A 75-year-old man presents with the chief concern, “I may have a bladder infection.” Further questioning reveals for several months he has been needing to void every couple of hours (can’t sit through a whole ball game), feels he must go as soon as he feels the urge (he tried putting it off and had urinary leakage), and is getting up two to three times at night to void. He denies delay in voiding or straining to initiate voiding, slow stream, feeling of incomplete emptying, or dribbling after completion of urination. He also denies dysuria and abdominal pain. Which of the following best describes the category or type of his lower urinary tract symptoms?

Correct Answer: D

Rationale: The correct answer is D) Storage (irritative) lower urinary tract symptoms. In this case, the patient's symptoms of needing to void frequently, urgency, nocturia, and urinary leakage when trying to delay voiding are indicative of storage symptoms. These symptoms suggest an overactive bladder, where there is involuntary detrusor muscle contractions causing urgency, frequency, and sometimes urge incontinence. Option A) Prostatism typically presents with symptoms such as slow stream, hesitancy, incomplete emptying, and dribbling, which are not seen in this patient. Option C) Postmicturition symptoms refer to issues that occur after urination, such as dribbling or incomplete emptying, which the patient denies. Educationally, understanding the different types of lower urinary tract symptoms is crucial in diagnosing and managing urological conditions. Recognizing the specific symptomatology helps healthcare providers differentiate between conditions like overactive bladder, benign prostatic hyperplasia, or other urinary issues, leading to appropriate treatment interventions. It is essential for healthcare professionals to be able to accurately assess and categorize lower urinary tract symptoms to provide optimal care for patients presenting with these complaints.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Inattention which best distinguishes delirium from depression or dementia. Delirium is characterized by acute onset fluctuating cognitive impairment, attention deficits, and altered levels of consciousness. Inattention is a key feature of delirium and is not typically seen as prominently in depression or dementia. Option A) Irritability is a symptom seen in both delirium and depression, but it is not a distinguishing feature. Option C) Paranoia is more commonly associated with conditions like schizophrenia or substance-induced psychosis rather than delirium, depression, or dementia. Option D) Aggressiveness can be seen in various mental health conditions but is not a specific feature that distinguishes delirium from depression or dementia. Educationally, understanding these distinctions is crucial for healthcare providers to accurately assess and manage patients. Recognizing the unique features of delirium, such as inattention, can guide appropriate interventions to address the underlying cause and prevent further complications in vulnerable populations like older adults with comorbidities.

Correct Answer: A

Rationale: Donepezil is a cholinesterase inhibitor commonly used to treat Alzheimer's disease. The correct answer, A) Thrombocytopenia, is NOT a common side effect of donepezil. Thrombocytopenia is a decrease in platelet count, and it is not typically associated with the use of donepezil. Option B) Bradycardia is a potential side effect of donepezil due to its cholinergic effects on the heart, leading to a decrease in heart rate. Option C) Vivid dreams may occur as a side effect of donepezil due to its impact on cholinergic neurotransmission in the brain. Option D) Gastrointestinal distress, such as nausea, vomiting, or diarrhea, is a common side effect of donepezil, as it affects cholinergic receptors in the GI tract. In an educational context, it is important for healthcare providers to be familiar with the common side effects of medications used to treat Alzheimer's disease, like donepezil, to monitor patients for adverse reactions and provide appropriate care. Understanding the side effect profile of medications helps in assessing and managing the patient's overall well-being and treatment outcomes.

Correct Answer: A

Rationale: In this case, the most likely cause of Randall Johnson's dizziness is orthostatic hypotension (Option A). Orthostatic hypotension is a common issue in the elderly, especially in those with a history of high blood pressure. When an individual stands up from a sitting or lying position, a sudden drop in blood pressure can occur, leading to symptoms like dizziness. Option B, benign positional paroxysmal vertigo, is less likely in this scenario as the patient's symptoms are ongoing and not triggered by specific head movements, which is characteristic of vertigo. Option C, overcontrol of thyroid, is also unlikely as hypothyroidism typically leads to symptoms like fatigue and weight gain rather than dizziness. Option D, Ménière disease, is less likely without symptoms like hearing loss or ringing in the ears, which are common in Ménière disease. In an educational context, understanding the common causes of dizziness in the elderly is crucial for healthcare providers to provide appropriate care and management. Recognizing orthostatic hypotension in patients with a history of conditions like high blood pressure is essential for timely intervention to prevent falls and other complications associated with low blood pressure.

Correct Answer: C

Rationale: The correct answer is C) All patients should receive referral to both psychiatry and neurology, neuroimaging, and screening polysomnography to identify underlying sleep disorder. This option is correct because patients receiving atypical antipsychotics are at increased risk for developing sleep disorders due to the pharmacological effects of these medications. Referral to psychiatry and neurology allows for a comprehensive evaluation of the patients' mental health and neurological status, which can uncover any underlying conditions contributing to their sleep disturbances. Neuroimaging can help identify any structural abnormalities in the brain that may be impacting their sleep, while polysomnography is essential for assessing their sleep patterns and identifying specific sleep disorders. Option A is incorrect because actigraphy monitoring alone may not provide sufficient information to diagnose underlying sleep disorders in these patients. Option B is incorrect because while cognitive behavioral therapy for insomnia may be beneficial for some patients, it does not address the need for a comprehensive evaluation of potential underlying causes of sleep disturbances in patients on atypical antipsychotics. Option D is incorrect because assuming all patients have irregular sleep-wake phase disorder without further evaluation can lead to missed diagnoses of other sleep disorders that may require different management strategies. In an educational context, understanding the importance of thorough evaluation and multidisciplinary approach in patients receiving atypical antipsychotics can help healthcare providers provide optimal care and address the complex interplay between psychiatric medications and sleep disorders.