Medical Examination Practices

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Questions and Answers

What is a primary reason to consider hospitalization for patients with complicated UTI?

Presence of severe pain not manageable at home

History of recurrent UTIs

Patient's preference for intravenous antibiotics

Inclusion of other parts of the renal tract in the infection (correct)

Which treatment is specifically recommended for catheter-associated UTI (CAUTI)?

Increased fluid intake without any other intervention

Prolonged antibiotic treatment irrespective of catheter changes

Immediate surgical intervention

Removal or changing of the catheter if it has been in place for more than 7 days (correct)

What defines recurrent UTI?

More than four episodes of UTI within a month period (correct)

Any UTI that requires hospitalization

Less than two episodes of UTI in a year

Presence of antibiotic-resistant organisms in urine

What benefit do intra vaginal oestrogens provide in the treatment of recurrent UTI in postmenopausal women?

Restoration of normal vaginal flora and reduced risk of vaginal colonization Signup and view all the answers

What is a common recommendation to help prevent UTIs?

Drink plenty of liquids, especially water Signup and view all the answers

What physiological correlation is associated with pseudohypertension in older adults?

Calcified brachial artery Signup and view all the answers

Which condition is indicated by end expiratory crackles in older patients?

Decreased elastic recoil Signup and view all the answers

What change in laboratory values may be expected in older adults with creatinine clearance (CrCl)?

Normal creatinine levels despite low CrCl Signup and view all the answers

What is a common finding during a comprehensive functional assessment of older adults?

Polypharmacy concerns Signup and view all the answers

Which test is used to evaluate falls risk in older adults?

Get up and Go test Signup and view all the answers

What is observed in the serum albumin levels of older adults?

Decreases or remains normal Signup and view all the answers

Which scale is used to assess cognitive function in elderly individuals?

Clock drawing test Signup and view all the answers

What is a common physiological finding associated with systolic hypertension in older adults?

Rigid aorta Signup and view all the answers

Which medications are considered adjuvants for pain management?

Antidepressants Signup and view all the answers

What is a key consideration when administering Tramadol to elderly patients?

Potential interaction with serotonergic medications. Signup and view all the answers

Which drug may be a better choice for elderly patients with renal impairment?

Hydromorphone Signup and view all the answers

Which of the following is categorized as a high-risk medication?

Analgesics/opioids Signup and view all the answers

Which psychological consequence can result from falls in elderly patients?

Loss of confidence Signup and view all the answers

What should be assessed when evaluating a history of falls?

Circumstances of the falls Signup and view all the answers

Which medication is used as a local analgesic for herpetic neuralgia?

Lidocaine patches Signup and view all the answers

Which of the following is NOT a consequence of falls in elderly patients?

Enhanced independence Signup and view all the answers

What is the significance of a plasma osmolarity greater than 295 mOsm/kg?

Indicates mild or preclinical dehydration Signup and view all the answers

Which of the following symptoms is NOT commonly associated with dehydration?

Increased sweating Signup and view all the answers

What management method is recommended for patients who are unable to eat?

Intravenous infusion of liquids totaling 2500 ml Signup and view all the answers

Which of the following tests is considered the gold standard for assessing osmolarity?

Plasma osmolarity test Signup and view all the answers

What might cause an increased plasma urea/creatinine ratio in elderly patients?

Heart failure Signup and view all the answers

Which condition is NOT a risk factor for dehydration in the elderly?

Regular exercise Signup and view all the answers

What is a significant indicator of dehydration based on body weight?

Reduction of body weight by 4% within 7 days Signup and view all the answers

What type of fluid infusion is recommended in cases of hyperosmolarity?

5% glucose 0.2% NaCl (hypotonic infusion) Signup and view all the answers

What is the prevalence of dementia syndrome in individuals aged 85 years and older?

1 out of 5 Signup and view all the answers

Which of the following is a key feature of dementia syndrome?

Progressing dependence Signup and view all the answers

In which stage of Alzheimer's disease do neuropsychiatric symptoms such as visual hallucinations usually emerge?

Moderate stage Signup and view all the answers

What type of assessment is essential when dementia syndrome is suspected?

Comprehensive physical assessment Signup and view all the answers

During which stage of Alzheimer's disease do patients typically experience short-term memory impairment along with anxiety and depression?

Initial, mild stage Signup and view all the answers

What laboratory test is commonly part of the evaluation for dementia syndrome?

Peripheral blood count Signup and view all the answers

Which type of dementia is considered more common?

Late onset, after 65 years Signup and view all the answers

What might correlate with the degree of dementia during an MRI evaluation?

Specific MRI findings Signup and view all the answers

Study Notes

General Examination

Rectal and annual stool examination recommended for patients over 50 to check for occult bleeding, BPH, and hemorrhoids.
Foot examination should include assessment for calluses, warts, ingrown toenails, deformities, infections, and vascular issues.

Physiological Correlations

Pseudohypertension: Non-compressible, calcified brachial artery can give misleading blood pressure readings.
Orthostatic Hypotension: Poor sensitivity of baroreceptors leads to difficulty with blood pressure regulation.
Systolic Hypertension: Characterized by a rigid aorta causing elevated blood pressure readings.
Early Systolic Murmur: Caused by aortic stenosis, which leads to turbulent blood flow.
End Expiratory Crackles: Indicative of decreased elastic recoil in the lungs.

Changes in Diagnostic Tests for Older Adults

CBC: Generally remains unchanged in older adults.
ESR: Typically normal, may not significantly indicate inflammation.
Urinalysis: Increased incidence of bacteriuria and pyuria; creatinine often appears normal despite decreased clearance.
Creatinine Clearance (CrCl): Generally decreases with age.
Serum Albumin: Levels may decrease or remain normal.
FSH/LH Levels: Typically increase with age.
ABG (pO2): Decreased levels noted in older adults.
Head CT: May show mild or no cerebral atrophy, with dilated ventricles noted.

Comprehensive Functional Assessment

Utilizes physical and psychosocial function assessments to identify diseases and monitor treatment.
Key assessment tools:
- Functional Status: Barthel’s Index, Instrumental Activities of Daily Living (IADL).
- Nutrition: Mini Nutritional Assessment (MNA-SF), Nutritional Risk Screen 2002 (NRS).
- Falls Risk: Get Up and Go test, Sharpened Romberg test.
- Cognitive Assessment: Mini Mental State Examination (MMSE), Clock Drawing Test (CDT).
- Emotional Assessment: Geriatric Depression Scale (GDS).
- Perceptive Evaluation: Assess hearing, speech, and vision.

Social factors play a significant role in health outcomes and healthcare needs.

Drug Considerations

High-risk medications: Analgesics/opioids, antipsychotics, anticonvulsants, benzodiazepines, diabetes medications.
Medium-risk medications: Antihypertensives, antiarrhythmics, antidepressants.
Low-risk medications: Diuretics.

Symptoms of Dehydration

Thirst when plasma osmolarity exceeds 292 mOsmol/kg; reduced sensitivity leads to thirst at 296 mOsmol/kg in elderly.
Signs include dry skin, headaches, dizziness, confusion, and oliguria.
Diagnosis based on plasma urea/creatinine ratio and serum osmolarity measures.

Management of Dehydration

Rehydration: Can be administered orally, intravenously, or subcutaneously; aim for 1200-1500 ml fluids if eating, or 2500 ml if not.
Monitor for osmolarity to guide fluid replacement.

Pain Management

Opioids:
- Tramadol: Risks include interaction with serotonergic medications and potential for seizures in older patients.
- Morphine: Clearance may be reduced in renal impairment; alternative medications like hydromorphone or fentanyl may be preferable.

Consequences of Falls

Physical Consequences: Skin tears, internal bleeding, fractures, and hospitalizations.
Psychological Impact: Increased dependency, fear of falling, anxiety, and depression.
Social Consequences: Withdrawal from social activities and declining mobility.

Evaluation for Falls

Assess fall history with the Morse Fall Scale; evaluate home safety, medication use, and vision changes.

Management of UTIs

Complicated UTIs may require hospitalization and intravenous antibiotics, particularly for renal involvement.
Catheter-Associated UTIs (CAUTIs): Remove or change catheter as soon as feasible, alongside appropriate antibiotic therapy.
Recurrent UTIs: May necessitate prophylactic antimicrobials; post-menopausal women may benefit from vaginal oestrogens.

Dementia and Cognitive Impairment

Prevalence: 5-7% in individuals 60+, 1 in 5 among those 85+.
Two types of dementia: Early onset (rare) and late onset (more common), characterized by memory impairment and behavioral changes.
Alzheimer's Disease progresses through three stages with distinct cognitive and functional decline.

Diagnostic Evaluation for Dementia

Comprehensive physical and lab assessments are essential, including blood tests for liver, renal, thyroid function, and neurological evaluations.

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Description

This quiz focuses on key medical examination practices such as rectal and foot examinations, particularly for conditions like occult bleeding, BPH, and hemorrhoids in patients over 50. It emphasizes the importance of thorough assessments and physiological correlations in identifying various health issues.