Exam (elaborations)
PRITE – GERIATRICS QUESTIONS AND ANSWERS
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PRITE – GERIATRICS QUESTIONS AND ANSWERS
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PRITE – GERIATRICS QUESTIONS AND ANSWERSD. Frequent small sips of water - Answers-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
A. Sex education - Answers-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
E. Information processing speed - Answers-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
B. has a ceiling effect for well-educated persons - Answers-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 assessment
E. focuses on attention and immediate recall, which are not the primary complaints
D. MDD with psychosis - Answers-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 years ago and the spouse has long
since forgiven the patient. Physical exam shows no evidence of infection. MSE is
significant for sad affect, and cognitive exam is WNL. Which of the following is the most
likely diagnosis for this patient?
A. Hypochondriasis
B. Delusional Disorder
C. Adjustment Disorder
D. MDD with psychosis
E. OCD
A. Vascular Dementia - Answers-A 74 year old, right hand patient presents with
significant memory loss, expressive aphasia, and left plantar extensor response. The
most likely diagnosis is:
A. Vascular Dementia
B. Dementia with Lewy Bodies
C. Alzheimer Dementia
D. Frontotemporal Dementia
E. Dementia due to Normal Pressure Hydrocephalus
B. Ramelteon - Melatonin acts at the MT1 and MT2 receptors to promote sleep and
exert an effect on circadian rhythms, but it is not directly sedating like BZDs. - Answers-
A 78 year old patient with a PMHx of mild dementia complains of chronic difficulty falling
asleep. Sleep hygiene training has not been helpful, and a number of sleep
medications, including temazepam and zolpidem were discontinued because they
caused daytime sedation and confusion in the patient. Which of the following
medications is most likely to be helpful for this patient while causing the fewest side
effects?
A. Trazodone
B. Ramelteon
, C. Mirtazapine
D. Quetiapine
E. Diphenhydramine
E. Use of dopaminergic agents - Answers-A 67 year old recently retired patient with
PMHx of Parkinson's Disease and no PPHx, has taken Pramipexole for several years
without evidence of cognitive decline. The patient's spouse reports that the patient has
started going with friends to casinos and has lost significant amounts of money. The
patient does not drink or use illicit substances. Which of the following is the most likely
cause of the patient's increased impulsive behavior?
A. Marital difficulties
B. Recent retirement
C. New onset mania
D. New onset dementia
E. Use of dopaminergic agents
C. Fewer drug interactions - Answers-When used in patients over the age of 65 with
depression, Bupropion has which of the following advantages over the SSRIS?
A. More sedating
B. Greater anxiolysis
C. Fewer drug interactions
D. Simpler dosing schedule
E. Greater evidence of efficacy in this population
A. Electrolytes - SSRI cause SIADH and hyponatremia, which increase thirst drive and
intake of hypotonic fluids, further worsening hyponatremia. Check Na+ - Answers-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
A. Changes in renal clearance make lithium problematic to use - Answers-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
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