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Level 2 COMLEX CE > Geriatrics > Flashcards

Geriatrics Flashcards

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1
Q

“Get up and go” test is failed if it takes longer than ____ seconds.

A

30

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2
Q

“Get up and go” test takes pts less than _____ seconds to pass.

A

20

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3
Q

10 RF for pressure ulcers:

A

External forces on skin, host specific factors, pressure moisture, nutritional status, neurological disease, tissue susceptibility, friction, immobility, Incontinency, circulatory

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4
Q

A congenital diverticulum involves:

A

all layers

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5
Q

A pressure ulcer is NOT stageable if it is:

A

Covered by a eschar

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6
Q

A pulsion diverticulum involves the:

A

mucosa and submucosa herniating through the muscle layer

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7
Q

A worse prognosis for Bence Jones (light chain) myeloma:

A

Lambda LCD has a 3x worse prognosis than Kappa LCD

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8
Q

Abnormal karyotype, especially:

A

Chromosome 13

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9
Q

Abx for diverticulitis should cover (2):

A

Gram negative anaerobes (and gram + anaerobes, too)

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10
Q

ACA stroke causes ___.

A

contralateral paralysis and sensory loss - lower limb

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11
Q

Activities of Daily Living (ADLs) (4)

A

Dressing, Mobility, Feeding, Toileting (grooming, bathing, and continence)

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12
Q

After being delirious a patient is ____ as likely to die in one year.

A

Twice

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13
Q

After starting levothyroxine the TSH should be checked at:

A

2 months and 6 months

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14
Q

Age-related cognitive decline (ARCD) should be:

A

the decline in cognitive function within normal limits given the person’s age

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15
Q

Allodynia is:

A

Pain from stimuli that are not usually pain

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16
Q

Alpha-1 blockers (Tamsulosin):

A

Relax sphincter to help with overflow incontinence

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17
Q

Amantadine 100mg bid: MOA and 4 ADV in tx Parkinsonism.

A

MOA is unclear, but has serious side effects: restlessness, confusion, anorexia, postural hypotension

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18
Q

An example of elder neglect:

A

A patient with multiple bed sores/ulcers with dehydration

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19
Q

Anticholinergics (Oxybutynin) improve __ incontinence and worse __.

A

Make urge better and overflow worse

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20
Q

Anticholinergics help with the _______ of Parkinson’s.

A

Tremor

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21
Q

Are there any contraindications for OMM in the elderly?

A

No CIs on age alone. Be cautious with pts with high risk of stroke

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22
Q

Assessing pain - PQRST:

A

Palliative, Quality, Region/radiation, Severity, Timing/type

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23
Q

Associated symptoms of hypothyroidism: (5)

A

Bilateral carpal tunnel, Urticaria, Pulmonary HTN, Anemia, Elevated lipids

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24
Q

Bacteriuria:

A

greater than 100,000 cfu/ml; send to hospital!

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25
Q

Bethanechol: 2

A

Stimulates cholinergic receptors and increases detrusor tone to improve urinary retention

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26
Q

Bisphosphonate MOA

A

bind hydroxyapatite in bone, inhibiting osteoclast activity

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27
Q

Bisphosphonates pose a great risk of:

A

Esophageal perforation

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28
Q

Bladder scan: normal and abnormal volumes

A

< 50mL left is normal; > 200mL left needs to be addressed

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29
Q

Bone loss increases in women around the time of ___.

A

Around the time of menopause, typically after age 50

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30
Q

Braden scale for pressure ulcers: what indicates high risk?

A

Less than 18 indicates high-risk

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31
Q

Break through dose needs to be:

A

10-20% of the total daily dose — if more than 2 break through doses needed, increase the around the clock dose

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32
Q

BUN Ratio showing dehydration:

A

20:01

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33
Q

Burning pain should be treated with:

A

Amitriptyline (TCA)

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34
Q

C. diff is confirmed with:

A

stool C. diff toxin assay

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35
Q

Causes of contractures (6):

A

Spasticity, Heterotopic ossification, DJD, Fracture, Dislocation, Psychogenic

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36
Q

Cellulitis is caused by (2):

A

Group A Strep and Staph aureus

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37
Q

Clinical features of RA: 5

A

Ulnar deviation, MCP joints, Multiple joints, Symmetrical, Morning for no more than 30 mins

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38
Q

Clinical manifestation of infection:

A

Decline in mental/cognitive function

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39
Q

Clinically fever if (3 sx)

A

Temp is greater than 2 degrees above baseline, oral 99, rectal 99.5

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40
Q

Cognitive dysfunction is declared when the MMSE score is less than:

A

23

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41
Q

Contractures are:

A

A shortening of muscle, CT, tendons, ligaments, or skin; elastic tissue replaced with fibrous

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42
Q

Delirium characteristics:

A

Acute onset that “waxes and wanes”

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43
Q

Delirium is a disorder of:

A

Attention

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44
Q

Delirium is treated with what medication:

A

Haloperidol

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45
Q

Dementia medications (3)

A

Acetylcholinesterase inhibitors (Donepezil, Rivastigmine), NMDA receptor agonist (Memantine)

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46
Q

Dementia medications should be considered when the MMSE is:

A

24 or below

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47
Q

Dementia risk factors include (2)

A

Smoking and head injury

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48
Q

DeQuervain’s thyroiditisis known to be:

A

Very painful and tender; Tx w/ bed rest and ASA

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49
Q

Diagnostic RA: 2

A

HLA-DR4 and other immune complexes

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50
Q

Distal interphalangeal joints contain what type of node?

A

Heberdon’s Nodes

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51
Q

Diverticulosis is ____________ rectal bleeding.

A

Painless

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52
Q

Dose of calcium for men and women greater than 51yo?

A

1200mg/day

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53
Q

Drugs and EtOH cause what type of delirium?

A

Hypervigilant

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54
Q

Elder abuse is defined as:

A

Intentional or unintentional hurting, either physical or emotional, of a person who is 60+ or over 18 and incapacitated

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55
Q

EtOH and sleeping pills should be discontinued for at least:

A

6 weeks

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56
Q

Fecal impaction requires:

A

Manual disimpaction

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57
Q

Fever in the nursing home is defined as __.

A

SINGLE reading of 100 degrees F is specific and sensitive

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58
Q

Formula for calculating creatinine clearance:

A

((140-Age)*Wt in Kg)/ (72 *serum creatinine)

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59
Q

Forward movement of the body of one vertebra on the vertebra below:

A

Spondylolisthesis

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60
Q

Fractional excretion sodium percent for dehydration:

A

Less than 1%

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61
Q

Functional incontinence: 4

A

Functional or situational involving both urinary and fecal incontinence — limited mobility, limited cognition —- NOT organic cause

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62
Q

Ginkgo biloba drug interaction:

A

Increased bleeding, especially with warfarin

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63
Q

Ginseng hazard:

A

Bleeding with warfarin

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64
Q

Hashimoto radioactive iodine test would show:

A

Uptake may increase initially, because of trapping

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65
Q

Holistic management of arthritis: 4

A

Weight control, Water exercises, Address “food allergies,” and Liver/CV4 for general detoxification

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66
Q

How do you differentiate contracture from hypertonicity?

A

Passive stretching

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67
Q

How is giant cell arteritis treated?

A

Immediate high dose of corticosteroids and then treat for 18-24 months while tapering dose

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68
Q

How is Polymyalgia rheumatica treated?

A

Low dose corticosteroids

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69
Q

How long does it take for skin erythema to occur?

A

Less than 2 hours on a standard mattress

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70
Q

How many weeks does it take to recover from delirium:

A

4-6 weeks

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71
Q

How would you treat diverticulosis without medications?

A

NPO

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72
Q

HVLA should be used with caution for those with: 2

A

Osteoporosis, RA

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73
Q

Hyperalgesia is:

A

Increased sensitivity to normally painful stimuli

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74
Q

Hyponatremia in the elderly is caused by:

A

A deceased thirst mechanism

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75
Q

Hypothyroidism is treated with:

A

Levothyroxine; start at 25mcg in older people, because it can cause heart failure

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76
Q

Hypoxia in joints with RA require ____ times more oxygen.

A

20

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77
Q

IBS subgroups (3):

A

Constipation predominant, Diarrhea predominant, Pain

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78
Q

Idiopathic Parkinson’s disease starts with a ___________ tremor.

A

Unilateral

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79
Q

If an older patient cannot have a PRN prescription then:

A

Give long acting analgesics to control the pain.

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80
Q

If the thyroid levels get to low:

A

Myxedema Coma

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81
Q

IgG < 35mg/dl ( < 3 M protein) indicates __.

A

SMM

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82
Q

IgG greater than 35mg/dl (> 3 M protein) suggests dx of __.

A

MGUS

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83
Q

IgM protein greater than 3mg/mL with Lymphoplasma =

A

Waldenstrom’s Macroblobulinemia

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84
Q

Infection is indicated by WBC count greater than _________ w/ or w/o fever, or (2):

A

14,000; (or bands greater than 6%; CBC greater than 1,500 cells)

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85
Q

JVP is measured:

A

with the vertical distance from the angle of Louis up

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86
Q

Kava hazard (2)

A

Dyskinesia, sedation

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87
Q

Less than 3 BMs a week are a sign of __.

A

Constipation

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88
Q

Lewy body dementia (3 characteristics)

A

Fluctuating, has visual hallucinations, and motor features similar to Parkinsonism

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89
Q

Lewy body dementia responds (poorly/well) to meds used in Parkinson’s.

A

poorly

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90
Q

Lewy body disease is characterized by classical Parkinson’s sx and:

A

prominent dementia with visual hallucinations

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91
Q

Light chain disease (Bence Jones) has a structural gene loss of:

A

Chromosome 14

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92
Q

Lower extremity facilitated segments:

A

T11-L2

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93
Q

MCA results in a:

A

Contralateral weakness/sensory loss in the FACE and ARM (sparing leg)

94
Q

Medial compartment osteoarthritis of the knee may produce a:

A

Genu valgus deformity

95
Q

Medications that can cause osteoporosis: (5)

A

Lithium, Long-term Heparin, Phenytoin, Prednisone, Warfarin

96
Q

Medications that can cause Parkinsonism:

A

Metoclopramide (antagonize dopamine),

97
Q

Medications that cause constipation (5). Which is most impt?

A

Laxative abuse, opioids, antidepressants, anticonvulsants, Cholestyramine

98
Q

Medications that cause hypothyroidism are: (2)

A

Lithium and Amiodarone

99
Q

Medications to treat Constipation (5):

A

Bulk forming, Emollient stool softeners, Osmotic Lax, Lubricant Lax, Stimulant Lax

100
Q

MM Stage I:

A

Hemoglobin > 10, Calcium< 12, Radiograph w/ normal bone; Low M protein values (IgG < 5, IgA < 3, Bence Jones < 4)

101
Q

MM Stage III:

A

Hemoglobin < 8.5, Calcium > 12, Radiograph advanced lytic bone, High M protein (IgG > 7, IgA > 5, Bence Jones > 12)

102
Q

Most common cause of hypothyroidism: (2)

A

Hashimoto’s; anti-TPO antibodies

103
Q

Most effective therapy for contractures:

A

Manual stretching exercises

104
Q

Multiple Myeloma MAJOR criteria (2, need 1):

A

30% of cells are plasma cells, monoclonal immunoglobin excess

105
Q

Multiple Myeloma MINOR criteria (4, need 3):

A

b/w 10-20% cells plasma cells, monoclonal found but not enough, Holes in bone, amount of normal antibody in the blood is abnormally low

106
Q

Neuropathic pain should be treated with: (3)

A

Anticonvulsants (gabapentin, carbamazepine, Valproic Acid)

107
Q

Neurotransmitters of pain: (3)

A

Serotonin, NE, and Nitrous oxide

108
Q

New onset bleeding should be considered __ until proven otherwise.

A

colon cancer

109
Q

No bone pathology or renal impairment w/ globulin levels > 3.5:

A

MGUS

110
Q

Non-pharm dementia treatment options (6)

A

Daily routine, Patience, Interaction, Performing simple tasks, Environment, Advanced directives

111
Q

Non-pharmacological management of delirium (6):

A

Reorientation, Behavioral intervention, Sitters, avoid restraints, Well-lit room, avoid overstimulation

112
Q

Normal stool frequency:

A

3 to 4 per day through one every 3 to 4 days

113
Q

Norton scale for pressure ulcers: what indicates high risk?

A

Less than 14 indicates high-risk

114
Q

Often times it is difficult to assess urinary incontinence because:

A

Patients do not often mention it on their own

115
Q

OMM treatment on arthritis: 6

A

Shorten disability, Increase ROM, Decrease pain, Improve ADLs, Reduce reliance on medications, Improve postural proficiency

116
Q

Onset and progression of vascular dementia?

A

abrupt and stepwise

117
Q

Opioid constipation reversal medication:

A

Methylnaltrexone

118
Q

Opioid conversion is done by converting everything to:

A

Oral morphine and translating that to a new dose and/or route

119
Q

Opioids need to be monitored for:

A

Sedation which precedes Respiratory depression

120
Q

Osteoarthritis is a disease which primarily affects __.

A

cartilage primarily

121
Q

Osteoarthritis pathophysiology: 2

A

Attacks cartilage and chondrocytes cannot replace; bone hypertrophy

122
Q

Osteoblasts _______ bone.

A

build

123
Q

Osteoclasts ______ bone.

A

Resorb

124
Q

Osteocyte precursor cytokine:

A

IL-6

125
Q

Osteopathic principles on arthritis:

A

Reduce side effects of meds and enhance function

126
Q

Osteoporosis risk factors for women (5):

A

Early menopause, white/asian, sedentary, small frame, EtOH abuse,

127
Q

Overflow incontinence is most common in:

A

Men, secondary to prostate enlargement

128
Q

Overflow incontinence: 2

A

Dribbling from incomplete bladder emptying; BPH in older men

129
Q

Parasympathetic response on the urinary system: (3)

A

Voiding; bladder contraction and sphincter relaxation

130
Q

Parkinson’s Is caused by:

A

a degeneration of pigmented dopaminergic neurons in the substantia nigra

131
Q

Patients over 65 take how many meds?

A

2-6 medications with several OTC

132
Q

Pharmacodynamics interactions:

A

Altered physio response to a second drug w/o altering the drug concentration. Ex.) EtOH/NSAID = GI bleed; Insulin/Beta blocker = hypoglycemia

133
Q

Pharmacokinetic interactions:

A

One drug alters the concentration of another drug by changing the metabolism. Ex.) Warfarin/paroxetine = ^INR

134
Q

Physical findings and labs for hypothyroidism would show (4):

A

Hyporeflexes, High cholesterol, Positive Tinels, and Slow speech

135
Q

Pneumonia if two conditions are met:

A

Respiratory rate is greater than 25 and Pulse ox is less than 90

136
Q

Pneumovax should be given at what age if haven’t received in last __ years.

A

All persons over 65 who have not received the vaccine in the last 5 years should receive another dose

137
Q

Polymyalgia rheumatica (PMR) is defined as:

A

Pain and stiffness in the hip or shoulder

138
Q

Polymyalgia rheumatica pathogenesis:

A

Immune destruction of internal elastic lamina by systemic monocyte activation

139
Q

Polypharmacy is a growing problem because (4 reasons):

A

Physicians encouraged to give more aggressive tx, Multiple new drug tx for chronic conditions, New preventative treatments, Growth of alternative treatments

140
Q

Polypharmacy is defined as the:

A

use of greater than 5 medications, which increases the risk of adverse events by 50%

141
Q

Postural instability is:

A

a late manifestation that is characterized by a greater degree of bradykinesia and muscle rigidity

142
Q

Pressure ulcers w/ poor healing: next test?

A

Obtain culture of purulent drainage or deep infected tissue

143
Q

Pt has an externally rotated and short lower extremity:

A

Suspect a right hip fracture

144
Q

Pt on Warfarin had an elevated INR:

A

Patient took a drug that interacted; perhaps acetaminophen

145
Q

Pt’s WBC is zero on high power field spun urine allows exclusion of __.

A

Exclude bacteriuria

146
Q

Pushing the arm “in and out” exams the:

A

Rotator cuff

147
Q

Pushing the arm “up and down” exams the:

A

Supraspinatus

148
Q

Red flags for constipation (5):

A

Bleeding, Fever, Wt loss, Persistent severe pain, Malnutrition

149
Q

Red flags for someone w/ suspected multiple myeloma: (6)

A

Age over 50; worse supine, worse at night, band-like, pain not relieved, constitutional sx

150
Q

Rheumatoid Arthritis Medication treatment: 3

A

DMARDs, TNF-alpha blockers, NSAIDs

151
Q

Rheumatoid Arthritis OMM treatment:6

A

Sympathetics, Lymphatics, Passive ROM, Joint pumps, Liver pump, CV4, Indirect techniques

152
Q

Rheumatoid arthritis pathophysiology: 3

A

Synovium is targeted, infiltrated by mononuclear cells; bone breakdown

153
Q

Rotator cuff movements for SItS:

A

Up, Out, Out, In

154
Q

Selegiline is a:

A

MAO-I that helps slow the breakdown of dopamine. AVOID TYRAMINE rich foods.

155
Q

Serial casting is:

A

Anesthetic block w/ stretching; Progressive casting to increase ROM from contractures

156
Q

Shy-Drager Syndrome:

A

Symptoms of generalized autonomic dysfunction in addition to Parkinsonism

157
Q

SSRIs may induce what metabolic change, esp if taken with __.

A

Hyponatremia, especially if given with a diuretic

158
Q

Stage I HTN:

A

Systolic: 140-159; Diastolic: 90-99

159
Q

Stage I pressure ulcer: change in (3), also __.

A

Change in skin temp, consistency, and/or sensation; nonblanching erythema

160
Q

Stage II pressure ulcer: 3

A

Partial thickness skin loss involving the epidermis and/or dermis; blister, abrasion

161
Q

Stage III pressure ulcer: (2)

A

Full thickness skin loss involving damage or necrosis; deep crater w/o damaging underlying tissue

162
Q

Stage IV pressure ulcer:

A

Full thickness skin loss w/ extensive destruction; damage extending to muscle, bone, etc

163
Q

Stress incontinence: 3

A

Leakage from impaired urethral support; multiparous, overweight women

164
Q

Suspect C. diff if (2 sx):

A

exposed to abx in previous 30 days and 3+ water stools w/ abdominal pain

165
Q

Sympathetic response on the urinary system: (3)

A

Distention for storage; relaxation of bladder and constriction of sphincter

166
Q

The best way to treat contractures is with:

A

PREVENTION! — move muscles and joints through full ROM on a daily basis

167
Q

The four cardinal signs of Parkinson’s disease are:

A

Bradykinesia, postural instability, muscular rigidity, tremor

168
Q

The greatest risk factor for osteoarthritis is:

A

Age

169
Q

The knee joint is effected by osteoarthritis the most from:

A

Obesity

170
Q

The mesenteric release is a(n) ________ OMM technique.

A

Indirect

171
Q

The most common cause of dementia in people over 65:

A

Alzheimer’s

172
Q

The most common sign of a contracture is:

A

Decreased ROM

173
Q

The most common site of atherosclerosis is:

A

at the common carotid bifurcation (origin of the ICA)

174
Q

The most common type of focal ischemic stroke is:

A

MCA

175
Q

The most important part of osteoporosis treatment is:

A

Diagnosis

176
Q

The neurotransmitter involved with delirium:

A

ACh

177
Q

The strokes of small vessels are:

A

Lacunar — 20% of strokes

178
Q

The thyroid is __________ in Hashimoto’s.

A

enlarged

179
Q

TIA is when neurologic symptoms last:

A

Less than 24 hours

180
Q

Tramadol will adversely interact with what commonly used drug?

A

SSRI’s, causing serotonin syndrome

181
Q

Transient urinary incontinence – “Diappers:”

A

Delirium, Infection, Atrophic urethritis, Pharm, Psych, Excessive fluid output, Restrictive mobility, Stool impaction

182
Q

Two most common symptoms of dehydration in the elderly:

A

Acute weight loss and hyponatremia

183
Q

Tx of subclinical hypothyroidism:

A

Antibody present, TSH is greater than 10mg/mL, Symptoms

184
Q

Uncomplicated inpatient diverticulitis treatment (3):

A

NPO, IV fluids, ABX

185
Q

Upper extremity facilitated segments:

A

T2-T8

186
Q

Urge incontinence: 3

A

Uninhibited bladder contractions or detrusor overactivity; most common cause of incontinence in older men

187
Q

Urinalysis needed for:

A

Residents with long-term indwelling urethral catheters

188
Q

Urine sodium concentration for dehydration:

A

Less than 25mEQ/L

189
Q

What are the 3 major types of urinary incontinence?

A

Urge, Stress, Overflow

190
Q

What are the different types of elder abuse (6):

A

Physical/verbal, Psychological/emotional, Neglect/abandonment, Sexual, Financial exploitation, and Healthcare fraud

191
Q

What are the medications used to treat diverticulitis? (3)

A

Cipro and Metro; Alt: Piperacillin-tazabactam

192
Q

What are TSH and T3/4 levels in hypothyroidism?

A

TSH is high; T3/4 would be low

193
Q

What disease is associated with a “M spike?”

A

Multiple Myeloma

194
Q

What drug can be used as a adjunct to Levodopa to reduce metabolism:

A

Tolcapone, a COMT-I

195
Q

What drugs can cause dementia? (4, and which is most impt?)

A

Anticholinergics, Narcotics, Sedatives, Metoclopramide

196
Q

What has a NNT of 7 for treating osteoporosis hip fractures?

A

Hip pads

197
Q

What imaging modality is most effective?

A

CT without contrast to rule out hemorrhage

198
Q

What is a contraindication to thrombolytic? (4)

A

a systolic BP greater than 185 or a diastolic greater than 110; bleeding; head trauma

199
Q

What is something that is NOT associated with normal aging?

A

Hypothalamic satiety becomes less sensitive, resulting in anorexia —- it actually becomes HYPERSENSITIVE

200
Q

What is the best “treatment” for pressure ulcers?

A

PREVENTION

201
Q

What is the best way to prevent diverticular disease?

A

High fiber diet

202
Q

What is the diagnostic test of choice for diverticulosis?

A

CT with contrast, BUT if perforation NO BARIUM

203
Q

What is the first thing ordered when working up suspected osteoporosis?

A

Plain frontal and lateral radiographs of spine

204
Q

What is the highest risk factor for stroke?

A

HTN

205
Q

What is the major complication of giant cell arteritis?

A

Blindness can develop from involvement of the ocular arteries

206
Q

What is the t-score of a woman dx w/ osteoporosis?

A

T is less than -2.5

207
Q

What medication reduces risk of future stroke by 30%?

A

Antiplatelet tx w/ Aspirin

208
Q

What nonstandard lab should be taken in a patient with dementia?

A

Methylmalonic acid — B12 precursor

209
Q

What part of the colon is most likely to bleed?

A

Right side

210
Q

What part of the colon is most often found to have diverticula?

A

Sigmoid colon

211
Q

What percentage of people over 85 have dementia?

A

25%

212
Q

What protein intake is necessary to help prevent pressure ulcers?

A

1g/kg/day in all pts with pressure ulcers

213
Q

What should someone with pressure ulcers avoid?

A

Topical antiseptics such as povidon-iodine or hydrogen peroxide

214
Q

What sx are common with Polymyalgia rheumatica? (5, with 1 most impt)

A

Fever is most common; also decreased ROM, pain, transient synovitis, normal muscle strength

215
Q

What tests indicate Polymyalgia rheumatica is present?

A

ESR > 40; CRP > 6

216
Q

What time of day do stroke onsets peak?

A

Late morning

217
Q

What time of day is Polymyalgia rheumatica worse?

A

Morning hours

218
Q

What timeframe provides the greatest success to RA treatment?

A

Start treating BEFORE 8 weeks

219
Q

What values may be increased with Polymyalgia rheumatica? (4)

A

HLA-DR4, IL-2, IL-6, CRP

220
Q

When should you order a follow up CT?

A

at 24 hours

221
Q

When would you use a Z-score for osteoporosis? (3)

A

Premenopausal women, men under 50, and children

222
Q

Which Stage has worse outcomes: A or B?

A

Stage B has worse outcomes, because kidney problems!

223
Q

Who are mandated to report elder abuse? (3)

A

Physicians, Nurses, Social workers

224
Q

Who first described “Total pain?”

A

Dame Cicely Saunders — Physical, Psychological, Emotional, Social, Spiritual

225
Q

Who is likely to suffer from polymyalgia rheumatica?

A

White women >50 yoa

226
Q

WHO Step 1 analgesics: (3)

A

APAP, NSAIDs, Tramadol

227
Q

WHO Step 2 analgesics:

A

APAP combined with hydrocodone, codeine, and oxycodone — ultimately APAP dependent

228
Q

WHO Step 3 analgesics: (5)

A

Morphine, oxycodone, fentanyl, hydromorphone, and methadone — no ceiling dose

229
Q

Why is lymphatic drainage important in arthritis?

A

To remove the waste products from the synovium and joint area, reducing congestion and proteins that would promote further fibrosis and inflammation

230
Q

Why is the onset of symptoms important?

A

If less than 3 hours, then thrombolytic are an option

Level 2 COMLEX CE (3 decks)

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