Deck 18: Geriatric

Question 1

An elderly, previously withdrawn nursing home patient is encouraged to start a program to improve his physical fitness. He begins participating 5 days a week in weight training, tai chi, and supervised walking. Four months later, his gait speed during a timed six-meter walk has increased by 50% compared to his baseline speed. This increase in speed:

A) Increases the likelihood he will fall
B) Is an indicator of better health and a reduced risk of mortality
C) Increases the likelihood he will have heart attacks and/or stroke
D) Is unlikely to be sustained

Answer 1

Is an indicator of better health and a reduced risk of mortality

Question 2

An older diabetic woman who has had two heart attacks in the past complains that shee cannot feel her toes any longer, but that they are difficult to walk on. She transfers weight very cautiously, seeming to bear weight primarily on her heels. You remove her shoes and socks and notice that several of her toes are blackened, atrophic and cold to the touch. You think the patient may have:

A) Lower extremity edema
B) Dry gangrene
C) Peripheral neuropathy
D) An allergic reaction to the material in her shoes or socks

Answer 2

Dry gangrene

Question 3

A 74-year old man tells you that he is having trouble seeing clearly, especially in bright light. When he is outdoors, for example, he says that sunlight seems to produce a blinding, distracting glare that impairs his vision. He also notices a blinding glare from oncoming headlights when he tries to drive at night. You should:

A) Draw blood for renal function, liver function, and cholesterol levels
B) Perform a Snellen test
C) As the patient if he has any history of tuberculosis
D) Ask the patient if he has any family history of visual problems

Answer 3

Perform a Snellen test

Question 4

A 68-year old woman reports dizziness, which has been bothering her for about a week. It seems to occur every time she stands up. Once or twice she has nearly fallen. When she gets dizzy, she feels her heart pounding and she has the sensation that she might faint. She has also noticed that her bowel movements have turned black. Her prescribed medications include: levothyroxine for hypothyroidism and simvastatin for high cholesterol. She has recently started to take over-the-counter ibuprofen for aching joints. She is allergic to penicillin. You should:

A) Check her temperature and assess her pain level
B) Check her for orthostatic blood pressure and pulse changes
C) Check her visual acuity
D) Assess her hearing to see if she can hear a whispered voice

Question 5

Which of the following devices should not be used to provide enteral nutrition to a patient who is unable to eat/

A) A jejunostomy tube
B) A tracheostomy tube
C) A gastrostomy tube
D) A nasogastric tube

Question 6

Which of the following is an uncommon disease in elderly individuals?

A) Parkinson disease
B) Reye's syndrome
C) Alcoholism
D) Depression

Question 7

The clearance of drugs from the bodies of most older patients is slower than that of younger adults and children. As a result older patients usually need:

A) A bolus of a medication followed by a maintenance dose of the drug
B) To begin any new medication at a lower dose than a younger patient of the same body weight
C) To begin any new medication at a higher dose than a younger patient of the same body weight
D) To combine their medications with herbal medications which enhance drug metabolism and clearance

Question 8

Which of the following diseases and conditions are more likely to have their onset in people over the age of 65, than in younger patients?

A) Bipolar disorder
B) Delirium
C) Intentional overdosing of drugs
D) Overuse injuries

Question 9

Arcus senilis is:

A) A support group for geriatric persons
B) A distinctive white circular band that surrounds the iris of the eye
C) Any genetic illness with an onset that is delayed until the latter years of life
D) The tendency of older individuals to wander, especially in circles

Question 10

Which of the following bone or joint diseases is UNCOMMON in older individuals?

A) Osteoporosis
B) Giant cell tumor of the femur
C) Osteoarthritis
D) Back pain

Question 11

An 80-year old woman informs you that she has had unprotected sexual intercourse with a male resident of her nursing home, and that she is now 6 months pregnant. She has an enlarged (protruberant) abdomen. You should:

A) Obtain a urine HCG screening test
B) Contact her primary care provider or psychiatrist, and consider assessing the patient for sexually transmitted illnesses
C) Contact an obstetrician
D) Reassure the patient

Question 12

Which of the following endocrine disorders is common in older women?

A) Pheochromocytoma
B) Hypothyroidism
C) Cushing syndrome
D) Acromegaly

Question 13

Elevated blood pressures in the eye can produce a disease that impairs peripheral visual acuity, known as:

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

Question 14

Which of the following health-promoting activities is NOT usually recommended for people who reach the age of 50?

A) A booster vaccination against tetanus.
B) Lung cancer screening
C) Vaccination against Varicella zoster virus
D) Screening for alcoholism
E) Colon cancer screening

Question 15

The glomerular filtration rate of the kidneys:

A) Tends to increase with aging
B) Tends to decrease with aging
C) Has an unpredictable response to aging. It increases in about half of all people and decreases in the other half.

Question 16

Which of the following agents is a stool softener, but not a laxative?

A) Senna
B) Docusate sodium
C) Milk of magnesia
D) Polyethylene glycol 3350

Question 17

Which of the following infectious diseases is relatively rare (compared to the other diseases listed in this question) in geriatric patients?

A) Pneumonia
B) Measles
C) Urinary tract infection
D) Clostridium difficile diarrhea

Question 18

Which of the following components of Medicare insurance provides a prescription drug benefit to covered individuals?

A) Part C
B) Part D
C) Part A
D) Part B

Question 19

Most people spend the largest amount of money on the health care during:

A) The first year of life
B) The last six months of life
C) Adolescence
D) Adulthood

Question 20

A 66 -year old man decides to begin testosterone supplementation. Which of the following is the least likely side effect of the medication?

A) Increased interpersonal aggressiveness
B) An increase in body fat
C) An increase in hemoglobin and hematocrit concentrations
D) A decrease in bone mineral density