Which one of the following is most true about the rule of fourths?
a. One fourth of geriatric problems are iatrogenic.
b. Little can be done to prevent three fourths of the problems of aging.
c. For every medical complaint a patient has, a careful assessment can identify three other diagnoses.
...
Which one of the following is most true about the rule of fourths?
a. One fourth of geriatric problems are iatrogenic.
b. Little can be done to prevent three fourths of the problems of aging.
c. For every medical complaint a patient has, a careful assessment can identify three other
diagnoses.
d. What used to be called normal aging can be largely explained by processes that are not
normal.
e. A good way to conduct a geriatric assessment is to use four categories: mental, physical,
psychosocial, and environmental. - ANS D
Which one of the following is most true about aging changes?
a. Stage 3 and 4 sleep decreases.
b. Renal perfusion is not reduced, but renal function is reduced.
c. Hearing acuity declines beginning in middle age.
d. Prostatic enlargement occurs only in a minority of men. - ANS A
An old woman who is cared for by attentive, cautious, concerned family is particularly likely to
suffer from which one of the following complications after an episode of gastroenteritis?
a. Immobility related to overconcern
b. Continued vomiting caused by too-rapid feeding
c. Diarrhea resulting from administration of milk products
d. Constipation related to overtreatment of diarrhea - ANS A
Which one of the following is most true about psychological aging?
a. Disengagement tends to promote better psychological health than continued engagement.
b. Having a spouse is the best way to be assured of having a caregiver when one becomes
disabled.
c. Ability to have quality of life is related to cognitive function.
d. Planning for the future is a key element of successful aging.
e. Many older people are ageist. - ANS E
Of the following conditions, which one is most common and most often preventable?
a. Falls
b. Frailty
c. Cognitive impairment
d. Iatrogenic disease
,e. Depression - ANS D
What is the hallmark of frailty in an aged patient?
a. The patient is unable to personally manage key activities of self-care.
b. The patient's reserve to withstand physiologic stress is significantly reduced.
c. The patient has long problem and medication lists. - ANS B
Which pattern of problems would more likely identify a frail aged patient?
a. She is unable to manage her own medications and her own wardrobe.
b. She requires supplemental oxygen at night and during exercises.
c. She walks very slowly, is losing weight, and does not have the strength to brush her own
teeth. - ANS C
Having identified an aged patient as being irreversibly quite frail, the physician would be wise to
do which of the following?
a. Begin a discussion with the patient and family about care goals and intervention limitations.
b. Withdraw disease-targeting medications and medical treatments.
c. Reduce functional maintenance modalities such as therapeutic exercise and activities. - ANS
A
Each of these factors can help serve to identify a patient as frail and vulnerable except:
a. Low activity level and easy fatigability
b. Major progressing weight loss
c. A large number of major organ-system comorbidities
d. Progressive loss of strength
e. Very advanced age
f. There is no "except"... all are important factors in frailty. - ANS F
Progress has been made in defining a valid concept of frailty. Pick the one true statement about
current understanding of the frailty syndrome.
a. Neither the Fried nor Rockwood model is well suited to frailty research.
b. Neither the Fried nor Rockwood model has found wide acceptance in clinical care.
c. The Fried model takes into account cognitive decline, pain, and chronologic age.
d. Regardless of the models used to characterize it, frailty is a syndrome that rarely improves
even with carefully tailored interventions. - ANS B
Which of these statements about frailty is (are) true? select all possible answers
a. The concepts of "frailty" and "disability" are essentially synonymous.
b. Identifying a patient as "frail" can help guide thinking about risks and benefits in choosing
care paths.
c. Neither of the two most prominent models of frailty includes age as a factor.
d. Frailty is typically irreversible, and when identified, primarily serves to initiate discussions
regarding comfort care. - ANS B and C
, All of the following concepts underlie the notion of "frailty in old age" except:
a. Progressive decline in organism reserves to be able to withstand a variety of stresses
b. Multiple interdependent organ systems progressing toward overt failure with age and/or
disease
c. A well-defined geriatric syndrome with a validated set of agreed-upon specific clinical markers
d. Higher risk for major untoward events with medical interventions that are generally safe in
younger patients - ANS C
A 75-year-old man visits your 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. Of the following screening tests you might use to
assess the patient's hearing loss, which is the most reliable and valid?
a. Whisper test
b. Audioscopy using otoscope with built-in audiometer
c. Tuning fork test
d. Finger rub test
e. Weber and Rinne tests - ANS B
A 67-year-old male with severe bilateral hearing loss comes to the 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 voice 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. - ANS D
Match each hearing aid technology item with its appropriate description (items 1 to 5):
a. Acoustic feedback control
b. Loop induction systems
c. Compression
d. Telecoil
e. Channels
(1) Circuitry that helps people talk on the telephone by converting electromagnetic signals from
telephone to amplified sound.
(2) Helps attenuate sounds that cause hearing aid to make a whistling noise.
(3) Circuitry that keeps loud sounds from being overamplified while dynamically increasing the
volume of soft sounds.
(4) Refers to the number of frequency bands into which the incoming sound signal is divided;
permits independent control of the intensity of low- and high-frequency sounds.
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