Medical Examination Practices

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 Status and Health

• 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.

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.