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56 Cards in this Set
- Front
- Back
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1. Which of the following signs of aging occurs earliest in most adults?
a. Difficulty reading fine print without glasses b. Inability to stay up all night and work the next day c. Radiologic evidence of osteoarthritis of the spine d. Intense awareness that life is limited ("midlife crisis") e. Fixed wrinkling around the mouth (ch 2 - Pretest) |
b. Inability to stay up all night and work the next day
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2. Which of the following statements is true about individuals at age 80 years?
a. Vibratory sensation in equally reduced in distal and proimal joints. b. More than half older persons report trouble sleeping at night. c. Renal perfusion is 75% to 80% of its value at age 30 years. d. Fewer than half of couples have been affected by death or disability or one or both spouses. (Ch2 Pretest) |
b. More than half older persons report trouble sleeping at night.
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3. Which one of the following sx referable to the urogenital system is commonly reported by older women?
a. Increased vaginal mucus b. Reduced urinary frequency c. Vaginal bleeding d. Incontinence (Ch2 Pretest) |
d. Incontinence
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1. Which of the following normal aging changes contributes to impaired night driving skills among 80-year-old individuals?
a. Reduced dark adaptation b. 19% decrease in foot reaction time compared with young adults c. 70% reduction in light reaching the retina d. Reduced ability to hear approaching sirens e. All of the above Ch2 Post test |
b. 19% decrease in foot reaction time compared with young adults
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2. Which one of the following statements is false about individuals aged 65-70y?
a. Reported happiness is greater than any other age b. Percentage of body fat is greater than at age 20 c. They report less independence and more financial worries than do younger adults. d. Sexual activity is correlated with physical health. Ch2 Post test |
c. They report less independence and more financial worries than do younger adults.
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3. All of the following are true about normal aging except which one?
a. Established routines often constitute a helpful adjustment to aging. b. Sensory impairments limit many older persons' ability to make friends. c. Major disability is uncommon among older persons. d. Worrying about memory loss is more often a symptom of normal aging than of Alzheimer's disease. Ch2 post |
c. Major disability is uncommon among older persons.
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4. Mr Carter, an 80yo retired engineer, is active in a bridge club, the local church, and a daily exercise class. His wife, on the other hand, spends the majority of her time either watching TV (during cold days) or sitting on the front porch (when it's warm). Which one of the following is false about this couple?
a. Mrs Carter exemplifies the disengagement theory of successful aging. b. Mr Carter exemplifies the activity theory of successful aging. c. Mr Carter is likely to live longer than Mrs Carter. d. The continuity theory could apply to either spouse. Ch2 post |
c. Mr Carter is likely to live longer than Mrs Carter.
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Which of the following is not a characteristic presentation of illness of old age?
a. Depression w/o sadness b. Infectious dz w/o leukocytosis c. fever w/o cause d. Apathetic thyrotoxicosis e. Myocardial infarction w/o chest pn |
c. fever w/o cause
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Which one of the following statements is F concerning ways in which clinicians might "harm" older persons?
a. the 1/2 life of many meds is prolonged in healthy older people. b. 20% of hospitalizations of older people are prolonged by major adverse advent. c. F/U to assess the effect of prescriptions is often lacking. Communication btw clinicians about pts often excludes consideration of the patients fnx level e. Premature mobilization after illness inc fall risk |
e. Premature mobilization after illness inc fall risk
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Which one of the following aspects of a dependent older person has not been demonstrated to be a major stressor of the caregiving fam member?
a. Pts ingratitude b. Use of multiple meds c. Pts being awake at night d. Physical dependance of pt |
b. Use of multiple meds
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69 y/o black woman who works full-time and lives w/her daughter has a lesion that she fears is cancer. 4 prob are defined at her brief visit. Which problem takes the highest priority?
a. BP 175/90 b. Demonstrable stress incontinence c. Hearing difficulties: pt can manage one on one d. The brown nevus on her ant chest that has remained unchanged for several yrs |
b. Demonstrable stress incontinence
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75 y/o woman is taking amitriptyline, isophane insulin suspension, digoxin, and a thiazide diuretic and has established dx of Congestive HF and L bundle branch block, DM, and depression. Which one of the following statements concerning the interactions btw her diagnoses and tx is false?
a. Thiazide predisposes her to digoxin toxicity b. Amitriptyline may be the cause of the bundle branch block c. Hyperglycemia may be worsened by the diuretic d. The digoxin predisposes her to the risk of hypoglycemia. |
d. The digoxin predisposes her to the risk of hypoglycemia.
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Which one of the following statements concerning family members and the care of elderly pts is false?
a. The clinician is obligated to carry out noninvasive investigations if demanded by the health care proxy. b. An individual named as health care proxy has the right to refuse tx on behalf of the pt, if the pt cannot understand. c. In the absence of a health care proxy, the family has no right to refuse tx on the pt's behalf. d. Disturbed nights head the list of pt characteristics that stress caregivers. |
a. The clinician is obligated to carry out noninvasive investigations if demanded by the health care proxy
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Recent rapid growth in Medicaid expenditures is attributed to:
a. The expanded coverage and utilization of services b. An increase in the number of persons requiring extensive acute and long-term care c. The increase in drug costs and the availability of new expensive drugs d. All of the above |
d. All of the above
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Which of the following is true in regards to funding sources for nursing home care?
a. Most patients admitted to a skilled nursing home beds do not use the full Medicare benefit of 100 skilled nursing facility days per episode of illness. b. Medicare payments account for approximately 20% of the average nursing facility's revenues. c. Medicare Part A does not include a copayment for skilled nursing facility days. d. Medicare Part A covers skilled nursing facility coverage without a prior qualifying hospitalization. |
a. Most patients admitted to a skilled nursing home beds do not use the full Medicare benefit of 100 skilled nursing facility days per episode of illness.
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Which one of the following statements concerning health care funding is false?
a. Medicare Part B is an optional program that covers excess hospital costs. b. Nursing home care accounts for the largest portion of Medicaid expenditures. c. The Older Americans Act helps fund some home- and community-based services. d. Medigap is private insurance that usually includes coverage for Medicare copayments and deductibles. |
a. Medicare Part B is an optional program that covers excess hospital costs.
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Which one of the following statements concerning Medicaid is false?
a. Medicaid covers Medicare deductibles and copayments b. States can set a higher income limit for Medicaid eligibility than is federally required. c. Mandatory Medicaid benefits covered by all states include equal access to institutional and community-based long-term care services. d. Eligibility for Medicaid coverage is based on both low income and low assets. |
c. Mandatory Medicaid benefits covered by all states include equal access to institutional and community-based long-term care services.
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Which one of the following statements concerning Medicare is false?
a. Medicare Part B covers 80% of the Medicare-approved physician charge. b. Medicare Part B covers 70% of approved mental health services. c. Medicare participating physicians agree to accept Medicare as payment in full. d. New elements of th Medicare program include prescription drug coverage, regional PPs, and HSAs. |
b. Medicare Part B covers 70% of approved mental health services.
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Which of the following distinguishes patients with delirium from those with depression or dementia?
a. Presence of lethargy b. Experience of hallucinations c. Aggressiveness d. Symptom fluctuation |
d. Symptom fluctuation
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Which of the following describes the main stress-induced modification of brain neurotransmission in delirium?
a. Cholinergic deficiency and dopaminergic excess b. Cholinergic excess and dopaminergic deficiency c. Cholinergic deficiency and dopaminergic deficiency d. Cholinergic excess and dopaminergic excess |
a. Cholinergic deficiency and dopaminergic excess
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All of the following are common PREDISPOSING factors for delirium among older adults hospitalized for a medical or a surgical illness EXCEPT:
a. Alzheimer's disease b. Dehydration c. Hemoglobin of 11 mg/dL d. Current use of anticholinergic medication |
c. Hemoglobin of 11 mg/dL
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All of the following are common PRECIPITATING factors for the development of delirium during hospitalization for medical or surgical illness EXCEPT:
a. Physician restraints b. Bladder catheter c. Early referral to physical therapy d. Untreated postoperative pain |
c. Early referral to physical therapy
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All of the following medications may precipitate or contribute to delirium in older adults EXCEPT:
a. Atorvastatin b. Amitriptyline c. Oxybutinin d. Diphenhydramine |
a. Atorvastatin
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Interventions that may prevent the onset of delirium among older adults hospitalized for a medical or surgical illness include all below EXCEPT:
a. Professional or family sitter b. Encourage 6 hours of uninterrupted sleep per night c. Use of lorazepam for excessive anxiety d. If needed, ensure that patient wears hearing aid/eyeglasses |
c. Use of lorazepam for excessive anxiety
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DS, a 76yo widow, presents for follow-up of her htn, DM, and chronic heart failure. She is taking 6 prescribed meds in addition to aspirin and a multivitamin. She reports a family history of dementia and heart disease and was involved in motor vehicle accident 10 years ago. What approach to dementia screening is recommended for this patient?
a. No dementia screening is necessary. b. Include the patient in the decision of screening for dementia. c. Use the MMSE, Mini-cog, or the clock-drawing test (CDT) to screen for dementia d. Refer the patient to memory clinic to conduct a formal dementia evaluation |
b. Include the patient in the decision of screening for dementia
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On taking a clinical history of an 82yo patient, his wife tells you that he has had trouble remembering to take his medications. Furthermore, last week he got lost while driving alone and had to be escorted home by strangers. What would be the most appropriate next step?
a. Refer the pt to the local memory clinic for formal evaluation. b. Conduct simple cognitive screening using the MMSE, mini-cog, or CDT. c. Order a brain imaging to detect any cortical infarct. d. Assure the patient that her symptoms are normal part of the aging process. |
b. Conduct simple cognitive screening using the MMSE, mini-cog, or CDT.
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AJ, a pt with moderate dementia, was admitted last summer to a nursing home. Today her daughter brings her in for her annual follow-up. The daughter tells you that over the past 2 months her mother has become increasingly irritable. She now spends most of the time in her room, no longer playing cards and bingo. Last week she declined her daughter's invitation to join a family picnic, something that she always used to enjoy. In addition, staff tell the daughter that AJ has been resisting taking her meds and is sleeping poorly at night. What is the most likely dx?
a. Episode of acute delirium b. Primary insomnia c. Depression superimposed on dementia d. An evolving serious medical problem, such as cancer or severe anemia |
c. Depression superimposed on dementia
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GK comes to your office with his wife. She takes you aside before the visit and tells you that over the past year she has to take over the driving, the checkbook, and managing his meds. Your exam reveals an MMSE of 28 and an otherwise normal neuro exam. the cardio exam is unremarkable, and your blood work rules out B12 deficiency and hypothyroidism. Which one of the following would be most appropriate for this pt?
a. Review the meds for side effects. b. Counsel the pt and spouse about Alzheimer's disease c. Ask for a follow-up appt in 6 months and repeat the MMSE. d. Start treatment with donepezil. |
a. Review the meds for side effects.
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Which one of the following is approved by the FDA for the tx of mild Alzheimer's disease?
a. Vitamin E b. Memantine c. Donepezil d. Risepridone |
c. Donepezi
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LW is an 87 yo woman with Alzheimer's disease who is managed at home on donepezil 10 mg QD. One afternoon her daughter, with whom she lives, calls to say that LW has become more confused lately and has been seeing the devil for the past 3 days. What is the most approrpiate next management step?
a. Start a low dose of olanzapine/ b. Assure the daughter that these symptoms are part of the natural progression of the disease and arrange for a follow-up visit in 2 weeks. c. Stop her CHEIs. d. Ask the daughter to bring her mother to your office immediately. |
d. Ask the daughter to bring her mother to your office immediately
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Which one of the following predisposes older adults to UTIs?
a. Thiazide diurectic therapy b. Cardiovascular dz c. Cognitive impairment d. Selective serotonin uptake inhibitors |
c. Cognitive impairment
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Which one of the following statements regarding the use of antibiotics in patient with indwelling catheters is false?
a. Indwelling urinary catheters are the leading cause of nosocomial UTI b. Indwelling urinary catheters are the most common predisposing factor in hospital acquired, fatal, Gram negative sepsis c. After 1 month, virtually all pt with indwelling catheters have asymptomatic bacteriuria d. Antibiotic tx should be prescribed for pt with asymptomatic bacteriuria who have indwelling urinary catheters. |
d. Antibiotic tx should be prescribed for pt with asymptomatic bacteriuria who have indwelling urinary catheters.
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Which of the following statements regardign bacteriuria is true?
a. Declining physical functioning may be associated with bacteriuria in older adults in long-term care. b. Lack of a febrile response (temperatures less than 101.2) rules out a sign bacteruria. b. Long term antibiotic tx is required for recurrent asymptomatic bacteruira d. Irrigating in-dwelling catheter decreases the risk of bacteruria |
a. Declining physical functioning may be associated with bacteriuria in older adults in long-term care.
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The most appropriate tx for a pt with a UTI in the presence of a bladder stone is?
a. A trial of antibiotics for 14 days and then repeat urine culture to test for cure b. Surgically remove the stone c. Lifelong tx with antibiotic for bacterial suppression d. Place indwelling catheter and perform daily bladder irrigation |
b. Surgically remove the stone
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Which of the following is (are) true regarding asymptomatic bacteruria in older adults?
a. There are no differences in the prevalence of incontinence or frequency, compared to those without bacteruria b. Bacteriuria requires at least one course of antibiotics to be resolved c. At least one course of antibiotics reduces mortality due to bacteruria d. Antibiotics decrease the likelihood of the development of ressistant micro-organism. |
Which of the following is (are) true regarding asymptomatic bacteruria in older adults?
a. There are no differences in the prevalence of incontinence or frequency, compared to those without bacteruria |
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Which of the following is are true regarding catheter-associated UTI?
a. Chronic indwelling catheterizatin has a lower rate of UTIs than intermittent catherterization b. Bacteruria is rare in pts with indwelling catheters c. UTIs in the presence of indwelling catheters require long-ter antibiotic tx d. Complications of chronic indwelling catheters include nephrolithiasis |
d. Complications of chronic indwelling catheters include nephrolithiasis
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Depletion of which of the following neurotransmitters is most strongly associated with Parkinson's disease?
a. Norepinephrine b. Dopamine c. Glutamate d. serotoni |
b. Dopamine
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Which factor most helps to distinguish Parkinson's disease from other causes of parkinsonism?
a. Bradykinesia b. Increased tone c. Postural instability d. Response to dopamine replacement |
d. Response to dopamine
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Your patient has difficulty with shaking and clumsiness of his left arm when reaching for objects. At rest, his arm does not shake. When asked to carry out with rapid alternating movements, he has difficulty with maintaining an even rhythm. This is most consistent with which type of disease?
a. Parkinson's disease b. Essential tremor c. Cerebellar disease d. Chorea Dyskinesia |
c. Cerebellar disease
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Which of the following medications could worsen symptoms of Parkinson's Disease?
a. Sinemet b. Amatadine c. Haloperidol d. Entacapone e. Pramipexole |
c. Haloperidol
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Mr. Smith is a 70 year old man attends your office with a complaint of tremor of the mouth. He has a hard time putting his thoughts together enough to give you a good history. On exam, you notice that he has repetitive lip smacking and tongue thrusting, along with occasional twisting truncal movements. Tone is somewhat increased throughout his body. He has no tremor in his arms or legs. What is the likely cause of his movements?
a. Side effect from chronic antipsychotic medication b. Early Parkinson's disease c. Cerebellar disease d. Parkinson's plus syndrome e. Essential Tremor |
a. Side effect from chronic antipsychotic medication
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Which one of the following statements about the Medicare program is false?
a. Medicare Part A is generally provided to persons age 65 or over who are eligible for social security or railroad retirement benefits. b. Medicare Part B funds physician and other outpatient services. c. The majority of medicare beneficiaries are enrolled in medicare Part C. d. medicare and private insurance primarily pay for hospital and physician care, whereas individuals and Medicaid pay for long-term care. |
c. The majority of medicare beneficiaries are enrolled in medicare Part C.
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Which one of the following is not a typical nonspecific presentation of illness in old age?
a. Self-neglect b. HA c. Anorexia e. Fatigue |
b. HA
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Even when access to health care is good, symptoms that have shown to be disproportionately not presented to clinicians include all except which one of the following?
a. Falling b. Depression c. Nocturia e. Incontinence |
e. Incontinence
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Which one of the following statements concerning illness in old age is F?
a. Depression can be diagnosed in the absence of sadness. b. Peritonitis often fails to localize in acute appendicitis c. CHF, once it occurs, rarely resolves. d. 1/3rd of MIs in old age are asymptomatic. e. Peripheral sensitivity is reduced. |
b. Peritonitis often fails to localize in acute appendicitis
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A 75 y/o man has dx of prostatism, constipation, depression, CHF, and allergic rhinitis. He regularly takes furosemide, amitriptyline, dioctyl, and an OTC hay fever med. Which one of the following is F?
a. 3 of his 4 med will inc the need for the dioctyl. b. the OTC prep may worsen 3 of 5 dxs. c. Only 2 of his meds inc the risk of acute retention of urine. d. He is at risk of orthostasis from 3 of the meds. |
d. He is at risk of orthostasis from 3 of the meds.
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Which 1 of the following is an instrumental activity of daily living rather than an activity of daily living?
a. Bathing b. Dressing c. Toileting d. Shopping e. Ambulation |
d. Shopping
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When seeing older pts, concerns about which one kind of symptoms should trigger mental status testing?
a. Behavioral changes b. Apathy c. Memory difficulties d. Concerns about judgment e. All of the above |
e. All of the above
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You are examining a new pt, an older male, in your office. Which of following physical examination findings are you not expecting to find and will trigger further investigations in this pt?
a. Presbycusis b. Cataracts c. S4 on cardiac examination d. Small testes e. Enlarged smooth prostate |
d. Small testes
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You are assessing a new pt's fnx status. Which item below is not an activity of daily living?
a. Eating b. Grooming c. Using the phone d. Dressing e. Ambulation |
c. Using the phone
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81 y/o new pt presents w/objective memory complaints, and trouble handling financial matters and has gotten lost driving in his hometown. He has a college education. You preform an MMSE w/a score of 27/30. To better evaluate this pt's mental status, the appropriate thing to do is
a. Preform a clock test b. Perform a set test c. Refer for formal neuropsychological testing d. Repeat the MMSE next visit |
c. Refer for formal neuropsychological testing
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Functional assessment plays a central role in caring for older pts b/c of which one?
a. Functional changes are common and are often the final common pathway for many illnesses. b. Functional changes may be the presenting symptom of a new medical problem c. Functional loss helps to set priorities for assessment and care d. Functional loss should trigger the immediate use of other health care disciplines for therapeutic interventions to restore fnx. e. All of the above |
e. All of the above
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In people 80 yrs or older, which condition listed below is the most common?
a. Urinary incontinence b. Degenerative joint dz c. Diabetes mellitus d. Coronary artery dz e. Alzheimer's dz |
b. Degenerative joint dz
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The term geriatric syndrome refers to all the following conditions except:
a. Urinary incontinence b. BPH c. Falls d. Mental status changes e. Wt loss |
b. BPH
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Reasonable goals for the initial office evaluation of an older pt include all of the following except:
a. Performing a complex PE b. Medication review c. Functional assessment d. Establishing a relationship w/pt e. Determining priorities of care |
a. Performing a complex PE
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Aspects of dz presentation that are characteristic of older pts include all of the following except:
a. Multiple medical conditions that often interact b. Related more to "hidden" effects than med effects c. Vague, ill-defined presenting sx rather than traditional sx for specific dz d. The common presentation of a "geriatric syndrome" representing a specific new medical problem e. The presence of dz almost unique to elders |
b. Related more to "hidden" effects than med effects
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