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.

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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"

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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:

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3. Which of the following instruments is most appropriate to assess physical functional abilities in a 75-year-old nursing home resident?

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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:

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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:

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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:

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7. A 75 year old man has depression. His systolic blood pressure decreases 10 mmHg upon standing. Which of these medications would be safest?

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8. Which of the following statements regarding the use of tube feeding in patients with severe dementia is correct?

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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?

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10. An assessment of instrumental activities of daily living (IADLs) typically includes which of the following?

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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?

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12. The memory deficit that is most commonly caused by depression is?

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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?

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14. Which of the following is not a result of bed rest?

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15. Approximately what percentage of the cost of long-term care is paid for directly by elderly persons or their families?

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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?

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17. Which of the following statements is correct regarding caregiver burden?

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18. The weakest predictor of survival to discharge after in-hospital cardiopulmonary resuscitation is:

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19. The most common self-reported health condition in older persons is arthritis.

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20. The most frequent cause of dementia is Alzheimer’s Disease.

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21. Impairment is restriction in function imposed by social factors.

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22. Women have a greater prevalence of dementia because of their greater life expectancy.

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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).

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24. Established treatment for dementia includes:
1. Donepezil
2. Memantine
3. Gingko biloba
4. Vitamin D

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25. The number one cause of hospitalization in the elderly is

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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

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27. Urge incontinence is caused by

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28. Drug of choice for treatment of depression with insomnia is

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29. First line treatment of depression in primary care setting is

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30. Risk of hypoglycemia in the elderly is most with

 
 50% of survey complete.

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