A 91 year old hospice patient with severe cachexia, end-stage dementia, renal
impairment has stopped eating and drinking. Which of the following comfort
measures would be most appropriate?
A. Total Parenteral nutrition
B. IV hydration
C. Nasogastric tube feeding
D. Frequent small sips of water
E. Appetite-inducing medications Answer - D. Frequent small sips of water
A 75 year old man and his 72 year old wife present requesting marital therapy.
They describe interesting conflict beginning about a decade ago when the wife
began refusing sexual activity. The husband explains that he still desires an
intimate relationship and is frustrated and hurt that his wife refuses him. She
says that she does not see herself as "sexy" and cannot understand how her
husband could still desire her. She has occasionally suggested he find "some
younger woman." He is insulted by these suggestions, saying that he would
never stray from the marriage. In treating this couple, the initial approach
should incorporate which of the following interventions?
A. Sex education
B. Sildenafil treatment
C. Sensate focus exercises
,D. Testosterone replacement therapy
E. Cognitive Behavioral therapy Answer - A. Sex education
Which of the following neurocognitive functions is most likely to show a decline
in people over age 65?
A. Attention span
B. Language
C. Long-term memory
D. Simple pattern recognition
E. Information processing speed Answer - E. Information processing speed
A 62 yea old patient is referred for complaints of memory problems. The
patient reports feeling more forgetful and give example of "losing my keys,
handbag, or forgetting the names of acquaintances." The patient denies any
other neurocognitive symptoms. Family member confirm the patient's report,
and feel that this has been a gradual change over the last year. Family members
report that the patient is a former history professor who continues to enjoy
intellectual activities, and they need to prepare if the patient is going to lose
these capabilities as a result of dementia. The standard MMSE would be a
relatively insensitive instrument for this patient because it:
A. has not been validate in people of the same age
B. has a ceiling effect for well-educated persons
C. requires considerable training and is not practical in the clinical setting
D. was designed to be a diagnostic tool rather than a general cognitive asse
Answer - B. has a ceiling effect for well-educated persons
A 70 year old patient with mild early Alzheimer disease who lives with a family
member has recently been prescribed an SSRI for depression. The patient also
, has HTN, adult onset DM and rheumatoid arthritis, which have been stable and
well-controlled with medication. The patient develops acute confusion but no
other medical or psychiatric symptoms. Which of the follwoign tests should be
ordered first to determine the etiology of the patient's confusion?
A. Electrolytes
B. Cardiac enzymes
C. Liver function tests
D. Thyroid function tests
E. ESR Answer - A. Electrolytes - SSRI cause SIADH and hyponatremia, which
increase thirst drive and intake of hypotonic fluids, further worsening
hyponatremia. Check Na+
Valproate is more commonly used than Lithium for Bipolar Disorder in adults
over age 65 and this treatment preference is best justified by:
A. Changes in renal clearance make lithium problematic to use
B. Valproate appears to be superior to lithium in comparison to trials
C. Lithium is more likely to interact with other drugs commonly used
D. The half-life of valproate is less affected by the physiological changes
E. Blood serum Valproate levels more accurately reflect the active quantity
available to the brain . Answer - A. Changes in renal clearance make lithium
problematic to use
A 79 year old man presents to the doctor c/o possibly having a "venereal
disease", explaining that he had an affair and these he contracted an STD. The
patient reports poor appetite, sleep, and energy for the last month, but claims
these are only because "I feel miserable and guilty, and cannot stop thinking
about it." The patient's spouse, who is present, seems surprised by the
patient's concerns, saying that the affair the patient describes occurred many
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