Добавил:
ivanov666
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Frailty syndrome clinic, diagnosis, treatment. Study aid
.pdf
101
TEST QUESTIONS AND TASKS
Variant 1
1. The syndrome of senile asthenia is characterized by:
a) the development of dependence on outside help
b) loss of ability to self-service
c) decreased muscle strength and mass
d) falls
d) all of the above
2. Prevention of what condition does not prevent frailty syndrome?
a) dementia
b) pathological fractures
c) obesity
d) progressive weight loss
e) hypoproteinemia
3. The most common psychosocial problem in older people is:
a) social isolation
b) feeling lonely
c) concern for the fate of loved ones
d) a feeling of worthlessness
4. Sarcopenia is:
a) malignant tumor
b) age-related degenerative-atrophic change in muscle tissue,
accompanied by a decrease in muscle strength
c) blood pathology
d) endocrine disorder
102
5. The syndrome of senile asthenia is not characterized by:
a) the development of dependence on outside help
b) loss of ability to self-service
c) increased physical activity
d) the presence of geriatric syndromes
6. The purpose of a specialized geriatric examination is:
a) identification of a specific disease
b) prolonging people's lives
c) identification of conditions leading to a decrease in the quality of life
d) identification of age-associated pathology leading to the
development of patient dependence and death
7. At what age can senile asthenia develop?
a) in adulthood
b) in senile
c) in the elderly
d) in the elderly and senile
8. Geriatric examination involves obtaining information on the
following items:
a) information about the identity of the patient
b) assessment of physical condition
c) assessment of mental status
d) social status
d) all of the above are correct
9. The extreme manifestation of senile asthenia is:
a) complete immobility
b) hypomobility
c) dementia
d) fall syndrome
103
10. Malnutrition syndrome is characterized by:
a) low body mass index values
b) high body mass index values
c) increase in body mass index
d) normal body mass index values
ANSWERS: 1d, 2c, 3b, 4b, 5c, 6d, 7d, 8d, 9a, 10a
Case 1:
Patient K., 75 years old, came to the appointment with complaints of
intense constant pain in the lumbar region, aggravated by turning the body
and bending forward. The patient considers himself within a week, when the
above pains appeared while working in the garden (harvesting potatoes). In
order to reduce the pain syndrome, she took baralgin — with little effect.
From the anamnesis: retired (previously worked as a teacher), denies
occupational hazards. Past surgeries: hysterectomy at 44 (for uterine
fibroids), surgical menopause. Objectively: the condition is satisfactory.
Height 160 cm, weight 52 kg, BMI 20.3 kg/m2. There are no edema.
Enhanced thoracic kyphosis, emphasized lumbar lordosis. Painful palpation
of the spinous processes in the lumbar region. Vesicular breathing in the
lungs, no wheezing, respiratory rate 16 per minute. Heart sounds are
muffled, the rhythm is correct. Heart rate 64 per minute, BP 125/80 mm Hg.
The tongue is not coated, wet. The abdomen is soft, painless on palpation in
all departments. The size of the liver is 9×8×7 cm. The spleen is not
enlarged. Tapping on the lumbar region is painless, there is no dysuria. The
chair is designed 1 time per day, without pathological impurities. Complete
blood count: erythrocytes — 4.5 × 1012/l, hemoglobin — 130 g/l,
leukocytes — 7.8 × 1012/l, basophils — 0 %, eosinophils — 1 %, segmented
neutrophils — 73 %, lymphocytes — 18 %, monocytes — 8 %, platelets —
267×109/l, ESR — 14 mm/hour. Urinalysis: pH — 6.8, specific gravity —
1018, protein and sugar — negative, leukocytes — 2–3 in the field of view.
Biochemical blood test: total protein — 74 g/l, AST — 16 U/l, ALT —
104
22 U/l, glucose — 4.5 mmol/l, creatinine — 75 μmol/l. On the radiograph
of the lumbosacral spine — anterior wedge-shaped deformity L3 and L4.
Questions:
1. Suggest the most likely diagnosis, justify it?
2. Draw up and justify a plan for an additional examination of the
patient?
3. Define a plan for managing the patient using pharmacological and
non-pharmacological methods (indicating the doses of the drugs used)?
Case 2:
A 72-year-old patient, a pensioner, turned to a general practitioner
with complaints of insomnia, memory loss, increased blood pressure to 160–
170/65–70 mm Hg, shortness of breath when walking. 29 From the
anamnesis it is known about the increase in blood pressure to max.
180/80 mmHg within 20 years of the first diagnosis of HD. The therapy
prescribed by the general practitioner was carried out irregularly.
Situationally, with an increase in blood pressure over 180 mm Hg. taking
captopril. Menopause for over 20 years. Physical inactivity after stopping
work 6 years ago. There are no bad habits. From the family history it was
established that heredity for CVD is not burdened. Objectively, the
condition is satisfactory. Height 162 cm, body weight 46 kg, BMI
17.7 kg/m2. The skin is clean, normal color, turgor is reduced. There are no
peripheral edema. Breathing is vesicular, no wheezing. BH — 18 in 1 min.
Heart sounds are muffled, rhythmic, accent II tone over the aorta. BP —
162/62 mm Hg.st. Pulse 76 in 1 min. The abdomen is soft and painless. The
liver and spleen are not enlarged. Tapping in the projection of the kidneys
is painless on both sides.
Questions:
1. Assume the most likely diagnosis, justify it.
2. What groups of antihypertensive drugs would you recommend to
the patient as part of combination therapy? Justify your choice.
3. After 6 months of regular antihypertensive therapy + rosuvastatin
10 mg/day + diet — blood pressure is in the range of 140–150/65 mm Hg,
105
total cholesterol 5.6; HDL cholesterol 1.14; TG 1.9 mmol/l, LDL
3.6 mmol/l, GFR 63 ml/min, fasting sugar 5.2 mmol/l. ALT 50 U/l, AST 38
U/l, KFK 121 U/l.
What is your next treatment strategy? Justify your choice.
Case 3:
Patient A., 72 years old, retired, was taken to the cardiology
department of emergency medical care with complaints of interruptions in
the work of the heart, dizziness, shortness of breath, chest discomfort, and
weakness. Until the age of 60, he considered himself healthy, BP =
120/70 mm Hg. At the age of 65, after working in the country, he began to
notice the appearance of aching pains in the heart, shortness of breath and
dizziness, an increase in blood pressure to 160/90 mm Hg. At rest, the
complaints passed, he did not go to the doctor. At the age of 70, after intense
physical exertion, a sharp dizziness appeared, he lost consciousness.
According to his wife, the fainting state lasted 3–4 minutes. BP 90/60 Hg
The next day he went to the local doctor, BP 150/90 mm Hg, ECG — 30 data
for acute coronary pathology no. He took aspirincardio 0.1/day, atoris
10 mg/day, enalapril 10 mg/day for 3 months. There were no complaints, he
stopped taking medication. 6 months after work at home (repaired the crane)
there was a sharp dizziness, fell down with loss of consciousness. The wife
called an ambulance. On the ECG — frequent ventricular extrasystoles.
AL=110/70 mm Hg, heart rate 80 beats/min. Hospitalized. Objectively:
consciousness is clear, no edema. In the lungs, vesicular breathing, no
wheezing. Percussion left border of the heart is displaced 1 cm laterally
l.medioclavicularis sin. During auscultation: in the 2nd intercostal space on
the right — weakening of the II tone, which merges with a rough pansystolic
murmur heard on the vessels of the neck. The rhythm is correct,
5 extrasystoles per minute. HR = 76 beats/min, BP = 130/80 mm Hg. The
liver is not enlarged. Focal neurological symptoms were not detected.
Questions:
1. Formulate and justify the preliminary diagnosis.
2. Make a survey plan.
3. Should this patient be referred to a cardiac surgeon?
106
Case 4:
Patient T., 85 years old, suddenly felt dizzy, nauseous, weak while
walking and fell down. An ambulance was called — the patient is conscious,
answering questions. The heart rate is correct. Heart rate = 45/min. BP=
115/70 mm Hg. On the ECG rhythm sinus, cicatricial changes in the lower
wall of the left ventricle. Delivered to the cardiology department. History:
10 years ago suffered a myocardial infarction, was observed in the clinic at
the place of residence, takes atorvastatin 20 mg/day, cardiomagnyl
75 mg/day, losartan 25 mg/day, carvedilol 12.5 mg/day. Independently
controls the pulse and blood pressure: pulse = 52-60 beats/min, blood
pressure = 110/70-125/75 mm Hg. There were no complaints. Objectively
in the hospital: clear consciousness, pasty feet. In the lungs, vesicular
breathing, no wheezing. Heart sounds are muffled, the rhythm is correct.
Heart rate = 52 beats/min. BP = 110/70 mm Hg The abdomen is soft, b/b.
Liver — along the edge of the costal arch.
Questions:
1. Formulate and justify the diagnosis.
2. What additional examination should be carried out?
3. What medications should the patient take?
Variant 2
1. Absolute indications for nutritional support in the form of liquid
oral nutritional supplements are:
a) The patient's initial signs of malnutrition: body mass index less
than 12 kg/m2, hypoproteinemia (< 30g/l), hypoalbuminenmia (< 30g/l)
b) The patient's initial signs of malnutrition: body mass index less
than 19 kg/m2, hypoproteinemia (< 60 g/l), hypoalbuminemia (< 3 0 g/l)
c) The presence of rapidly progressive and significant weight loss of
more than 10 % per week
d) Presence of rapidly progressive and significant weight loss of more
than 2 % per week
107
2. All drugs for the treatment of osteoporosis are recommended to be
prescribed in combination:
a) vitamin D with potassium preparations
b) vitamin D with calcium preparations
c) vitamin A with calcium preparations
d) vitamin B with potassium preparations
3. Vitamin D deficiency corresponds to the concentration
a) 15(OH)D3 < 10 ng/ml
b) 25(OH)D3 < 20 g/ml
c) 25(OH)D3 < 20 ng/ml
d) 45(OH)D3 < 20 ng/ml
4. The duration of a comprehensive geriatric assessment of patients
with senile asthenia is:
a) 1.5–2 hours
b) 1–1.5 hours
c) 30 minutes — 1 hour
d) 30–45 minutes
5. For secondary prevention of cardiovascular diseases, it is
recommended to take acetylsalicylic acid in the following doses:
a) 75–100 mg/day
b) 75–200 mg/day
c) 75–90 mg/day
d) 85–150 mg/day
6. For the correction of behavioral and mental disorders, it is first of
all recommended to apply:
a) neurocognitive drugs
b) neuroleptics
c) non-drug methods
d) tranquilizers
108
7. For the treatment of chronic pain syndrome, it is recommended:
a) venflaxin
b) duloxetine
c) melipramine
d) escitalopram
8. To assess the cognitive functions of the patient, the following are
used:
a) Montreal Cognitive Assessment Scale
b) battery of frontal tests
c) Luria test
d) Stroop test
9. For patients with senile asthenia, the following types of physical
activity are recommended:
a) anaerobic loads
b) strength exercises
c) Balance exercises
d) resistance exercises
10. Long-lived is:
a) persons aged 75 years and over
b) persons aged 80 and over
c) persons aged 90 and over
d) persons aged 100 years and older
ANSWERS: 1b, d; 2b; 3с; 4b; 5а; 6с; 7b; 8а, b; 9b, c, d; 10с.
Case 1:
A 76-year-old man went to the doctor with complaints of weakness,
dizziness, flies flickering before his eyes. From the anamnesis it is known
that 3 months ago the patient had an acute inferior myocardial infarction
with ST elevation; The patient underwent coronary angiography — 90 %
109
stenosis of the right coronary artery was detected (LAAD stenosis 35 %, OS
30 %), in connection with which transballoon angioplasty and stenting of
the RCA with a drug-eluting stent were performed. From the anamnesis it
is known that for a long time he suffers from arterial hypertension with a
maximum increase in blood pressure numbers up to 210/110 mm Hg. Art.
Bad habits: smoking for 20 years, 10 cigarettes a day. On examination: a
state of moderate severity. The skin is clean, somewhat pale. Hard breathing
in the lungs, no wheezing. Heart sounds are muffled, rhythmic. Heart rate
98 beats. in min., BP — 110/60 19 mm Hg. Art. The abdomen is soft,
painless on palpation in all departments. The liver and spleen are not
enlarged. The symptom of tapping in the lumbar region is negative.
Physiological functions are normal. The patient did not seek medical help
for the last 2 months, continued to take the therapy recommended at
discharge: aspirin 75 mg 1 time/day, ticlopidine 90 mg 2 times/day,
bisoprolol 10 mg/day, perindopril 10 mg/day, rosuvastatin 20 mg/day,
indapamide 2.5 mg/day. In addition, on the advice of a neighbor, to “cleanse
the liver”, he bought and takes dietary supplements (biologically active
additive) of unknown composition and nimesulide as needed — up to
400 mg/day — for the prevention of pain (the patient has bilateral
gonarthrosis).
Questions:
1. What mistakes were made in the management of the patient?
2. Explain to the patient the need to quit smoking.
3. Correct pharmacotherapy.
4. Formulate your explanation to the patient and his relatives about
the need to take each drug you recommend.
Case 2:
At the reception, the patient is 81 years old, accompanied by her
daughter. Clinical diagnosis: Main disease: coronary artery disease: Angina
pectoris III FC. Background disease: 1. Hypertension III stage, 3 degrees,
the risk is very high. 2. Type 2 diabetes mellitus, target HbA1 ≤ 8 %.
Complications of the underlying disease: CHF stage IIA, II FC. Single
110
supraventricular extrasystole. CKD C2, A1. Associated diseases:
Parkinsonism. Bilateral gonarthrosis, coxarthrosis. Bilateral cataract.
Sensorineural hearing loss.
Questions:
1. Therapy of which disease is selected in the first place, provided that:
a) the severity of background and concomitant diseases is insignificant;
b) the patient has a high frequency of hyper- and hypoglycemia; c) against
the background of the selected therapy, the frequency of angina attacks
decreased to 1–2 per week, but pain in the knee joints became almost
unbearable.
2. What difficulties do you see in ensuring adherence to treatment in
such a patient?
3. What actions will you take to improve adherence?
Case 3:
The patient is 75 years old. Complaints of pain in the knee joints, the
pain is permanent, aggravated by normal physical activity. Objectively:
Hypersthenic physique. Body temperature 36.6 °C. There is swelling in the
area of the knee joints. There is no hyperemia. Movements in both knee
joints are painful, slightly limited.
In KLA: ESR 12 mm/h. On the radiograph of the knee joints: a slight
narrowing of the joint space, small osteophytes on the edges of the articular
surfaces of the bones, mild subchondral sclerosis.
Questions:
1) make a clinical diagnosis
2) formulate treatment tactics
Case 4:
A 75-year-old woman came to an appointment with complaints of
intense constant pain in the lumbar region, which worsened when turning
the body and bending forward. The patient considers himself within a week,
when the above pains appeared while working in the garden (harvesting
potatoes). In order to reduce the pain syndrome, she took baralgin — with
Соседние файлы в предмете [НЕСОРТИРОВАННОЕ]