Geriatrics Module 2

According to a recent comprehensive meta-analysis on the use of Potentially Inappropriate Medications (PIM) in older outpatients, which of the following medications is MOST commonly prescribed as a PIM in this population?

Benzodiazepines

Correct Incorrect Correct answer

Antidepressants

Correct Incorrect Correct answer

Beta-blockers

Correct Incorrect Correct answer

Statins

Correct Incorrect Correct answer

Antibiotics

Correct Incorrect Correct answer

An 88-year-old man with a 10-year history of dementia is brought in by his 85-year-old wife. They have been happily married for 55 years. The man has a history of falls, prostatism and postural hypotension. The wife describes her husband’s delusions and accusations over the last six months about her supposed infidelities with his brother who has been dead for 20 years. The wife is so distressed by the accusations that she is considering placing him in a nursing home.

The most appropriate initial pharmacological treatment for this man is:

haloperidol

Correct Incorrect Correct answer

donepezil

Correct Incorrect Correct answer

thioridazine

Correct Incorrect Correct answer

fluoxetine

Correct Incorrect Correct answer

selegiline

Correct Incorrect Correct answer

Which clinical feature of delirium is most useful for differentiating it from dementia?

Inability to count backwards from 30

Correct Incorrect Correct answer

Failure to recall 3 items after a three-minute delay

Correct Incorrect Correct answer

Disorientation in time and place but not person

Correct Incorrect Correct answer

Paranoid delusions

Correct Incorrect Correct answer

Sleep-wake disturbance with nocturnal wandering.

Correct Incorrect Correct answer

A son brings her 72-year-old mother to hospital with concerns about a change in his mother’s mental state over the preceding week. He tells you that her mother had been wandering around the house at night and has become uncharacteristically suspicious of her daughter-in-law, accusing her of stealing her belongings.

She also complained to her son of seeing thieves in her bedroom at night, but failed to prove of having anything stolen. There is no previous psychiatric history.

What would be the most likely diagnosis?

delirium

Correct Incorrect Correct answer

late onset schizophrenia

Correct Incorrect Correct answer

psychotic depression

Correct Incorrect Correct answer

dementia

Correct Incorrect Correct answer

temporal lobe epilepsy

Correct Incorrect Correct answer

Which of the following is the most beneficial intervention for preventing the development of delirium in an elderly woman?

Use of glasses and hearing aid

Correct Incorrect Correct answer

Bed restraints

Correct Incorrect Correct answer

Olanzapine

Correct Incorrect Correct answer

Lorazepam

Correct Incorrect Correct answer

Vitamin D supplementation

Correct Incorrect Correct answer

The Mini Mental State Examination (MMSE) is most appropriately used in detecting which condition?

Alzheimer's disease

Correct Incorrect Correct answer

Age related cognitive decline

Correct Incorrect Correct answer

Frontotemporal dementia

Correct Incorrect Correct answer

Lewy body dementia

Correct Incorrect Correct answer

Vascular dementia

Correct Incorrect Correct answer

Which one of the following is the first line treatment for a 65 year old woman with stress incontinence?

Pelvic floor muscle exercises

Correct Incorrect Correct answer

Imipramine

Correct Incorrect Correct answer

Oxybutynin

Correct Incorrect Correct answer

Tolterodine

Correct Incorrect Correct answer

Treat constipation

Correct Incorrect Correct answer

What is the most common cause of irreversible visual loss in Australia?

Age related macular degeneration

Correct Incorrect Correct answer

Glaucoma

Correct Incorrect Correct answer

Diabetic retinopathy

Correct Incorrect Correct answer

Cataracts

Correct Incorrect Correct answer

Trauma

Correct Incorrect Correct answer

Which of the following medication is least likely to cause falls in the elderly population?

Metoprolol

Correct Incorrect Correct answer

Digoxin

Correct Incorrect Correct answer

Oxycontin

Correct Incorrect Correct answer

Risperidone

Correct Incorrect Correct answer

Alprazolam

Correct Incorrect Correct answer

Dementia with Lewy bodies is characterized by progressive cognitive impairment among other features.

Which other clinical feature would be most consistent with this diagnosis?

Spontaneous motor Parkinsonism

Correct Incorrect Correct answer

Agitation and restlessness

Correct Incorrect Correct answer

Urine incontinence

Correct Incorrect Correct answer

Impaired social behaviour

Correct Incorrect Correct answer

Rapid onset of symptoms

Correct Incorrect Correct answer

In an elderly patient with a history of falls, which of the following intervention will most likely reduce the incidence of future falls?

Twice weekly strength and balance training program.

Correct Incorrect Correct answer

Reduction of medication

Correct Incorrect Correct answer

Use of a walking frame

Correct Incorrect Correct answer

Use of a visual aid

Correct Incorrect Correct answer

Vitamin D

Correct Incorrect Correct answer

A nursing home dietitian notifies you that an 85-year-old patient is gradually losing weight involuntarily. One year ago she weighed 59 kg, six months ago 55 kg and this month 51 kg, a loss of approximately 7% over six months and approximately 14% over one year.

Her current medical problems include osteoarthritis, Parkinson’s disease, probable Alzheimer’s disease, congestive heart failure and chronic constipation.

Her medications include digoxin 0.25 mg/day, levodopa/carbidopa 250/25 mg four times/day and ibuprofen 400 mg four times/day.

What is the least likely cause of her weight loss?

Gastrointestinal malignancy

Correct Incorrect Correct answer

Poorly fitting dentures

Correct Incorrect Correct answer

Anorexia due to medications

Correct Incorrect Correct answer

Depression

Correct Incorrect Correct answer

Inadequate feeding assistance

Correct Incorrect Correct answer

Which of the following medication is associated with weight loss in the elderly population?

Digoxin

Correct Incorrect Correct answer

Amitriptyline

Correct Incorrect Correct answer

Megestrol acetate

Correct Incorrect Correct answer

Dexamethasone

Correct Incorrect Correct answer

Olanzapine

Correct Incorrect Correct answer

Which of the following anti-depressant is associated with weight loss in the elderly population?

Citalopram

Correct Incorrect Correct answer

Amitriptyline

Correct Incorrect Correct answer

Bupropion

Correct Incorrect Correct answer

Mirtazapine

Correct Incorrect Correct answer

Phenelzine

Correct Incorrect Correct answer

Maximal oxygen consumption (V.O2 maximum) is the best measure of aerobic capacity or cardiovascular fitness and declines with age.

In healthy ageing, the most important physiological change which contributes to this decline is a reduction in:

maximum heart rate

Correct Incorrect Correct answer

stroke volume.

Correct Incorrect Correct answer

arterial PO2.

Correct Incorrect Correct answer

forced expiratory volume in 1 second (FEV1).

Correct Incorrect Correct answer

total lung capacity

Correct Incorrect Correct answer

Which of the following are the most consistent changes in regional deposition of adipose tissue that occur with ageing?

Increase in both visceral and truncal fat.

Correct Incorrect Correct answer

Increase visceral fat but decrease truncal fat.

Correct Incorrect Correct answer

Increase in subcutaneous and appendicular fat

Correct Incorrect Correct answer

Increase in subcutaneous but decrease appendicular fat

Correct Incorrect Correct answer

Increase in both subcutaneous and visceral fat.

Correct Incorrect Correct answer

Which of the following is most characteristic of healthy ageing muscle?

Type 2 fiber atrophy

Correct Incorrect Correct answer

Type 1 fiber atrophy

Correct Incorrect Correct answer

Decreased capillary density

Correct Incorrect Correct answer

Decreased oxidative capacity

Correct Incorrect Correct answer

Intramuscular lipid accumulation

Correct Incorrect Correct answer

Which one of the following hormone shows the most consistent decline in blood levels (in both sexes) with ageing?

Dehydroepiandrosterone (DHEA)

Correct Incorrect Correct answer

Cortisol

Correct Incorrect Correct answer

Adrenocorticotrophic hormone (ACTH)

Correct Incorrect Correct answer

Thyrotropin

Correct Incorrect Correct answer

Insulin

Correct Incorrect Correct answer

What is the main factor responsible for systolic hypertension in the elderly?

Reduced arterial compliance

Correct Incorrect Correct answer

Impaired renal perfusion

Correct Incorrect Correct answer

High cardiac output

Correct Incorrect Correct answer

Sympathetic activation

Correct Incorrect Correct answer

High peripheral resistance

Correct Incorrect Correct answer

The most important reason for the higher incidence of adverse drug reactions in the elderly compared to young people is:

polypharmacy

Correct Incorrect Correct answer

pharmacokinetic changes

Correct Incorrect Correct answer

pharmacodynamic changes

Correct Incorrect Correct answer

reduction in the efficiency of homeostatic mechanisms

Correct Incorrect Correct answer

the presence of co-existing pathologies

Correct Incorrect Correct answer

When comparing tricyclic antidepressants with selective serotonin reuptake inhibitors (SSRIs) as treatments for major depression in the elderly, which of the following side effects represents the most clinically significant difference between these drugs?

Dry mouth.

Correct Incorrect Correct answer

Gastrointestinal disturbance

Correct Incorrect Correct answer

Risk of developing dementia

Correct Incorrect Correct answer

Time to improvement

Correct Incorrect Correct answer

Efficacy in treatment of depression.

Correct Incorrect Correct answer

As part of a multicomponent intervention, which of the following measure is less likely to prevent delirium in an elderly hospitalized population?

Benzodiazepine therapy

Correct Incorrect Correct answer

Optimising vision.

Correct Incorrect Correct answer

Optimising hearing

Correct Incorrect Correct answer

Early treatment of dehydration

Correct Incorrect Correct answer

Sleep enhancement protocols

Correct Incorrect Correct answer

Medication withdrawal is frequently undertaken in elderly patients with polypharmacy.

Which of the following medication can be stopped abruptly with minimal risk of a withdrawal syndrome in the elderly?

Amlodipine

Correct Incorrect Correct answer

Levodopa

Correct Incorrect Correct answer

Metoprolol

Correct Incorrect Correct answer

Oxazepam

Correct Incorrect Correct answer

Sertraline

Correct Incorrect Correct answer

Which of the following cardiovascular parameter is unchanged in healthy aging during exercise?

stroke volume

Correct Incorrect Correct answer

maximum heart rate

Correct Incorrect Correct answer

ejection fraction snd contractility

Correct Incorrect Correct answer

end systolic volume

Correct Incorrect Correct answer

end diastolic volume

Correct Incorrect Correct answer

Old age is associated with diminished pharmacodynamic response to beta adrenergic antagonists (beta blockers).

Which of the following mechanism best explains this phenomenon?

Decrease in density of beta-receptors.

Correct Incorrect Correct answer

Reduction in the hepatic clearance of beta blockers.

Correct Incorrect Correct answer

Decrease in renal clearance of active metabolites.

Correct Incorrect Correct answer

Increase in blood levels of noradrenaline.

Correct Incorrect Correct answer

Decreased intracellular concentrations of cAMP (cyclic adenosine monophosphate).

Correct Incorrect Correct answer

Which of the following lung function increases with healthy aging after maximum expiration?

Residual volume

Correct Incorrect Correct answer

Forced Expiratory Volume in 1 second (FEV1)

Correct Incorrect Correct answer

Forced Vital Capacity (FVC)

Correct Incorrect Correct answer

Total lung capacity

Correct Incorrect Correct answer

Diffusing capacity (DLCO)

Correct Incorrect Correct answer

Which of the following physiological changes in the kidney that increases with aging?

Distal tubular diverticula

Correct Incorrect Correct answer

Renal mass

Correct Incorrect Correct answer

Number of glomeruli

Correct Incorrect Correct answer

Renal blood flow

Correct Incorrect Correct answer

Glomerular filtration rate

Correct Incorrect Correct answer

Which of the following hormone increase is responsible for nocturnal polyuria?

Atrial natriuretic peptide

Correct Incorrect Correct answer

Antidiuretic hormone

Correct Incorrect Correct answer

Adrenocorticotrophic hormone

Correct Incorrect Correct answer

Cortisol

Correct Incorrect Correct answer

Insulin

Correct Incorrect Correct answer

An 87-year-old man presents to the Accident and Emergency Department on a hot day complaining of feeling lightheaded.

Age related change in which one of the following is most likely to hinder blood pressure maintenance in this man?

Baroreceptor reflex sensitivity.

Correct Incorrect Correct answer

Basal and stimulated renin and aldosterone levels.

Correct Incorrect Correct answer

Atrial natriuretic peptide.

Correct Incorrect Correct answer

Thirst mechanism.

Correct Incorrect Correct answer

Plasma noradrenaline concentration.

Correct Incorrect Correct answer

Which of the following physiological changes in the bladder increases with age?

Detrusor hyperactivity

Correct Incorrect Correct answer

Bladder capacity

Correct Incorrect Correct answer

Bladder contractility

Correct Incorrect Correct answer

urethral flow resistance in women

Correct Incorrect Correct answer

No changes whatsoever

Correct Incorrect Correct answer

Which of the following organ system has the least significant functional change with age?

Liver

Correct Incorrect Correct answer

Lung

Correct Incorrect Correct answer

Kidneys

Correct Incorrect Correct answer

Heart

Correct Incorrect Correct answer

Adrenals

Correct Incorrect Correct answer

Geriatrics Module 2

Quiz Summary

Information

Results

Results

Categories

1. Question

2. Question

3. Question

4. Question

5. Question

6. Question

7. Question

8. Question

9. Question

10. Question

11. Question

12. Question

13. Question

14. Question

15. Question

16. Question

17. Question

18. Question

19. Question

20. Question

21. Question

22. Question

23. Question

24. Question

25. Question

26. Question

27. Question

28. Question

29. Question

30. Question

31. Question

Average score
Your score