Question 6#

Determination of an elderly patient's nutritional status and reversal of malnutrition is important to prevent all of the following complications EXCEPT:

A. Poor wound healing

Poor nutritional status in elderly patients is common. It is estimated that 9 to 15% of patients older than 65 years are malnourished in the outpatient setting, and this increases to 12 to 50% in the acute hospital setting, and 25 to 60% in the chronically institutionalized. A formal nutritional assessment and preoperative nutritional repletion, if needed, can significantly reduce the incidence of postoperative complications. The incidence of postoperative complications is increased in patients with an albumin level <3.5 g/L.

Question 7#

In elderly patients undergoing heart valve replacement, bioprosthetic valves are preferred over synthetic valves because:

A. There is less need for anticoagulation which is hazardous in the elderly

Prolonged anticoagulation is more hazardous in the elderly where the risk of falls is increased. Even a fall from the standing position can result in a fatal intracranial bleed in an anticoagulated patient.

Question 8#

Cancer treatment in elderly patients is:

A. Always less successful

The frequency of referrals for surgical treatment of equivalent stage cancer is decreased in the elderly for virtually all tumors. Despite this, survival after surgery is nearly equivalent for same stage malignancy as in younger patients. The data derived from clinical trials of adjuvant and neoadjuvant therapy are less helpful for decision making in elderly patients because elderly subjects are usually not included in clinical studies.

Question 9#

Avoidance of surgical resection of breast cancer in an elderly patient is unacceptable because:

A. Mortality rates of breast surgery are very low in the elderly

Elderly patients have a higher incidence of breast cancer than younger patients, and their mortality risk from breast surgery is less than 1%. Medical therapy is less effective than surgical removal of the primary tumor, and screening mammography reduces cancer-related mortality in patients up to age 75.

Question 10#

What is the likelihood that an asymptomatic, 2 cm, solitary pulmonary nodule seen on chest X-ray in a 70-year-old smoker is a malignancy?

A. 25%

Lung cancer is the leading cause of cancer-related death in patients older than 70 years. The peak incidence is between 75 and 79 years. Non-small-cell lung cancer accounts for roughly 80% of all cases. In cases of resectable primary lung cancer, resection remains the treatment of choice, with an expected survival of almost 3 years.