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CLINIC Geriatrics Post-Assessment
1. Clinic Geriatrics Post-Assessment
This test consists of multiple choice questions in which only one alternative is the correct answer. Please select the correct answer.
1
. The percentage of community-dwelling individuals older than 65 years who require assistance with bathing, dressing, walking within their homes, using the toilet, or eating is closest to"
The percentage of community-dwelling individuals older than 65 years who require assistance with bathing, dressing, walking within their homes, using the toilet, or eating is closest to"
10%
30%
50%
70%
2
. A 78-year-old nursing home resident has mild dementia associated with Alzheimer’s disease. She is disoriented to time and place but knows family members and regular nurse aides by name. This patient’s capacity to make decisions regarding her health care is best determined by:
A 78-year-old nursing home resident has mild dementia associated with Alzheimer’s disease. She is disoriented to time and place but knows family members and regular nurse aides by name. This patient’s capacity to make decisions regarding her health care is best determined by:
Mental status exam
Her ability to understand treatment options
Probate court decision
Psychiatric examination
3
. Which of the following instruments is most appropriate to assess physical functional abilities in a 75-year-old nursing home resident?
Which of the following instruments is most appropriate to assess physical functional abilities in a 75-year-old nursing home resident?
Activities of Daily Living Scale
Face/Hand Test
Instrumental Activities of Daily Living Scale
Zung Self-Rating Depression Scale
4
. An 82-year-old man has worsening of urge incontinence, urinary frequency, and nocturia three months after transurethral resection of the prostate for benign prostatic hyperplasia. Symptoms of obstruction, including hesitancy, straining, and intermittent urinary stream, have improved. He is otherwise healthy and takes no medications. Urinalysis shows normal findings. After voiding 220 mL without straining, postvoid residual volume is 40 mL. The most appropriate next step in management is:
An 82-year-old man has worsening of urge incontinence, urinary frequency, and nocturia three months after transurethral resection of the prostate for benign prostatic hyperplasia. Symptoms of obstruction, including hesitancy, straining, and intermittent urinary stream, have improved. He is otherwise healthy and takes no medications. Urinalysis shows normal findings. After voiding 220 mL without straining, postvoid residual volume is 40 mL. The most appropriate next step in management is:
Oxybutynin 2.5 mg three times daily for a two-week trial
Terazosin 0.5 mg twice daily for a two-week trial
Cystoscopy
Cystometrography
5
. An 80 year old woman presents to you with urinary incontinence. She complains of urgency and frequent voiding (but is dry between voids). Her anal reflexes and perineal sensation are intact. Post void residual is less than 10 cc's of urine. Bedside cystometry suggests uninhibited bladder contractions at low volumes. You recommend all of the following EXCEPT:
An 80 year old woman presents to you with urinary incontinence. She complains of urgency and frequent voiding (but is dry between voids). Her anal reflexes and perineal sensation are intact. Post void residual is less than 10 cc's of urine. Bedside cystometry suggests uninhibited bladder contractions at low volumes. You recommend all of the following EXCEPT:
Bladder training
Adjustments of fluid intake patterns
A urinalysis and culture be done
Consider use of tolterodine
Consider use of bethanechol
6
. A 75 year old man comes to your office for a routine check up. He is a retired attorney and active in volunteer affairs. He feels fine, but his wife is concerned because he has been misplacing things and cannot tally his golf score. The patient says that he has "no problems." He has a history of hypertension treated with diuretics. He takes no other medications. On PE his blood pressure is 180/90 mmHg and he has mild cardiac enlargement; he is oriented times three.
ADLs: normal
IADLs: normal
Folstein Mini-Mental State Exam: 24/30
Geriatric Depression Scale: 4/15
Your best preliminary conclusion for these findings is:
A 75 year old man comes to your office for a routine check up. He is a retired attorney and active in volunteer affairs. He feels fine, but his wife is concerned because he has been misplacing things and cannot tally his golf score. The patient says that he has "no problems." He has a history of hypertension treated with diuretics. He takes no other medications. On PE his blood pressure is 180/90 mmHg and he has mild cardiac enlargement; he is oriented times three. ADLs: normal IADLs: normal Folstein Mini-Mental State Exam: 24/30 Geriatric Depression Scale: 4/15 Your best preliminary conclusion for these findings is:
Mild, cognitive impairment
Depression, creating cognitive impairment (pseudo dementia)
Delirium, possible due to drug toxicity
Alzheimer’s disease
7
. A 75 year old man has depression. His systolic blood pressure decreases 10 mmHg upon standing. Which of these medications would be safest?
A 75 year old man has depression. His systolic blood pressure decreases 10 mmHg upon standing. Which of these medications would be safest?
Amitriptyline
Doxepin
Imipramine
Sertraline
Thioridazine
8
. Which of the following statements regarding the use of tube feeding in patients with severe dementia is correct?
Which of the following statements regarding the use of tube feeding in patients with severe dementia is correct?
It does not improve survival
It protects against aspiration pneumonia
It promotes the healing of pressure ulcers
It improves patient comfort
It improves functional status
9
. An otherwise healthy 73-year-old man with Parkinson's disease has difficulty walking. He has had many changes in his antiparkinsonian medication and feels that the present regimen is the best he has ever had. Analysis of gait reveals very slow step initiation, decreased stride length with shuffling, and moderate retropulsion. Which of the following devices is most likely to improve his gait?
An otherwise healthy 73-year-old man with Parkinson's disease has difficulty walking. He has had many changes in his antiparkinsonian medication and feels that the present regimen is the best he has ever had. Analysis of gait reveals very slow step initiation, decreased stride length with shuffling, and moderate retropulsion. Which of the following devices is most likely to improve his gait?
A straight cane
A four-prong quad cane
A walker with arm troughs attached
A pickup four-legged walker
A front-wheeled walker
10
. An assessment of instrumental activities of daily living (IADLs) typically includes which of the following?
An assessment of instrumental activities of daily living (IADLs) typically includes which of the following?
Urinary continence
Ability to take medications
Recreational activities
Use of assistive devices
Social supports
11
. An 80-year-old woman is hospitalized for repair of a hip fracture sustained in a fall.
Which of the following medications found in her medicine cabinet at home is least likely to have contributed to her fall?
An 80-year-old woman is hospitalized for repair of a hip fracture sustained in a fall. Which of the following medications found in her medicine cabinet at home is least likely to have contributed to her fall?
Amitriptyline
Chlorpromazine
Flurazepam
Hydrochlorothiazide
Phenobarbital
12
. The memory deficit that is most commonly caused by depression is?
The memory deficit that is most commonly caused by depression is?
Amnesia for traumatic events
Difficulty with free recall
Difficulty with multiple choices
Disorientation to person, place, and time
Symmetrical loss of multiple cognitive functions
13
. An 89-year-old man is brought to the emergency department because of agitation, confusion, abdominal discomfort, and urinary incontinence that have been getting worse over the last week. His daughter reports that he has a normal baseline mental status, and he was recently hospitalized elsewhere for a condition she cannot characterize. Although he was taking no medications before that hospitalization, he was discharged with nifedipine, simvastatin, terazosin, a cromolyn inhaler, and aspirin.
On abdominal examination, he has a distended bladder. Catheterization yields 385 mL of urine and urinalysis is normal. His abdominal discomfort and agitation improve over the next few hours. You decide to leave the catheter in place while discontinuing the medication most likely to be causing urinary retention.
Which medication should you consider discontinuing first?
An 89-year-old man is brought to the emergency department because of agitation, confusion, abdominal discomfort, and urinary incontinence that have been getting worse over the last week. His daughter reports that he has a normal baseline mental status, and he was recently hospitalized elsewhere for a condition she cannot characterize. Although he was taking no medications before that hospitalization, he was discharged with nifedipine, simvastatin, terazosin, a cromolyn inhaler, and aspirin. On abdominal examination, he has a distended bladder. Catheterization yields 385 mL of urine and urinalysis is normal. His abdominal discomfort and agitation improve over the next few hours. You decide to leave the catheter in place while discontinuing the medication most likely to be causing urinary retention. Which medication should you consider discontinuing first?
Aspirin
Cromolyn
Nifedipine
Simvastatin
Terazosin
14
. Which of the following is not a result of bed rest?
Which of the following is not a result of bed rest?
Increased risk of pressure ulcers
Increased risk of aspiration
Orthostatic incompetence
Reversal of sleep-wake cycle
Bone loss
15
. Approximately what percentage of the cost of long-term care is paid for directly by elderly persons or their families?
Approximately what percentage of the cost of long-term care is paid for directly by elderly persons or their families?
30%
50%
70%
90%
16
. An 83-year-old woman presents with a history of three recent falls. She reports that her legs "gave way" while she was walking, soon after arising from bed or from sitting, and that she experienced transient lightheadedness but no loss of consciousness. She takes hydrochlorothiazide 12.5 mg daily for hypertension but is otherwise in generally good health. Which of the following is least likely to be contributing to her risk for falls?
An 83-year-old woman presents with a history of three recent falls. She reports that her legs "gave way" while she was walking, soon after arising from bed or from sitting, and that she experienced transient lightheadedness but no loss of consciousness. She takes hydrochlorothiazide 12.5 mg daily for hypertension but is otherwise in generally good health. Which of the following is least likely to be contributing to her risk for falls?
Muscle weakness related to age and inactivity
Unsteady gait
Impaired global functional status
Cerebrovascular disease
Postural hypotension
17
. Which of the following statements is correct regarding caregiver burden?
Which of the following statements is correct regarding caregiver burden?
Caregiver education has not been shown to reduce caregivers’ subjective ratings of burden
Caregiver variables, such as perceived burden and physical health, are stronger predictors of institutionalization than are patient variables
Caregivers for patients who are more severely cognitively impaired tend to report greater burden
Men who are caregivers tend to report greater burden than do women who are caregivers
18
. The weakest predictor of survival to discharge after in-hospital cardiopulmonary resuscitation is:
The weakest predictor of survival to discharge after in-hospital cardiopulmonary resuscitation is:
Metastatic malignancy
Age
Admission diagnosis of pneumonia
Serum creatinine > 1.7
Poor functional status
19
. The most common self-reported health condition in older persons is arthritis.
The most common self-reported health condition in older persons is arthritis.
True
False
20
. The most frequent cause of dementia is Alzheimer’s Disease.
The most frequent cause of dementia is Alzheimer’s Disease.
True
False
21
. Impairment is restriction in function imposed by social factors.
Impairment is restriction in function imposed by social factors.
True
False
22
. Women have a greater prevalence of dementia because of their greater life expectancy.
Women have a greater prevalence of dementia because of their greater life expectancy.
True
False
23
. Who should be screened for osteoporosis?
1. BMI less than 20.
2. Alcohol intake of more than one drink per day.
3. Hyperthyroidism, Cushing’s syndrome, Hypogonadism.
4. GI diseases (Ulcerative colitis, malabsorption, gastric bypass).
Who should be screened for osteoporosis? 1. BMI less than 20. 2. Alcohol intake of more than one drink per day. 3. Hyperthyroidism, Cushing’s syndrome, Hypogonadism. 4. GI diseases (Ulcerative colitis, malabsorption, gastric bypass).
1
2
1,2,3
1,3,4
24
. Established treatment for dementia includes:
1. Donepezil
2. Memantine
3. Gingko biloba
4. Vitamin D
Established treatment for dementia includes: 1. Donepezil 2. Memantine 3. Gingko biloba 4. Vitamin D
1
1,2,3
1,2
All of the above
25
. The number one cause of hospitalization in the elderly is
The number one cause of hospitalization in the elderly is
Pneumonia
CHF
UTI
Falls
26
. Risk factors for falls in the elderly include
1. Age more than 70
2. Cognitive impairment
3. Psychotropic drugs
4. Low vitamin D levels
5. Decreased visual acuity
Risk factors for falls in the elderly include 1. Age more than 70 2. Cognitive impairment 3. Psychotropic drugs 4. Low vitamin D levels 5. Decreased visual acuity
2,3,5
1,3
1,2,3,4
All of the above
27
. Urge incontinence is caused by
Urge incontinence is caused by
Detrusor overactivity, CNS hypereflexia, cystitis
Detrusor underactivity, cystitis
Normal physiologic aging
Urologic/gynaecological procedures
28
. Drug of choice for treatment of depression with insomnia is
Drug of choice for treatment of depression with insomnia is
Sertraline
Mirtazapine
Bupropion
Paroxetine
29
. First line treatment of depression in primary care setting is
First line treatment of depression in primary care setting is
Tricyclic antidepressants
SSRI
Drugs acting on multiple receptors,, like venlafaxine
MAO inhibitors
30
. Risk of hypoglycemia in the elderly is most with
Risk of hypoglycemia in the elderly is most with
Glyburide
Glipzide
Metformin
Pioglitazone
50%
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