Geriatrics- Block 4

Mild cognitive impairment is characterized by which one of the following?

A) Localized motor dysfunction

B) Impairment in at least one activity of daily living

C) Impairment in at least one instrumental activity of daily living

D) The presence of the APO E4 allele

E) Objective evidence of memory decline

A long-term care resident is admitted to the hospital. The patient has a living will which specifies that “treatment be withheld or withdrawn and that I be permitted to die naturally with only the administration of medication or the performance of any medical treatment deemed necessary to alleviate pain.” The patient has appointed his wife as his health care surrogate. He has mild Alzheimer’s disease and scored 26 out of 30 on a Mini-Mental State Examination performed within the last month. He is alert and pleasant and responds appropriately to questions but cannot remember the current date. His wife is with him. Which one of the following would be most appropriate with regard to decision making and ordering related to the patient’s code status?

A) Determine the patient's competence

B) Assess the patient's decision making capacity

C) Confirm the code status with the patient's wife

D) Write a Do Not Resuscitate (DNR) order

E) Order comfort measures only

Which one of the following changes would be most appropriate for an elderly man with coronary artery disease, type 2 diabetes, and benign prostatic hyperplasia who has symptomatic orthosatic hypotension and who is taking finasteride 5mg daily, doxazosin 2mg daily, and atenolol 50mg daily?

An 85-year-old woman with end stage COPD and frequent hospitalizations is about to be discharged following prolonged and complicated hospital stay. During a discussion with the family about goals of care, the clinical team recommends that she be discharged to a nursing home rather than her home, but her son disagrees. Which one of the following questions is most appropriate to initiate a discussion with her son?

Have you been unhappy with the quality of your mother's care?

What problems have you noticed at nursing facilities you've visited?

Do you understand that keeping your mother in the hospital unnecessarily increases her risk for infection?

Do you feel your mother needs a higher level of care than we've planned for her after discharge?

How do you think your mother is doing?

Which one of the following is associated with bisphosphonate use for the treatment of osteoporosis?

A 90-year-old male with a history of metastatic lung cancer is admitted to hospice. You agree to follow the patient. The following week the hospice nurse calls you because the patient is complaining of significant dyspnea. His oxygen saturation is 91% on room air. A physical examination reveals diminished but otherwise clear breath sounds. Which one of the following is the treatment of choice for this patient's dyspnea?

You are seeing a colleague’s patient for a follow-up visit. The patient has been taking opioids for 12 months for chronic low back pain. After reviewing his chart you notice numerous phone messages from the patient asking for early refills, as he has been using his opioids more frequently than prescribed. During the encounter, the patient admits to borrowing pain medications from his wife. In the absence of other aberrant behavior, this is highly indicative of?

dependence

addiction

pseudoaddiction

drug trafficking

A drug available for over 20 years has been noted to have beneficial effects for a common disease. Because it is a cheap, generically available drug, no pharmaceutical firm is willing to fund a clinical trial. What type of study would be best suited to evaluate this treatment?

Which one of the following medications used in the treatment of osteoporosis can also be used to treat the pain associated with acute and chronic vertebral compression fractures?

Which one of the following medications should be started at a low dosage and titrated slowly to minimize the risk of Stevens-Johnson syndrome?