Myasthenia Gravis, Guillian-Barre Syndrome (GBS)

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31
Q

Myasthenia Gravis

S/S you DEFINITELY NEED TO REMEMBER

MOST COMMON***

A

Diplopia & Ptosis== MOST COMMON SX’S

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32
Q

Myasthenia Gravis

S/S

A
  • MOST COMMON→ Diplopia & Ptosis (droopy eyelid)
  • PROX mm weakness, CN weakness, Prob controlling eye mvmt & facial expresses
  • Diff swallow/chewing
  • Dysarthria (slurred speech)
  • Change voice qual.
  • NO sensory/DTRs changes***
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33
Q

Guillian-Barre Syndrome (GBS)

S/S

A
  • *Weakness→ symmetrical LE > UE > Resp.
  • Parasthesias start in toes & progress PROX. (NO loss sensation)
  • Asymmetrical facia weak, dysphasia, dysarthrias
  • CNs can be affected
  • UNSTABLE VITAL SIGNS***
  • DEC reflexes & hypOtonia
  • Fever, nausea, fatigue
  • PAIN= LB & buttocks
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34
Q

Systems Review: Neuromuscular

Normal Pressure Hydrocephalus

3 Things occur w/ this Patho

A
  1. System of draining/absorbing CSF is disrupted
  2. Can occur after a head injury, TIA, meningitis, infx, or tumor, or unknown
  3. Pressure slowly INCs→ NPH is misleading**
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35
Q

NPH

Dx how?

A

CT/MRI

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36
Q

NPH: Sx’s

3 Parts of Brain MOST often affected

A

Legs, Bladder, Cognition

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37
Q

NPH: Sx’s

3 Parts of Brain MOST often affected

Legs vs Bladder vs Cognition

A
  • Legs→ Gait disturbs, Wide BOS, Slow/Shuffling steps
    • *retain arm swing unlike PD
  • Bladder→ Urinary freq (every 1-2hrs)=> incont.
  • Cognition→ Dementia, forgetful, STM loss
    • *may fluctuate bc pressure changes- unlike Alzheimer’s
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38
Q

NPH: Clinical Traid (SLOW Progression)

3 W’s

A

Wobbly, Wozzy, Wet

  • Wobbly on foot
    • “feet glued to floor”
    • NO loss of arm swing like PD
  • Wozzy in head
    • Beware misDx w/ hearing loss
  • Wet on bottom
    • Beware of meds
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39
Q

GREAT Tx for NPH:

In video viewed in class, DRASTIC IMPROVEMENTS IN Gait

A

Shunt

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40
Q

NPH Scale

A

For reference

3 Cats: Gait, Cognitive, Sphincter

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41
Q

Parkinson’s Disease

Cardinal Motor Symptoms (remember PWPD are TRAPPED)

A

Most common onset= 60-70yo

  • Cardinal Motor Sx’s
    • Tremor @ rest
    • Rigidity
    • Bradykinesia
    • Gait & Balance probs
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42
Q

PD

Tremor DOES NOT have to be present to make Dx****

A

******

It is most common initial sx in PD though

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43
Q

PD

Craniofacial, Sensory, Autonomic, Neuropsychiatric Features

A
  • Craniofacial→ Masked face, Sialorrhea (drool), Anosmia (lose smell), soft speech*, Dysarthria, Dysphagia
  • Sensory→ Parasthesia
  • Autonomic→ Urinary urgency, Constipation, Sexual dysf
  • Neuropsychiatric→ Depression/Anxiety, Apathy, Dementia*, Psychosis*
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44
Q

PD

FYI

Talking about making Dx

A
  • PD is a clinical dx (acting out dreams)
  • Levodopa Test→ NOT 100% accurate, NOT used to definitively dx PD
  • MRI/CT findings unremarkable
  • NO lab biomarkers exist for PD
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45
Q

PD an Flavonoid-rich foods***

A
  • May help improve life-expect.
  • Greater consumption berries and red wine (rich in flavonoids)→ assocd w/ LOWER mortality

see pics for foods*

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46
Q

A note on Cognition…

A

Even w/ inc’ing obesity, DM rates, aging pop, incidence of dementia has declined by 20% every decade over 30yrs

Limtd to those w/ @ least high school edu.

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47
Q

Healthy Brain vs. Alzheimer’s Pts

Tau PROs

A

When Tau no longer stabilizes axons, neuron shrivels and dies, leaving behind its tangled carcass

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48
Q

Precivity Alzheimer’s Disease (AD)

A
  • Rx blood test
  • Measures PROs linked to toxic amyloid plaque buildup in brain→ TAU PROs
  • 94% as accurate as PET scans
  • Adults 60yo w/ memory loss
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49
Q

Stages of Alzheimer’s Disease

Listed here w/ Titles:

A
  • Stage 1: No cog. impair
  • Stage 2: Very mild decline
  • Stage 3: Mild decline
  • Stage 4: Moderate decline (Mild or Early stage AD)
  • Stage 5: Moderately severe decline (Mod or Mid-stage AD)
  • Stage 6: Severe Decline (Moderately severe or Mid-stage AD)
  • Stage 7: Very severe decline (Severe or Late Stage AD)
50
Q

Stages of Alzheimer’s Disease

Stage 1: NO cog impair

A

NO memory problems

51
Q

Stages of Alzheimer’s Disease

Stage 2: VERY mild decline

A
  • Indiv reports memory lapses→ forgets words, names, loc. of everyday obj’s
  • Probs are NOT evident to med prof’s, friends, family
52
Q

Stages of Alzheimer’s Disease

Stage 3: Mild decline

A
  • Prob w/ memory or concentration may be measurable in clinical testing
  • Friends, family, co-workers notice deficiencies
  • Common Diffs: word finding, decd ability to remember names, poor reading retention, lose/misplace valuable objs, decd ability to plan or organize
53
Q

Stages of Alzheimer’s Disease

Stage 4: Moderate decline (mild or early stage AD)

A
  • Deficiencies noted in med. interview
  • Decd knowledge or recent occasions OR current events
  • Impaired ability to perform challenging mental math
    • ex. serial 7’s (backwards from 100)
  • Decd complex task capacity→ plan dinner, pay bills
  • Reduced memory of personal hx
  • Indiv subdues & w/drawals in socially or mentally challenging situations
54
Q

Stages of Alzheimer’s Disease

Stage 5: Moderately severe decline (Moderate or Mid-Stage AD)

A
  • MAJOR gaps in memory & deficits in cog. function
  • Assist. in day-day acts.
  • Cannot recall address, #, name of alma mater
  • Confused about time, day, season
  • Trouble w/ LESS challenging math- count backwards (20s by 2, 40s by 4)
  • Retains knowledge about self, names of spouse & children
  • Usually does NOT req assist w/ eating/toileting
55
Q

Stages of Alzheimer’s Disease

Stage 6: Severe decline (Moderately severe or Mid-Stage AD)

A
  • Sig. personality changes, hallucinations, compulsive behaviors*
  • Loss of awareness of recent exp’s
  • Gen. recall own name & distinguish familiar faces, but may forget name of spouse/caregiver
  • Needs help w/ ADLs & toileting; disrupted sleep/wake cycles
  • Tends to wander and become lost*
56
Q

Stages of Alzheimer’s Disease

Stage 7: Very severe decline (Severe or Late-Stage AD)

A
  • Loss of ability to resp to environ & the ability to control mvmt
  • Speech unrecognizable
  • Needs help w/ eating (diff swallow); gen incontinent
  • Loss of ability to amb w/out assist
  • Poor mm control, abnorm reflexes, mm rigidity
57
Q

Good Test w/ AD

Mini Mental State Exam

A

Orientation

Registration

Attn & Calculation

Recall

Lang

costs $$ now though**

58
Q

MMSE Test

A

Max Score=30

  • 4 Categories:
    • 24-30: Normal
    • 20-23: mild impair/Alzheimer’s
    • 10-19: mod impair/Alzheimer’s
    • 0-9: severe impair/Alzheimer’s
59
Q

Royalty free test also really good for AD

A

Montreal Cognitive Assessment (MoCA)

www.moca

60
Q

Comparison: MMSE vs MoCA

For Mild Cognition Impairment (cut off 26)

A
  • MMSE:
    • Sn= 18%
  • MoCA
    • Sn= 90%**
61
Q

Comparison: MMSE vs MoCA

For Alzheimer’s Disease (cutoff 26)

A
  • MMSE:
    • Sn= 78%
    • Sp= 100%
  • MoCA
    • Sn= 100%**
    • Sp= 87%
62
Q

Comparison: MMSE vs MoCA

For Post-Stroke Cognitive Impairment (cutoff 24)

A
  • MMSE:
    • Sn= 70%
    • Sp= 97%
  • MoCA
    • Sn= 67%
    • Sp= 90%
63
Q

Peanut Butter Test

For WHAT and WHY???

A

Alzheimer’s typ affects sense of smell bc olfactory cortex is first to show signs of dysf**

  • Test: measure dist. that PB could be smelled thru L vs R nostril
  • (+) Test: could NOT detect smell until 5” closer to the L compared to R nostril
64
Q

System Review: CV & Pulmonary

TIA==

May include:

A

Precursor to stroke

*Focal neuro signs, Occurs suddenly, Lasts short time, Resolves w/in 24hrs

  • Blurred vision, slurred speech, flashes of light, Migraine*, vertigo, facial weakness, confusion, Ataxia
65
Q

System Review: CV & Pulmonary

DVTs

Virchow’s Triad

3 Parts:

A
  • Localized Trauma/Sx intervention→
  • Venous Stasis→
    • venous dilation, intima dmg, clotting factor
  • HypERcoagulation
    • dehydration, malignancy, oral contraceptives*, smoking*
66
Q

DVT

Risk associations Venn Diagram

A

Hypercoagulabilty, Vessel Injury, Stasis (blood flow)

67
Q

DVT= Deep Vein Thrombosis

VTE= VenoThromboEmbolism

A
  • 10% all hospital deaths
  • 1st appear in superficial veins @ valve/cusp
  • 90% in Long Saphenous Vein***
  • Proximal mortality > Distal
    • Knee= dividing point*
68
Q

Homans Sign (DF Sign)

For what

A

DVT*

  • Need a better tool
  • DVT→ “insecure thrombus waving in current”
  • Stats:
    • Majority DVTs predicted w/ S/S
69
Q

What is the REALLY GOOD TEST for DVT??

A

Wells Clinical Score for DVT

*Understand HOW to score

  • >3= HIGH RISK***
70
Q

Caprini Risk Assessment for_____

A

DVT

  • On Caprini thats NOT on Wells:
    • For women only: *See box!
  • Score/Risk/VTE Incidence
    • 0-2 Very low-low <1.5%
    • 3-4 Mod 3%
    • 5-8 High 6%
    • >8 Very high 6.5-18.3%
71
Q

VTE ==

A

VenoThromboEmbolism

  • After NeuroSx = risk as high as 50% & remains in hypERcoagulation state for wks
  • COPD INCs risk due to immobility
72
Q

Strong Risks of DVT

Pathos/Conditions

5:

A
  • SCI
  • Major Trauma
  • Major Sx
  • Total Joint Replacement
  • Fx→ pelvis, femur, tibia (notice locations!!!)
73
Q

Add’l Risks of DVT

Pathos/Cond’s

A
  • AIDS
  • Varicose veins
  • Pacemakers
  • Pregnancy→ Stasis, Viscosity of blood
  • Obesity
  • Acute MI
  • Long airline flights (>2hrs)
  • Recent central venous cath.
  • Blood Type A→ clots + myocardial issues
  • Anti-thrombin deficiency
  • Oral contraceptives***
74
Q

DVT Morbidity & Mortality

A

30% pts suffer recurrent DVT w/in next 10yrs, GREATEST risk in the first 2 yrs*

75
Q

**Clinical Pearl for DVTs

A

1min active ankle pumping DECs venous stasis & INCs venous blood flow for up to 30mins after exercise*

76
Q

Clinical Pearl #2 for DVTs

ASA/NSAIDs

A
  • ASA→ works via irreversible binding of COX-1 enzyme rendering platelet permanently UNable to aggregate
  • NSAIDs→ do the same on a reversible basis w/ inhibition related to half-life (2-12hrs)

*ASA (not enteric-coated) should be taken @ least 30mins BEFORE or more than 8 hrs AFTER ibuprofen (NSAID) to avoid attenuation of ASA effect

77
Q

ASA ______ BEFORE NSAID

78
Q

Black Box Warning: FDA Warning about ASA & NSAID

A

ASA 30mins BEFORE NSAID

79
Q

S/S of a PE

A
  • Angina-like pain or crushing chest pain
  • Dyspnea, wheezing, rales
  • DEC BP
  • Hemoptysis, chronic cough
  • Fever
  • Tachypnea (>16/min)
  • Tachycardia (>100/min)
  • Diaphoresis
80
Q

Cond’s that Mimic DVT

A

Bakers cyst, Sciatica, Cellulitis, Hematoma, Myositis,

81
Q

Clinical Signs of HTN

A
  • Spont. epistaxis (nosebleed)
  • Occipital HA
  • Dizzy, visual changes
  • Nocturnal urinary freq*
  • Flushed face
82
Q

7th Report of Joint Nat’l Committee on Prevention, Detection, and Tx of High BP

Following are major CV Risk Factors:

A

see pics but NOTE:

  • Elevated LDL (or total >/= 240
  • DM, obesity
  • Age >55 men, >65 women
  • Lack of exercise***
83
Q

System Review: CV & Pulmonary

Leukemia

BEST Dx CRITERIA???

A

Enlarged Lymph nodes***

84
Q

System Review: CV & Pulmonary

Leukemia

A
  • Enlarged lymph nodes→ best Dx criteria**
  • Epistaxis, bleeding gums
  • Hematuria, rectal bleed
  • Bruised skin, petechiae
  • Infxs, fever
  • Weak, fatigue
  • wt loss, loss of appetite
  • Enlarged spleen*
85
Q

Effects of Dehydration

Causes

A
  • DEC CNS fx w/ DEC thirst
  • Vom/diarrhea
  • DM
  • Excess sweat/fever
  • Sx
  • Meds (diuretics)
86
Q

Effects of Dehydration

S/S

A

Altered mentation, Lethargic/agitated, Lt headed or syncope, OH, Weakness

87
Q

One of the most common causes of death in Elderly***

88
Q

System Review: CV & Pulmonary

PNA

Typical Symptoms:

A
  • Fever*, chills
  • Productive cough→ rust-colored sputum
  • Pleuritic chest pain
  • SOB

Additional→ confused, lose appetite, change sleep habits

89
Q

System Review: Integumentary

Braden Scale for ________

A

Risk of Pressure Ulcers

LOWER score==HIGHER risk***

90
Q

Common Bacterial skin infx

A

Cellulitis

  • @ Risk:
    • DM
    • Circ. probs
    • CHF
    • Liver disease
    • Eczema
    • Psoriasis
    • Severe acne
91
Q

Cellulitis

S/S

A
  • RECENT skin disruption***
  • pain, swell, warmth
  • Erythema w/ streaks/vague borders
  • fever & chills
  • HA
  • LOW BP
  • Enlarged lymph nodes
  • Small red spots appear on top of reddened skin*
92
Q

Herpes Zoster

Vaccine: Shringrix

FACTS

A

⅔ of pts are >50yo*

Contagious→ via resp. droplets OR Direct Contact w/ blisters*

93
Q

Herpes Zoster

Talk about Trigeminal N.

A

Thoracic (50%) & opthalmic division of Trigeminal N. MOST commonly affected regions

94
Q

Herpes Zoster

A
  • Pain/tenderness/parasthesia in the dermatome 3-5d before vesicular eruption
  • Prodromal pain→ mimics cardia or pleural pain
  • Erythema & vesicles follow dermatomal distribution
  • Pustular vesicles from crusts
  • Thoracic (50%) & opthalmic div. of Trigeminal N.
95
Q

Herpes Zoster

A

Acyclovir should be admin’d w/in 72hrs of onset of rash

Rash DOES NOT cross midline of body

96
Q

Systems Review: Endocrine

Gout

Why the Toe?

A

Toe is typ coldest area in body→ Uric Acid crystallizes in cold environ’s

97
Q

System Review: Endocrine

Gout

Main things are bolded**

A
  • Prob w/ INC purine leading to INC uric acid
  • Foods high in Purine (Rich Man’s Disease*)= shellfish, organ meats, dried beans, peas, anchovies, high-fructose corn syrup
  • Alcohol (esp beer)→ DEC ability to get rid of purines***
98
Q

Gout

S/S

A
  • Inflammation of 1st MTP, knee, wrist, or elbow
  • rapid onset of sudden severe pain
  • red/swell
  • Tender/hypersensitive
  • fever, chills
99
Q

Gout

Tx

A
  • NSAID (beware GI bleed)
  • Colchicine
  • Corticosteroids
  • Meds that DEC uric acid lvls

*Female sex hormones INC urinary excretion of uric acid so PREmenopausal women have LOWER prev. of gout

100
Q

HypOthyroidism (SLOW Motor)

S/S

(MOM’S SO TIRED)

A
  • Memory loss
  • Obesity
  • Malar flush/ Menorrhagia
  • Slowness (mentally and physically)
  • Skin and hair dryness
  • Onset gradual
  • Tiredness
  • Intolerance to cold
  • Raised BP
  • Energy levels fall
  • Depression/ Delayed relaxation of reflexes
101
Q

HYPOthyroidism

A
  • PR <60 in untrained person***
  • DEC BMR
  • Dry skin
  • Mm/Jt painf
  • PROX weakness
  • Lethargy/depression/apathy
  • Confusion
  • Wt GAIN
  • Edema around eyes
  • Loss of lateral eyebrow*
  • Cardiomegaly
  • Contipation
  • Cold INtolerance
  • Brittel nails*
  • Sparse/course hair
  • Periph. edema
  • Jt effusion w/ Ca++ deposits
  • CTS
  • SLOW healing
  • Hoarseness
102
Q

Hyperthyroidism

(SWEATING)

A
  • Sweating
  • Weight loss
  • Emotional lability
  • Appetite increased
  • Tremor/ tachycardia
  • Intolerance of heat/ Irregular menstruation/ Irritability
  • Nervousness
  • Goitre and GI problems (diarrhea)
103
Q

Hyperthyroidism (FAST Motor)

Pts = 50yo

Order of likelihood*

A
  • TACHYcardia*
  • HypERactive reflexes*
  • INC sweating (see mnemonic)*
  • Heat intol.*
  • Fatigue
  • Tremor
  • Nervous
  • Polydipsia
  • Weakness
  • INC appetite
  • Dyspnea
  • Wt LOSS*
104
Q

Hyperthyroidism (FAST Motor)

Pts >/= 70yo

Order of likelihood

A
  • TACHYcardia*
  • Fatigue*
  • Wt LOSS*
  • Tremor
  • Dyspnea
  • Apathy
  • Anorexia
  • Nervousness
  • Hyperactive reflexes
  • Weakness
  • Depression
  • INC sweating
  • Polydipsia
105
Q

System Review: Urogenital

106
Q

Systems Review: Urogenital

UTIs caused by any ______ diff bacteria

107
Q

Systems Review: Urogenital

Urogen Patho’s ex’s

A
  • Pain w/ micturition, Leukocytes+Bacteria in urine (white casts), cloudy urine, Back pain
  • fever/chills, nausea, loss of app., Pain w/ percussion over kidneys
108
Q

Cx

Most Common Primary Sites of Metastatic Tumors

5:

A
  • Lung
  • Prostate
  • Renal
  • Breast
  • Colon
109
Q

Cx

Most Common Primary Sites of Metastatic Tumors

Lung:

Where are the mets?

A

Brain, Vertebrae, Liver

110
Q

Cx

Most Common Primary Sites of Metastatic Tumors

Lung

A
  • >60yo
  • Smoker
  • C/S, shoulder, chest pain**
  • TOS sx’s
  • Chronic cough, bloody sputum
  • Wt loss; malaise
  • Fever
  • Dyspnea, Wheezing
  • Fecal breath odor**
  • Neural sx’s 2* spinal fluid mets
111
Q

Cx

Most Common Primary Sites of Metastatic Tumors

Renal

A
  • 55-60
  • Hematuria** (sign of patho)
  • WT loss
  • Malaise, Fever
  • Palpable posterior lateral abdominal mass
112
Q

Cx

Most Common Primary Sites of Metastatic Tumors

Prostate

A

*Men in USA have 16.5% lifetime risk for prostate cx

  • >50
  • L/S pain*
  • Freq urination, Weak urine stream, Diff starting urination*
  • Sacral plexus sx’s**
113
Q

Cx

Most Common Primary Sites of Metastatic Tumors

Prostate

Talking about PSA Lvls (naturally INC w/ age)

A
  • Only 30% time does elevated PSA indicate prostate cx
  • Guidance falls bw extremes of “testing nobody” & “testing everybody”

See pics for PSA Lvls→ Simonds taught us bw 4-10==NORMAL

114
Q

PSA Testing

A
  • Updated guidelines state men should gen be referred for prostate biopsy when PSA >3ng/mL
    • creates problems!!!
  • PSA INCs w/ age→ using this LOW threshold will INC # of False-(+)s & subject men to harms of biopsy**
  • REPEAT BLOODWORK FIRST***
  • AUA suggests biopsy threshold of 10ng/mL***
115
Q

PSA Testing

A

Best evidence supports use of serum PSA for early detection of prostate cx

116
Q

PSA Testing and Life Expectancy

A
  • Mbrs agreed PSA testing should only be offered to men w/ life expect. >10-15yrs
    • IF <5yrs→ question value of any cx screening
  • Acute prostatitis→ transient rise in PSA lvls for 48hrs
117
Q

Prostate Nutrition*

“Claimed” to reduce prostate risks:

A

Greens (34% lower risk), Cooked tomatoes, Citrus fruits, Olive Oil, Soy Foods (edamame!, 35% lower risk)

118
Q

Cx

Most Common Primary Sites of Metastatic Tumors

Breast

A
  • 20-50 & >65yo
  • Nip discharge, Dimpling of breast
  • Palpable mass
  • Brachial plexus sx’s (notice how w/ Breast its B. plexus sx’s, and w/ prostate its Sacral plexus!!!!)
119
Q

Prostate & Breast Cx Nutrition*

A
  • >2.2kg weight gain doubles risk of recurrence*
  • Wt gain of 10% bf INCs breast & prostate mortality
  • Plant based diet DECs risk of all cx’s by 8%→ Breast cx by 15%
  • Alcohol→ INCs risk cx by 5% preMENO & 9% PostMENO
120
Q

Cx

Most Common Primary Sites of Metastatic Tumors

Colon

A
  • >50yrs old
  • Abdom pain, Lumbosacral pain
  • Changes in bowel habits, bloody stools
  • Malaise, wt loss
  • Pain unaffected by pos.

Differential Diagnosis & Med Screening (12 decks)

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