NREMT Emergency Medical Technician (EMT) Cognitive ExamMedical EmergenciesMedium
A 78-year-old male, a resident of a long-term care facility, presents with new-onset confusion, lethargy, and a slight increase in urinary frequency. His temperature is 99.0°F (37.2°C), heart rate 88 bpm, blood pressure 130/80 mmHg. What is the most likely underlying condition?
- AStroke
- BUrinary tract infection (UTI)
- CMyocardial infarction
- DHypoglycemia
Show answer & explanationAnswer & explanation
Correct answer: B. Urinary tract infection (UTI)
In elderly patients, especially those in long-term care, urinary tract infections (UTIs) often present atypically with altered mental status (confusion, lethargy) rather than classic symptoms like high fever or severe dysuria. The slight increase in urinary frequency supports this diagnosis. This is a common and important presentation to recognize.
Why the other options are wrong
- A. Stroke would likely present with focal neurological deficits, not just generalized confusion and lethargy, and would not explain increased urinary frequency.
- C. Myocardial infarction typically presents with chest pain or other acute cardiac symptoms, not primarily confusion and lethargy without other cardiac signs.
- D. Hypoglycemia would cause confusion and lethargy but would be accompanied by a low blood glucose reading and usually cool, clammy skin.
Atypical UTI in Elderly
Urinary tract infections in older adults often present with non-specific symptoms like confusion, lethargy, and functional decline, rather than classic urinary symptoms or fever.
- Altered mental status is a common presentation.
- May not have fever or dysuria.
- Increased risk in long-term care residents.
- Early recognition prevents severe complications (e.g., sepsis).
Memory trick: Confused Elder, Check Bladder