Geriatrics Midterm Study

Evidence suggests that cervical cancer screening for women over age 65 with recent negative Pap and HPV test results is

a. Not recommended

b. Strongly recommended

a. Not recommended

Which of the following is an Activity of Daily Living (ADL)?

a. Managing household finances

b. Maintaining personal hygiene

c. Cooking

d. Shopping

b. Maintaining personal hygiene

With usual aging, lung vital capacity typically ______.

a. Increases

b. Decreases

c. Remains the same

b. Decreases

The Lawton scale is used to evaluate a person's ability to perform ____.

a. Instrumental activities of daily living (IADLs)

b. Activities of daily living (ADLs)

c. Physical skills requiring balance

d. Tasks involving hand-eye coordination

a. Instrumental activities of daily living (IADLs)

Presbyopia refers to age-related decrease of ______ vision.

a. Near

b. Distance

c. Peripheral

d. Night

a. Near

An inspection finding of actinic purpura on the forearms and hands of older adults would suggest ______.

a. Elder abuse

b. Repetitive overuse injuries

c. Diabetes mellitus

d. Chronic sun exposure

d. Chronic sun exposure

It is particularly important to check the feet of older adults with fungal _____ for infections and ulcers.

a. Aortic stenosis

b. Macular degeneration

c. Diabetes

d. Emphysema

c. Diabetes

A 67-year-old has lost 13 pounds in the last 6 months without any notable changes in their diet or exercise routines. Which of the following is the least likely explanation for the weight loss?

a. Malnutrition

b. Usual aging

c. Hyperthyroidism

d. Cancer

b. Usual aging

A 76-year-old's pulse is 68 beats per minute, which represents a _____ heart rate.

a. Faster than normal

b. Normal

c. Slower than normal

b. Normal

A 68-year-old presents with new-onset headache, scalp tenderness, and jaw claudication. Other symptoms include fatigue and episodes of blurred vision. Laboratory tests reveal an elevated erythrocyte sedimentation rate (ESR) and C- reactive protein (CRP). Based on these findings, what is the most likely diagnosis?

a. Temporal arteritis

b. Migraine

c. Tension headache

d. Glaucoma

a. Temporal arteritis

Why is it important to take the baseline temperature of an adult over age 65 when they are feeling well? Older adults ______ compared to younger adults.

a. Have a higher baseline temperature

b. Typically exaggerate their symptoms

c. Are less cooperative when they're sick

d. Have a lower fever response to infection

d. Have a lower fever response to infection

One component of usual aging is involution, which is:

a. Genetically programmed shrinkage of the thymus

b. Finite doubling capacity of mammalian cells

c. Damage that occurs to chromosomes due to free radicals

d. Mitotic errors that create mutations causing accelerated aging

a. Genetically programmed shrinkage of the thymus

In the aging cardiovascular system, _______ is a typical change.

a. Increased amplitude of peripheral pulses

b. Increased maximum heart rate

c. Decreased heart rate variability

d. Decreased supine systolic blood pressure

c. Decreased heart rate variability

It is recommended that which individuals have a diagnostic ultrasound to screen for aortic aneurysm?

a. Males over 65 who have ever smoked

b. Females over 65 who have never smoked

c. Males 75-84 who have never smoked

d. Females 75-84 who currently smoke

a. Males over 65 who have ever smoked

? While the perception of many flavors becomes less distinct with usual aging, older people can usually still detect well when something is______.

a. Bitter

b. Sour

c. Sweet

d. Salty

c. Sweet

? A 78-year old who needs assistance with more demanding tasks but who can independently do all daily activities would be called:

a. Oldest-old

b. Old-old

c. Young-old

c. Middle-old

Middle-old

Which of the following is not an x-ray feature of Paget disease of bone?

a. Squaring of the anterior vertebral body

b. Cortical thickening

c. Enlarged vertebral body

d. Anterior scalloping of the vertebral body

d. Anterior scalloping of the vertebral body

Sarcopenia refers to age-related decrease of________.

a. Bone mass and quality

b. Muscle mass and quality

c. Brain size and function

d. Kidney size and function

b. Muscle mass and quality

Why is prostate specific antigen (PSA) testing not recommended for men over age 70?

a. Expected harms outweigh expected benefits

b. PSA testing is too invasive for older adults

c. Men over age 70 rarely develop prostate cancer

d. Most men over age 70 no longer have a prostate

a. Expected harms outweigh expected benefits

What is one reason age-friendly health systems document conversations about what matters to older adults? Ensuring that care plans______.

a. Can be billed to all major insurance plans

b. Follow national guidelines, regardless of patient preference

c. Prioritize the patient's priorities for goals of care

d. Are standardized across all patients of the same age group

c. Prioritize the patient's priorities for goals of care

Examination of an 86-year old's deep tendon reflexes is unremarkable except for a bilaterally symmetrical decrease of the Achilles' tendon reflex. The decreased Achilles' reflex is most likely due to____.

a. Usual aging

b. Upper motor neuron lesion

c. Peripheral nerve entrapment

d. L5 radiculopathy

a. Usual aging

Which of the following suggests an elder may be at risk for malnutrition? They have___.

a. Advanced culinary skills

b. Persistent loss of appetite

c. Groceries delivered weekly

d. Comfortable, well-fitting dentures

b. Persistent loss of appetite

Increase of the _________ is a usual change in the spine with aging.

a. Cervical lordosis

b. Thoracic kyphosis

c. Lumbar stature

d. Sacral base angle

b. Thoracic kyphosis

Senescence is best defined as:

a. The scientific study of aging and older adults

b. The gradual loss of cellular growth and function over time

c. The average number of years a person is expected to live

d. The ability of cells to divide indefinitely

b. The gradual loss of cellular growth and function over time

With aging the ligamentum flavum tends to hypertrophy making ____ more likely with advanced age.

a. Cord compression

b. Vertebral fracture

c. Disc herniation

d. Sprain injuries

a. Cord compression

Usual aging is most likely to cause changes in which of the following sensory abilities?

a. Perception of sweet taste

b. Joint position sense of the fingers

c. Vibration sense over feet and ankles

d. Light touch on the face

c. Vibration sense over feet and ankles

A 72-year old has a resting respiratory rate of 28 breaths per minute. This finding is consistent with_______.

a. Heart failure

b. Usual aging

c. Bradypnea

d. Hepatic cirrhosis

a. Heart failure

Which of the following is a benign bladder-related change commonly seen in normally-aging adults?

a. Total incontinence

b. Hematuria

c. Urinary retention

d. Nocturia

d. Nocturia

Performing the Timed Get Up and Go test assesses which "M" of age-friendly healthcare?

a. Medication

b. Mobility

c. What Matters

d. Mentation

b. Mobility

Benign senescent forgetfulness typically involves occasional lapses involving ____memory.

a. Long-term

b. Short-term

b. Short-term

For older patients, the initial consideration for any new sign or symptom should be which of the following until proven otherwise? Possible ______.

a. Hypertension

b. Malingering

c. Onset of depression

d. Adverse drug reaction

d. Adverse drug reaction

With usual aging, which lung volume typically remains unchanged?

a. Vital capacity

b. Residual volume

c. Total lung capacity

c. Total lung capacity

Which of the following changes in fasting blood sugar represents usual aging?____mg/dL per decade after age 50.

a. Increases 5

b. Decreases 10

c. Decreases 15

d. Increases 20

a. Increases 5

Which of the following is the most effective strategy to obtain a complete inventory of an older adult's medications and nutraceuticals? Ask them to______.

a. Have their primary medical doctor call in with a list of their prescriptions

b. Call their pharmacist for a printed list of their medications

c. Create an alphabetized list from memory at the time of their examination

d. Bring all their medications, supplements and remedies to their appointment

d. Bring all their medications, supplements and remedies to their appointment

Which of the following is a risk factor for developing incontinence?

a. History of multiple pregnancies

b. Performing Kegel exercises daily

c. Consistent hydration levels

d. Having a stable pelvic floor

a. History of multiple pregnancies

An individual with presbycusis has age-related decrease of________.

a. Olfaction

b. Hearing

c. Vision

d. Gustation

b. Hearing

An 80 year old presents with heel pain that started about six months prior. The pain is a deep ache that is worsened by standing or walking on hard surfaces. There haven't been any recent traumas or increased activity levels. There are no signs of infection, redness, swelling, or abnormalities on xray. Which of the following is the most likely diagnosis?

a. Fat pad syndrome

b. Calcaneal stress fracture

c. Tarsal tunnel syndrome

d. Plantar fasciitis

a. Fat pad syndrome

Which of the following office lighting designs would be beneficial for a patient with age-related vision changes?

a. Provide a bright reading lamp for patients completing paperwork

b. Position extra lights near reflective surfaces in the exam rooms

c. Use dim lighting in the entryway to maximize contrast from the outside

d. Use varied lighting that requires the pupils to frequently accommodate

a. Provide a bright reading lamp for patients completing paperwork

_________ is based on the average number of years of life remaining to a person at a particular age and based on a given set of age-specific death rates.

a. Life expectancy

b. Lifespan

c. Hayflick constant

d. Frailty

a. Life expectancy

Visual inspection of a 78-year old's eyes reveals a blue-gray ring around both irises. Which of the following is the most likely cause?

a. Hypertension

b. Usual aging

c. Wilson disease

d. Cataracts

b. Usual aging

Which symptom is commonly associated with vitreoretinal traction?

a. Gradual peripheral vision loss

b. Severe eye pain and redness

c. Sudden onset of floaters and/or flashes of light

d. Chronic dry eyes and irritation

c. Sudden onset of floaters and/or flashes of light

Constipation is an inevitable part of the usual aging process.

a. True

b. False

b. False

Which of the following changes in blood pressure from supine to standing would confirm orthostatic hypotension as the reason a person feels their vision darkening when they stand up?

a. Increase of 30 mmHg systolic, 20 mmHg diastolic

b. Increase of 15 mmHg systolic, 10 mmHg diastolic

c. Decrease of 20 mmHg systolic, 10 mmHg diastolic

d. Decrease of 10 mmHg systolic, 5 mmHg diastolic

c. Decrease of 20 mmHg systolic, 10 mmHg diastolic

An 89-year old reports an insidious onset of pain, tingling, and numbness down their arm and into their hand. Which of the following is the least likely cause of this patient's symptoms?

a. Acute disc herniation

b. Osteophytes adjacent to the nerve root

c. Adhesions around the nerve root

d. IVF stenosis

a. Acute disc herniation

Which of the following is a normal age-related vision change?

a. Tunnel vision

b. Straight grid lines appearing wavy

c. Difficulty reading small print

d. Developing a central blind spot

c. Difficulty reading small print

All of the following are signs of frailty except?

a. Unintentional weight loss

b. Low activity level

c. Feeling exhausted

d. Firm grip strength

d. Firm grip strength

A 72-year-old patient presents for a routine check-up. BP consistently measures 160/90 mmHg. What is the most accurate classification?

a. Stage 2 hypertension

b. Normal

c. Hypertensive crisis

d. Stage 1 hypertension

a. Stage 2 hypertension

What is a common initial symptom of benign prostatic hypertrophy in older men?

a. Unintentional weight loss

b. Difficulty urinating

c. Severe pelvic pain

d. Blood in urine

b. Difficulty urinating

What is the classic triad of symptoms associated with normal pressure hydrocephalus (NPH)?

a. Nausea, vomiting, abdominal pain

b. Urinary incontinence, gait instability, dementia

c. Chest pain, shortness of breath, fatigue

d. Headache, blurred vision, fever

b. Urinary incontinence, gait instability, dementia

Which is a common early symptom of ovarian cancer?

a. Severe abdominal pain

b. Abdominal bloating

c. Hematemesis

d. Frequent urination

b. Abdominal bloating

What is the most common comorbidity of diffuse idiopathic skeletal hyperostosis (DISH)?

a. Hyperlipidemia

b. Ankylosing spondylitis

c. Diabetes mellitus

d. Hypotension

c. Diabetes mellitus

Amaurosis fugax is caused by a loss of blood flow to what structure of the eye?

a. Lens

b. Retina

c. Conjunctiva

d. Sclera

b. Retina

Which of the following is a common sign of primary hyperparathyroidism?

a. Osteopenia

b. Elevated phosphate levels

c. Hyponatremia

d. Tetany

a. Osteopenia

Which of the following is a primary sign of Parkinson's disease?

a. Weight loss

b. Bradykinesia

c. Intention tremor

d. Tachycardia

b. Bradykinesia

Which is the most effective strategy for reducing the risk of fractures in patients with osteoporosis?

a. Strict bed rest to prevent falls

b. Decrease vitamin D and increase magnesium intake

c. Dietary supplementation with vitamin C

d. Regular weight-bearing and resistance exercises

d. Regular weight-bearing and resistance exercises

What type of vision is affected by macular degeneration?

a. Central

b. Peripheral

c. Left side

d. Right side

a. Central

A 67-year-old with a high red meat intake presents with painful, swollen right big toe. Most likely diagnosis?

a. Turf toe

b. Fat pad syndrome

c. Osteoarthritis

d. Gout

d. Gout

Which test is used to diagnose diabetes mellitus and prediabetes?

a. Creatinine kinase

b. Electrolyte panel

c. Hemoglobin A1c

d. Complete blood count (CBC)

c. Hemoglobin A1c

An 82-year-old with new-onset temporal headaches, jaw claudication, and scalp tenderness. Untreated complication?

a. Cervical radiculopathy

b. Bell's palsy

c. Trigeminal neuralgia

d. Permanent vision loss

d. Permanent vision loss

Which is a primary characteristic of age-related macular degeneration?

a. Increased intraocular pressure

b. Loss of peripheral vision

c. Difficulty seeing in dim light

d. Clouding of the lens

c. Difficulty seeing in dim light

X-rays reveal flowing ossification of the anterior longitudinal ligament across four vertebral bodies & normal disc height. Which lab test?

a. ESR

b. HLA-B27

c. Fasting glucose

d. Serum calcium

c. Fasting glucose

Gout most commonly occurs in what part of the body?

a. PIPs of hands

b. DIPs of feet

c. MCP of 1st digit of a hand

d. MCP of 1st digit of a foot

d. MCP of 1st digit of a foot

Which symptom is commonly associated with vitreoretinal traction?

a. Severe eye pain and redness

b. Chronic dry eyes and irritation

c. Gradual peripheral vision loss

d. Sudden onset of floaters and/or flashes of light

d. Sudden onset of floaters and/or flashes of light

What is the most common clinical presentation of a vertebral compression fracture?

a. Radiculopathy extending to the lower extremities

b. Sudden, severe back pain with kyphotic posture

c. Intermittent, localized back pain relieved by rest

d. Midline thoracic pain worsened by flexion and rotation

b. Sudden, severe back pain with kyphotic posture

Which is a primary risk factor for developing multi-infarct dementia?

a. High-calcium diet

b. Chronic hypertension

c. Long-term NSAID use

d. Low-sodium diet

b. Chronic hypertension

Which condition is associated with kidney stones?

a. Hyperparathyroidism

b. Hyperthyroidism

c. Myxedema

d. Graves disease

a. Hyperparathyroidism

Which of the following is a common clinical feature of Paget's disease?

a. Increased hat size

b. Coast of Maine cafe au lait spots

c. Coast of California cafe au lait spots

d. Decreased hat size

a. Increased hat size

What common form of geriatric vision loss often presents as tunnel vision?

a. Glaucoma

b. Cataracts

c. Temporal arteritis

d. Macular degeneration

a. Glaucoma

Fat pad syndrome in older adults most commonly refers to pain due to thinning of subcutaneous tissue in which location?

a. Wrist

b. Elbow

c. Heel

d. Hip

c. Heel

Which tremor is a characteristic feature of Parkinsons? _________ tremor.

a. Wing-beating

b. Intention

c. Resting

d. Postural

c. Resting

Which of the following signs/symptoms in an elderly patient is most suggestive of colorectal cancer?

a. Epigastric pain that improves with food

b. Chronic diarrhea following antibiotic use

c. Occasional abdominal bloating relieved by belching

d. Iron-deficiency anemia with occult blood in stool

d. Iron-deficiency anemia with occult blood in stool

A patient with a hiatal hernia is most likely to present with which of the following symptoms?

a. Heartburn after meals

b. Pain radiating to the right shoulder

c. Fatty, floating stools

d. Alternating constipation and diarrhea

a. Heartburn after meals

In the geriatric population, there is often ventricular thickening in response to increased peripheral resistance, which leads to _________.

a. Increase stroke volume

b. Decreased stroke volume

c. Decreased heart rate

d. Increased cardiac output

b. Decreased stroke volume

Which of the following clinical presentations is most characteristic of diverticulitis?

a. Epigastric pain relieved by antacids

b. Diffuse abdominal pain worsened by eating fatty foods

c. Right lower quadrant pain with rebound tenderness and nausea

d. Left lower quadrant pain with fever and leukocytosis

d. Left lower quadrant pain with fever and leukocytosis

Older persons take longer to recover from physical and psychological stress.

a. True

b. False

a. True

Older people tend to become more spiritual as they grow older.

a. True

b. False

a. True

Most older people are living in nursing homes.

a. True

b. False

b. False

The modern family no longer takes care of its elderly.

a. True

b. False

b. False

Retirement is often detrimental to health i.e. people frequently seem to become ill or die soon after.

a. True

b. False

b. False

As people live longer, they face fewer acute conditions and more chronic health conditions.

a. True

b. False

a. True

With menopause, _____ hormone production ceases.

a. ovarian

b. parathyroid

c. adrenal

d. thyroid

a. ovarian

Presbyopia refers to age-related decrease of ____ vision.

a. distance

b. near

c. peripheral

d. night

b. near

In the aging cardiovascular system, ____ is a typical change.

a. Increase heart rate variability

b. Decrease maximum heart rate

c. Increased amplitude of peripheral pulses

d. Decreased average peripheral resistance

b. Decrease maximum heart rate

With usual aging, the residual volume in the lung typically _____.

a. Increases

b. Decreases

c. Remains the same

a. Increases

_____ refers to a syndrome characterized by lack of physiologic capacity, even without a diagnosable illness.

a. senescence

b. geriatrics

c. presbyopia

d. frailty

d. frailty

______ is the longest period over which an organisms life may extend based on available biological knowledge.

a. Senescence

b. Life expectancy

c. Hayflick constant

d. Lifespan

d. Lifespan

A 73 yo has lost 16 pounds in the last 6 months without trying. Which of the following should be suspected?

a. Hyperthyroidism

b. Hypothyroidism

c. Usual aging

d. Congestive heart failure

a. Hyperthyroidism

Which of the following is considered a sign of frailty in older adults?

a. Increased appetite

b. Slow walking

c. Increased muscle mass

d. Hyperactivity

b. Slow walking

The Hayflick limit refers to:

a. A finite number of cellular divisions

b. Loss of vibration sensation in the feet

c. Increased fibrosis with age

d. The decline in heart rate variability

a. A finite number of cellular divisions

Which of the following is most associated with conductive hearing loss during Weber testing?

a. Louder sound in the unaffected ear

b. Equal sound in both ears

c. Louder sound in the affected ear

d. Inability to perceive vibration

c. Louder sound in the affected ear

Which letter in the DIAPPERS mnemonic refers to medications causing transient incontinence?

a. D

b. A

c. P

d. R

c. P

Which physical exam finding is most suggestive of COPD or emphysema in an older adult?

a. Pursed-lip breathing

b. Increased chest expansion

c. Bradycardia

d. Increased tactile fremitus

a. Pursed-lip breathing

Which of the following is true regarding older adults and medications?

a. Older adults receive very few prescriptions

b. Medication reactions rarely cause hospitalization

c. Medications are a major modifiable fall risk

d. Drug metabolism improves with age

c. Medications are a major modifiable fall risk

A positive jugular venous pulse elevation in an older adult most strongly suggests:

a. COPD

b. Heart failure

c. Osteoporosis

d. Hyperthyroidism

b. Heart failure

Which of the following is a red flag for possible cancer in an older adult?

a. Improved energy at night

b. Night sweats

c. Mild seasonal allergies

d. Increased appetite

b. Night sweats

Presbycusis most commonly affects the ability to hear:

a. Low-pitched sounds

b. Mid-range tones

c. High-pitched sounds

d. Vibratory sounds

c. High-pitched sounds

Which of the following is part of the Katz/CAT ADL assessment?

a. Managing finances

b. Shopping

c. Bathing

d. Transportation

c. Bathing

Which of the following is considered an IADL?

a. Feeding oneself

b. Toileting

c. Dressing

d. Medication management

d. Medication management

Actinic lentigines are best described as:

a. Malignant skin lesions

b. Brown "liver spots" from sun exposure

c. Fungal skin infections

d. Pressure ulcers

b. Brown "liver spots" from sun exposure

Which age-related nervous system change increases susceptibility to subdural hematoma?

a. Shrinking brain mass

b. Increased dopamine synthesis

c. Enlarged ventricular system

d. Increased neuron production

a. Shrinking brain mass