An 80-year-old woman comes to the office to request a prescr…
An 80-year-old woman comes to the office to request a prescription for an antidepressant. Over the past 2 months she has been sleeping poorly, and her appetite has decreased. She describes feeling miserable all the time, crying often, and fighting with everybody. She has no somatic symptoms. History includes obesity, hypothyroidism, osteoarthritis, and longstanding bipolar disorder. Medications include levothyroxine and acetaminophen as needed. She has been asymptomatic off medication for bipolar disorder for 2 years; shortly before she stopped, she experienced lithium toxicity and was hospitalized. The patient and her family believe that the bipolar disorder has abated because of her age. Physical examination is unremarkable. She appears restless, starts to talk of a new hobby, but then switches topic. There is a substantial change from her baseline cognition: she is not sure of the date, and she makes mistakes about events that are familiar to her. CBC and basic chemistry panel are within normal limits. During the past week, she has become increasingly tearful, confused, and restless. Which of the following is most likely to be true?
Read DetailsThe 9-item Patient Health Questionnaire (PHQ 9) and the Geri…
The 9-item Patient Health Questionnaire (PHQ 9) and the Geriatric Depression Scale (GDS) are the screening tests for geriatric depression with the best validity to support their use in primary care practice. Which of the following statements is true?
Read DetailsA 79-year-old man with a history of heart failure with prese…
A 79-year-old man with a history of heart failure with preserved ejection fraction, gout and chronic insomnia is concerned about falling. His medication list indicates he takes furosemide, carvedilol, lisinopril, aspirin, allopurinol and temazepam. He lives alone and earlier in the year fell getting out of bed to go to the bathroom but did not suffer any injury. Last week, he missed a step and stumbled but did not fall. Which one of the following would most likely reduce this patient’s fall risk?
Read DetailsA 75 y/o patient reports weakness, difficulty urinating and…
A 75 y/o patient reports weakness, difficulty urinating and feeling dehydrated. Although afebrile, the nurse practitioner conducts a thorough physical examination, including urinalysis and complete blood count (CBC). The total assessment is necessary because:
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