Conceptual Actual Emended Exam Questions With Reviewed 100% Correct Detailed
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If an elderly patient walks in with increas-
ing confusion after days, weeks, or even
chronic subdural hematoma
months after a minor head trauma need
to rule out what?
If an elderly patient walks in with increas-
ing confusion after days, weeks, or even
months after a minor head trauma and it refer to emergency department (ED)
is neurologically severe and progressing,
who do you refer out to?
If an elderly patient walks in with increas-
cardiopulmonary concerns - changes in
ing confusion after days, weeks, or even
BP, changes in pulse, S.O.B. or chest
months after a minor head trauma, when
pain
do you call 911?
If an elderly patient walks in with in-
creasing confusion after days, weeks, or
even months after a minor head trauma
refer to PCP semi-urgent basis
but neurological changes are not severe
or less severe and no cardiopulmonary
concerns, who do you refer out to?
slow onset of symptoms/signs over days,
weeks, or months and may be after minor
head trauma
Chronic Subdural Hematoma in Elderly confusion
(S/S) slurred speech
difficulty balancing and walking
headache
lethargy
What can chronic subdural hematoma
be mistaken for, that an elderly patient dementia
may already be diagnosed with?
What is a key sign that a chronic subdur-
a faster than normal decline in mental
al hematoma is present and it is not just
function
the patient's dementia?
What physical exam(s) may be used for mental status exam or mini-mental
an elderly patient with increasing con- health screening exam (MMSE)
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Conceptual Actual Emended Exam Questions With Reviewed 100% Correct Detailed
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fusion for days, weeks or months after
minor head trauma?
MMSE mini-mental health screening exam
anticoagulant medication (blood thin-
ners, aspirin)'
Risk factors for chronic subdural long term alcohol abuse
hematoma recurrent falls
repeated head injuries
elderly age
If a patient presents with severe dizzi-
ness immediately after standing up, what severe orthostatic hypotension
condition do you want to rule out?
Consequences that may occur if a pa- possible syncope and falling, especially
tient has severe dizziness immediately in elderly, causing fractures and possibly
after standing up death
If a patient presents with severe dizzi-
refer to PCP for possible adjustment of
ness immediately after standing up, who
medications and/or diagnostic workup to
should you refer out to? (orthostatic
determine cause of the condition
dizziness)
Physical exam(s) for orthostatic hypoten-
repeated blood pressure readings
sion
simple dehydration
overmedication with antihypertensive
Potential causes of orthostatic hypoten- medicine
sion more complex dysfunctions of the car-
diovascular, neurological, endocrine, or
renal systems
Additional sign(s)/symptom(s) that may varying dizziness (not just from rising)
point to orthostatic hypotension with underlying cause of hypotension
age 65 years or older
medications
cardiovascular, neurological, renal,
Risk factors for orthostatic hypotension and/or endocrine problems
heat exposure & dehydration
bed rest
crossing legs at the knees for prolonged
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periods of time
pregnancy
malnutrition
debilitation
diuretics (Furosemide - Lasix)
beta-blockers
Medications that can be risk factors for
anti-Parkinson's drugs
orthostatic hypotension
tricyclic antidepressants
sildenafil (Viagra)
If a patient has orthostatic hypotension, patient lying down in a stable position
how should acupuncture treatment be plus careful monitoring for syncope upon
performed? arising after treatment
If an elderly patient presents with dizzi-
ness and a slow heartbeat, less than
(<) 60 beats per minute and the heart sick sinus syndrome (SSS)
rate does not increase with activity, what
condition do you want to rule out?
Consequences of sick sinus syndrome debility, falling (resulting in fractures,
(SSS) in elderly if untreated head/brain injuries, etc.), possible death
An elderly patient presents with dizzi-
ness and a slow heartbeat, less than (<)
60 beats per minute and the heart rate
patient cannot drive themselves to their
does not increase with activity. They are
PCP
not presenting with S.O.B. You suspect
SSS and refer them out to their PCP.
What can you not let the patient do?
An elderly patient presents with dizzi-
ness and a slow heartbeat, less than (<)
60 beats per minute and the heart rate refer out to PCP on timely basis
does not increase with activity. They do
not present with S.O.B. What do you do?
An elderly patient presents with dizzi-
ness and a slow heartbeat, less than (<) refer out on a semi-urgent basis (urgent
60 beats per minute and the heart rate care or immediate referral to PCP aka
does not increase with activity. They also same day)
present with S.O.B. What do you do?
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An elderly patient presents with dizzi-
ness and a slow heartbeat, less than (<)
60 beats per minute and the heart rate
does not increase with activity. They also call 911
present with severe S.O.B. while resting,
chest pain, falling blood pressure, and/or
syncope. What do you do?
fatigue, weakness, dizziness especially
with exertion
Sick Sinus Syndrome (SSS) (S/S) S.O.B.
chest pain
near-syncope or syncope
Physical Exam for sick sinus syndrome
check pulse rate (below 60 bpm)
(SSS)
An adult or child patient presents with
inattention and/or hyperactivity that is attention deficit hyperactivity disorder
severely interfering with daily functions. (ADHD)
What condition needs to be ruled out?
increased risk of:
bipolar
conduct disorders
oppositional-defiance disorders
impaired self-esteem & self-confidence
Consequences of ADHD being left un- decreased performance at school and/or
treated work
social isolation & dysfunction
depression
possible death from substance abuse &
risk-taking behaviors
refer out on a timely basis to expert
A patient presents with inattention and/or or group of experts in ADHD (skilled
hyperactivity that is severely interfering acupuncturist, family physician, psychol-
with daily functions. Who should you do? ogist, psychiatrist, dietician and/or neu-
rologist)
ADHD (S/S)