Geriatrics Module 3

Mrs. Smith, a 72-year-old woman, has been diagnosed with mild to moderate Alzheimer’s disease. She has been on donepezil, an anticholinesterase inhibitor, for the past 6 months.

Despite this treatment, her cognitive function has continued to decline, and she is experiencing increasing difficulty with daily activities such as managing her finances and remembering appointments.

Her caregiver reports that she is becoming more forgetful and occasionally disoriented.

Given that Mrs. Smith has not responded adequately to an anticholinesterase inhibitor, which of the following is the most appropriate next step in her treatment?

What is the primary goal of cognitive stimulation therapy (CST) for Alzheimer’s patients?

A 60-year-old individual, diagnosed with adult-onset attention-deficit/hyperactivity disorder (ADHD) several years ago, visits your office due to concerns about their cognitive health, particularly noting forgetfulness and decreased attention span.

Which condition is this patient more likely to develop as a result of their ADHD diagnosis?

In the elderly nursing home population, which of the following factor is less likely to contribute to constipation?

Hepatic drug clearance is reduced in old age.

Which of the following ageing changes is currently believed to have the biggest impact on hepatic drug metabolism?

In an elderly patient with urinary incontinence secondary to detrusor instability, which of the following would be the most appropriate therapy?

A hospitalised patient is seen with a stage III pressure ulcer (full thickness skin loss and necrosis of subcutaneous tissue extending down to, but not through, underlying fascia) on the sacrum that measures 10 x 10 cm. There is extensive eschar adhering to the centre and to one side of the wound and a large amount of purulent drainage is expressible from under the eschar. There is no surrounding skin erythema. The patient is afebrile.

Which one of the following approaches would best control local infection?

A 91-year-old nursing home resident has end stage Alzheimer’s disease. She is bed bound, unable to speak, and incontinent of urine and faeces. Daily inspection of skin reveals non-blanching erythema of the heels and normal sacral skin. Which of the following is most likely to prevent a pressure ulcer in this patient?

An 87-year-old man is admitted to hospital with a dense left hemiplegia and is totally bedbound and immobile.

Which of the following strategy is most effective in reducing the risk of developing pressure ulcers in this patient?

The following interventions are helpful in preventing pressure sores in the elderly group, except?

The timed stand up and go test is used in elderly patients to quantify which of the following parameters?

Which of the following medication should be avoided in the management of delirium?

Pramipexole is a dopamine agonist of the non-ergoline class indicated for treating early-stage Parkinson’s disease (PD) and restless legs syndrome (RLS).

However the use of this medication in the elderly may increase the risk of:

Which of the following drug class poses the highest risk of falling in the elderly population?

On presentation, certain forms of dementia can be difficult to differentiate from delirium.

Which form of dementia has similar features to that of a delirium?

Which of the following is the strongest visual risk factor for falls in the elderly population?

In an elderly who has had a fall, which of the following is the strongest predictor of fall in the next 1 year?

Which of the following has the highest prediction of delirium?

A usually fit and well 74 year old man undergoes surgery following a hip fracture.

Which of the following intervention will most likely reduce his risk of developing delirium?

What is the strongest risk factor for development of Alzheimer’s dementia?

An 82-year-old female complains of a decline in short-term memory, specifically difficulty remembering some names and telephone numbers. She lives alone in her own home and has been independent in all activities of daily living and instrumental activities of daily living, since the death of her husband one year previously.

Her mini-mental state examination (MMSE) score is 27 out of 30, with short-term recall of only one out of three items.

The most likely diagnosis is:

Cholinesterase inhibitors such as Donepezil is least useful in:

Donepezil, a cholinesterase inhibitor that is used to improve cognitive function in Alzheimers disease is least likely to cause which of the following side effect?

Which class of drug has strong evidence for association with the risk of falling in older people?

Which of the following intervention is the best treatment for mild cognitive impairment?

When administered to a 70 year old man, which of the following drugs is most likely to cause urinary retention?

If a healthy and independent 80 year old person performs daily moderate exercise for 3 months, which of the following performance is likely to improve?

What is the most common cause of blindness in the elderly population?

An elderly man comes to see you complaining of having poor sleep quality.

Which one of the following age related factors is least likely to contribute to this man’s problem?

Which of the following modifiable risk factor has the highest prevalence in the development of dementia in later life (age >65)?

In an 18-month clinical trial involving patients with early Alzheimer’s disease, the administration of lecanemab was evaluated for its effects on cognitive and functional decline.

Which of the following best summarizes the findings of this trial?

Which of the following diagnostic tools is NOT recommended for routine delirium detection in older adults?