Presentationof Disese In The Elderly Flashcards
What are some barriers to eliciting a helpful hx?
Language/culture
Education/life experience
Fear of loss of autonomy
Fear of pain/cost
Hearing and vision difficulties
Depression/apathy
Misunderstanding the significance of symptoms
Mental status abnormalities
Symptoms related to organ system from one other than the pathology: delirium due to hypoxia from COPD
Multiple disease states
Attitudes of care givers: not looking for reversible causes of sx like meds
Bi basilar lung cracked are common in what?
Normal elderly lung and pneumonia
How might an infection present differently in the elderly?
No fever, which carries a worse prognosis than having a fever
What isn’t cause of majority of influenza fatalities?
Pneumonia
What influenza drug therapy is preferred in an older patient?
Oseltamivir
What constitutes a nursing home influenza outbreak and what is the management?
3 or more PTS. W/ fever of 101 and flu like symptoms w/in 3 days
- Isolate symptomatic patients
- Encourage staff to stay home if I’ll
- Vaccinate any susceptible patients
- Consider anti-viral prophylaxis
Cancer signs and symptoms?
- New weight loss
- Increasing fatigue
- Recent change in taste
- Decreased appetite
- Acute mental status change
- HA
- Spine pain
- Low impact frx
New onset serous otitis media can indicate what?
Oral cancer
What is the second MC cause of death worldwide?
Stroke
What tests should you have for your eyes?
> 60 annual tonometry
Diabetic: annual optometrist/ophthalmologist exam
How to screen for macular degeneration?
Amsler grid
What medicating may cause hyperthyroidism?
Amiodarone: contains iodine
How does thyroid disease differ in elderly from younger patients?
Classic eye findings less common
Tremor may be benign
How might and MI present in the elderly?
No chest pain,
SOB, pulm edema, CHF, cardiac rupture, shock
Also new Heart block
What to do if someone presents w/ risk factors for CAD and atypical symptoms?
Perform ECG
Cardiac enzymes
Risk factors same as younger people
Treatment for acute coronary artery disease?
Throomboebolytic
CT
Daily aspirin, ACEI, b-blocker, statin
CHF is most commonly associated w/?
Systolic HTN
What test is the preferred test for evaluation of LV function, but what is the gold standard?
Echo preferred test, cardiac cath gold standard
Treatment for systolic CHF?
ACEI for afterload reduction
Diuretic for volume
Digoxin for exacerbation
Beta blockers unless CI
what is the MC valvular disease of the elderly and what’s it’s treatment?
MR and ACEI if mod-severe
mitral stenosis is associate w/ __ ___ and its presentation looks like CHF or new onset fibrillation. treatment
rheumatic fever, thombolytic therapy
aortic regurg treatment?
contraol HTN and treat dyslipidemia
what is the second most common indication for heart surgery in the elderly after CABG?
aortic stenosis
patient presents w/ exertional angina, dizziness, dyspnea? dx
aortic stenosis
pt. presents w/ new onset afib/flutter. TRX workup?
rate/rhythm control, thrombolytic therapy
echo, r/o hyperthyroidism and electrolyte imbalance
patient presents w/ ache in calf, buttock, or thigh that resolves w/ rest. They have dimished distal pulses and skin is cool to touch. They have non healing LE ulcers or gangrene. dx. trx
peripheral artery disease
reduce risks exercise Daily ASA percutaneous angioplasty surgery
pt. presens w/ edema aound the ankle that spares the dorsum of the foot. They have an ache, heaviness or tightness in the LE. They have varicose veins, painless ulcers and skin is war, dry, shiny and has bluish redish hue. DX trx
chronic venous insufficiency
compression stockings
frequent ulcer care
weight loss
exercise
COPD therapy
o2 when hypoxic on room air
when to screen for vit-b12 defieciency?
frail, changes in RBCs and WBCs w/ or w/o anemia (megolobastic?), gait disorder, unexplained neuro symptoms
what can acute appenidicitis look like for elderly?
low grade fever and general abdominal pain, MUST SURGERIZE
diverticulitis and or mesenteric/colonic ischemia can cause?
peritonitis, typ absent bowel sounds, generalized tenderness and rigidity. Hypotension and cv collapse will occur if untreated
what might not occur in peptic ulcer disease?
evidence of perf like sudden pain and rigidity
management of consitpation?
hydration, excercise, stool softender: colace, lactulose or sorbitol titrate to achieve a BM everyday or every other day
work up for BPH?
DRE, urinanalysis, renal function tests
treatment for BPH?
alpha 1 blocker, 5 alpha reductase, surgery: transurethral incision of prostate, transurethral resection of prostate
is urinary incontience normal?
no
types of urinary incontinence?
total, stress (increased abdominal pressure), urge (>7x perday or 2 or more at night), overflow (BPH) retention issue
transient cause of urinary incontinence?
diappers delirium infection atrophic vaginitis pharm psych excess fluid output restricted mobility stool impaction
osteoarthritis treatment?
acetaminophen 1,000 mg
treatment for gout?
NSAID (not indomethacin) or prednisone are alternative therapies
patient presents w/ HA, scalp tenderness, jaw claudication, and vision loss. his ESR is greater than 50. dx treatment
giant cell arteritits (confirm w/ biopsy of temp. artery)
corticosteroids
treatment for basal cell/squamous cell cacner?
electrodesiccation and curettage, or excision
patient presents / scaly, rough, adherent lesion of face, lips, ears, forearms, dorasl asepcts of hands. what are you concerned for? dx trx
SCC
Actinic keratosis
cryotherapy, imiquimod, fluorouracil
