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MI Differential Diagnosis & Med Screening > GULICK: Medical Screening in Geriatric Pts > Flashcards

GULICK: Medical Screening in Geriatric Pts Flashcards

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1
Q

MSK Changes

General….

A
  • DECs In:
    • mm mass & strength
    • motor unit recruitment
    • speed of mvmt (DEC type II (FT) mm fibers)
    • jt flexibility
    • bone mass & strength
  • Cartilage degen.
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2
Q

Neural Changes

General

A
  • DECs in:
    • conduction= altered pain
    • enyzmatic activity
    • reflexes
    • responsiveness
  • INCs in:
    • postural sway
  • Change in sleep patterns
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3
Q

Cardiovascular Changes

General

A
  • INCs In:
    • Vascular resistance
  • DECs In:
    • CO (HR*SV)
    • Lipid catabolism
    • Vascular elasticity==> INC DBP
    • Response to postural stress
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4
Q

Pulmonary Changes

General

A
  • DECs In:
    • Recoil w/in lung
    • PO2 from 20-70yrs
    • VO2 max
    • Pulmonary blood flow==> DEC O2sats
  • INCs In:
    • RV (residual volume)
  • Calcification of soft tissue in chest wall
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5
Q

Integumentary Changes

General

A
  • DECs In:
    • vascularity== altered thermoreg.
    • SubQ tissue== INC risk for hypOthermia
    • thickness w/ INC risk breakdown
  • Uneven pigmentation
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6
Q

GI Changes

General

A
  • DECs In:
    • peristalsis
    • enzymatic activity
    • motility
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7
Q

Urogenital/Renal Changes

General

A
  • DECs In:
    • bladder capacity, bladder elasticity
    • kidney mass
    • GFR
    • creatinine clearance*
  • Prostate hyperplasia (BPH)
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8
Q

Special Senses Changes

General

A
  • DECs In:
    • visual acuity
    • hearing
    • smell&taste
    • Thymus function* (HUGE role in immunity)
    • Ca++ control
    • sweating*
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9
Q

Immune Changes

General

A
  • DECs In:
    • function/resistance
    • T-cells
    • Temp regulation
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10
Q

Psychosocial Changes

General

A
  • INCs In:
    • depression
    • fatigue
  • Cognitive deficits
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11
Q

Medications

Rule of Thumb

A

DEC meds w/ INC age

Due to DEC liver & DEC kidney metabolism

  • Polypharmacy→ adverse effects, interactions***
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12
Q

Keeping Track of Medications

*USE Medscape Interaction Checker

All suffixes you will need to KNOW @ some point!!!

SAVE THIS!!!!

A
  • -caine= local anasthetic
  • -cillin= antibx
  • -dine= anti-ulcer agent
  • -done= opioid analgesic
  • -ide= oral hypoglycemic
  • -iam= anti-anxiety agent
  • -micin= diuretic
  • -mycin= antibx
  • -nium= NM blocking
  • -olol= beta blocker
  • -oxacin= antibx
  • -pam= anti-anxiety
  • -pril= ACE inhibitory
  • -sone= steroid
  • -statin= anti-lipemic (Cholesterol meds)
  • -vir= anti-viral
  • -zide= diuretic
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13
Q

Risk of Falls

The Vicious Cycle

  • >2.5 mill falls end up in ER
  • >13K
  • 52% Am’s >65yo fall/yr
A

FALLS→ DEC function→Fear→Isolation→ Inactivity→Weakness→FALLS

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14
Q

Risk of Falls

Some great Outcome Measures

A

Berg, Tinetti, TUG, Gait Abnorm Rating Scale, Gait Velocity (5th Vital Sign?), 5xSTS, DGI, Activity-Specific Balance Confidence (ABC) Scale

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15
Q

TUG

*Get up, walk 3m, go around obj, walk back and sit down

A

see pics for #’s

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16
Q

TUG-Cog

*Dual-Tasking

A
  • Stand, walk 3m, return & sit
  • Perform phys task while subtracting 3 for any given # from 66-100
    • OR serial 7’s, days of week, etc…
  • Cut-Off is 15s***
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17
Q

Gait Velocity

Gait Speed as a Predictor of Hospitalization

A

see pics

Slow walkers 4x MORE LIKELY have hospitalization w/in 12-mos

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18
Q

5xSTS

Description + Norm Values

A

see pics

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19
Q

“Balance” Borg Scale

Like RPE for BALANCE*

A

SEE PICS

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20
Q

Questionnaire to Calculate Falls Risk

A

jscalc.io/calc/Y53w0rSwoRCx0fuE

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21
Q

Warning Signs of Elder Abuse

A

see pics***

YOU MUST SAY SOMETHING!!!

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22
Q

TOP Reasons for ER Visits in Elderly…

A
  • Injuries→ Falls/Accidents
  • PNA
  • Comps after Sx
  • Chest pain
  • SEs from meds
  • Dehydration
  • Stroke
  • Back/Abdominal pain
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23
Q

Systems Review: MSK

Arthritis

Osteoporosis

A
  • Arthritis→ see pics for loc’s
  • Osteoporosis
    • ~12% women 50-70 have vertebral compression fx’s
    • ~20% >70yo
  • NOTE: Ginger + Cinnamon for OA*** ½ tsp, 2-3x/day
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24
Q

Systems Review: MSK Patho

Patellar-Pubic Percussion Test (Geriatrics) → Screening Test

A

Sn= 94 (-LR)=0.06 Sp= 95 (+LR)= 20.4

  • Technique: Pt in SUPINE, scope on symphysis pubis & tuning fork on patella; listen for change in sound qual w/ both LEs
  • (+)= Osseous problem, i.e. fx, cx
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25
Tech. for Fx ID
Use of 128-Hz vibrating tuning fork & stethoscope to ID Fx's ## Footnote **Dx accuracy= 81%**
26
Systems Review: **MSK** ## Footnote **Influence of Fluoroquinolone (FQ): Gram (-) antibx for Resp, Uro, GI Infx's**
* HIGH affinity for **connective tissue** * FQ toxic to **type I collagen synthesis (esp. Achilles) & promotes collagen degen.** * Risk is dose dependent * **“Black Box Warning”== Severe SEs, but still on market bc value** * Mean onset== 6d * **Look for→** Heel pain, Calf pain, Heel lifts
27
Influence of **Fluoroquinolone (FQ):** ## Footnote **Risk of Tendon Damage INCs if:**
* \>60yo * Concurrent corticosteroid use (46-fold INC)\* * Renal failure * DM * Hx of tendon rupture
28
Influence of **FQ:** ## Footnote **On tendons and esp. Achilles Tendon**
* 89.9% Achilles Tendon * **S/S:** * Pain 2-3cm prox. to calcaneal attach. * Swelling/inflammation * “Snap”, “Pop” w/ bruise * (+) Thompson Sign
29
Influence of FQ: ## Footnote **Avoiding ruptures**
S/S can occur **up to 2wks BEFORE rupture** * **Avoid rupture:** * tendon protected from WB * Heel lift used * Crutches/Bracing * May need to protect tendon up to 6mos
30
Systems Review: **Neuromuscular** ## Footnote **These 2 pathos have _Bi-Modal Distribution:_**
Myasthenia Gravis, Guillian-Barre Syndrome (GBS)
31
Myasthenia Gravis ## Footnote **S/S you DEFINITELY NEED TO REMEMBER** **MOST COMMON\*\*\***
Diplopia & Ptosis== MOST COMMON SX'S
32
Myasthenia Gravis ## Footnote **S/S**
* **MOST COMMON→** Diplopia & Ptosis (droopy eyelid) * PROX mm weakness, CN weakness, Prob controlling eye mvmt & facial expresses * Diff swallow/chewing * Dysarthria (slurred speech) * Change voice qual. * **NO sensory/DTRs changes\*\*\***
33
Guillian-Barre Syndrome (GBS) ## Footnote **S/S**
* \***Weakness→ symmetrical LE \> UE \> Resp.** * Parasthesias **start in toes** & **progress PROX. (NO loss sensation)** * Asymmetrical facia weak, dysphasia, dysarthrias * CNs can be affected * **UNSTABLE VITAL SIGNS\*\*\*** * DEC reflexes & hypOtonia * Fever, nausea, fatigue * **PAIN=** LB & buttocks
34
Systems Review: **Neuromuscular** ## Footnote **Normal Pressure Hydrocephalus** **3 Things occur w/ this Patho**
1. System of **draining/absorbing CSF is _disrupted_** 2. Can occur after a **head injury, TIA, meningitis, infx, or tumor, or unknown** 3. Pressure **slowly INCs→** NPH is misleading\*\*
35
NPH ## Footnote **Dx how?**
CT/MRI
36
NPH: **Sx's** ## Footnote **3 Parts of Brain MOST often affected**
Legs, Bladder, Cognition
37
NPH: **Sx's** ## Footnote **3 Parts of Brain MOST often affected** **Legs vs Bladder vs Cognition**
* **Legs→** Gait disturbs, Wide BOS, Slow/Shuffling steps * **\*retain arm swing _unlike PD_** * **Bladder→** Urinary freq (every 1-2hrs)=\> incont. * **Cognition→** Dementia, forgetful, STM loss * **\*may fluctuate bc pressure changes- _unlike Alzheimer's_**
38
NPH: **Clinical Traid (SLOW Progression)** ## Footnote **3 W's**
Wobbly, Wozzy, Wet * **Wobbly** on foot * “feet glued to floor” * **NO loss of arm swing like PD** * **Wozzy** in head * **Beware misDx w/ hearing loss** * **Wet** on bottom * **Beware of meds**
39
**GREAT Tx for NPH:** **In video viewed in class, DRASTIC IMPROVEMENTS IN Gait**
Shunt
40
NPH Scale
**For reference** **3 Cats: Gait, Cognitive, Sphincter**
41
Parkinson's Disease ## Footnote **Cardinal Motor Symptoms (remember PWPD are TRAPPED)**
Most common onset= 60-70yo * **Cardinal Motor Sx's** * Tremor @ rest * Rigidity * Bradykinesia * Gait & Balance probs
42
PD ## Footnote **Tremor DOES NOT have to be present to make Dx\*\*\*\***
\*\*\*\*\*\* It is most common **initial sx in PD though**
43
PD ## Footnote **Craniofacial, Sensory, Autonomic, Neuropsychiatric Features**
* **Craniofacial→** Masked face, Sialorrhea (drool), Anosmia (lose smell), soft speech\*, Dysarthria, Dysphagia * **Sensory→** Parasthesia * **Autonomic→** Urinary urgency, Constipation, Sexual dysf * **Neuropsychiatric→** Depression/Anxiety, Apathy, Dementia\*, Psychosis\*
44
PD ## Footnote **FYI** **Talking about making Dx**
* PD is a **clinical dx (acting out dreams)** * **Levodopa Test→** NOT 100% accurate, NOT used to **definitively dx PD** * MRI/CT findings **unremarkable** * NO lab **biomarkers** exist for PD
45
PD an **Flavonoid-rich foods\*\*\***
* May help improve life-expect. * Greater consumption **berries and red wine (rich in flavonoids)→ assocd w/ LOWER mortality** ## Footnote **see pics for foods\***
46
A note on **Cognition…**
Even w/ inc'ing obesity, DM rates, aging pop, **incidence of dementia has declined by 20% every decade over 30yrs** **Limtd to those w/ @ least high school edu.**
47
Healthy Brain vs. **Alzheimer's Pts** ## Footnote **Tau PROs**
When Tau no longer stabilizes axons, neuron shrivels and dies, leaving behind its tangled carcass
48
**Precivity Alzheimer's Disease (AD)**
* Rx blood test * Measures PROs linked to toxic amyloid plaque buildup in brain→ **TAU PROs** * 94% as accurate as PET scans * Adults 60yo w/ memory loss
49
Stages of Alzheimer's Disease ## Footnote **Listed here w/ Titles:**
* **Stage 1: No cog. impair** * **Stage 2: Very mild decline** * **Stage 3: Mild decline** * **Stage 4: Moderate decline (Mild or Early stage AD)** * **Stage 5: Moderately severe decline (Mod or Mid-stage AD)** * **Stage 6: Severe Decline (Moderately severe or Mid-stage AD)** * **Stage 7: Very severe decline (Severe or Late Stage AD)**
50
Stages of Alzheimer's Disease ## Footnote **Stage 1: NO cog impair**
NO memory problems
51
Stages of Alzheimer's Disease ## Footnote **Stage 2: VERY mild decline**
* Indiv reports memory lapses→ forgets words, names, loc. of everyday obj's * **Probs are NOT evident to med prof's, friends, family**
52
Stages of Alzheimer's Disease ## Footnote **Stage 3: Mild decline**
* Prob w/ memory or concentration **may be measurable in clinical testing** * **Friends, family, co-workers _notice_ deficiencies** * **Common Diffs:** word finding, decd ability to remember names, poor reading retention, lose/misplace valuable objs, decd ability to plan or organize
53
Stages of Alzheimer's Disease **Stage 4: Moderate decline (mild or early stage AD)**
* Deficiencies **noted** in med. interview * Decd knowledge or recent occasions OR current events * Impaired ability to perform challenging mental math * ex. serial 7's (backwards from 100) * Decd complex task capacity→ plan dinner, pay bills * Reduced memory of personal hx * Indiv subdues & w/drawals in socially or mentally challenging situations
54
Stages of Alzheimer's Disease ## Footnote **Stage 5: Moderately severe decline (Moderate or Mid-Stage AD)**
* MAJOR gaps in memory & deficits in cog. function * Assist. in day-day acts. * Cannot recall address, #, name of alma mater * Confused about time, day, season * Trouble w/ LESS challenging math- count backwards (20s by 2, 40s by 4) * Retains knowledge about self, names of spouse & children * Usually does NOT req assist w/ eating/toileting
55
Stages of Alzheimer's Disease ## Footnote **Stage 6: Severe decline (Moderately severe or Mid-Stage AD)**
* Sig. personality changes, hallucinations, compulsive behaviors\* * Loss of awareness of recent exp's * Gen. recall own name & distinguish familiar faces, but may forget name of spouse/caregiver * Needs help w/ ADLs & toileting; disrupted sleep/wake cycles * **Tends to wander and become lost\***
56
Stages of Alzheimer's Disease ## Footnote **Stage 7: Very severe decline (Severe or Late-Stage AD)**
* Loss of ability to resp to environ & the ability to control mvmt * Speech unrecognizable * Needs help w/ eating (diff swallow); gen incontinent * Loss of ability to amb w/out assist * Poor mm control, abnorm reflexes, mm rigidity
57
Good Test w/ AD ## Footnote **Mini Mental State Exam**
Orientation Registration Attn & Calculation Recall Lang ***costs $$ now though*****\*\***
58
MMSE Test
Max Score=30 * **4 Categories:** * **24-30: Normal** * **20-23: mild impair/Alzheimer's** * **10-19: mod impair/Alzheimer's** * **0-9: severe impair/Alzheimer's**
59
Royalty free test also really good for AD
Montreal Cognitive Assessment (MoCA) www.moca
60
Comparison: **MMSE vs MoCA** ## Footnote **For Mild Cognition Impairment (cut off 26)**
* MMSE: * Sn= 18% * MoCA * Sn= 90%\*\*
61
Comparison: **MMSE vs MoCA** ## Footnote **For Alzheimer's Disease (cutoff 26)**
* MMSE: * Sn= 78% * Sp= 100% * MoCA * Sn= 100%\*\* * Sp= 87%
62
Comparison: **MMSE vs MoCA** ## Footnote **For Post-Stroke Cognitive Impairment (cutoff 24)**
* MMSE: * Sn= 70% * Sp= 97% * MoCA * Sn= 67% * Sp= 90%
63
Peanut Butter Test ## Footnote **For WHAT and WHY???**
***Alzheimer's typ affects _sense of smell_ bc olfactory cortex is _first_ to show signs of dysf*****\*\*** * **Test:** measure dist. that PB could be smelled thru L vs R nostril * **(+) Test:** could NOT detect smell until **5"** closer to the L compared to R nostril
64
System Review: **CV & Pulmonary** ## Footnote **TIA==** **May include:**
Precursor to stroke \***Focal neuro signs, Occurs suddenly, Lasts short time, Resolves w/in 24hrs** * Blurred vision, slurred speech, flashes of light, Migraine\*, vertigo, facial weakness, confusion, Ataxia
65
System Review: **CV & Pulmonary** ## Footnote **DVTs** **Virchow's _Triad_** **3 Parts:**
* **Localized Trauma/Sx intervention→** * **Venous Stasis→** * venous dilation, intima dmg, clotting factor * **HypERcoagulation** * dehydration, malignancy, oral contraceptives\*, smoking\*
66
DVT ## Footnote **Risk associations Venn Diagram**
Hypercoagulabilty, Vessel Injury, Stasis (blood flow)
67
DVT= Deep Vein Thrombosis VTE= VenoThromboEmbolism
* 10% all hospital deaths * **1st appear in _superficial veins_ @ valve/cusp** * **90% in Long Saphenous Vein\*\*\*** * **_Proximal_ mortality \> Distal** * **Knee= dividing point\***
68
Homans Sign (DF Sign) ## Footnote **For what**
DVT\* * **Need a better tool** * **DVT→ “insecure thrombus waving in current”** * **Stats:** * Majority DVTs predicted w/ S/S
69
What is the **REALLY GOOD TEST for DVT??**
Wells Clinical Score for DVT **\*Understand _HOW_ to score** * **\>3= HIGH RISK\*\*\***
70
Caprini Risk Assessment for\_\_\_\_\_
**DVT** * **On Caprini thats NOT on Wells:** * **For women only: \*See box!** * Score/Risk/VTE Incidence * **0-2 Very low-low \<1.5%** * **3-4 Mod 3%** * **5-8 High 6%** * **\>8 Very high 6.5-18.3%**
71
VTE ==
VenoThromboEmbolism * **After NeuroSx = risk as high as 50% & remains in hypERcoagulation state for wks** * COPD INCs risk due to **immobility**
72
Strong Risks of DVT ## Footnote **Pathos/Conditions** **5:**
* SCI * Major Trauma * Major Sx * Total Joint Replacement * Fx→ pelvis, femur, tibia (notice locations!!!)
73
Add'l Risks of DVT ## Footnote **Pathos/Cond's**
* AIDS * Varicose veins * Pacemakers * **Pregnancy→** Stasis, Viscosity of blood * Obesity * Acute MI * Long airline flights (\>2hrs) * Recent central venous cath. * Blood Type A→ clots + myocardial issues * Anti-thrombin deficiency * Oral contraceptives\*\*\*
74
DVT Morbidity & Mortality
**30% pts suffer _recurrent_ DVT w/in next 10yrs, _GREATEST risk_ in the _first 2 yrs_\***
75
**\*\*Clinical Pearl for DVTs**
1min active **ankle pumping** DECs **venous stasis** & INCs **venous blood flow** for **up to 30mins _after_ exercise\***
76
Clinical Pearl #2 for **DVTs** ## Footnote **ASA/NSAIDs**
* **ASA→** works via irreversible binding of COX-1 enzyme rendering platelet **permanently UNable to aggregate** * **NSAIDs→** do the same on a reversible basis w/ inhibition related to half-life (2-12hrs) ## Footnote **\*ASA (not enteric-coated) should be taken _@ least 30mins BEFORE_ or _more than 8 hrs AFTER_ ibuprofen (NSAID) to avoid _attenuation of ASA effect_**
77
ASA ______ BEFORE NSAID
30mins!!!
78
Black Box Warning: **FDA Warning about ASA & NSAID**
ASA 30mins BEFORE NSAID
79
S/S of a **PE**
* Angina-like pain or **crushing chest pain** * Dyspnea, wheezing, rales * DEC BP * Hemoptysis, chronic cough * Fever * **Tachypnea (\>16/min)** * **Tachycardia (\>100/min)** * **Diaphoresis**
80
Cond's that **Mimic DVT**
Bakers cyst, Sciatica, Cellulitis, Hematoma, Myositis,
81
Clinical Signs of **HTN**
* Spont. **epistaxis (nosebleed)** * **Occipital HA** * Dizzy, visual changes * **Nocturnal urinary freq\*** * Flushed face
82
7th Report of Joint Nat'l Committee on Prevention, Detection, and Tx of High BP ## Footnote **Following are major CV Risk Factors:**
see pics but **NOTE:** * Elevated LDL (or total \>/= 240 * DM, obesity * Age \>55 men, \>65 women * Lack of exercise\*\*\*
83
System Review: **CV & Pulmonary** ## Footnote **Leukemia** **BEST Dx CRITERIA???**
Enlarged Lymph nodes\*\*\*
84
System Review: **CV & Pulmonary** ## Footnote **Leukemia**
* **Enlarged lymph nodes→ best Dx criteria\*\*** * Epistaxis, bleeding gums * Hematuria, rectal bleed * Bruised skin, petechiae * Infxs, fever * Weak, fatigue * wt loss, loss of appetite * **Enlarged spleen\***
85
Effects of **Dehydration** ## Footnote **Causes**
* DEC CNS fx w/ DEC thirst * Vom/diarrhea * DM * Excess sweat/fever * Sx * Meds (diuretics)
86
Effects of **Dehydration** ## Footnote **S/S**
Altered mentation, Lethargic/agitated, Lt headed or syncope, OH, Weakness
87
One of the **most common causes of death in Elderly\*\*\***
PNA
88
System Review: **CV & Pulmonary** ## Footnote **PNA** **_Typical Symptoms:_**
* **Fever\*,** chills * Productive cough→ **rust-colored sputum** * Pleuritic chest pain * SOB Additional→ confused, lose appetite, change sleep habits
89
System Review: **Integumentary** ## Footnote **Braden Scale for \_\_\_\_\_\_\_\_**
Risk of **Pressure Ulcers** ## Footnote **LOWER score==HIGHER risk\*\*\***
90
Common **Bacterial skin infx**
Cellulitis * **@ Risk:** * DM * Circ. probs * CHF * Liver disease * Eczema * Psoriasis * Severe acne
91
Cellulitis ## Footnote **S/S**
* **RECENT skin disruption\*\*\*** * pain, swell, warmth * Erythema w/ streaks/vague borders * fever & chills * HA * LOW BP * Enlarged lymph nodes * **Small red spots appear on top of reddened skin\***
92
Herpes Zoster ## Footnote **Vaccine: Shringrix** **FACTS**
⅔ of pts are \>50yo\* **Contagious→** via resp. droplets OR Direct Contact w/ blisters\*
93
Herpes Zoster ## Footnote **Talk about Trigeminal N.**
**Thoracic (50%)** & opthalmic division of Trigeminal N. MOST commonly affected regions
94
Herpes Zoster
* Pain/tenderness/parasthesia in the **dermatome** 3-5d before vesicular eruption * **Prodromal pain→ mimics cardia or pleural pain** * Erythema & vesicles follow **dermatomal distribution** * Pustular vesicles from crusts * **Thoracic (50%)** & opthalmic div. of Trigeminal N.
95
Herpes Zoster
Acyclovir **should be admin'd** w/in 72hrs of onset of rash Rash DOES NOT cross midline of body
96
Systems Review: **Endocrine** ## Footnote **Gout** **Why the Toe?**
Toe is typ **coldest area in body→** Uric Acid crystallizes in **cold environ's**
97
System Review: **Endocrine** ## Footnote **Gout** **Main things are bolded\*\***
* **Prob w/ INC _purine_ leading to INC _uric acid_** * Foods high in Purine (Rich Man's Disease\*)= shellfish, organ meats, dried beans, peas, anchovies, high-fructose corn syrup * Alcohol (esp beer)→ DEC ability to get rid of purines\*\*\*
98
Gout ## Footnote **S/S**
* **Inflammation of 1st MTP,** knee, wrist, or elbow * rapid onset of sudden severe pain * red/swell * Tender/hypersensitive * fever, chills
99
Gout ## Footnote **Tx**
* NSAID (beware GI bleed) * Colchicine * Corticosteroids * Meds that DEC uric acid lvls \***Female sex hormones INC urinary excretion of uric acid so PREmenopausal women have LOWER prev. of gout**
100
HypOthyroidism (SLOW Motor) **S/S** **(MOM’S SO TIRED)**
* **M**emory loss * **O**besity * **M**alar flush/ **M**enorrhagia * **S**lowness (mentally and physically) * **S**kin and hair dryness * **O**nset gradual * **T**iredness * **I**ntolerance to cold * **R**aised BP * **E**nergy levels fall * **D**epression/ **D**elayed relaxation of reflexes
101
HYPOthyroidism
* **PR \<60 in untrained person\*\*\*** * DEC BMR * Dry skin * Mm/Jt painf * PROX weakness * Lethargy/depression/apathy * Confusion * Wt GAIN * Edema around eyes * Loss of lateral eyebrow\* * Cardiomegaly * Contipation * Cold INtolerance * Brittel nails\* * Sparse/course hair * Periph. edema * Jt effusion w/ Ca++ deposits * CTS * SLOW healing * Hoarseness
102
Hyperthyroidism **(SWEATING)**
* **S**weating * **W**eight loss * **E**motional lability * **A**ppetite increased * **T**remor/ tachycardia * **I**ntolerance of heat/ Irregular menstruation/ Irritability * **N**ervousness * **G**oitre and **G**I problems (diarrhea)
103
Hyperthyroidism (FAST Motor) ## Footnote **Pts = 50yo** **Order of likelihood\***
* TACHYcardia\* * HypERactive reflexes\* * INC sweating (see mnemonic)\* * Heat intol.\* * Fatigue * Tremor * Nervous * Polydipsia * Weakness * INC appetite * Dyspnea * Wt LOSS\*
104
Hyperthyroidism (FAST Motor) ## Footnote **Pts \>/= 70yo** **Order of likelihood**
* TACHYcardia\* * Fatigue\* * Wt LOSS\* * Tremor * Dyspnea * Apathy * Anorexia * Nervousness * Hyperactive reflexes * Weakness * Depression * INC sweating * Polydipsia
105
System Review: **Urogenital**
106
Systems Review: **Urogenital** ## Footnote **UTIs caused by any ______ diff _bacteria_**
1 of 5
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Systems Review: **Urogenital** ## Footnote **Urogen Patho's ex's**
* Pain w/ micturition, Leukocytes+Bacteria in urine (white casts), cloudy urine, Back pain * fever/chills, nausea, loss of app., **Pain w/ percussion over kidneys**
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**Cx** **Most Common _Primary Sites_ of _Metastatic Tumors_** **_5:_**
* Lung * Prostate * Renal * Breast * Colon
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**Cx** **Most Common _Primary Sites_ of _Metastatic Tumors_** **Lung:** **Where are the mets?**
Brain, Vertebrae, Liver
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**Cx** **Most Common _Primary Sites_ of _Metastatic Tumors_** **_Lung_**
* \>60yo * Smoker * C/S, shoulder, chest pain\*\* * TOS sx's * Chronic cough, **bloody sputum** * Wt loss; malaise * Fever * Dyspnea, Wheezing * Fecal breath odor\*\* * Neural sx's 2\* **spinal fluid mets**
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**Cx** **Most Common _Primary Sites_ of _Metastatic Tumors_** **_Renal_**
* 55-60 * **Hematuria\*\* (sign of patho)** * WT loss * Malaise, Fever * **Palpable _posterior lateral_ abdominal mass**
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**Cx** **Most Common _Primary Sites_ of _Metastatic Tumors_** **_Prostate_**
\*Men in USA have 16.5% **lifetime risk** for **prostate cx** * \>50 * L/S pain\* * Freq urination, Weak urine stream, Diff starting urination\* * **Sacral plexus sx's\*\***
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**Cx** **Most Common _Primary Sites_ of _Metastatic Tumors_** **_Prostate_** **Talking about PSA Lvls (naturally INC w/ age)**
* Only 30% time does elevated PSA **indicate prostate cx** * Guidance falls bw extremes of “testing nobody” & “testing everybody” See pics for PSA Lvls→ **Simonds taught us bw 4-10==NORMAL**
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PSA Testing
* Updated guidelines state men should gen be referred for prostate biopsy **when PSA \>3ng/mL** * **creates problems!!!** * **PSA INCs w/ age→** using this LOW threshold will INC # of **False-(+)s & subject men to harms of biopsy\*\*** * **REPEAT BLOODWORK FIRST\*\*\*** * AUA suggests biopsy threshold of **10ng/mL\*\*\***
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PSA Testing
Best evidence supports use of **serum PSA** for early detection of prostate cx
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PSA Testing and **Life Expectancy**
* Mbrs agreed PSA testing should **_only_** be offered to men w/ life expect. \>10-15yrs * IF \<5yrs→ question value of any cx screening * **Acute prostatitis→ transient rise in PSA lvls for 48hrs**
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Prostate Nutrition\* “Claimed” to reduce prostate risks:
Greens (34% lower risk), Cooked tomatoes, Citrus fruits, Olive Oil, Soy Foods (edamame!, 35% lower risk)
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**Cx** **Most Common _Primary Sites_ of _Metastatic Tumors_** **_Breast_**
* 20-50 & \>65yo * **Nip discharge, Dimpling of breast** * Palpable mass * **Brachial plexus sx's (notice how w/ Breast its B. plexus sx's, and w/ prostate its Sacral plexus!!!!)**
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Prostate & Breast Cx **Nutrition**\*
* \>2.2kg weight gain **doubles risk of recurrence\*** * Wt gain of **10% bf INCs breast & prostate mortality** * Plant based diet DECs risk of all cx's by 8%→ Breast cx by 15% * **Alcohol→** INCs risk cx by 5% preMENO & 9% PostMENO
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**Cx** **Most Common _Primary Sites_ of _Metastatic Tumors_** **_Colon_**
* \>50yrs old * **Abdom pain, Lumbosacral pain** * Changes in bowel habits, **bloody stools** * Malaise, wt loss * Pain **unaffected by pos.**

MI Differential Diagnosis & Med Screening (12 decks)

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