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Exam theory > hx taking > Flashcards

hx taking Flashcards

1
Q

LO 1: Describe communication barriers common to clinical encounters with geriatric patients

A
  1. Patients may under-report (hidden illness).
    Or symptoms assumed normal part of aging.
  2. Provide an inadequate description of the chief complaint due to memory loss, depression, hearing impairment and or cultural issues.
  3. **Age gap ** makes it difficult to establish rapport.
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2
Q

LO 2: Discuss ways to overcome the barriers

A
  1. Quiet rooms; reduce noise
  2. Speak distinctly and where they can read your lips
  3. Don’t shout
  4. Take your time and avoid ageist remarks
  5. Conservatively dressed
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3
Q

Think anatomy

Why is shouting at the patient if you think they have hearing problems not helpful?

A

Because age-related stiffening of the tympanic membrane and ear ossicles distorts high-volume sound

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4
Q

LO3: Describe how history of presenting complaint and past medical history differs in a geriatric patient compared to a younger adult

A
  • Elderly often present with multiple concurrent problems.
  • Acute illnesses often have atypical presentations with non specific symptoms.
  • general rule; comorbidities
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5
Q

LO4: List and describe the components of a functional assessment for older adults

A
  • Vision
  • Hearing
  • Cognitive
  • Depression
  • Nutritional Status
  • Mobility
  • Physical disability/Functional status
  • Urinary Incontinence
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6
Q

LO5: Discuss import aspects of nutritional assessment for older adults

A

elderly are more vulnerable to inadequate nutrition.
* Issues with dentition or ill-fitting dentures.
* Diminished appetite due to depression, loneliness, or appetite-suppressing drugs.
* Conditions prevalent in elderly include constipation, congestive heart failure, cancer, dementia.
* Lack of financial resources.
* Disabilities resulting in limited access to food&/or inability to prepare meals.

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7
Q

LO6: Discuss the issues that should be considered routinely in the geriatric social history

A
  • working status/income
  • Participation in economic assistance programs
  • Living arrangments
  • Availabilty of transportaton and shopping
  • Education reading level
  • Motivation and adherence to health recommendations
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8
Q

Order of components for standard history

A
  • Demographic data,
  • Chief complaint and presenting illness,
  • PMH (past medical Hx)
  • Functional Status Screen,
  • Social History,
  • Family History
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9
Q

Compare acute MI presentation between elderly and younger populations

A

Younger: Presents sudden onset of crushing chest pain and diaphoresis.
Elderly: Sudden onset of dyspnea (feeling a lack of air in breathe) accompanied with anxiety and confusion.

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10
Q

List some common hidden illnesses in an older person

A

Heart failure, osteoporosis, hypertension, diabetes etc.

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11
Q

Mc deficiencies in elderly

A

riboflavin (B2) and pyridoxine (B6).

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12
Q

High levels of alcohol consumption over a long time =

A

thiamine (B1) deficiency, resulting in Wernicke-Korsakoff syndrome (brain damage)

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13
Q

Characteristic of trace element deficiencies associated with:
Weight loss, glucose intolerance, and diabetic neuropathy

A

chromium

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14
Q

Characteristic of trace element deficiencies associated with: Goiters

A

iodine

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15
Q

Characteristic of trace element deficiencies associated with: Anaemia and leukopenia

A

Copper

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16
Q

Characteristic of trace element deficiencies associated with:
Diarrhea, dermatitis, hair loss, poor wound healing, alteration in the senses of taste and smell

A

zinc

17
Q

A loss of central vision could mean:

A

Macula Degeneration (MD)

18
Q

Causes of macula degeneration

A

genetic and environmental factors.

19
Q

risk factors for macula degeneration

A

Risk factors include age, family history, smoking and diet and lifestyle factors.

20
Q

Screening for MD

A

Amsler Grid

21
Q

loss of peripheral vision could mean:

A

Glaucoma or Stroke

22
Q

Eye pain could mean

A

Glaucoma
Temporal Arteritis

23
Q

An elderly patient bothered by glare from lights at night, especially when driving. What might this suggest?

A

Cataracts ( clouded lens)

24
Q

Simple hearing tests performed

A
  • Screen “Do you have difficulty hearing?”
  • Tuning fork tests
  • Rubbing sound near ear.
  • Whispered Voice Test:
25
Q

Which simple hearing tests are more appropriate for elderly? explain your justification for why you didn’t choose the others?

A
  • Rubbing sound near ear.
  • Whispered Voice Test

Elderly typically lose high frequency, forks may miss this range.
Screen (Self reporting) has low sensitivity

26
Q

Vision and hearing are important sensory factors to consider for eldery population. What are two assessment/exams that ensure these are intact.

A

Mini Mental State Exam (MMSE)
Mini-Cog assessment instrument

27
Q

SPLATT

A

Symptoms prior to fall – dizziness? New symptoms?
Previous falls or near falls – no.1 risk factor for a fall.
Location of fall – environmental factors (wet floor, furniture layout)
Activity at time of fall – sit-stand? Reaching outside BOS
Time of fall – night? After medication?
Trauma, physical and psychological – fear of falling can lead to greater levels of weakness and others performing ADLs for them => increasing risk of future fal

28
Q

Urinary Incontinence
Risk Factors for elderly population:

A
  • Female 2:1
  • Age
  • Parity
  • Dementia
  • Polypharmacy
29
Q

What do older patients fear the most?
A. Death
B. Illness
C. …or?

A

Loss of independance, being a burden.

30
Q

Things to consider with social history of elderly

A
  • Vocation (a strong feeling of suitability for a particular career or occupation)
  • habits/lifestyle,
  • living arrangements/transport,
  • social network,
  • adaptation.
31
Q

Average number of medications taken by community dwellers?
A. 0-1
B. 2-3
C. 4-5
D. 6-7
E. 8-9

A

C. 4-5

32
Q

Average number of medications taken by nursing home residents?

A

7-9

33
Q

Key links/factors in vocation for elderly

A
  • Career
  • Current and previous employment (paid or volunteer)
  • Duration of retirement
  • Highest level of education
34
Q

Key lifestyle habits for elderly

A
  • Exercise
  • Sleep
  • Tobacco
  • Alcohol
  • Recreational activities
35
Q

Key things to consider with social activity in elderly

A
  • Marital status
  • Number of children and frequency of visits
  • Existence and involvement of other relatives or close friends
  • Frequency of attendance at community or religious meetings or events

Exam theory (9 decks)

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