PowerPoint Questions for Weeks 3 and 4 (EXAM 2) - Computer Skills Course

Patient ER is a 67-year-old female without any complaints. She is a functional patient living in the community with a history of hypertension. Blood work reveals a low-density lipoprotein (LDL) significantly above goal for the second time this year, despite lifestyle modification. Select the most appropriate therapeutic plan at this time.

start simvastatin 10 mg daily

3 multiple choice options

Patient SL is a 68-year-old male you are seeing for follow-up of uncontrolled hypertension. He is currently prescribed amlodipine 10 mg daily, azilsartan (Edarbi) 40 mg daily, metoprolol tartrate 50 mg BID, and hydrochlorothiazide (HCTZ) 25 mg daily, and his blood pressure is consistently above target. Secondary causes of hypertension have been ruled out. You ask him about missing doses, and he tells you that it is difficult to take so many tablets and the brand-name medication is very expensive. Select the best way to improve this patient's adherence.

discontinue azilsartan and HCTZ; initiate losartan/HCTZ 50/25 mg once daily

3 multiple choice options

Which of the following is a potential consequence of persistent pain?

depression

3 multiple choice options

Mr. Peters, a 75-year-old patient, comes to the office with leg pain. He has a 10-year history of diabetes that is managed with glipizide 10 mg by mouth twice per day. He describes his pain as a burning sensation in his feet and ankles that is moderate in intensity and worse at night. His latest A1c was 8. In addition to improving his diabetes control, which of the following would be the most appropriate treatment for his pain?

gabapentin 100 mg twice daily by mouth

3 multiple choice options

Which of the following medications would have the greatest efficacy in treating persistent neuropathic pain?

gabapentin

3 multiple choice options

Ms. Anderson has chronic spinal stenosis rating her pain today as 3/10 with household activities. She is presently taking gabapentin 200 mg by mouth twice per day and sertraline 50 mg by mouth daily. She reports her mood as good and is sleeping well. She is concerned about her ongoing mild pain and fearful about resuming her usual social and volunteer activities. Which of the following is most likely to result in the patient returning to her prior level of function?

cognitive behavioral therapy

3 multiple choice options

An 83-year-old woman visits your office with complaints of decreased appetite and weight loss. Which of the following is not responsible for reduced calorie intake in older adults?

an increase in senses such as smell and taste that make food more palatable

3 multiple choice options

Your 86-year-old nursing home patient can no longer meet her nutritional needs orally and is losing weight. Your first consideration in addressing this situation is to

check the chart for an advance directive

3 multiple choice options

Mr. Lee is an 80-year-old man who lives alone and comes to the office for a routine visit. He lost 10 lbs in the last 3 months and complains of fatigue, poor appetite, and trouble sleeping. Which of the following is least useful during his initial assessment?

vaccination history

3 multiple choice options

Mrs. Miller is a 78-year-old female admitted to the hospital with pneumonia. She is on oxygen and is fatigued. The nurses notice her coughing when she drinks regular liquids. She states this happens at home as well. Her appetite has been poor in the hospital, and she is only eating 50% of her meals. What is your first nutrition intervention?

consult speech therapy for a swallowing evaluation

3 multiple choice options

Which one of the following statements about oral-systemic linkages is false?

there is evidence that periodontal disease is a causative factor for atherosclerotic disease

3 multiple choice options

Dry mouth may cause which one of the following problems in older adults?

all of the above

3 multiple choice options

Benefits of oral disease screening of older adults with chronic systemic diseases within the medical office include all except

intensive management of diabetes and its complications in older adults is not likely to provide benefit

3 multiple choice options

A walking speed that may be predictive of poor functional outcome and reduced life expectancy is

0.6-0.8 meters per second

2 multiple choice options

Mr. Jones, a 67-year-old male, arrives at your clinic complaining of difficulty walking. He reports no pain in the hip. Among other things, your clinical examination reveals that he has marked weakness of the right hip abductors. The most likely gait pattern he exhibits is

trendelenburg gait

2 multiple choice options

Of the following, which is the most predictive risk factor for falls in older adults?

muscle weakness

3 multiple choice options

Which type of exercise has been proven to reduce the number of falls by patients?

tai chi

3 multiple choice options

Important causes of impaired gait include all of the following except

anemia

3 multiple choice options

Which class of medications is least likely to contribute to fall risk?

anti-platelet agents

3 multiple choice options

Which test/examination is typically most helpful as part of a fall workup?

orthostatic vitals

3 multiple choice options

Which of the following types of dizziness is most commonly reported by older persons?

combination of two or more types

3 multiple choice options

You are asked to evaluate an 80-year-old nursing home resident with past medical history of Alzheimer's disease, hypertension, and reflux esophagitis, who complains of feeling dizzy, a sensation of being about to pass out on the dining table after eating his breakfast. He had similar episodes in the past after finishing his meals. He denies any chest pain or shortness of breath. On examination, he is alert, awake, and oriented to person and place. Vital signs show heart rate of 74 bpm and blood pressure of 110/70. His vital signs at 7 am showed a heart rate of 70 bpm and blood pressure 130/80. Other system examination was unremarkable. No recent medication changes were made. What is the most likely diagnosis?

postprandial hypotension

3 multiple choice options

A 71-year-old woman with hypertension, diabetes, and ischemic cardiomyopathy visits your office after a witnessed episode of syncope at a church gathering. She does not remember the event, but her daughter describes her suddenly appearing pale while sitting and then slumping over and hitting her head on the side of a table. After about 30 seconds, she came to on her own. She has a normal physical exam except for an abrasion on her forehead and her only ECG abnormalities are the changes from her previous MI. What type of syncope is most likely in your differential diagnosis?

cardiac

3 multiple choice options

A 67-year-old man with no significant medical problems passes out at a cookout soon after standing up to go to the bathroom. He had recently finished his barbecue dinner and admits to having consumed three beers. He denies any previous syncopal episodes. His complete physical exam reveals a very healthy-appearing man with no abnormal findings. His ECG is normal. What should you do?

reassure him and follow up with him in clinic again later in the week

3 multiple choice options

A 75-year-old woman visits your office with concerns that she may have to stop driving. You discover that she has difficult seeing on bright, sunny days and especially at night with oncoming automobile headlights. You suggest that she see her eye care provider for further evaluation because the most likely source of her visual difficulty is

a cataract

3 multiple choice options

You are on your porch when you hear your older neighbor who is out gardening yell for help. She says that she splashed fertilizer spray into her eyes. What do you do?

use the garden hose and run water into her eyes

3 multiple choice options

As the medical director at the local nursing home, you are seeing an 84-year-old female nursing home resident for the first time. She has a past medical history of vascular dementia and hypertension. The patient needs assistance with her activities of daily living and instrumental ADLs, but she is able to communicate her needs. The nurse asks you to reorder her antibiotic eye drops that her previous provider used to treat her recurrent episodes of conjunctivitis because the patient's eyes seem to be getting red again. When you see the patient, she denies any pain or blurriness of her vision. Her visual acuity is 20/20, and she has bilateral injection of her sclera without any ciliary flush noted. Her bilateral lower eyelids are everted outward (ectropion), and she has bilateral tearing. Her pupils are equal round and reactive to light and accommodation, her extraocular muscles are intact. What should you recommend?

lubricating eye drops

3 multiple choice options