ADULT GERONTOLOGY ACUTE CARE 621
PRACTICE QUESTIONS AND RATIONALE GUIDE
2026
◉ Compartment syndrome. Answer: Pain, paresthesias, pulses are
normal, this is in the fascia, if it's not a cast cause it needs hourly
tape measures, fasciotomy when critical
◉ SLE. Answer: Butterfly rash, bedrest, afternoon naps, sun
protection, topical steroids, NSAIDs
◉ Drugs that can cause lupus like syndrome. Answer:
Chlorpromazine (tHorazine), Cardizem/diltazem, isoniazid/INH,
methyldopa, procainamide, quinidine
◉ Giant cell arteritis/temporal arteritis. Answer: Older person with
fever, normal wbc, elevated ESR, can cause blindness. Prednisone
and referral
◉ Glaucoma open angle/chronic. Answer: Increased ocular pressure
(normal 10-20), cupping of the optic disc, constriction of visual
fields, tonometry is test done starting at age 40, alpha 2 adrenergic
agonists, beta-adregeneric blockers
,◉ Gluacoma/close angle/acute emergent. Answer: Extreme PAIN,
halos on lights, dilated pupil, Diamox or mannitol immediate
referral/surgery
◉ Cataract. Answer: Old people, clouding, diplopia, halos around
lights, no red reflex, treat with glasses and ophthalmology referral
◉ Immunosenescence. Answer: Diminished function with age leads
to decline in ability to fight infection
◉ Mixed SV02. Answer: Normal is 60-80
<60 patient has tapped into reserves caused by decreased 02 supply
or increased 02 demand
>80 increased 02 supply , decreased 02 demand, decreased effective
02 delivery and uptake (sepsis etc)
◉ Acute Renal /Pre Renal Disease labs. Answer: Serum BUN to Cr:
10:!, urine sodium <20, spec grav >1.1015, urinary sediment normal,
FeNa<1
Treat with volume, dopamine for BP
◉ Pre Renal. Answer: Outside kidney, typical trauma pt, prerenal
only if reversed when underlying cause of hypoperfusion correted,
no damage to tubules
,Volume and dopamine
◉ Intrarenal/renal/intrinsic. Answer: Caused by something that
directly affects renal cortex, i.e. hypersensitivity rxn (contrast),
nephrotoxic agents MOST COMMON, mismatched blood, damage to
nephrons ACUTE TUBULAR NECROSIS most common
Stop nephrotoxic drugs, perfuse
◉ Post renal. Answer: Urine flow obstruction is cause
Mechanical: Obstruction of some kind like BPH or stone
TX: remove source of problem
◉ Criteria for Dialysis. Answer: AEIOU
A=acidosis
E=electrolytes
I=intoxication
O=oliguria
U=uremia
◉ Acute Renal Insufficiency. Answer: Bun increased out of
proportion to Cr, ATN, Obstruction, or contrast media, reversible
, ◉ Chronic renal insufficiency. Answer: Steady increase in BUN:Cr
ratio 10:1, intrinsic but progression can be slowed with tx
◉ Stages of renal failure. Answer: Diminished renal reserve :50%
loss of nephrons
Renal insufficiency 75% loss
End stage 90% loss
◉ Chronic renal failure treatment. Answer: Control htn and DM
Reduce proten to 40g/day
Renal dose meds
◉ CVA infarct. Answer: Subtle or sudden neurological deficits, visual
alterations, change sin vital signs, notor weakness, changes in LOC
◉ CVA hemorrhagic. Answer: Acute onset of focal neurologic deficits
Sudden increased ICP, hed and vomiting when bleed is extensive
Right (non dominant) side: left hemiparesis right visual field
changes spatial disorientation
Left dominant: right hemiparesis aphasia dysrrthria difficulty
writing
PRACTICE QUESTIONS AND RATIONALE GUIDE
2026
◉ Compartment syndrome. Answer: Pain, paresthesias, pulses are
normal, this is in the fascia, if it's not a cast cause it needs hourly
tape measures, fasciotomy when critical
◉ SLE. Answer: Butterfly rash, bedrest, afternoon naps, sun
protection, topical steroids, NSAIDs
◉ Drugs that can cause lupus like syndrome. Answer:
Chlorpromazine (tHorazine), Cardizem/diltazem, isoniazid/INH,
methyldopa, procainamide, quinidine
◉ Giant cell arteritis/temporal arteritis. Answer: Older person with
fever, normal wbc, elevated ESR, can cause blindness. Prednisone
and referral
◉ Glaucoma open angle/chronic. Answer: Increased ocular pressure
(normal 10-20), cupping of the optic disc, constriction of visual
fields, tonometry is test done starting at age 40, alpha 2 adrenergic
agonists, beta-adregeneric blockers
,◉ Gluacoma/close angle/acute emergent. Answer: Extreme PAIN,
halos on lights, dilated pupil, Diamox or mannitol immediate
referral/surgery
◉ Cataract. Answer: Old people, clouding, diplopia, halos around
lights, no red reflex, treat with glasses and ophthalmology referral
◉ Immunosenescence. Answer: Diminished function with age leads
to decline in ability to fight infection
◉ Mixed SV02. Answer: Normal is 60-80
<60 patient has tapped into reserves caused by decreased 02 supply
or increased 02 demand
>80 increased 02 supply , decreased 02 demand, decreased effective
02 delivery and uptake (sepsis etc)
◉ Acute Renal /Pre Renal Disease labs. Answer: Serum BUN to Cr:
10:!, urine sodium <20, spec grav >1.1015, urinary sediment normal,
FeNa<1
Treat with volume, dopamine for BP
◉ Pre Renal. Answer: Outside kidney, typical trauma pt, prerenal
only if reversed when underlying cause of hypoperfusion correted,
no damage to tubules
,Volume and dopamine
◉ Intrarenal/renal/intrinsic. Answer: Caused by something that
directly affects renal cortex, i.e. hypersensitivity rxn (contrast),
nephrotoxic agents MOST COMMON, mismatched blood, damage to
nephrons ACUTE TUBULAR NECROSIS most common
Stop nephrotoxic drugs, perfuse
◉ Post renal. Answer: Urine flow obstruction is cause
Mechanical: Obstruction of some kind like BPH or stone
TX: remove source of problem
◉ Criteria for Dialysis. Answer: AEIOU
A=acidosis
E=electrolytes
I=intoxication
O=oliguria
U=uremia
◉ Acute Renal Insufficiency. Answer: Bun increased out of
proportion to Cr, ATN, Obstruction, or contrast media, reversible
, ◉ Chronic renal insufficiency. Answer: Steady increase in BUN:Cr
ratio 10:1, intrinsic but progression can be slowed with tx
◉ Stages of renal failure. Answer: Diminished renal reserve :50%
loss of nephrons
Renal insufficiency 75% loss
End stage 90% loss
◉ Chronic renal failure treatment. Answer: Control htn and DM
Reduce proten to 40g/day
Renal dose meds
◉ CVA infarct. Answer: Subtle or sudden neurological deficits, visual
alterations, change sin vital signs, notor weakness, changes in LOC
◉ CVA hemorrhagic. Answer: Acute onset of focal neurologic deficits
Sudden increased ICP, hed and vomiting when bleed is extensive
Right (non dominant) side: left hemiparesis right visual field
changes spatial disorientation
Left dominant: right hemiparesis aphasia dysrrthria difficulty
writing
