Multiple Choice Questions (MCQ)

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Category: Medicine--->Geriatrics
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Question 1# Print Question

A 75-year-old woman is accompanied by her daughter to your clinic. The daughter reports that her mother fell in her yard last week while watering flowers. Her mother suffered scratches and bruises but no serious injury. The daughter is concerned that her mother might fall again with serious injury. The patient has hypertension and osteoarthritis of the knees. She takes HCTZ, lisinopril, naproxen, and occasional diphenhydramine for sleep. The daughter reports some mild forgetfulness over the past 2 years. The patient gets up frequently at night to urinate.

Blood pressure is 142/78 lying and 136/74 standing. Pulse is 64 lying and standing. Except for some patellofemoral crepitance of the knees, her physical examination is normal. A Folstein Mini-Mental Status test is normal except that she only remembers two of three objects after 3 minutes (29/30). She takes 14 seconds to rise from sitting in a hard backed chair, walk 10 ft, turn, return to the chair, and sit down (timed up-and-go test, normal less than 10 seconds). CBC, chemistry profile, and thyroid tests are normal.

What is the next best step?

A. CT scan of the brain
B. Holter monitor
C. Discontinue hydrochlorothiazide and prescribe donepezil
D. Discontinue diphenhydramine, assess her home for fall risks, and prescribe physical therapy

Question 2# Print Question

A 78-year-old woman with mild renal insufficiency complains of pain in the right knee on walking. The pain interferes with her day-to-day activities and is relieved by rest. There is no redness or swelling. There is minimal joint effusion. An x-ray of the knee shows osteophytes and asymmetric loss of joint space. ESR and white blood cell count are normal.

Which of the following is the best initial management of this patient? 

A. Naproxen
B. Indomethacin
C. Intra-articular corticosteroids
D. Acetaminophen
E. Total knee arthroplasty

Question 3# Print Question

An 82-year-old man is admitted to a long-term care facility after a right hemiplegic stroke. He is unable to walk and has limited ability to move himself in bed. He is frequently incontinent of urine. He has a past history of type 2 diabetes mellitus. On examination you note a 3-cm area of persistent erythema on the right buttock.

Which of the following treatments would you recommend at this time? 

A. Sharp surgical débridement to remove the area of erythema
B. Application of a hydrocolloid dressing (such as Duoderm) to be left in place for 5 days
C. Placement of a Foley catheter
D. Use of a foam mattress, repositioning at least every 2 hours, and scheduled voidings
E. Admission to the hospital for IV antibiotics

Question 4# Print Question

A 65-year-old man has had symptoms of progressive cognitive dysfunction over a 1-year period. Memory and calculation ability are worsening. The patient has also had episodes of paranoia and delusions. Antipsychotic medication resulted in extrapyramidal signs and was stopped. The patient has recently complained of several months of visual hallucinations. There is no history of alcohol abuse.

Which of the following is the most likely diagnosis?

A. Lewy body dementia
B. Alzheimer disease
C. Early Parkinsonism
D. Delirium
E. Vascular dementia

Question 5# Print Question

An 80-year-old nursing home patient has become increasingly confused and unstable on her feet. On one occasion she has wandered outside the nursing home. In considering the issue of restraints for this individual,

which of the following is correct?

A. A geri-chair would provide the best approach to safety and restraint
B. Physical restraints are the best method to prevent falls
C. Restraints cause many complications and increase the risk of falls
D. Sedative medication should be used instead of restraints
E. Wrist restraints are more effective than ankle restraints

Category: Medicine--->Geriatrics
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