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An 82 year old mamn is seen in the primary care office with complaints of dribbling urine and difficulty starting his stream. Which of the following should be included in the list of differential diagnosis. a. parkinson's disease b. prostate cancer c. all options are appropriate d. benign prostatic hyperplasia (BPH) ------CORRECT ANSWER--------------
- c. all options are appropriate A 67 year old man is seen in the clinic with a chief complaint of nocturia. Which of the following should be included in the differential diagnosis? a. psychogenic nocturia b. benign prostatic hypertrophy c. drug induced impotence d. irritative posterior urethral lesion ------CORRECT ANSWER---------------b. benign prostatic hypertrophy Which of the following maneuvers is contraindicated in acute prostatitis a. palpation of the epididymis b. massaging the infected prostate c. serial urine samples d. rectal exams ------CORRECT ANSWER---------------b. massaging the infected prostate
You are working up a 52 year old patient for microscopic hematuria. Your differential diagnosis list includes all of the following except a. nephrocalcinosis b. acute pyelonephritis c. renal stenosis d. bladder cancer ------CORRECT ANSWER---------------c. renal stenosis A 48 year old male patient screened for diabetes has a fasting plasma glucose level of 120mg/dl (6.7mmol/L). The nurse practitioner plan includes: a. prescribe metformin 500mg po BID b. educate the patient on lifestyle changes to lower blood glucose c. initiate self monitoring of blood glucose d. review the effects of oral hypoglycemic medications ------CORRECT ANSWER---------------b. educate the patient on lifestyle changes to lower blood glucose Terazosin, an alpha blocker, is prescribed to treat the following conditions: a. benign prostatic hypertrophy and hypertension b. benign prostatic hypertrophy and hypotension c. urinary tract infection and arrythmia d. chronic prostatitis and atrial fibrillation ------CORRECT ANSWER----------- ----a. benign prostatic hypertrophy and hypertension A 65 year old hispanci woman presents to the office for routine follow up for her type 2 diabetes mellitus. Her routine UA reveals few epithelial cells, negative leukocytes, negative nitrates, negative protein, no ketones. Which of the following tests should also be ordered annually for diabetic patients.
d. educate that the diuretic is causing thirst ------CORRECT ANSWER------- --------b. order a fasting blood glucose Diabetes is one of the leading causes of which medical condition? a. chronic lung disease b. disability c. kidney failure d. cardiac death ------CORRECT ANSWER---------------c. kidney failure In the late stages of dementia, a phenomenon called "sun downing" occurs, in which cognitive disturbances tend to : a. peak mid-day b. becomes worse toward the evening c. improves as the day goes on d. fluctuates during the course of the day ------CORRECT ANSWER---------- -----b. becomes worse toward the evening The proposed mechanism by which diphenhydramine caused delerium is: a. anticholinergic effects b. dopaminergic effects c. gabanergic effectis d. serotinergic effects ------CORRECT ANSWER---------------a. anticholinergic effects According to the Palliative Care Presentation, palliative care may be provided to a. only cancer patients b. anyone regardless of their life expectancy or disease progression
c. those with a life expectancy > 6 months d. those with a life expectancy< 6 months ------CORRECT ANSWER--------- ------b. anyone regardless of their life expectancy or disease progression The highest level of evidence with the use of adjuvant analgesics is with a. therapeutic trials before discontinuing drugs b. patients with fibromyalgia are candidates for adjuvant analgesics c. tricyclic antidepressants avoided due to high adverse affects d. neuropathic pain patients are candidates for adjuvant analgesia ------ CORRECT ANSWER---------------d. neuropathic pain patients are candidates for adjuvant analgesia According o the Sexuality presentation, the biggest barrier to appropriate sexual evaluation in the older patient a. older people dont talk about sex b. most elderly patients are not interested in sex c. ageist attitudes d. female post menopausal changes ------CORRECT ANSWER--------------- c. ageist attitudes The patient with BPH is seen for follow-up.. He has been taking finasteride (Proscar) for 6 months. The clinician should assess this patient for which of these side effects? a. headache b. urinary incontinence c. hypotensionn d. impotence ------CORRECT ANSWER---------------d. impotence Which of the following statements is true regarding pain?
d. ibuprofen/impraminen ------CORRECT ANSWER---------------c. acetaminophen/hydrocodone K B age 54 presents to your office. her husband has just died suddenly and she states she cannot function. She is crying all the time, cant seem to focus and she has so much she needs to do to plan the funeral service and get through the next few days. YOu decide to prescribe a benzodiazepine. Please choose the correct treatment decision statements below. a. benzodiazepines are safe to prescribe long term b. benzodiazepines should not be stopped abruptly if taken for > 1 month c. benzodiazepines are first line treatment for anxiety in the elderly d. benzodiazepines should be prescribed at the highest dose tolerated for the best effect ------CORRECT ANSWER---------------b. benzodiazepines should not be stopped abruptly if taken for > 1 month Mrs. L, a 66 year old Asian female, presented for her yearly physical last week. A review of her chart reveals she smokes 2 packs of cigarettes a day, and drinks 2 beers every evening since she retired. She stopped walkingn two years ago when she started having knee pain. As part of heallth maintenance, a DEXA was ordered. You have received the results, a T score of - 2.5. The score is consistant with a. normal result b. osteoporosis ------CORRECT ANSWER---------------b. osteoporosis Healthcare providers should recommend that older adults engage in which one of the following? a. 150 minutes of moderate intensity physical activity weekly b. 20 minutes of moderate intensity physical activity 3 days per week c. 10 minutes of vigorous physical activity most days of the week
d. 30 minutes of vigorous physical activity 3 days per week ------CORRECT ANSWER---------------a. 150 minutes of moderate intensity physical activity weekly A 69-year-old female presents to your office for routine primary care. Her elder sister was recently diagnosed with Alzheimer disease, and she wonders what steps she can take to reduce her own risk of developing dementia. Which of the following statements about the prevention of dementia is true? a. There is moderate quality evidence to support daily use of vitamin B and fish oil to prevent risk of cognitive decline. b. Risk of dementia is modulated by nonmodifiable risk factors, such as genetics, family history, and educational attainment, and there are no behavioral interventions that can be taken to reduce risk of developing dementia. c. There is moderate quality evidence to suggest control of cardiovascular and metabolic risk factors, such as blood pressure, weight, and blood sugar, may reduce risk of dementia. d. There is moderate to low quality evidence supporting cannabinoids maementia.y reduce rates of pro ------CORRECT ANSWER---------------c. There is moderate quality evidence to suggest control of cardiovascular and metabolic risk factors, such as blood pressure, weight, and blood sugar, may reduce risk of dementia. An 86-year-old female comes to your office for a wellness visit. Her blood pressure is 125/70 mmHg, pulse 69 beats per min, and respiratory rate 18 breaths per min. She is well appearing and reports she is up to date on her routine vaccinations. She introduces her partner of 35 years whom she would like to make medical decisions for her in case she becomes unable to make decisions for herself. She reports that she and her partner are not married. She asks if she needs any further documentation to ensure her goals of care are followed. Which one of the following would be the most appropriate recommendation for this patient and her partner? a. Advise them to complete a POLST.
- An 81-year-old transgender female with history of depression and hyperlipidemia presents to your clinic for routine care. She endorses a history of smoking, currently smoking 1 pack per day, and occasionally drinks a glass of wine, although she denies illicit drug use. She reports she takes atorvastatin 20 mg and subcutaneous estrogen therapy. Which of the following is the most important next step in this patient's primary care? a. Counseling on starting aspirin b. Counseling on alcohol cessation c. Counseling on smoking cessation d. Counseling on mammogram ------CORRECT ANSWER---------------c. Counseling on smoking cessation Which of the following is true about tolterodine? a. It should be avoided in men with prostatic hypertrophy. b. It increases the risk of constipation compared with oral oxybutynin. c. It acts by ablating detrusor spasms. d. It has greater risk of adverse effects with its twice-daily formulation. ------ CORRECT ANSWER---------------d. It has greater risk of adverse effects with its twice-daily formulation. An 82-year-old man, Mr. A, complains of worsening nocturia, occurring four times per night. His other lower urinary tract symptoms are slow stream, occasional urgency, and urgency-related leakage once weekly. Medical problems include poorly controlled hypertension, diastolic heart failure, hyperlipidemia, osteoarthritis, and prediabetes. His medications include lisinopril 20 mg daily, metoprolol succinate 75 mg daily, atorvastatin 10 mg daily, metformin 500 mg twice daily, hydrocodone-acetaminophen as needed, and aspirin 81 mg daily. Amlodipine 5 mg daily was recently added by his cardiologist. On review of systems, Mr. A complains that nocturia is causing daytime fatigue, and he is more constipated. Physical examination is notable for blood pressure 162/83 mmHg, heart rate 60 beats per minute,
clear lungs, soft abdomen, enlarged prostate, and 21 pretibial edema. Your next step in management should be: a. Stop hydroc ------CORRECT ANSWER---------------b. Stop amlodipine and increase lisinopril. The daughter of a 79-year-old woman notes that her mother, who has dementia and lives with her, is wetting herself when she attends her new day program. Program staff have requested that "something be done" as she is requiring a clothes change nearly every time she is there. She cannot describe the circumstances of leakage, saying "it just comes." Leakage is uncommon at home. Her medications include donepezil and acetaminophen. Physical examination is normal. Initial treatment approach will require intervention by which of the following? a. Mrs. A's physician b. Mrs. A's daughter c. Day program staff d. Physical therapist through a home care agency ------CORRECT ANSWER---------------c. Day program staff Ms. J, who is 82 years old, complains of urine leakage while playing golf. This has gotten worse over the past year, and she rarely makes it through nine holes without feeling like she needs to "run into the bushes and go." Leakage is usually small volume, but causes her extreme embarrassment because she is afraid she will smell of urine. She has tried limiting caffeine in the morning before she golfs and avoiding drinking water while playing, to no effect. She also tried "those Kegler" exercises in the past without success. Which of the following is the most appropriate recommendation for Ms. J? a. Bladder training b. Referral for biofeedback training in pelvic muscle exercise c. Trial of solifenacin d. Trial of topical estrogen ------CORRECT ANSWER---------------a. Bladder training
A 79-year-old woman with a 1.5-cm breast cancer underwent lumpectomy. Pathology revealed ductal carcinoma that is hormone receptor negative (estrogen receptor 0%, progesterone receptor 1%) and HER2/neu negative. Surgical margins were adequate and uninvolved with cancer. Sentinel lymph node sampling was negative for lymph node involvement. She has good performance status and no activities of daily living (ADL) or instrumental (IADL) dependencies. What treatment would you recommend? a. Adjuvant chemotherapy b. Adjuvant chemotherapy with irradiation c. Adjuvant irradiation only d. Hormonal therapy only e. None of the above ------CORRECT ANSWER---------------D. Hormonal therapy only An 86-year-old man with no ADL deficits who has stopped driving because of macular degeneration is evaluated for a urinary tract infection associated with urinary retention. The consulting urologist places a Foley catheter and sends a prostate-specific antigen (PSA) level that comes back 12 ng/mL. Three months later after the Foley has been removed and he has had a good response to tamsulosin, his PSA is still 10 ng/mL. What is the appropriate next step in managing this man's prostate problem? a. Transrectal ultrasound and biopsy b. Empiric finasteride c. Bone scan d. Repeat PSA in 6 months e. Observation ------CORRECT ANSWER---------------b. Empiric finasteride In which of the following patients is chemical or surgical castration likely to prolong survival? a. A 78-year-old man with advanced dementia and prostate cancer metastatic to the bone. b. A 78-year-old man who had a radical prostatectomy 10 years earlier and now has a PSA level of 5.7 ng/mL. A year ago it was 0.1 ng/mL. A bone scan is negative and an abdomen-pelvis computed tomography (CT) is negative.
c. A 78-year-old man who had a radical prostatectomy and external beam radiation therapy 10 years earlier now has a PSA level of 24.5 ng/mL. A CT scan of the pelvis shows an enlarged pelvic lymph node, and a bone scan is positive in the pelvis. d. A 78-year-old man with prostate cancer limited to the prostate with a Gleason score of 6. e. None of the above. ------CORRECT ANSWER---------------c. A 78-year- old man who had a radical prostatectomy and external beam radiation therapy 10 years earlier now has a PSA level of 24.5 ng/mL. A CT scan of the pelvis shows an enlarged pelvic lymph node, and a bone scan is positive in the pelvis On admission to the hospital, an 85-year-old woman was found to have a fungating mass on her right breast. The mass is 9 cm in diameter, partially ulcerated, and associated with edema of the arm and obvious pain. The patient has no children and had lived alone until recently, when a neighbor became concerned for what appeared to be a progressive loss of memory and neglect of the house. A nephew living in another city eventually came to take care of the situation and arranged for the admission. The patient appears confused and withdrawn; her appearance is disheveled, but she seems to be independent in her ADLs. The medical history is negative for any serious illnesses. She was able to drive her own car until shortly before this admission. The nephew does not wish to authorize hospice "right now." A positron-emission tomography scan was negative for metastatic disease. In addition to determining the cause of her deliri ------CORRECT ANSWER- --------------b. The mass should be biopsied to study hormone receptor and HER2/neu antigen status. A 78-year-old man has an emergency partial colectomy for lower gastrointestinal bleeding. A localized colonic adenocarcinoma is completely resected. The surgeon did not dissect lymph nodes for metastatic sampling. The patient wants to know if he should have chemotherapy. Should he? a. Yes because without knowing his complete staging it would be safer.
b. Treatment decisions for pneumonia are based on its severity, the presence of comorbid illnesses, and a prior history of MRSA or Pseudomonas respiratory infection. c. All older adults with pneumonia must be treated in hospital. d. Pulse oximetry, respiratory rate, and chest radiography would not be helpful fo ------CORRECT ANSWER---------------b. Treatment decisions for pneumonia are based on its severity, the presence of comorbid illnesses, and a prior history of MRSA or Pseudomonas respiratory infection.
- An 80-year-old woman that you follow in a nursing home has an acute decline in her mental status. She has a fever >100° F, but no other focal complaints or findings on physical examination except for a chronic indwelling urinary catheter. What statement is true? a. Fever in an older adult with an indwelling urinary catheter is an appropriate indication to start empiric antibiotic therapy. b. Older adults with an indwelling urinary catheter are less likely to have bloodstream infection than older adults without a catheter. c. It is not necessary to obtain a urine culture; empiric antibiotic treatment is sufficient. d. She only needs antibiotic treatment for 3 days. ------CORRECT ANSWER---------------a. Fever in an older adult with an indwelling urinary catheter is an appropriate indication to start empiric antibiotic therapy. An 82-year-old woman receives oral amoxicillin-clavulate for a skin abscess on her leg. She develops new onset of frequent watery stool that persists for several days after the antibiotic is stopped. You obtain a stool for Clostridium difficile antigen, toxin, and polymerase chain reaction (PCR). The antigen and PCR are both positive. She has never had C. difficile infection before. What one statement is the best answer regarding her management? a. Metronidazole is the treatment of choice for C. difficile infection. b. Older adults with their first episode of C. difficile require a longer duration of treatment with vancomycin. c. Fecal transplantation is the treatment of choice for C. difficile infection.
d. Either vancomycin or fidaxomicin are recommended for the first episode of C. difficile infection. ------CORRECT ANSWER---------------d. Either vancomycin or fidaxomicin are recommended for the first episode of C. difficile infection A 75-year-old man presents with the chief concern, "I may have a bladder infection." Further questioning reveals for several months he has been needing to void every couple of hours (can't sit through a whole ball game), feels he must go as soon as he feels the urge (he tried putting it off and had urinary leakage), and is getting up two to three times at night to void. He denies delay in voiding or straining to initiate voiding, slow stream, feeling of incomplete emptying, or dribbling after completion of urination. He also denies dysuria and abdominal pain. Which of the following best describes the category or type of his lower urinary tract symptoms? a. Prostatism b. Overactive bladder c. Postmicturition d. Storage (irritative) e. Voiding (obstructive)
- A 70-year-old man has bothersome ------CORRECT ANSWER--------------
- d. Storage (irritative) A 70-year-old man has bothersome lower urinary tract syndrome (LUTS) associated with benign prostatic hyperplasia (BPH). His symptoms are no longer well managed with lifestyle modifications. He is interested in medication to reduce his urinary symptoms but is concerned about possible side effects. He notes that he is recently married and sexual activity is very important to him. Which of the following medications would be most appropriate for this patient? a. Alfusozin b. Ditropan c. Dutasteride d. Tamsulosin e. Tadalafil ------CORRECT ANSWER---------------a. Alfusozin
Mr. Roberts, a 72-year-old patient who has sought medical care on an intermittent basis in the past, complains of aching discomfort in his perineal area, urinary urgency, and frequency for the past few years. He also complains of insomnia and intermittent anxiety that he attributes to loneliness after his wife's death about a year ago. Digital rectal examination (DRE) reveals a slightly enlarged, nontender prostate with no palpable nodules. Perineal examination is normal. Bladder scan is unremarkable and postvoid residual urine volume is 50 mL. Urinalysis shows no WBCs or RBCs. Urine culture is negative. Previous treatment has included dietary modification and alpha-blocker medication. What is the most appropriate next step? a. Start an 8-week course of ciprofloxacin. b. Start a 5-alpha-reductase inhibitor. c. Perform urodynamic testing. d. Screen for depression. ------CORRECT ANSWER---------------d. Screen for depression. Mr. Hunter, a 69-year-old man, complains of urinary frequency and urgency that have increased over the past several months. There is no dysuria, hematuria, or sensation of incomplete voiding. He drinks 2 cups of coffee daily and diet cola multiple times a day. His International Prostate Symptom Score (IPSS) is 6, with a bother score of 1 indicating mild voiding symptoms with low impact on his quality of life. His medical history includes hypertension, coronary artery disease, and benign prostatic hyperplasia. Current medications are aspirin, metoprolol, and hydrochlorothiazide. Physical examination reveals normal sized prostate. Which of the following is the best next step? a. Urinalysis b. Cystoscopy c. Lifestyle modifications d. Tamsulosin e. Finasteride ------CORRECT ANSWER---------------c. Lifestyle modifications
Two years later Mr. Hunter reports progression of his urinary symptoms and desires "a pill to make this better." His current IPSS is 17, with a bother score of 3 indicating moderate voiding symptoms with moderate impact on his quality of life. On review of systems he notes that his vision has worsened, especially in his left eye. His ophthalmologist has recommended cataract surgery. For which of the following medications would initiation of therapy be delayed until after cataract surgery? a. Finasteride b. Tamsulosin c. Tadalafil d. Oxybutynin ------CORRECT ANSWER---------------b. Tamsulosin Several years later, Mr. Hunter, who is now 75 years old, seeks additional intervention for his urinary symptoms that have progressed further. He now experiences slow urinary stream, hesitancy, straining, and a feeling of incomplete emptying in addition to the previous urinary urgency and frequency. At times, he has noted blood in his urine. He has had five urinary tract infections (UTIs) in the past 2 years. His current IPSS is 24, with a bother score of 5 indicating severe voiding symptoms with high impact on his quality of life. Mr. Hunter's updated medical history includes hypertension, coronary artery disease, benign prostatic hyperplasia, cataract surgery 4 years ago, and two falls within the past year while rushing to the bathroom during the night. Current medications are aspirin, metoprolol, finasteride, and tamsulosin. Physical examination reveals an enlarged, nontender prostate, about 50 g in size without d ------CORRECT ANSWER---------------d. Perform surgical resection of prostate. The US Advisory Committee on Immunization Practices and the Centers for Disease Control currently recommend which one of the following? a. All older adults be immunized against influenza annually and that they receive at least one pneumococcal vaccination. b. All high-risk older adults should receive an additional pneumococcal vaccination 5 years or more after their first immunization.
