Description

1. Question: A 56 year old man is diagnosed with acute prostatitis, he is afebrile without severe pain and will be managed He should initially be treated with antibiotics for how long?
2. Question: An 80 year old female widow asks her nurse practitioner about her end of life Her diagnosis includes congestive heart failure, hypertension and type 2 diabetes mellitus. She has noticed that in the last month she has lower extremity edema and she if finding it difficult to walk to the grocery store and church. She does not use oxygen.
3. Question: She is able to maintain her home but requires more frequent rests after She does not wish to be admitted to the hospital again in the future but if admitted wants to maintain full code status. How should the NP address this patients concerns today?
4. Question: Hospice services and palliative care services are underutilized due to
5. Question: X returns to office for follow-up of first line tx of UI. He reports continued UI despite compliance w/first line measures. PE and lab findings today are normal. You initiate 2nd line tx and prescribe:
6. Question: The US Advisory Committee on Immunization Practices and the Centers for Disease Control currently recommend which one of the following?
7. Question: Healthcare providers should recommend that older adults engage in which one of the following?
8. Question: Guidelines for the primary prevention of stroke recommend that aspirin be used in which one of the following?
9. Question: Even though older adults are less likely to get counseled for smoking cessation, they have which one of the following?
10. Question: A 67-year-old female with a history of congestive heart failure and myocardial infarction is admitted to the hospital because of increasing altered mental status and decreased arousal over the last week. Physical examination reveals a confused woman with right lower lobe crackles and a pulse oximetry of 86% on room While you are interviewing the patient, she is irritable, paranoid, and inattentive, which her family tells you is out of character. You notice waxing and waning in her alertness and impaired short-term memory during your examination. Which one of the following features present in this patient best distinguishes delirium from depression or dementia?
11. Question: A 72-year-old man with colonic diverticulosis was admitted to the hospital with gastrointestinal bleeding and abdominal He underwent colonoscopy under conscious sedation using fentanyl and midazolam. The following day, the patient was positive on the Confusion Assessment Method performed by the geriatric consultation services. Presence of delirium in this patient predisposes him to all of the following except:
12. Question: A 78-year-old male who resides at a nursing home has Lewy Body dementia, frequent falls, visual hallucinations, and sleep disturbances. He is transferred to your hospital with poor oral intake and confusion of 3 days’ Physical examination reveals a thin man with dry mucous membranes, tachypnea, tachycardia, and confusion. To reliably identify delirium in this patient in a time-efficient manner (<5 minutes), what will be your instrument of choice?
13. Question: An 84-year-old woman complains of nausea and vomiting for the past 3 She has a history of multiple abdominal surgeries, adhesions, and recurrent hospitalizations for partial small bowel obstruction. She has visual and hearing impairment and is currently taking oxybutynin for neurogenic bladder. You recognize she is high risk for development of delirium. Interventions that may prevent the onset of delirium among older adult hospitalized patients include all of the following except:
14. Question: An 86-year-old female comes to your office for a wellness 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?
15. Question: 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 She reports she takes atorvastatin 20 mg and subcutaneous estrogen therapy.
16. Question: An 84-year-old male with history of stroke without residual deficit, systolic heart failure, and type 2 diabetes presents to clinic for follow-up. He is independently living in a retirement community and still works part time on a golf He currently takes aspirin 81 mg, metoprolol tartrate 25 mg BID (twice a day), furosemide 20 mg BID, and lisinopril 10 mg daily. He reports his last colonoscopy was 8 years ago, with no abnormality. He reports he is sexually active with men and women, engaging in receptive oral, receptive anal, and penetrative sex. He states he has had over three sexual partners in the last year with intermittent condom use. What sexually transmitted infection testing should be offered?
17. Question: Which of the following is true about tolterodine?
18. Question: An 82-year-old man, 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:
19. Question: 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 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?
20. Question: 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?
21. Question: What is the most common cause of erectile dysfunction in older men?
22. Question: Which is the most reasonable first step in the treatment of older men with erectile dysfunction?
23. Question: A 72-year-old woman reports vaginal dryness that interferes with Her medical history includes type 2 diabetes, hypertension, and osteoarthritis. Medications are glyburide, chlorthalidone, and acetaminophen. What would be your first step in therapy?
24. Question: A 70-year-old woman reports sexual pain with deep penetration What is the most likely cause of her problem?
25. Question: A 79-year-old woman with a 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.
26. Question: Surgical margins were adequate and uninvolved with cancer. Sentinel lymph node sampling was negative for lymph node She has good performance status and no activities of daily living (ADL) or instrumental (IADL) dependencies. What treatment would you recommend?
27. Question: 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 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?
28. Question: In which of the following patients is chemical or surgical castration likely to prolong survival?
29. Question: On admission to the hospital, an 85-year-old woman was found to have a fungating mass on her right 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.
30. Question: She was able to drive her own car until shortly before this 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 delirium:
31. Question: A 78-year-old man has an emergency partial colectomy for lower gastrointestinal 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?
32. Question: An 80-year-old woman has no weight loss, no pain, and no distention but over 2 years increasingly complains of constipation despite adequate medical A colonoscopy is negative. An abdominal CT is performed. It reveals well-circumscribed pelvic masses, the largest adherent to the ovarian ligament. The best first step is: