Geriatrics EOR questions and answers 100% correct

Geriatrics EOR questions and answers 100% correct What are 5 areas of consideration unique to the geriatric population? 1. decreased physiologic reserve 2. cognitive and physical function status 3. social context 4. patients/caregivers' needs/desires based on prognosis 5. multiple conditions/polypharmacy What is the most common bacterial infection in older adults? UTI What is the most overdiagnosed condition in older adults? UTI RF for UTI BPH w/ retention, H/O recurrent UTI, loss of protective effect of estrogen on bladder mucosa, functional disability, cognitive impairment, catheter When can low dose prophylactic antibiotics be considered to prevent UTI? in women w/ 3+ UTIs in a year and no other urinary abnormalities (must exclude anatomic abnormality) What are the 3 most common antibiotics used for UTI prophylaxis in women? Bactrim, nitrofurantoin, cephalexin S/S of UTI dysuria, increased urinary frequency, urgency, hematuria, change in color of urine, suprapubic pain, confusion S/S of pyelonephritis N/V, fever, chills, abdominal/flank pain, CVA tenderness What triad of symptoms best predicts UTI in older adults? dysuria, change in character of urine, mental status changes When should you treat asymptomatic bacteriuria? before genitourinary surgery or procedure to prevent sepsis; NOT routinely! What are the top 5 pathogens involved in CAUTIs? E. coli, Enterococcus, Candida, P. aeruginosa, Klebsiella What is the most common cause of microscopic hematuria in male patients? BPH What is the most common lower urinary tract cause of gross hematuria, in the absence of infection? urothelial cell carcinoma of the bladder What are the most common pathogens involved in pyelonephritis? E. coli, Proteus, Klebsiella, Enterobacter, Pseudomonas How is pyelonephritis spread? ascending, except for S. aureus (usually hematogenous) Lab findings for pyelonephritis leukocytosis + L shift UA = pyuria, bacteriuria, hematuria, +/- WBC casts UC = heavy growth of organism blood culture may be + Inpatient treatment for pyelonephritis IV ampicillin + gentamicin first, then Ab based on urine and blood cultures continue IV Ab for 24 hr after fever resolves, then PO Ab for 7-14 d Outpatient treatment for pyelonephritis cipro, ofloxacin, or Bactrim for 7-14 d What follow up labs MUST be performed after treatment completion for pyelonephritis? urine culture What pathogens commonly cause acute bacterial prostatitis? E. coli, Pseudomonas >> Enterococci How is acute bacterial prostatitis spread? ascending or reflux of infected urine into the prostatic ducts S/S of acute bacterial prostatitis perineal, sacral, or suprapubic pain; fever; irritative voiding; +/- urinary retention; warm, exquisitely tender prostate on exam Lab findings for acute bacterial prostatitis CBC = leukocytosis w/ L shift UA = pyuria, bacteriuria, hematuria UC = growth of pathogen Inpatient treatment for acute bacterial prostatitis IV ampicillin + gentamicin, then Ab based on culture PO quinolones after afebrile for 24-48 hr, continued for 4-6 weeks Outpatient treatment for acute bacterial pancreatitis PO ciprofloxacin, ofloxacin, or Bactrim for 21 d What labs should be performed after completion of treatment for acute bacterial prostatitis? urine culture and exam of prostatic secretions Etiology of chronic bacterial prostatitis H/O acute bacterial prostatitis, or no H/O acute infection Common pathogen causing chronic bacterial prostatitis E. coli, gram negative rods only one gram positive = Enterococcus S/S of chronic bacterial prostatitis asymptomatic; irritative voiding; low back/perineal pain; unremarkable PE; prostate may feel soft, boggy, or indurated Lab findings for chronic bacterial prostatitis UA = NL, unless cystitis present expressed prostatic secretions = inc. leukocytes culture of expressed secretions necessary to make diagnosis Treatment for chronic bacterial prostatitis PO cipro, ofloxacin, or Bactrim for 1-3 mo. Which AB is associated with the best cure rates of chronic bacterial prostatitis? Bactrim, b/c TMP diffuses into the prostate Which is the most common prostatitis syndrome? nonbacterial prostatitis S/S of nonbacterial prostatitis irritative voiding; low back/perineal pain; soft, boggy, or indurated prostate (identical to chronic bacterial prostatitis!) Lab findings for nonbacterial prostatitis UA = normal UC = normal expressed prostatic secretions = inc. leukocytes, but negative culture How does the clinical picture of nonbacterial prostatitis differ from chronic bacterial prostatitis? negative UC and culture of prostatic secretions; normal UA; no H/O UTI What must be excluded in older men with s/s of nonbacterial prostatitis? bladder cancer (urine cytology and cystoscopy) What is the cause of nonbacterial prostatitis? unknown! speculation: chlamydia, mycoplasma, ureaplasma, virus, autoimmunity Treatment for nonbacterial prostatitis Ab trial against suspected pathogens = erythromycin Pathogenesis of herpes zoster reactivation of latent varicella zoster virus in DRG Which dermatomes are most commonly affected by herpes zoster? ophthalmic division of trigeminal nerve, cervical, thoracic What is Hutchinson sign? Who do these patients need to be referred to? skin lesions of herpes or varicella zoster on the side of tip or nose; ophthalmologist Describe postherpetic neuralgia. persistent pain after resolution of cutaneous eruption of herpes or varicella zoster; more common > 60 y/o and on the face S/S of herpes/varicella zoster pain preceding skin eruption; primary lesion = grouped vesicles on erythematous base; secondary = crusts and pustules; dermatomal distribution Treatment for herpes zoster antivirals (acyclovir, famciclovir, valacyclovir) w/in 48-72 hr of rash onset NSAIDs, acetaminophen, opioids if needed for pain Prevention of herpes zoster Zostavax > 60 y/o How long does it take for a dermatome to heal after herpes zoster infection? 3-4 wk, may leave scar Risk factors for herpes zoster age (also increases risk of PHN), physical trauma, malignancy, immunosuppression (CMI), chronic lung or kidney disease Can a person with herpes zoster spread VZV? yes, to people who have never had chickenpox or the varicella vaccine spread via direct contact with lesions When are herpes zoster lesions contagious? until they dry and crust over What medications are often used for pain relief for herpes zoster? NSAIDs, acetaminophen may require oxycodone or morphine What is Ramsay Hunt syndrome? reactivation of latent VZV affecting the otic ganglion Ramsay Hunt triad ipsilateral facial paralysis, ear pain, vesicles in auditory canal and on auricle Treatment for Ramsay Hunt UTD says valacyclovir + prednisone When is the diagnosis of PHN made? pain persists 4+ mo. after herpes zoster infection How can the transmission of VZV from a patient with herpes zoster be prevented? cover the lesions; avoid contact with pregnant women, LBW or premature infants, immunocompromised people Etiology of cervical strain poor posture, whiplash, overexertion S/S of cervical strain neck pain + stiffness, tightness in upper back/shoulder, dec. ROM, paraspinal muscle spasms, identifiable muscle trigger points, HA + shoulder pain if whiplash How long does it take for mild-moderate cervical or lumbar strains to heal? typically 2-3 weeks; if symptoms beyond 6 weeks, need to re-evaluate for imaging Treatment components of cervical muscle strain posture modification, pain relief, muscle relaxants, gentle stretching, heat, cervical collar (short duration!) What is the most common cause of cervical spinal stenosis? cervical spondylosis (degeneration of cervical spine) What percent of older people have some degree of cervical spondylosis? 80% by age 50, 100% by age 70 S/S of radiculopathy radiating pain, numbness, tingling, weakness, diminished DTRs in the distribution of a nerve root What is the most common cause of spinal radiculopathy? degenerative changes of the spine (i.e. cervical spondylosis) What is the most common cause of myelopathy in adults over 55? cervical spondylotic myelopathy S/S of cervical spinal myelopathy insidious gait impairment, weakness in arms/legs, loss of sensation, urinary/rectal sphincter dysfunction, UMN in legs, LMN in arms, radiculopathy in arms, loss of pain sensation in LE, + Lhermitte's sign Imaging to diagnosis cervical spondylotic myelopathy MRI or CT Treatment for cervical spondylotic myelopathy refer for possible surgery S/S of lumbar strain/sprain diffuse pain in lower back +/- buttocks, worse w/ movement, improved w/ rest, radiation unusual, painful muscle spasms, local tenderness, limited ROM, normal neuro exam Treatment for lumbar strain/sprain no bed rest! NSAIDs, acetaminophen, opioids if needed, muscle relaxants, massage, heat, gentle stretching