Altered presentations

Question 1

Acute abdomen

Answer 1

• Diffuse, mild or absent pain rather than localized
• Mild discomfort, constipation
• Tachypnea and vague respiratory symptoms
• Lack white count, fever, present with hypothermia
• Consider cholecystitis, obstruction, diverticular, cancer

Question 2

Myocardial infarction

Answer 2

• Mild to no pain
• No dyspnea
• New-onset fatigue, dizziness and confusion
• loss of appetite

Question 3

Depression

Answer 3

• Anxiety
• Diminished care
• Irritability
• Wt loss
• Hyperactive
• Vague GI sx
• Sleep impairment
• New cognitive impairment
• Somatic sx and insomnia

Question 4

Pneumonia

Answer 4

• Absence of cough, normal cxr
• Malaise and confusion
• Temp 37.3 may indicated infection due to lower basal metabolic rate

Question 5

Thyroid disease

Answer 5

Hyper: apathetic thyrotoxicosis, fatigue & slowing down

- Hypo: confusion & agitation

Question 6

Sepsis

Answer 6

• No leukocytosis or fever
• Falls, decreased appetite, fluids
• Confusion