Blog

An 82-year-old woman with PMH of dementia, currently residing in a skilled nursing facility, presents for evaluation of recent-onset fatigue, loss of interest in daily activities, lack of motivation, worsening short-term memory loss, and crying episodes, which have been noted over the past month.  The nursing home staff have documented that the patient has also recently stopped wanting to eat, and has even been found trying to leave the dining room early and return to her room during meal times.  When questioned by the staff, she indicates that she finished eating, but she clearly has eaten very little.  The nursing home staff is not aware of any recent significant psychosocial stressors that could be contributing to these symptoms.  Based on this information, which of the following conditions is the most likely diagnosis for this patient?

A Medical Order for Life Sustaining Treatment (MOLST) form is intended to convey the patient’s wishes regarding cardiopulmonary resuscitation (CPR) and other life-sustaining treatment in which of the following situations?

A 76-year-old female present for evaluation of excessive fatigue during the day, and the need for frequent afternoon naps.  She has a long history of insomnia symptoms and admits to taking “sleeping medicine” for fifty years.  Her daytime fatigue is a new symptom.  An age-related increase in which of the following parameters may account for a prolongation in the metabolism of the sleep medication prescribed for this patient?

An 80-year-old male is a current patient of yours and comes to the clinic for evaluation of depressed mood, insomnia, and difficulty dealing with the loss of his daughter who died of cancer. You already have him on antidepressant medication and now you want to consider an adjunct treatment that will address this patient’s specific situation. Which of the following interventions would be most appropriate for this patient?

A 74-year-old male presents to your clinic with complaints of seeing “wavy lines” in the visual field of his left eye. He is not sure when it started but does believe it has gotten progressively worse. He denies pain, photophobia, or other ocular symptoms. His PMH is significant for Type II Diabetes and HTN. His current medications include metformin and lisinopril. On examination, his visual acuity is 20/400 in the left eye and 20/70 in the right eye. His pupils are 2 mm bilaterally and equally reactive to light with accommodation. There are no extraocular motor deficits. A fundoscopic exam of his left eye is shown (see image below). What is the best next step in management of this patient?            

Full thickness tissue loss; subcutaneous fat may be visible but bone, tendon or muscle are not exposed describes what stage of a pressure ulcer?

A 74-year-old woman with PMH of hypertension, diabetes, CAD, and osteoarthritis came to the clinic with her son for assessment of her worsening cognitive decline. The son is concerned about her short-term memory problems for the past 10 months. The patient had a fall 10 months ago; after that fall, she started to ask the same questions over and over again. The patient had another fall 4 months ago and also an episode of dizziness 2 months ago. With these incidents, her son noticed further decline in cognition. Recently, her son noticed that she has become a bit more suspicious of her daughter-in-law and has been hoarding things. She has lost interest in her day-to-day activities and forgets to include the right ingredients when cooking. Family members have to remind her to take her medications, and her son is helping with the management of her finances. On the Mini-Mental Status Examination (MMSE), the patient scored 21/30 with abnormal clock drawing. On the Geriatric Depression Scale (GDS-15), the patient scored 2/15. CT scan of the head showed multiple lacunar infarcts in the right basal ganglia and left cerebellar region. Based on this information, which of the following conditions is the most likely cause of this patient’s cognitive decline?

A 76-year-old male patient with a PMH significant for osteoarthritis, presents for evaluation accompanied by his wife.  She is very concerned about some recent symptoms that he has been experiencing.  She states that her husband has begun ‘staring into space’ for lengthy periods of time, and reports that he has also had episodes of disorganized speech.  The patient has become increasingly drowsy during the day, and now frequently takes daytime naps.  Most frightening to the patient and his wife, is the occurrence of visual hallucinations.  Based on this information, which of the following conditions would be your provisional diagnosis for the patient?

An 88-year-old male complaining of abdominal pain arrives at the Emergency Department with his wife. A mini-mental status exam reveals pronounced forgetfulness and confusion. The patient is discovered to have acute appendicitis requiring immediate surgery. He is unable to understand the situation and cannot provide informed consent.  The wife of the patient is his designated Health Care Proxy.  What further action should the medical provider take?

An 82-year-old male presents to your office for follow-up of his multiple medical problems, including a history of cerebrovascular accident and dementia. The patient is bedridden and is cared for at home by his family. Examination of his sacrum reveals an area of intact skin with erythema that does not blanch with palpation. What stage decubitus ulcer is this lesion?