Deck 20: The Older Adult

Question 1

Which of the following changes are expected in vision as part of the normal aging process?

A) Cataracts
B) Glaucoma
C) Macular degeneration
D) Blurring of near vision

Answer 1

Blurring of near vision

Question 2

A 72-year-old retired truck driver comes to the clinic with his wife for evaluation of hearing loss. He has noticed some decreased ability to hear what his wife and grandchildren are saying to him. He admits to lip-reading more. He has a history of noise exposure in his young adult years: He worked as a sound engineer at a local arena and had to attend a lot of concerts. Based on this information, what is the most likely finding regarding his hearing acuity?

A) Loss of acuity for middle-range sounds
B) Increase of acuity for low-range sounds
C) Loss of acuity for high-range sounds
D) Increase of acuity for high-range sounds

Answer 2

Loss of acuity for middle-range sounds

Question 3

A 79-year-old retired banker comes to your office for evaluation of difficulty with urination; he gets up five to six times per night to urinate and has to go at least that often in the daytime. He does not feel as if his bladder empties completely; the strength of the urinary stream is diminished. He denies dysuria or hematuria. This problem has been present for several years but has worsened over the last 8 months. You palpate his prostate. What is your expected physical examination finding, based on this description?

A) Normal size, smooth
B) Normal size, boggy
C) Enlarged size, smooth
D) Enlarged size, boggy

Answer 3

Enlarged size, smooth

Question 4

A 70-year-old retired auto mechanic comes to your office because his neighbor is concerned about his memory. The patient himself admits to misplacing his keys more often and forgets what he is supposed to buy from the grocery store and where he has parked the car. He denies getting lost in familiar places. Upon further questioning, he states that his wife of 40 years died 8 months ago; his three children live in three different states; and he has limited his activities because the people he interacted with were "his wife's friends, not his." He drinks a six-pack of beer daily; he does not smoke or use illicit drugs. You perform a mini-mental state examination and obtain a total score of 24 out of 28. Based on this information, what is your most likely diagnosis?

A) Benign forgetfulness
B) Dementia
C) Meningitis
D) Depression

Question 5

An 85-year-old retired teacher comes to your office for evaluation of weakness. You obtain a complete history, perform a thorough physical examination, and order laboratory tests. You diagnose her with hyperthyroidism. Based on her age, which of the atypical symptoms of hyperthyroidism is more likely to be seen?

A) Fatigue
B) Weight loss
C) Tachycardia
D) Anorexia

Question 6

A 78-year-old retired seamstress comes to the office for a routine check-up. You obtain an ECG (electrocardiogram) because of her history of hypertension. You diagnose a previous myocardial infarction and ask her if she had any symptoms related to this. Which of the following symptoms would be more common in this patient's age group for an acute myocardial infarction?

A) Chest pain
B) Syncope
C) Pain radiating into the left arm
D) Pain radiating into the jaw

Question 7

An 88-year-old retired piano teacher comes for evaluation of fatigue. You notice that her clothes are hanging loosely off her frame and that she has lost 15 pounds. She is unaware of this. Her husband of 63 years died a few months ago. You ask the patient to complete a Rapid Screen for Dietary Intake. Which of the following statements is considered to be part of this rapid screen?

A) I eat more than two meals per day.
B) I drink one glass of alcohol every day.
C) Without wanting to, I have lost or gained 10 pounds in the last 6 months.
D) I eat with at least one other person most of the time.

Question 8

An 89-year-old retired school principal comes for an annual check-up. She would like to know whether or not she should undergo a screening colonoscopy. She has never done this before. Which of the following factors should not be considered when discussing whether she should go for this screening test?

A) Life expectancy
B) Time interval until benefit from screening accrues
C) Patient preference
D) Current age of patient

Question 9

Which of the following booster immunizations is recommended in the older adult population?

A) Tetanus
B) Diphtheria
C) Measles
D) Mumps

Question 10

You are asked to perform a home safety assessment for an 87-year-old retired farmer who lives by himself. Which of the following is not considered to be an increased risk for falls?

A) Loose electrical cords
B) Slippery or irregular surfaces
C) Chairs at awkward angles
D) Bright lighting

Question 11

A 73-year-old retired accountant comes to your office for her annual examination. She has incontinence of urine when she coughs or sneezes. She takes several medications for control of hypertension and diabetes. You use the DIAPERS mnemonic to assess the cause of her incontinence. All of the following are items represented by the mnemonic except for:

A) Atrophic vaginitis
B) Depression
C) Pharmaceuticals
D) Restricted mobility

Question 12

Which of the following brief screening measures is useful in assessing memory?

A) Three-item recall
B) Serial 7s
C) Spelling "world" backward
D) Copying intersecting pentagrams

Question 13

Which of the following questions is part of the screening for physical disability?

A) Are you able to go shopping for groceries or clothes?
B) Are you able to walk one block?
C) Are you able to pass the driver's license test?
D) Are you able to perform light dusting and pick up after yourself around the house?

Question 14

It is summer and an 82-year-old woman is brought to you from her home after seeing her primary care doctor 2 days ago. She was started on an antibiotic at that time. Today, she comes to the emergency room not knowing where she is or what year it is. What could be a likely cause of this?

A) Alzheimer's dementia
B) Stroke
C) Delirium
D) Meningitis

Question 15

Blood pressure abnormalities found more commonly in Western elderly include which of the following?

A) Isolated elevation of the diastolic BP
B) Narrow pulse pressure
C) Elevation of the systolic BP
D) Elevation of the BP with standing

Question 16

Which of the following represents age-related changes in the lungs?

A) Decrease in chest wall compliance
B) Speed of expiration increases
C) Increase in respiratory muscle strength
D) Increased elastic recoil of lung tissue

Question 17

Mrs. Stanton is a 79-year-old widow who presents to your office for a routine BP visit. You note a new pulsatile mass in the right neck at the carotid artery. Which of the following is the most likely cause for this?

A) Anxiety
B) Carotid artery aneurysm
C) Kinking of the artery
D) Tortuous aorta

Question 18

Mr. Chin is an 82-year-old man who comes to your office for a routine check. On examination, you notice a somewhat high-pitched murmur in the second right intercostal space during systole. It does not radiate and the rest of his examination is normal for his age. Which is true of the most likely cause of this murmur?

A) It often decreases carotid upstroke.
B) It carries with it increased risk for cardiovascular disease.
C) It is usually accompanied by an S3 gallop.
D) It is found in 10% of otherwise normal elderly patients.

Question 19

Mrs. Buckley is a 75-year-old widow who wants you to look at her teeth because over the past 2 weeks she has had right-sided jaw pain when eating. It does not occur otherwise. She also has had a headache. Which of the following should be considered?

A) Palpation of her temples
B) Dental referral
C) Ultrasound of the gallbladder
D) Inquiry about anosmia

Question 20

Which of the following is commonly seen in aging men?

A) Erectile dysfunction in 20% of all men
B) Testicles ride higher within the scrotum
C) Strong response to visual erotic cues
D) Persistent sexual interest

Question 21

Which of the following accompanies decreased ovarian function?

A) Increased sleep
B) Diminution of sexual interest
C) Enlargement of the clitoris
D) Decrease in vaginal secretions

Question 22

You are examining an elderly man and notice the following: decreased vibration sense in the feet and ankles, diminished gag reflex, right patellar reflex less than the left, and diminished abdominal reflexes. Which of these is abnormal?

A) Decreased vibration sense
B) Diminished gag reflex
C) Diminished right patellar reflex compared to the left
D) Diminished abdominal reflexes

Question 23

Mrs. Glynn is 90 years old and lives alone. She is able to bathe, dress, prepare her food, and transfer from bed to chair independently. She has children in the area who help her with her medications and transportation needs. Which of the following is considered an instrumental activity of daily living?

A) Bathing
B) Dressing
C) Preparing food
D) Transferring from bed to chair

Question 24

Mr. Kelly comes to you today for a burning pain in his lower abdomen. This has gone on for 2 months. He has received radiation for prostatic cancer for the past quarter. What assumptions could you draw from this?

A) This represents persistent pain.
B) His pain reporting is likely to be unreliable.
C) There are "red flags" present.
D) He is depressed.

Question 25

Mr. White's son brings him in today because he notes that Mr. White has not been himself lately. He seems forgetful and has not taken care of himself as he normally does. He has reported falling twice at home to his son and has telephoned late at night because of insomnia. His blood pressure and diabetes have been difficult to control and his warfarin dosing has become more difficult. Which of the following should you suspect?

A) Alzheimer's dementia
B) Alcohol use
C) Urinary tract infection
D) Stroke

Question 26

Claire's daughter brings her in today after Claire fell at her home. Which assessments are indicated at this time?

A) Orthostatic vital signs
B) Review of her medications
C) Assessment of gait and balance
D) All of the above

Question 27

Mrs. Geller is somewhat quiet today. She has several bruises of different colors on the ulnar aspects of her forearms and on her abdomen. She otherwise has no complaints and her diabetes and hypertension are well managed. Her son from out of state accompanies her today and has recently moved in to help her. What should you suspect?

A) Overuse of aspirin
B) Frequent falls
C) Elder abuse
D) Depression

Question 28

A patient comes to you for the appearance of red patches on his forearms that have been present for several months. They remain for several weeks. He denies a history of trauma. Which of the following is likely?

A) Actinic keratoses
B) Pseudoscars
C) Actinic purpura
D) Cherry angiomas

Question 29

On routine screening you notice that the cup-to-disc ratio of the patient's right eye is 1:2. What ocular condition should you suspect?

A) Macular degeneration
B) Diabetic retinopathy
C) Hypertensive retinopathy
D) Glaucoma

Question 30

Which of the following is true of assessment of the vascular system in the elderly?

A) Fewer than one third of patients with peripheral vascular disease have symptoms of claudication.
B) An aortic width of 2.5 cm is abnormal.
C) Bruits are commonly benign findings.
D) Orthostatic blood pressure and pulse are not useful in this population.