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52 Cards in this Set
- Front
- Back
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People age 65 and over account for 13% of the population in the United States and account for
a. Less than 10% of all prescriptions that are written b. More than 90% of all prescriptions that are written C. More than 30% of all prescriptions that are written D. Less than 2% of all prescriptions that are written |
C. More than 30% of all prescriptions that are written
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Which of the follwing statements regarding adverse drug reactions in the elderly are correct?
I. Elders are admitted to the hospital at three times the rate of younger people ass consequence of an an adverse drug reaction (ADR). II. The elderly are more likely to suffer greater morbidity and mortality for ADRs because of a decrease in physiologic reserve. III. Over one-fourth of Hospital admissions through the emergency room by older people are due to poor outcomes from drug therapy. |
E. I, II, and III
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Which of the following pharacokinetic changes that occur in the elderly is least clinically important?
A. Distribution B. Elimination C. Absorption D. Metabolism |
C. Absorption
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Which of the following statements regarding geriatric pharmacotherapy are correct?
I. First-pass metabolism decreases with age; thus less nitrates, such as isosorbide dinitrate, would be necessary to exert their desired effect II. Amitriptyline would be an excellen antidepressant to initiate in an 85 year old patient with depression III. Phase I hepatic metabolism slows down with age |
C. I and III
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When considering the use of hydrochlorothiazide in an 81 year old patient with isolated systolic hypertension, which of the following would be the most appropriate initial dose?
A. 12.5 mg B. 25 mg C. 50 mg D. 100 mg E. 200 mg |
A. 12.5 mg
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When asked to recommend a dose of warfarrin for an 83 year old patient with atrial fibrillation for the purpose of stroke prophylaxis, which of the following are likely to lead to recommend a low dose and careful monitoring for efficacy and toxicity?
I. Old age II. Reduced renal function III. Decreased plasma protein concentration |
C. I and III
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Which factor is not an important element in crosscultrual care?
A. Individual versus family decision making about health issues B. Causation of illness C. Treatment preferences D. Preferences for liquid rather than pill forms of medications |
D. Preferences for liquid rather than pill forms of medications.
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Which statement about treatment preferences is true
a. African Americans tend to favor more agressive tharapy than do whites B. Complementary alternative therapies are used mainly by persons of higher socioeconomic class C. Physicians should insist that patients accept their recommended therapies D. Physicians should adamantly discourage patients from contacting folk heaers |
A. African Americans tend to favor more aggressive therapy than do whites.
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Which statement about cross-cultural communications is true?
A. Family members are often effective medical interpreters B. Any person who can speak the same language as the patient can be an effective medical interpreter C. Miscommunications betsween members of different ethnic groups originate from differences in style, grammar, word use, and body language D. Medical interpreters must be the same sex as the patient |
C. Miscommunications between members of different ethnic groups originate from differences in style, grammar, word use, and body language.
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As monotherapy, which antihypertensive class is relatively ineffective in African Americans compared to whites?
A. Thiazide diuretics B. Beta blockers C. Centrally acting agents D. Direct vasodilators |
A. Thiazide diuretics
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Which statemennt about biomedica ethics is true?
A. Some cultrues value extended life of their loved ones as a fundamental filial obligation B. Physicians can improve patient care byy insisting that mentally capable adults make decisions about their health care to the exclusion of family members C. Self-determination and autonomy are accepted ethical principles in all cultures. |
A. Some cultures value extended life of their loved ones as a fundamental filial obligation.
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Which medical disorder is especially prevalent among African Americans, Asians, Hispanics, and American Indians?
A. GI cancers B. Arthritis C. Diabetes mellitus D. Chronic obstructive pulmonary disease |
C. Diabetes mellitus
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Which statement about health care delivery is untrue?
A. The quality of care provided minorities is similar once one adjusts for economic factors and pravalence of disease B. Urban, in contrast to rural, Hispanics have health insurance rates combrable to that of whites C. Part of the problem in delivering effective care to minority ethnic groups and cultures is and inadequate number of minority health providers. |
B. Urban, in contrast to rural, Hispanics have health insurance rates comparable to that of whites.
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Which of the follwing is a true statement regarding falls in the elderly persons?
A. Most falls in elderly persons are associated with significan injury B. Falls are the leading cause of accidental death in the elderly C. Approximately 5% of elders residing in a nursing home fall each year D. Survivors of hip fractures secondary to falls are rarely instituionalized |
B. Falls are the leading cause of accidental death in the elderly
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A 76 yo man who is a resident of an Alzheimer's unit of long-term care facility has had three falls since admission 1 month ago. Which of the follwing medications is least likely to contribute to his falls?
A. Diazepam, 5 mg twice daily B. Sertraline, 50 mg daily C. Metformin, 500 mg daily D. Riperidone, 2mg at bedtime |
C. Metfroming, 500 mg daily
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An 83 year-old female patine with a history of Parkinson's disease and maculardegeneration is brought to your clinic after a fall. She was discharged from the hospital 2 days ago with a diagnosis of pneumonia. Which of the following statements is tru regarding her ris for falls?
a. Since she has been discharged from the hopital, this patient is no longer at risk for falls. B. This patient is only at risk for falls until her pneumonia has completely resolved C. this fall proves that this patient should not have been discharged from the hospital D. This patient's Parkinson's disease and macular degeneration as well as recent hopitilazation all place her at higher risk for falls. |
D. the patients Parkinson's disease and macular degeneration as well as recent hospitilization all place her at higher risk for falls.
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An 86 year-old woman has had two recent falls in her home. She fractured her humerus 3 months ago and resents today with some bruising on her right cheek from a fall yesterday. She has a history of hypertension and osteoporosis. Which of the following should be the first step in evaluating the falls?
A. Carotid sinus massage B. History, medication review, and observation of gait C. Electrocardiogram D. Computed tomography of the head E. Chest x-ray |
B. History, medication review, and observation of gait.
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An 86 year old woman on 12 medications with a nistory of hypertension, mild dementia, and painful bunions could potentially reduce her risk of alling with all except which one of the following?
A. reduction in medication number B. An exercise program for balance and strength C a Prescription for sertraline D. Podiatry evaluation E. Evaluation of orthostatic hypotension |
C. A prescription for sertraline
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A 74 year old male patient has had three falls within the last 6 weeks. Which of the following would be reasonable studies to perform at this time?
A. Complete blood count, urinalysis, and 24 hour urine of heavy metals B. CBC, electrolytes, glucose, and thyroid stimulating hormone C. Electrolyes and PET scan D. Electrolytes, antinuclear antibody, erythrocyte sedementation rate, and follicle-stimulating hormone |
B. CBC, electrolytes, glucose and thyroid-stimulating hormone
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A 69 year old female patient asks you what sort of exercise she should do to prevent falls. You tell her:
A. Jogging or other aerobic exercise B. Deep-breathing exercises daily C. Balance and strength exercise D. Bicycling and swimming (non-weight-bearing exercise) |
C. Balance and strength exercises
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A 90 year-old male patient has come to see you in clinic after a second fall at home. As part of your assessment, you ask an occupational therapist to evaluate his home. The therapist finds multiple environmental risk factors int he home. Which of the follwing is not an environmental risk factor for falls?
A. Throw rug B. Freshly waxed kitchen floor C. Electrical cords lying on the floor D. Grab bars in the bathroom |
D. Grab bars in the bathroom
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Normal aging of the lower urinary tract includes:
A. Bladder capacity decreases with age while residual urine volume decreases B. Aging leads to a decline in bladder outlet and urethral resistance prssure C. Ten to twenty percent of elderly patients with no medical problems will have involuntary contractions of the bladder D. As many as 75% of elderly patients with functional incontinence will have involuntary bladder contractions E. All of the above |
E. All of the above
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An abnormal flow rate is specific for the following types of incontinence:
A. Overflow incontinence B. Urge incontinence C. Stress incontinence D. Intractable incontinence E. Transient incontinence |
A. Overflow incontinence
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The best way to initially assess incontinence in an older patient is by combination of:
A. Urinalysis, culture and sensitivity, residual volume determination, and clinical symptoms B. Catheterization C. Cystourethrography D Renal ultrasound E. Cystoscopy |
A. Urinalysis, culture and sensitivity, residual volume determination, and clinical symptoms
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The following symptoms are diagnostic for urge incontinence (detrusor hyperreflexia):
A. Urgency, frequency, and a feeling of incomplete bladder emptying B. Frequency and pain or discomfort in the suprapubic area C. Nocturia D. Urgency and nocturia E. None of the above |
E. None of the above
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The following drugs can cause incontinence except:
A. Narcotics B. Hypnotics C. Antipsychotics and antidepressants D. Calcium channel blockers E. Beta blockers |
E. Beta blockers
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Pelvic floor exercises (Kegel) has been shown to be effective for which type of incontinence:
A. Urge incontinence B. Overflow incontinence C. Stress incontinence D. Urge and stress incontinence E. Acute incontinence |
D. Urge and stress incontinence
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Which of the following pharmacalogical agents used for urge incontinence can cross the blood brain barrier and cause significant cognitive dysfunction in an older patient?
A. Trospium B. Oxybutynin C. Tolterodine D. Darifenacin |
C. Tolterodine
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A 75-year-old man presents to clinic accompanied by his wife who reports that he is having hearing difficulties. He denies hearing loss and reports that people around him "mumble too much." His ear canals are free of cerumen impaction. Which of the following is the most reliable and valid screening test for hearing loss?
A. Whisper test B. Audioscoping using otoscope with built in audiometer C. Tuning Fork test D. Finger-rub test E. Weber and Rinne tests |
B. Audioscoping using otoscope with built in audiometer
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A 67-year-old male with severe bilateral hearing loss comes to clinic to establish primary care. A Nurse practitioner observes that he does not understand what is said to him during his assessment. He has no hearing aids. Which of the following actions is least likely to ease communication with the patient?
A. Use a hard-wired voie amplification system such as a pocket talker. B. Ensure that the speaker's face is in full view of the listener and speak clearly at a slightly louder than normal intensity; avoid shouting. C. When repetition is necessary, paraphrase the message or write key words. D. Lean forward and speak directly into the patient's ear at a distance of 5 to 10 inches E. Speak with adequate pauses between sentences and signal to the listener when the subject of conversation is changing |
D. Lean forward and speak directly into the patient's ear at a distance of 5 to 10 inches
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Matching (items 1 to 4): Match each hearing and technology item with its appropriate description
A. Nonprogrammable hearing aid B. Programmable hearing aid C. Compression D. Telecoil E. Channels (1) circuitry that helps people talk on the phone by converting electromagnetic signals from telephone to amplified sound (2) Offers good sound quality at a reasonable price, limited flexibility in adjustments (3) Circuitry that keeps loud sounds from being over amplified while dynamically increasing the volume of soft sounds (4) Refers to the number of frequency bands into which the incoming sound signnal is divided; permits independent control of the intensity of low and high frequency sounds |
1. d
2. a 3. c 4. e |
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A 78--year-old woman complains of difficulty understanding conversations, especially in noisy social gatherings. Her audiogram 2 years ago showed moderately severe symmetrical bilateral sensorineutral hearing loss. She declined hearing aid fitting at the time. You discover that she has some misconceptions about hearing aids. Each of the following statements reflects myths about hearing aids, except:
A. Most people with hearing aids do not like how they sound B. Hearing aids cannot help people with sensorineural hearing loss C. All hearing aid users can achieve adequate speech recognition with hearing aids D. Hearing aids restore hearing to normal E. Clinical trials have demonstrated significant improvements in social, emotional, and communication function, and depressive symptoms among hearing aid recipients |
E. Clinical trials have demonstrated significant improvements in social, emotional, and communication function, and depressive symptoms among hearing aid recipients
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A 65-year-old female with type 2 diabetes and diabetic peripheral neuropathy was hospitalized 1 week ago and received piperacillin-tazobacam and gentamycin for treatment of bibasilar pneumonia. At the time of hospital discharge, she complained of dizziness and poor balance during ambulation. She now reports that her dizziness has worsened and she has bee afraid to walk. Her unsteadiness is worse if she atempts to ambulate in the dark. She reports chronic bilateral hearing loss mildly worse in her left ear, but denies. Orthostatic testing is unremarkable. Her neurological examination is remarkable only Romberg test and postural instability during ambulation. An audiogram reveals moderately severe bilateral sensoroineural hearing loss (left mildly greater than right) with gently sloping high frequency hearing loss. The most likely cause of her dizziness and poor balance is
A. Benign positional vertigo B. Viral cochleitis C. Bilateral vestibular dysfunction induced by gentamycin D. Complication of diabetic peripheral neuropathy E. Meniere's disease |
C. Bilateral vestibular dysfunction induced by gentamycin
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What proportion of older people experience persistent pain?
A. 1% to 3 % B. 5% to 10% C. 15% to 20% D. 25% to 50% |
D. 25% to 50%
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Which of the following is a consequence of persistent pain?
A. Increased pain threshold B. Altered self-concept C. Depression D. Mental status changes |
C. Depression
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Which of the following agents would be expected to have the greatest efficance in treating persistent neuropathic pain?
A. Acetaminophen B. Codeine C. Gabapentin D. Celecoxib |
C. Gabapentin
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Ms. Dixon is seen in follow-up for a slowly healing pelvic fracture. Current therapy is alendronate 70mg orally weekly, vitamin D 800 IU orally daily, a and oxycontin 10 mg orally twice daily. A review of her pain record shows that she has well-controlled symptoms (minimal to mild pain) except during twice weekly shopping trips and when riding in a car for more than short distances. Which of the following is the most appropriate adjustment to her ongoing therapy?
A. Oxycodone 5 to 10 mg orally every 3-4 hours as needed for pain B. Oxycontin 20 mg orally twice daily C. Gabapentin 100 mg orally three time daily D. Celecoxib 100 mg orally twice daily |
A. Oxycodone 5 to 10 mg orally every 3-4 hours as needed for pain
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You evaluate a 73-year-old married man for problems with leg pain. He has a 10-year history of adult onset diabetes and currently is treated with glipizided 10 mg orally twice daily. He describes a burning sensation in his feet and ankles that causes mild to moderate pain at night but is also mildly ymptomatic at other times. The most recent glycosylated hemoglobe was 8%(normal rage 4.6 to 6.5%). In addition to improving his diabetes control, which of the following is the most appropriate treatment for this patient?
A. Oxycodone 5-10 mg orally efvery 3-4 hours as needed for pain B. Oxycontin 20 mg orally twice daily C. Gabapentin 100 mg orally twice daily D. Celecoxib 100 mg orally twice daily |
C. Gabapentin 100 mg orally twice daily
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Ms. Morris returns for follow-up of painful spinal stenosis. Current therapy consists of gabapentin 200 mg orally twice daily, and sertraline 50 mg daily. Her mood is good, she is sleeping well, and she rates her pain as mild with household activity. However, she is concerned about ongoing pain and is fearful about resuming her usual social andvolunteer activities. Which of the following is most likely to result in patient resuming full activities?
A. Acupuncture B. Trancutaneous nerve stimulation C. Cognitive-behavioral therapy D. Chiropractic Care |
C. Cognitive-behavioral therapy
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A 67 yo woman presents for her annual physical examination. She has no chronic medical conditions, worrisome symptoms, or findings on physical examination. With regard to bone health, which of the following is the best course of action?
A. Recommend water aerobics and increased dietary calcium B. Order a dual-energy X-ray aborptiometry (DXA) scan and recommend calciuma nd vitamin D supplements and program of weight-bearing exercise C. Recommend calcium and vitamin D suppleents and order a DXA scan if she has risk factors for osteoporosis D. Recommend calcium and vitamin D supplements and order a DXA scan only if she has abnormalities on her screening laboratory studies. |
B. Order a dual-energy X-ray aborptiometry (DXA) scan and recommend calciuma nd vitamin D supplements and program of weight-bearing exercise
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A 76 yo man was recently started on high-dose corticosteroids for biopsy-proven giant-cell arteritis and symptoms of polymyalgia rheumatica. Which of the following is the most appropriate intervention to preserve bone integrity?
A. Order a DXA scan B. Recommend calcium and vitamin D supplements C. Recommend calcium and vitamin D supplements and begin bisphosphonate therapy D. Recommend calcium and vitamin D supplements and begin a program of weight-bearing exercise |
C. Recommend calcium and vitamin D supplements and begin bisphosphonate therapy
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You are taking over the practice of a retiring physician. On reviewing the medication of a 65yo woman who you are seeing for the first time, you note that she is taking estrogen and progestin. She is not certain why this was initially prescribed but believes that it had something to do with her bones. Which of the following statements reflects our current understanding regarding hormone replacement therapy (HRT)?
a. HRT should be prescribed in the lowest possible dose for the shortest period of time for relief of symptoms associated with menopause b. The benefits of long-term treatment with HRT are offset by the risks of therapy c. Treatment with HRT confers an increased risk of breast cancer, heart attack, stroke, and blood clots in the lung d. All of the above statements are correct |
d. All of the above statements are correct
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You are seeing a 75yo man who sustained a wrist fracture when he fell while picking up the newspaper from the path outside his home. Which of the following medical conditions and medications increase the likelihood that this man has osteoporosis?
a. Alcoholism b. Hyperthyroidism c. Hypogonadism d. Glucocorticoid therapy e. All of the above |
D. Glucocorticoid therapy
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You are reviewing the results of a screening DXA scan ordered on a healthy 67 yo woman. Her T score is – 2.8 at the spine and – 2.6 at the hip. She walks daily and participates in a weight-bearing exercise program three times per week, in addition to taking an optimal dose of vitamin D and calcium supplements. Which of the following has been shown to be most effective for reducing the risk of vertebral and nonvertebral fractures in post-menopausal women with osteoporosis?
a. Estrogen b. Raloxifene c. Risedronate and alendronate d. Calcitonin e. Recombinant parathyroid hormone |
c. Risedronate and alendronate
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All patients should be advised to optimize their intake of calcium and vitamin D. Which one of the following statements regarding supplementation is correct?
a. The recommended calcium intake for older men and women is 1000 mg/day b. Calcium supplements should be taken on an empty stomach c. H2 antagonists and proton pump inhibitors interfere with calcium absorption d. The recommended vitamin D intake for older men and women is 200 IU/day e. All supplements contain the same amount of elemental calcium |
c. H2 antagonists and proton pump inhibitors interfere with calcium absorption
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To optimize absorption and decrease adverse effects on the esophagus, patients taking oral bisphosphonates should be given which of the following instructions?
a. Take bisphosphonate with a sig of water upon awakening and remain upright. b. Set your alarm clock 30min before you have to get up. Take the bisphosphonate with a tall glass of water, and then press the snooze button for another half hour of sleep c. Upon awakening, take bisphosphonate with a tall glass of orange juice and remain upright. d. After an overnight fast, take bisphosphonate first thing in the morning with a tall glass of water, remain upright and take nothing more by mouth for at least 30min. |
d. After an overnight fast, take bisphosphonate first thing in the morning with a tall glass of water, remain upright and take nothing more by mouth for at least 30min.
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Mrs. Johnson, an 82 yo resident of a nursing home, develops chills, fever and cough. A rapid influenza test reveals influenza A. an outbreak of influenza A is occurring in the local community. Which of the following is the best option for treating this patient and preventing further infection?
a. Osteltamiver 75 mg daily for Mrs. Johnson and for other residents in the facility. b. Amantadine 100 mg daily for Mrs. Johnson and for other residents in the facility. c. Osteltamiver 75 mg twice daily for Mrs. Johnson and 75 mg daily for other residents in the facility. d. Rimantadine 100 mg daily for Mrs. Johnson and for other resident in the facility e. Zanamivir 10mg twice daily for the patient and amantadine 100 mg daily for other resident in the facility |
c. Osteltamiver 75 mg twice daily for Mrs. Johnson and 75 mg daily for other residents in the facility.
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A 75 yo man presents to your office with complaints of cough and shortness of breath. He has been eating and drinking poorly for 2 days. His temperature is 38.4 degrees C, pulse 90, and respirations 24. Lungs show coarse crackles at his left base, and a chest radiograph confirms an infiltrate. His pulse oximetry shows 88% O2 saturation on room air. One month ago he finished a course of levofloxacin for prostatitis. In addition to admitting him to the hospital, which of the following antibiotic regimens will you start?
a. Levofloxacin and azithromycin b. Clindamycin c. Cefotaxime and clindamycin d. Ceftriaxone and azithromycin e. Gatifloxacin |
d. Ceftriaxone and azithromycin
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An 85 yo nursing home resident with severe dementia is admitted to the hospital by your partner while you are out of town. On your return, she is slowly responding to treatment for pneumonia with levofloxacin. Which of the following would best guide future appropriate care?
a. As she already has severe dementia, her prognosis is unchanged by this recent pneumonia episode. b. As aspiration is a likely cause of the pneumonia, a feeding tube should be considered. c. She probably has aspiration pneumonia and clindamycin should be added. d. In determining her 30-day mortality risk, the absence of an elevated white blood count would predict a poor prognosis. e. Average mortality in similar patients in 6 months is about 50%, and you should re-evaluate future care goals with her family. |
e. Average mortality in similar patients in 6 months is about 50%, and you should re-evaluate future care goals with her family.
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A healthy 70 yo woman living in the community has been repeatedly exposed to a handyman who is found to have active tuberculosis. The man, who was a Cambodian refugee, was actively coughing as he worked on several projects for the patient. Because of volunteer work, she had a PPD placed 2 years ago, which was read as showing 5 mm of induration. Which of the following is most correct about the interpretation of a new PPD placed after discovery of her tuberculosis exposure?
a. If her reaction remains at 5mm, she has no increase in risk of developing active tuberculosis. b. If her reaction increases to 15 mm, she should be regarded as a new converter and should be counseled about receiving treatment for latent tuberculosis infection. c. She should not receive treatment unless her reaction increases by 15 mm in size to 20 mm. d. She should only receive treatment if a chest radiograph shows a fibrotic lesion. e. The booster phenomenon means that her reaction will definitely increase in size. |
b. If her reaction increases to 15 mm, she should be regarded as a new converter and should be counseled about receiving treatment for latent tuberculosis infection.
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A 75 yo man living in the community has a 60 pack year smoking history. He has a persistent cough and milk dyspnea. He has slightly quiet breath sounds and scattered wheezes. After bronchodilators, FEV1/FVC is 65% of predicted and FEV1 is 60% of predicted. Which of the following groups of treatments are most likely to be appropriate therapy for this patient?
a. Smoking cessation counseling, a B2 agonist bronchodilator, inhaled corticosteroids. b. Smoking cessation counseling, pulmonary rehabilitation, short-acting bronchodilators only c. Pulmonary rehabilitation, short-acting bronchodilators, inhaled corticosteroids. d. Smoking cessation counseling, a B2 agonist bronchodilator e. Smoking cessation counseling, pulmonary rehabilitation, a B2-agonist bronchodilator |
e. Smoking cessation counseling, pulmonary rehabilitation, a B2-agonist bronchodilator
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A 70 yo woman consults you because of slowly increasing shortness of breath. She has smoked one pack of cigarettes per day for 20 years. After pulmonary function testing, you diagnose moderate (stage 2) COPD. Which of the following treatments is most apt to alter the long-run course of her disease?
a. Smoking cessation counseling and prescription of nicotine replacement therapy b. Pulmonary rehabilitation c. Oxygen therapy when her oxygen saturation has declined to 90% d. Prescription of a tiotropium inhaler to be used daily e. Prescription of inhaled corticosteroids. |
a. Smoking cessation counseling and prescription of nicotine replacement therapy
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