Multiple Choice Questions (MCQ)

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Category: Medicine--->Geriatrics
Page: 3

Question 11# Print Question

A 79-year-old man who has not had routine medical care presents for a physical examination and is found to have blood pressure of 165/80. He has no other risk factors for heart disease. He is not obese and walks 1 mile a day. Physical examination shows no retinopathy, normal cardiac examination including point of maximal impulse, and normal pulses. There is no abdominal bruit, and neurological examination is normal. ECG, electrolytes, blood glucose, and urinalysis are normal. A low-sodium DASH diet is recommended. The patient returns 6 weeks later, having strictly followed the diet; blood pressure is 168/76.

Which of the following is the best next step in management? 

A. Obtain renal artery Doppler
B. Begin therapy with low-dose thiazide diuretic
C. Follow patient; avoid toxicity of antihypertensive agents
D. Begin therapy with a beta-blocker
E. Begin therapy with a short-acting calcium channel blocker

Question 12# Print Question

A 65-year-old man inquires about the pneumonia vaccine. He had a friend who recently died of pneumonia. The patient is in good health without underlying disease.

Which of the following is the most appropriate management of this patient? 

A. Recommend the pneumococcal vaccine and check on the status of other immunizations, particularly influenza vaccination
B. Inform the patient that he has no risk factors for pneumonia
C. Do not give the pneumococcal vaccine if he has had one in the past
D. Emphasize that the influenza vaccine is more important
E. Give pneumonia vaccine and influenza vaccine 4 weeks apart

Question 13# Print Question

An 82-year-old patient presents with nausea and weakness. She has a 3-year history of type 2 diabetes mellitus, as well as essential hypertension and congestive heart failure. Her medications include insulin glargine, hydrochlorothiazide, lisinopril, metoprolol, and digoxin. Medication doses have not recently been changed. Physical examination reveals clear lung fields, regular heart rhythm at 56 beats/minute, a soft systolic murmur that radiates to the axilla, and normal liver size. There is no peripheral edema or jugular venous distension. Chest x-ray shows cardiomegaly without pulmonary vascular congestion. Her CBC is normal. Multichannel chemistry profile shows potassium of 4.0 mEq/L and serum creatinine of 1.2 mg/dL (normal range 0.5-1.3). Digoxin level is 2.2 (therapeutic 0.8-1.5).

What condition is most likely to account for her symptoms? 

A. Decreased glomerular filtration rate
B. Polypharmacy
C. Progressive decline in cardiac output
D. Diabetic gastroparesis
E. “Senile” emphysema

Question 14# Print Question

A 67-year-old man is brought by his wife for evaluation of memory loss. Over the last 2 years he has had difficulty recalling the names of friends. On two occasions he has become lost in his own neighborhood. Recently, he has become suspicious that his wife is trying to put him in a nursing home.He has hypertension. He has never used alcohol. He does not have urinary incontinence. His only medication is hydrochlorothiazide 25 mg daily. His mother was diagnosed with Alzheimer disease at age 60.

Blood pressure is 130/76. There are no focal neurologic findings and gait is normal. He is not oriented to date and cannot recall any of three objects at 3 minutes. He cannot speak the name of common objects such as a pen or watch. His clock drawing test is abnormal. Complete blood count, blood chemistries, liver function tests, serologic test for syphilis, thyroid stimulating hormone, and vitamin B12 levels are all normal. CT scan of the brain reveals age-related atrophic changes but is otherwise normal.

Of the following choices, which is the next best step? 

A. Begin treatment with donepezil 5 mg daily
B. Order APOE gene testing
C. Refer the patient for neurocognitive testing
D. Begin treatment with ginkgo biloba
E. Begin treatment with olanzapine 25 mg at bedtime

Question 15# Print Question

A 76-year-old married man consults with you about erectile dysfunction. He has osteoarthritis and hypertension, well controlled on acetaminophen and amlodipine 5 mg daily. He is able to walk 3 miles daily at a moderate pace. He has no evidence of coronary artery disease. He has been monogamous with his wife, who uses an estrogen-containing vaginal cream twice weekly and has not experienced dyspareunia. Over the past 12 months, he has noticed progressive difficulty maintaining an erection during intercourse; for the past 3 months he has been unable to achieve penetration despite the use of vaginal lubricants. His libido is good; he and his wife have a close emotional relationship. Physical examination is unremarkable. In particular, testicular size is normal. There is no evidence of neurological or peripheral vascular disease. Morning serum testosterone level is 800 ng/dL (normal 270-1070).

What is the best next step in this patient’s management? 

A. Refer to cardiologist for exercise testing prior to resuming sexual activity
B. Discontinue amlodipine
C. Prescribe sildenafil 25 to 50 mg po 1 hour before anticipated intercourse
D. Check free testosterone and prolactin level
E. Advise that most patients his age are sexually inactive and further therapy is not beneficial

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