Multiple Choice Questions (MCQ)

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Category: Medicine--->Geriatrics
Page: 2

Question 6# Print Question

An 86-year-old woman lives home alone. Her husband died 2 years ago; since then her self-care has deteriorated. She has lost weight and has become increasingly frail. She has fallen on several occasions and appears bewildered when faced with simple household decisions. Physical examination shows no focal neurological deficits and a Folstein Mini-Mental Status score of 19 (out of possible 30). A workup for reversible causes of dementia is negative, and treatment in a balance disorder clinic is not helpful because the patient cannot remember her instructions. The patient appears in your office, accompanied by her daughter, who is concerned about her mother’s safety. She inquires about nursing home placement but is worried about the financial implications of this decision.

Which of the following statements is true? 

A. Medicare will pay 80% of the costs associated with nursing home care
B. The patient will need to be hospitalized for 3 days before Medicare will pay for her care
C. Medicaid will pay for nursing home care if her income falls below the national poverty level
D. Medicaid will pay for her nursing home care if she falls below her state’s eligibility levels
E. The patient should not be placed in a nursing home since the daughter can take her into her own home

Question 7# Print Question

A frail 80-year-old nursing home resident has had several episodes of syncope, all of which have occurred while she was returning to her room after breakfast. She complains of light-headedness and states she feels cold and weak. She takes nitroglycerin in the morning for a history of chest pain, but denies recent chest pain or shortness of breath.

Which of the following is the best initial test?

A. Carotid Doppler ultrasound
B. Postprandial blood pressure monitoring
C. Holter monitoring
D. CT scan of the head

Question 8# Print Question

A 78-year-old woman with mildAlzheimer disease falls at home and suffers a left hip fracture. She is admitted to the hospital and undergoes a left total hip replacement. Postoperatively she is D5W and treated with meperidine for pain, diphenhydramine for sleep, and prophylactic ranitidine. On the second postoperative day, she pulls out her Foley catheter and her IV. On examination blood pressure is 150/90, pulse rate is 80, and temperature 36.7°C (98°F). Oxygen saturation on room air is 92%. She is markedly confused and appears agitated. She has no focal neurologic findings. Laboratory testing reveals:

  • WBC = 7500
  • Hemoglobin = 10.2 
  • Na = 132 
  • K = 3.2
  • BUN = 6
  • Creatinine = 0.9
  • CXR, ECG, and liver tests are normal

What is the best next step in her management?

A. Order CT scan of the brain
B. Order ventilation perfusion lung scan
C. Obtain blood cultures and begin broad-spectrum antibiotics
D. Restrain the patient and order lorazepam for agitation
E. Remove Foley catheter, change fluids to NS with KCL, and discontinue meperi-dine, diphenhydramine, and ranitidine

Question 9# Print Question

A 78-year-old man complains of slowly progressive hearing loss. He finds it particularly difficult to hear his grandchildren and to appreciate conversation in a crowded restaurant. On examination, ear canal and tympanic membranes are normal. Audiology testing finds bilateral upper-frequency hearing loss with difficulty in speech discrimination.

Which of the following is the most likely diagnosis? 

A. Presbycusis
B. Cerumen impaction
C. Ménière disease
D. Chronic otitis media
E. Acoustic neuroma

Question 10# Print Question

A 76-year-old man complains of memory difficulties. He has trouble remembering where he parks his car at the supermarket and struggles with the names of new acquaintances. He has no trouble managing his finances, can readily recall the names of close friends and family members, and does not get lost in familiar settings. He has hypertension managed with an ACE inhibitor and takes acetaminophen for knee pain. He is optimistic and enjoys life. His general physical examination is normal. On the Folstein Mini-Mental State Exam, he scores 27 out of a possible 30 points. He only recalls one out of three objects after a 5-minute interval. Tests of language, calculation, and executive function are normal.

What is your best course of management for this patient?

A. MRI of head to rule out mass lesion
B. Institute sertraline 50 mg daily
C. Refer for neuropsychological testing
D. Begin donepezil 10 mg daily
E. Reassure and reevaluate in 6 months

Category: Medicine--->Geriatrics
Page: 2 of 3