Quiz Geriatrics

Geriatrics 14Mar2009

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Geriatrics #1 – Aging Impacts on Health Care (Demographics)

1) In 1900, the elderly population (>65) was approximately 1 in 24. Approximately what

number of the U.S. population (2005) is elderly now?

a) 1 in 2

b) 1 in 4

c) 1 in 8

d) 1 in 12

e) 1 in 24

2) The elderly population (>65) is expected to increase by what percentage by the year

2030, when compared to the 35-million in 2000?

a) 5%

b) 15%

c) 24%

d) 36%

e) 44%

3) The population of adults older than 85 is expected to increase by what percentage by

the year 2030, when compared to 2000?

a) 5%

b) 15%

c) 24%

d) 36%

e) 44%

4) Which of the following represents the largest percentage?

a) Men living with spouse

b) Men living alone

c) Women living with spouse

d) Women living alone

e) Other

5) Which of the following is NOT currently a state with a significant elderly population?

a) Pennsylvania

b) California

c) New York

d) Florida

e) Minnesota

6) For the average 75-year-old, approximately what percentage has at least one

disability?

a) 25%

b) 20%

c) 15%

d) 10%

e) 5%

7) According to JAMA in December 2001, what percentage of elderly patients is

receiving inappropriate prescriptions?

a) 5%

b) 10%

c) 15%



d) 20%

e) 25%

8) The average 75-year-old has at least how many chronic conditions?

a) 1

b) 2

c) 3

d) 4

e) 5

9) Which of the following is true of the elderly?

a) Make up 13% of the population

b) Make up 36% of hospital stays

c) Make up 49% of all days of hospital care

d) Make up 50% of all physician hours

e) All of the above

10) What percentage of all hospital admissions are caused by inappropriate drug

prescribing?

a) 3%

b) 7%

c) 13%

d) 17%

e) 23%

11) Which of the following would be paid by Part B of Medicare?

a) Hospitals

b) Nursing homes

c) Ambulances

d) Home-care agencies

e) Hospice programs

12) Which of the following is currently the most common scenario for patients 65 or

older who are eligible for Part B?

a) If entitled to Part A (e.g. paid taxes for 10 years), Part B is free

b) Part B has a monthly cost and is usually paid by personal check

c) Part B has a monthly cost and is usually paid by credit card

d) Part B has a monthly cost and is usually deducted from a monthly pay check

e) Part B has a monthly cost and is usually deducted from a social security check

13) An 86-year-old white female presents to the ER with chief complaint of shortness of

breath. The patient is admitted to the hospital medical floor for bilateral pneumonia.

During the stay, it was noted that the patient has been falling at home. The patient

received IV antibiotics for 48-hours and was switched to PO antibiotics on the third day

of admission. The patient was seen by her primary care physician during her stay. The

primary care physician consulted a geriatric service for rehabilitation evaluation and was

recommended to start in-patient physical therapy. It was also recommended that the

patient be transferred to a Transitional Care Unit (Short-Term Skilled Nursing Facility)

for 7-10 days of rehabilitation for ambulatory dysfunction and strengthening. The patient

has Medicare Part A and Part B with Highmark Blue Cross insurance for secondary. Who

pays for the acute hospital stay?

a) Medicare Part A



b) Medicare Part B

c) Highmark Blue Cross

d) Medicare Part B and Highmark Blue Cross

e) Patient (out of pocket)

14) In the above 86-year-old patient, who pays for the majority of the physician’s fees?

a) Medicare Part A

b) Medicare Part B




15) In the above 86-year-old patient, who pays for in-patient physical therapy?

a) Medicare Part A

b) Medicare Part B




16) In the above 86-year-old patient, who pays for the short-term rehabilitation stay?

a) Medicare Part A

b) Medicare Part B




17) What chronic condition has the highest prevalence among persons aged 65 and over?

a) Arthritic symptoms

b) Heart disease

c) Hypertension

d) Chronic obstructive pulmonary disease

e) Cancer

18) Who has the lowest life expectance to age 65 in the United states?

a) White males

b) White females

c) Black males

d) Black females

19) What is the most common cause of death in patients aged 65 or older?

a) Diseases of the heart

b) Malignant neoplasms

c) Cerebrovascular disease

d) Chronic lower respiratory disease

e) Influenza and pneumonia

20) Which of the following insurance plans covers all traditional Medicare benefits plus

additional services but restricts the patient to a single network?

a) Fee-For-Service Medicare

b) Medicaid

c) Medigap insurance

d) Medicare Advantage plan



Geriatrics #2 – Cellular Aging & Tissue (Biology)

1) Earl Stadtman of the National Institute of Health (NIH) said which of the following is

the cause of aging as a disease?

a) Atrophy of cells

b) Free radical damage to cells

c) Programmed cell apoptosis

d) Spontaneous loss of cellular function

e) Decreased cell production due to enzymes

2) Which of the following is associated with primary aging (senescence)?

a) Heart disease

b) Diabetes

c) Hypertension

d) Osteoporosis

e) Presbycusis

3) Which of the following refers to aging where deleterious effects are minimized?

a) Normal aging

b) Senescence

c) Healthy aging

d) Disease

4) Which of the following is NOT part of normal aging?

a) Glucose intolerance

b) Memory impairment

c) Chronic alcohol abuse

d) Vision impairment

e) Muscle strength loss

5) Which of the following involves the transfer of electrons and can lead to altered gene

expression, altered enzyme activity, and altered signaling pathways?

a) Redox

b) Oxidation

c) Glycation

d) Cross-linking

6) Which of the following is a common area for cells to be lost due to apoptosis and

necrosis with aging, as this area has many non-dividing cells?

a) Bone

b) Liver

c) Spleen

d) Brain

e) GI tract

7) Which of the following describes the Hayflick phenomenon (e.g. in fibroblasts)?

a) Loss of chromosome ends over time

b) Loss of cell division due to telomere loss

c) A limited doubling capacity of cells

d) A decrease in free radical damage over time

e) p53 recognition of cell damage

8) What is the common vertebrate telomere sequence added to the 3’ end of DNA by

active telomerase?



a) TTAGGG

b) AATCCC

c) GGGATT

d) CCCTAA

9) What is the hallmark of cell necrosis?

a) Cell DNA fragmentation

b) Cell atrophy

c) Decreased cell replication

d) Storage of lipids

e) Loss of ion gradients

10) What is the hallmark of cell apoptosis, such as in Alzheimer disease?

a) Cell DNA fragmentation

b) Cell atrophy

c) Decreased cell replication

d) Storage of lipids

e) Loss of ion gradients

Geriatrics #3 – Theories on Aging (Immunology)

1) Which of the following is an endogenous form of DNA damage?

a) Oxidative deamination

b) Ultraviolet radiation

c) Thermal disruption

d) Plant toxins

e) Mutagenic chemicals

2) Non-enzymatic attachment of which of the following to proteins increases with age,

which is probably responsible for many disorders such as cataracts?

a) Sodium

b) Iron

c) Glucose

d) Zinc

e) Lipids

3) Which of the following has been shown to slow the degenerative changes of aging in

renal vessels and the heart?

a) Ubiquinone

b) Lipofuscin

c) Gingko biloba

d) Aminoguanidine

e) Glycation

4) Darkened skin spots that develop with age, “aging spots,” are due to free radicals

attacking structures of the cell membrane, creating what metabolic waste product?

a) Ubiquinone

b) Lipofuscin

c) Gingko biloba

d) Aminoguanidine

e) Glucose



5) Which of the following free radicals is converted to water and oxygen via glutathione

peroxidase?

a) Superoxide ion

b) Hydrogen radial

c) Singlet oxygen

d) Hydrogen peroxide

e) Hypochlorous acid

6) Which of the following has NOT been shown to prevent the harmful effects of

oxidation?

a) Selenium

b) Beta carotene

c) Vitamin C

d) Vitamin D

e) Vitamin E

7) Advanced glycation end (AGE) products are engulfed by macrophages, enter the blood

stream, and are eventually filtered out by what organ?

a) Spleen

b) Liver

c) Kidney

d) Biliary tract

e) They are not filtered

8) Which of the following symptoms of progeroid (e.g. Hutchinson-Gilford Syndrome

mutation of Lamin A gene) is NOT similar to normal changes observed in the elderly?

a) Decreased gonadal activity

b) Dry, wrinkled skin

c) Osteoporosis

d) Baldness

9) What gene is affected in autosomal recessive Werner syndrome?

a) Lamin A

b) DNA helicase

c) Topoisomerase

d) Dystrophin

e) Fibrillin

10) Which of the following is also known as neonatal progeroid syndrome?

a) Hutchinson-Gilford syndrome

b) Werner syndrome

c) Wiedemann-Rautenstrauch syndrome

d) Down syndrome

11) Which of the following shares pathology with Alzheimer patients and could have

CNS that stains apple-green with Congo red stain?

a) Hutchinson-Gilford syndrome

b) Werner syndrome

c) Wiedemann-Rautenstrauch syndrome

d) Down syndrome

12) Which of the following are most affected by thymic involution due to aging?

a) T-cells



b) B-cells

c) NK cells

d) RBCs

e) Platelets

13) Which of the following is true in the elderly when comparing the ratio of naïve T-

cells to memory T-cells?

a) The ratio is high

b) The ratio is about 1

c) The ratio is low

14) Which of the following is true of CD markers on aged T-cells?

a) CD28 and CD69 markers are high

b) CD28 marker is high and CD69 marker is low

c) CD28 marker is low and CD69 marker is high

d) CD28 and CD69 markers are low

15) A decrease in which of the following in T-cells with age effectively halts signal

transduction by failing to stimulate enzymes (e.g. protein kinase C) and can also impair

production of cytokines?

a) Sodium

b) Potassium

c) Glucose

d) Zinc

e) Calcium

16) What immunoglobulin is the first class of antibodies to respond to infection and

decreases in production with aging?

a) IgA

b) IgD

c) IgE

d) IgG

e) IgM

17) Long-term deficiency of which of the following in the elderly causes a decrease in

cytokine production and impaired regulation of helper T-cell activity?

a) Sodium

b) Potassium

c) Glucose

d) Zinc

e) Calcium

18) What vitamin has been implicated as a possible treatment for Alzheimer disease?

a) Vitamin A

b) Vitamin B9

c) Vitamin B12

d) Vitamin D

e) Vitamin E

Geriatrics #4 – Physiology of Aging

1) Which of the following is true of basal metabolic rate (BMR) and growth hormone

with age, which can account for 80% of the change in cardiac output (CO)?



a) BMR increases with age and growth hormone decreases BMR

b) BMR increases with age and growth hormone increases BMR

c) BMR decreases with age and growth hormone decreases BMR

d) BMR decreases with age and growth hormone increases BMR

e) BMR does not change with age

2) Which of the following is NOT seen with aging?

a) Decreased thermogenesis

b) Reduced cold-induced vasoconstriction

c) Decreased fat mass and increased protein mass

d) Reduced sweating

e) Decreased ability to radiate heat

3) What is the approximate occurrence of atherosclerosis in those who live to their 6th or

7th decade of life in the United States, leading to increased systolic pressure with a

normal diastolic pressure?

a) 50%

b) 66%

c) 75%

d) 90%

e) 100%

4) Which of the following has been shown to be the most effective in treating isolated

systolic hypertension (ISH)? ISMN = isosorbide mononitrate

a) Ramipril + ISMN

b) Ramipril + felodipine

c) ISMN + metoprolol

d) ISMN + felodipine

e) ISMN alone

5) Carotid atherosclerosis can lead to cerebral insufficiency, contributing to dementia.

Treatment includes diet, exercise, anti-platelets, and drugs such as pentoxifylline

(Trental), which has what mechanism of action?

a) PDE1 selective inhibitor

b) PDE2 selective inhibitor

c) PDE3 selective inhibitor

d) PDE4 selective inhibitor

e) PDE5 selective inhibitor

6) Which of the following respiratory changes is increased with aging?

a) Lung compliance

b) Lung diffusion area

c) Response to hypoxia

d) Mucocilliary clearance

e) Immunity

7) After age 20, vital capacity declines by how much per decade?

a) 50%

b) 20-30%

c) 4mmHg

d) 200mL

e) 250mL



8) Which of the following is NOT true of the liver in the elderly?

a) Decreased portal blood flow

b) Decreased albumin synthesis

c) Increased drug clearance

d) Reduced secretion of iron and B12

e) Reduced vitamin absorption

9) By age 80, cell numbers have been reduced in the central nervous system by what

percentage?

a) 10%

b) 20%

c) 30%

d) 40%

e) 50%

10) Which of the following is increased in the peripheral nervous system with aging?

a) Sensory and motor

b) Conduction velocities

c) Synaptic connections

d) Skeletal muscle cells

e) Circulating catecholamines

11) Which of the following is increased in the renal system with aging?

a) Glomerular filtration rate (changes 6-8%/decade)

b) ADH and thirst response

c) Ability to regulate salts and volume

d) Glucose content in urine

e) Regulation of acid-base balance

Geriatrics #5 – Atypical Disease Presentation

1) As few as 1/3rd of the elderly actually report symptoms. What is the most common

pathway for most clinical problems in older persons, especially in those over age 75?

a) Atypical symptoms

b) Loss of function

c) Using more than 3 medications

d) Modified cultural beliefs

e) Good self-perception of health

2) An elderly man presents with difficulty driving at night, especially in dim areas. His

friends told him to “light up his home” since his “night vision was going.” The bright

lights he bought made it difficult to see as well. He says daylight is not a problem. Which

of the following is NOT true for this patient?

a) The problem is due to light adaptation changes with age

b) Aged pupils get more rigid and adapt poorly to light

c) In the hospital, this patient should avoid dim/bright lights and be monitored for

falls risk due to decreased vision

d) Cataract removal in this patient has more risks than benefits

e) Lens changes in the older adult make them more sensitive to glare

3) What is the first ophthalmologic manifestation of normal aging?

a) Presbyopia



b) Hypermetropia

c) Astigmatism

d) Keratoconus

e) Glaucoma

4) Hearing impairment with the older adult has an insidious onset and become clinically

evident in the 5th and 6th decades of life. Auditory nerve deterioration leads to

presbycusis. Why type of hearing impairment is most common?

a) Asymmetric (unilateral) high frequency loss

b) Asymmetric (unilateral) low frequency loss

c) Symmetric (bilateral) high frequency loss

d) Symmetric (bilateral) low frequency loss

5) Which of the following is true?

a) Infection is an uncommon sequela of xerodermia

b) Lac-Hydrin cream is an option for xerodermia

c) Fever is more common in infection of the elderly

d) Peak fever temperature is higher in the elderly

e) Thirst drive is increased in the elderly

6) What is the formula for pO2 changes with advancing age?

a) 100 – (age/2)

b) 100 + (age/2)

c) 100 – (age/3)

d) 100 + (age/3)

7) What percentage of elderly patients have olfactory impairment, according to a 2002

JAMA study?

a) 5%

b) 10%

c) 15%

d) 20%

e) 25%

8) Over 60% of people over 80 surveyed had olfactory impairment. Which of the

following is NOT a risk factor?

a) Age

b) Smoking

c) Stroke

d) Female gender

e) Medications

9) Which of the following is a more ominous finding suggestive of Alzheimer dementia

instead of delirium?

a) Misplacing one’s car keys

b) Forgetting names of casual acquaintances

c) Forgetting one’s address

d) Forgetting items at the grocery store

e) Forgetting appointments

10) As a member in good standing of the American Geriatrics Society, you are asked to

help design the normal ranges table that is attached to the end of the test booklet for the



American Osteopathic Boards of Internal Medicine. Which of the following tests would

show changes in the geriatric population?

a) Ejection fraction on echocardiogram

b) Hemoglobin level

c) Thyroid stimulating hormone

d) Prostate-specific antigen

11) What stage of sleep is increased in the elderly?

a) Stage 1

b) Stage 2

c) Stage 3

d) Stage 4

e) Early-onset REM

12) Which of the following changes seen in the elderly is important as it increases the

risk of falling?

a) Two-point discrimination

b) Proprioception

c) Stereognosis

d) Vibratory sense

e) Graphesthesia

13) An elderly patient with diabetes presents with increased somnolence. Blood glucose

is 300mg/dL. No fever or suprapubic pain is present. Patient denies urinary frequency.

Urine analysis reveals cloudy, foul-smelling urine. Urine dipstick shows nitrates,

leukocyte esterase, and multiple white blood cells. Skin is cool to the touch with mild

tending. Which of the following is most likely?

a) Septicemia

b) Pyelonephritis

c) Urosepsis

Geriatrics #6 – Frailty

1) Which of the following is NOT associated with the definition of frailty (e.g.

homeostenosis)?

a) Co-morbid disease

b) Dependency

c) Disability

d) Age < 80

2) Which of the following, along with the sympathetic nervous system (e.g.

norepinephrine), increases with age?

a) Growth hormone & IGF-1

b) DHEA-S

c) Cortisol

d) Estrogen

e) Testosterone

3) Elevated levels of C-reactive protein and IL-6 in the elderly may have which of the

following effects?

a) Decreased iron metabolism

b) Loss of muscle mass



c) Decreased erythropoietin production

d) Osteoporosis

e) All of the above

4) Studies have shown that frailty is synonymous with disability and comorbidity.

a) True

b) False

5) Which of the following is NOT a phenotype associated with frailty?

a) Weight loss

b) Thirst

c) Exhaustion

d) Inactivity

e) Walk time

Geriatrics #7 – Fall Assessment & Gait Abnormalities

1) In patients over the age of 65, what percentage of falls results in injury?

a) 10%

b) 20%

c) 30%

d) 40%

e) 50%

2) Which of the following is NOT a risk factor for falls?

a) Slow “Get-Up-and-Go” test

b) Male gender

c) Sensory impairment

d) Psychotropic medications

e) Osteoarthritis

3) Geriatric patients should be screened for falls by asking if there have been any falls

within what time frame?

a) Last month

b) Last 3-months

c) Last 6-months

d) Last year

e) Last 3-years

4) Which of the following is true?

a) Physical therapy in long term care has been shown to prevent falls

b) Individual patient modification has been shown to prevent falls

c) Falls are three times more common in ambulatory care than long term care

d) Both A & B

e) None of the above

5) Which of the following can decrease fall risk?

a) Seated exercise programs

b) Standing exercise programs

c) Short-term exercise programs

d) Aerobic exercises only

6) Which of the following, along with the femur, is considered a fragility fracture?

a) Vertebra



b) Humerus

c) Cranium

d) Wrist

e) Ankle

7) A fracture obtained from a fall from the standing position is diagnostic for

osteoporosis, even without lab testing.

a) True

b) False

8) An elderly patient presents with anticholinergic symptoms and extrapyramidal signs.

The patient also complains of oscillopsia (sensation of environment moving while

walking or turning head). It is determined that the cause is one of their medications.

Which of the following is most likely the cause?

a) Benzodiazepines (e.g. diazepam)

b) Zolpidem (Ambien)

c) Neuroleptic (e.g. haloperidol)

d) Digoxin (Lanoxin)

e) Diphenhydramine (Benadryl)

9) An elderly patient presents with complains of feeling like they are going to faint

(presyncope). The patient states the feeling almost always occurs when they are trying to

reach for items on a high shelf in the kitchen. Physical exam reveals no nystagmus with

head thrust, no symptoms with head turning, but asymmetric blood pressure in the arms.

Which of the following is most likely?

a) Orthostatic hypotension

b) Postprandial hypotension

c) Carotid sinus syndrome

d) Subclavian steal syndrome

e) Congenital coarctation of the aorta

10) Which of the following is most associated with a positive sternal nudge test and a

positive glabella tap test?

a) Huntington disease

b) Alzheimer disease

c) Parkinson disease

d) Sydenham chorea

e) Wernicke-korsakoff syndrome

11) What is a normal timed Get Up and Go test?

a) Less than 5 seconds

b) Less than 10 seconds

c) Less than 15 seconds

d) Less than 20 seconds

e) Less than 30 seconds

12) Which of the following has been shown to increase falls risk?

a) 25-OH-Vitamin D levels < 32ng/mL

b) Hypothyroidism

c) Cervical spinal stenosis

d) Proprioception loss

e) All of the above



Geriatrics #8 – Pharmacology of Aging

1) Which of the following increases with age?

a) Absorptive surfaces

b) Splanchnic flow

c) Gastric pH

d) Total body water

e) Serum albumin

2) Which of the following is a result of increased fat mass and decreased hepatic mass

and hepatic blood flow with age?

a) Increased half-life and increased first-pass clearance (phase I metabolism)

b) Increased half-life and decreased first-pass clearance (phase I metabolism)

c) Decreased half-life and increased first-pass clearance (phase I metabolism)

d) Decreased half-life and decreased first-pass clearance (phase I metabolism)

3) What pharmacodynamic changes are seen in the elderly with regard to

benzodiazepines and beta-blockers?

a) Increased response to benzodiazepines and beta-blockers

b) Decreased response to benzodiazepines and beta-blockers

c) Increased response to benzodiazepines, decreased to beta-blockers

d) Increased response to benzodiazepines, increased to beta-blockers

4) Which of the following has been shown to increase drug adherence in the elderly?

a) Complex drug schedules

b) Safety closure drug containers

c) Increased number of medications

d) Long period of drug use

e) Physician explanation

5) An elderly patient presents to the primary care clinic with complaints of constipation,

urinary retention, and xerostomia (dry mouth). Which of the following types of drugs

might be to blame?

a) Antiarrhythmics

b) Anticholinergics

c) Antipsychotics

d) Diuretics

e) Sedative-hypnotics

6) Which of the following types of drugs is associated with renal failure and hearing loss

in the elderly?

a) Aminoglycosides

b) Antiarrhythmics

c) Anticholinergics

d) Antipsychotics

e) Diuretics

f) Narcotics

g) Sedative-hypnotics

7) Which NSAID has the most CNS adverse effects in the elderly, per the Beers List?

a) Acetylsalicylic acid

b) Indomethacin



c) Ibuprofen

d) Ketorlac

e) Naproxen

8) Which of the following anti-emetics is the LEAST effective in the elderly?

a) Ondansetron

b) Diphenhydramine

c) Midazolam

d) Trimethobenzamide

e) Granisetron

9) Which of the following tricyclic antidepressants is highly sedative and anticholinergic

in the elderly and therefore is not recommended as a first line agent?

a) Iprindole

b) Opipramol

c) Amoxapine

d) Trimipramine

e) Amitriptyline

10) Which of the following is associated with confusion and prolonged sedation in the

elderly due to its central antihistamine action?

a) Ondansetron

b) Diphenhydramine

c) Midazolam

d) Trimethobenzamide

e) Granisetron

11) Methyldopa combination and cause which of the following effects?

a) Bradycardia

b) Tachycardia

c) Hypotension

d) Hypertension

e) Improved mood

12) Why should barbiturates (except phenobarbital) be avoided in the elderly?

a) Increase fall risk

b) Highly addictive

c) Cause confusion

d) Cause sedation

e) Aspiration risk

13) Long acting NSAIDs (e.g. naproxen, piroxicam) can have all of the following affects

on the elderly EXCEPT:

a) Renal failure

b) GI bleeding

c) Heart failure

d) Hypotension

14) What common SSRI antidepressant should be avoided in the elderly due to CNS

stimulation, sleep disturbances, and increased agitation?

a) Sertraline

b) Paroxetine

c) Fluoxetine



d) Citalopram

e) Escitalopram

15) Nitrofurantoin, a drug used commonly for urinary tract infections, should be avoided

in the elderly due to an increase risk of damage to which of the following?

a) Brain

b) Liver

c) Spleen

d) Kidney

e) GI tract

16) Mineral oil should be avoided in the elderly for what reason?

a) Increase fall risk

b) Highly addictive

c) Cause confusion

d) Cause sedation

e) Aspiration risk

Geriatrics #9 – Polypharmacy

1) Which of the following is true for the elderly population?

a) Have an increase in total body water

b) Have a decrease in body fat

c) Have a reduction in loading dose for water soluble drugs

d) Have a decreased duration of effect for fat soluble drugs

e) Have an increase in lean body mass

2) An elderly woman undergoes a bronchoscopy requiring 50mcg of fentanyl. Six months

later, the same drug dose causes apnea. What is the most likely cause?

a) Altered concentrations of proteins

b) Altered body fat

c) Altered lean body mass

d) Altered glomerular filtration rate

e) Altered liver function

3) An elderly man has recurrent episodes of ventricular fibrillation and is started in IV

lidocaine. Twelve hours later, the man suffers a heart attack and becomes slightly

hypotensive. Over the next 24-hours, the man becomes increasingly confused. What is

the most likely cause?


b) Altered body fat




4) An elderly patient with coronary artery disease (CAD) and diabetes mellitus (DM) has

been taking insulin, atenolol, aspirin, and simvastatin for over 10-years. Recently, her

resting pulse has dropped from 64 to 48. What is the most likely cause?


b) Altered body fat






5) To estimate creatinine clearance in the elderly, the following equation is used: CrCl =

((140 - age) * weight) / (72 * Cr). What should the clearance rate be multiplied by if the

patient is female?

a) 70%

b) 75%

c) 85%

d) 90%

e) 95%

6) An elderly woman with essential hypertension is given verapamil. On a follow-up

visit, she complains of lightheadedness when going from a supine to standing position.

Which of the following etiologies is most likely?

a) Dehydration

b) Osteoporosis

c) Increased salt retention

d) Decreased baroreceptor reflex

e) Increased norepinephrine stores

7) An elderly woman presents with a history of hypertension, diabetic neuropathy, and

mild Parkinson disease. Her symptoms are well controlled with hydrochlorothiazide,

carbidopa/levodopa, nortryptiline, enalapril, and insulin. She complains of severe

xerostomia. What is a likely sequela for this patient’s xerostomia?

a) Tongue atrophy

b) Dental caries

c) Increased taste sensation

d) Chipped teeth

e) Increased GI motility

8) Which of the following is NOT a component of proper drug prescription etiquette for

the elderly?

a) Start low and go slow

b) Ask about drug allergies

c) Switch drugs prior to reaching maximal dosages

d) Ask about alcohol intake

e) Review current prescriptions and non-prescription drugs

9) An elderly patient with osteoporosis presents with a suspected urinary tract infection

(UTI). She is currently taking alendronate, vitamin D, and calcium. Which of the

following antibiotics may be chelated, and thus rendered less effective, by the drugs she

is currently taking, especially calcium?

a) Nitrofurantoin

b) TMP-SMX

c) Ciprofloxacin

d) Amoxicillin

e) Erythromycin

10) Phenytoin can precipitate in which of the following IV solutions?

a) Normal saline

b) D5W dextrose

c) Lactated Ringer



11) Amphotericin precipitates in which of the following solutions, and can erode the

bladder wall if used for bladder washes?

a) Normal saline

b) D5W dextrose

c) Lactated Ringer

12) Which of the following drugs used to treat a UTI has drug-drug interations via P450

mechanism (2C9) with warfarin?

a) Nitrofurantoin

b) TMP-SMX

c) Ciprofloxacin

d) Amoxicillin

e) Erythromycin

13) Which of the following drugs is a prodrug that requires P450 2D6, which can be

inhibited by the use of fluoxetine?

a) Acetaminophen

b) Morphine

c) Naproxen

d) Fentanyl

e) Codeine

14) What side-effect is seen in the elderly who take tricyclics, alpha-agonists, or

anticholinergic medications?

a) Delirium

b) Postural hypotension

c) Diarrhea

d) Urinary retention

e) Tachycardia

15) Which of the following drugs can exacerbate congestive heart failure (CHF)

symptoms in the elderly?

a) Diuretics

b) Anticholinergics

c) Antihistamines

d) Antibiotics

e) NSAIDs

16) Which of the following drugs is considered completely safe for the elderly?

a) Long acting benzodiazepines (e.g. diazepam (Valium))

b) Propoxyphene (Darvon)

c) Merperidine (Demerol)

d) Anticholinergics (e.g. Benadryl, Levsin)

e) Amitryptyline (Elavil)

f) Indomethacin (Indocin)

g) Muscle relaxants (e.g. Soma, Flexeril)

h) None of the above

17) Which of the following improves drug adherence in the elderly?

a) Belief that the drug will work

b) Increased number of drugs

c) Long duration of therapy



d) Complex drug scheduling

e) Child safety bottles

Geriatrics #10 & 11 – Dementia & Delirium

1) Which of the following is consistent with the DSM-IV definition of dementia (not

delirium)?

a) Symptoms fluctuate over the day

b) Disturbance of consciousness

c) Interferes with occupational or social functioning

d) Develops over a short period of time

2) What is the approximate one-year mortality rate in patients with dementia?

a) 3%

b) 5%

c) 15%

d) 25%

e) 40%

3) Which of the following describes the Confusion Assessment Method (CAM)?

a) Acute onset AND inattention AND disorganized thinking AND altered LOC

b) Acute onset AND inattention AND disorganized thinking OR altered LOC

c) Acute onset AND inattention OR disorganized thinking AND altered LOC

d) Acute onset OR inattention AND disorganized thinking AND altered LOC

e) Acute onset OR inattention OR disorganized thinking OR altered LOC

4) What is the strongest risk factor for delirium?

a) Dementia

b) Multiple medications

c) Hypertension

d) Diabetes mellitus

e) Frailty

5) What is the most common cause of dementia?

a) Lewy body dementia

b) Frontotemporal dementia

c) Vascular dementia

d) Alzheimer disease

e) Toxic-metabolic disorders

6) The “A” Test is performed by reading a list of letters, up to 60, with the letter “A”

occurring more frequently and in the same tone. The patient is asked to indicate each time

they hear an “A.” Errors are counted as omission or commission. How many errors does

it take for the test to be considered abnormal (fail)?

a) >1

b) >2

c) >3

d) >4

e) >5

7) A patient presents with behavioral deterioration in the evening hours (“sun-downing”).

Which of the following drugs might be helpful for this patient?

a) Trazodone



b) Percocet

c) Diazepam

d) Propoxyphene

e) Amitryptyline

8) To prevent dehydration in an elderly patient, what should their BUN:Creatinine ratio

be maintained at?

a) <5

b) <7

c) 10

d) >13

e) >17

9) An elderly hospitalized patient has “dangerous” agitation. They are unwilling to take

oral medication. Which of the following is a safe medication to help reduce their

agitation?

a) Risperidone

b) Phenytoin

c) Diazepam

d) Haldol

e) Trazodone

10) In the six-item screener, three items are used as recall (e.g. apple, penny, table) and

three items are for temporal orientation (e.g day of week, month, year). An abnormal test

occurs if how many are missed?

a) 1 or more

b) 2 or more

c) 3 or more

d) 4 or more

e) 5 or more

11) Which of the following patients would NOT have dementia per the MINI-COG test,

which has been shown to outperform the mini mental status examination (MMSE)?

a) A score of 0 on 3-item recall with normal clock-draw test (CDT)

b) A score of 1 on 3-item recall with abnormal clock-draw test (CDT)

c) A score of 1 on 3-item recall with normal clock-draw test (CDT)

d) A score of 2 on 3-item recall with abnormal clock-draw test (CDT)

e) A score of 0 on 3-item recall with abnormal clock-draw test (CDT)

12) CLOX, an executive drawing task, involves having a patient draw a clock with 1:45

on the face and then copying a clock drawn by the evaluator. This test is used to

discriminate cerebral vasculopathy (CVD) from which of the following?


b) Alzheimer disease

c) Parkinson disease

d) Sydenham chorea

e) Neurosyphilis

13) Which of the following pharmacologic agents used to reduce cognitive deterioration

is an NMDA-receptor antagonist (not a cholinesterase inhibitor)?

a) Memantine

b) Galantamine



c) Rivastigmine

d) Donepezil

14) Which of the following has the highest rate of nausea, vomiting, and diarrhea?

a) Memantine

b) Galantamine

c) Rivastigmine

d) Donepezil

15) During the attention and calculation portion of the mini mental status exam (MMSE),

the patient is asked to count backwards from 100, subtracting what number each time?

a) 1

b) 3

c) 5

d) 7

e) 9

16) Asking a patient during the MMSE to “take a paper in your right hand, fold it in half,

and put it on the floor” is addressing what component?

a) Orientation

b) Registration

c) Recall

d) Language

e) Construction

17) Asking a patient during the MMSE to copy a design of a complex polygon (two

overlapping pentagons) is addressing what component?

a) Orientation

b) Registration

c) Recall

d) Language

e) Construction

18) The Memory Impairment Screen (MIS) involves 4 items in a delayed and cued free

recall test over 3-minutes, with a total of 8 points. What is the cutoff score for this exam?

a) 2

b) 3

c) 4

d) 5

19) Which of the following mental status examinations involves having the patient name

as many animals as they can in a minute, repeat a series of numbers backwards,

identifying a geometric shape, and answering questions about a short story?

a) Mini Mental Status Exam (MMSE)

b) Memory Impairment Screen (MIS)

c) Functional Activities Questionnaire (FAQ)

d) St. Louis University Mental Status Exam (SLUMS)

Geriatrics #12 & 13 – Depression in the Elderly

1) The DSM-IV for a major depressive episode requires at least 5 symptoms within what

time period?

a) Two days



b) One week

c) Two weeks

d) One month

e) Two months

2) Which of the following older adult populations has the highest incidence of

depression?

a) Medical outpatients

b) Female medical inpatients

c) Male medical inpatients

d) Female long-term care facility patients

e) Male long-term care facility patients

3) Which of the following is NOT true?

a) Women are more likely to complete suicide than men

b) Guns is a suicide mechanism used mostly by men

c) Laceration is a suicide mechanism used mostly by women

d) Hanging is a suicide mechanism used mostly by men

e) Overdose is a suicide mechanism used mostly by women

4) Approximately what percent of patients who attempt suicide have seen a primary care

physician in the past 30 days?

a) 5%

b) 14%

c) 35%

d) 50%

e) 75%

5) Which of the following is true according to the 1999 JAMA article regarding

psychothereapy and medication for treating depression?

a) Placebo was the most effective

b) Therapy alone was the most effective

c) Nortrip alone was the most effective

d) Therapy and nortrip in combination was the most effective

e) Adding nortrip to ongoing therapy had no significant affect

6) A patient is being treated for depression and presents with complaints of nausea,

diarrhea, anorexia, and fatigue. Testing shows hyponatremia. Which of the following is

most likely being taken by the patient?

a) Bupropion (Wellbutrin)

b) Fluoxetine (Prozac)

c) Mirtazepine (Remeron)

d) Venlafaxine (Effexor)

e) Duloxetine (Cymbalta)

7) Which of the following anti-depressants is associated with sedation and possible

weight gain?

a) Bupropion (Wellbutrin)

b) Fluoxetine (Prozac)

c) Mirtazepine (Remeron)

d) Venlafaxine (Effexor)

e) Duloxetine (Cymbalta)



f) Phenelzine (Nardil)

8) What is the minimal treatment time for anti-depressants such as nortriptyline

(tricyclic), as relapse risk with early discontinuation is up to 70%?

a) 2 weeks

b) 4 weeks

c) 8-12 weeks

d) 9-12 months

e) 2-3 years

9) Which of the following is a fundamental aspect of Alzheimer disease and is associated

with low metabolic rate?

a) Apathy

b) Dysphoria

c) Forgetfulness

d) Poor executive skills

e) Poor concentration

10) Electroconvulsive therapy (ECT) is a safe and effective treatment for older persons

with depression and psychotic features.

a) True

b) False

Geriatrics #14 – Urinary Incontinence

1) Which of the following nerve levels keeps the urethra contracted and inhibits detrusor

muscle contraction?

a) T5-T9

b) T8-T10

c) T11-L2

d) L2-L4

e) S2-S4

2) Alpha-adrenergic blockers (e.g. terazosin and tamsulosin) can cause what form of

incontinence?

a) Urge incontinence

b) Stress incontinence

c) Overflow incontinence

d) Atonic bladder

e) Functional incontinence

3) Anticholineric drugs along with Alzheimer disease and Parkinson disease can cause

what form of incontinence?




d) Atonic bladder


4) An elderly patient with limited mobility and congestive heart failure is taking a

diuretic. The patient says they “have to urinate when they get up” so they stay sitting as

much as possible during the day. Sometimes, the patient states she urinates in her pants

because she waits too long. Which of the following describes this patient’s incontinence?






d) Atonic bladder


5) A 69-year-old female presents to the primary care clinical for a follow-up. The patient

is taking Motrin in the morning and evenings, aspirin, Diovan, and Lipitor. History

reveals she drinks 2 glasses of wine with dinner most nights. Patient reports she has to go

to the bathroom “all the time.” The frequency occurs throughout the day, includes three

episodes of nocturia over the past 3 months, and has incontinence at minimum of 2 times

per day in small amounts. Which of the following is most likely?




d) Atonic bladder


6) Which of the following is the first-line therapy for a patient with urge incontinence?

a) Detrol LA

b) Enablex

c) Oxybutin

d) Bladder training

e) Pelvic floor exercises

7) Which of the following is usually due to pelvic floor muscle dysfunction and involves

a loss of small amounts of urine with coughing, laughing, or sneezing?




d) Atonic bladder


Geriatrics #15 – Nutrition Case Studies

1) Which of the following is used to estimate the amount of fluid a patient would need in

a given day?

a) 10mL per kg per day

b) 20mL per kg per day

c) 30mL per kg per day

d) 40mL per kg per day

e) 50mL per kg per day

2) Which of the following is used to estimate the amount of energy (food) a patient would

need in a given day?

a) 5-10kcal per kg per day

b) 15-20kcal per kg per day

c) 25-30kcal per kg per day

d) 35-40kcal per kg per day

e) 45-50kcal per kg per day



3) The Harris-Benedict equation for estimation of basal body expenditure, for males, is

66 + (13.6 * kg weight) + (5 * cm height) – (6.8 * age). What should this be multiplied

by in stressed individuals to determine basal body expenditure?

a) 0.95

b) 1.5

c) 1.95

d) 2.5

e) 2.95

4) A 59-year-old male is admitted for acute respiratory failure, COPD exacerbation, and

bilateral pneumonia. History includes type-II diabetes, COPD, obesity, and hypertension.

The patient is intubated and placed in the ICU. At ICU day #2, the patient is started on a

Glucerna tube that feeds at 80cc/hr (1920kcal/day). The patient weights 100kg, is 168cm

tall, and has a BMI of 35. How many calories does this patient actually need?

a) 1800

b) 2000

c) 2300

d) 2700

5) Which of the following hospital diets is low sodium and low cholesterol?

a) Regular

b) ADA

c) Regular with NCS

d) Cardiac

e) Mechanical soft

6) Which of the following supplements is given to improve wound healing?

a) Ensure

b) Two Cal HN

c) Arginaid

d) Pulmocare

e) Glucerna

7) Which of the following supplements is given to decrease CO2 production?

a) Ensure

b) Two Cal HN

c) Arginaid

d) Pulmocare

e) Glucerna

8) Which of the following is true of tube feeds in patients with dementia?

a) Reduce aspiration

b) Reduce pressure ulcers

c) Improve mortality

d) Improve quality of life

e) None of the above

9) Which of the following appetite stimulants can cause somnolence and dysphoria?

a) Megestrol (Megace)

b) Mirtazapine (Remeron)

c) Dronabinol (Marinol)

d) Cyproheptadine (Periactin)



10) Which of the following appetite stimulants is a serotonin and histamine antagonist

and can increase confusion?

a) Megestrol (Megace)

b) Mirtazapine (Remeron)

c) Dronabinol (Marinol)

d) Cyproheptadine (Periactin)

Geriatrics #16 – Schism (Movie Created in Erie, PA)

1) At the beginning of the movie, Neil Woodard is dropped off by EmergyCare

ambulance at what location?

a) Psychiatric institution

b) Retirement home

c) Medical clinic

d) Assisted living facility

2) What was the reason for Mr. Woodard’s original hospitalization?

a) Left shoulder injury

b) Right hip injury

c) Left femur injury

d) Right knee injury

3) As the movie progresses, Neil starts acting strangely. On the fourth of July, he asks a

staff member several times to “check if my family called today.” At another point, he

sees his dead wife Evelyn during a bingo game. One night, Neil has a nightmare where

his family yells at him for causing them grief. Toward the end of the movie, Neil sees an

army of soldiers run through the hallway and has a conversation with his new friend

Roger, who had passed away. At the very end, Neil is seen sitting in a chair where he

spends most of the rest of his days. What was the cause of these events?


b) Frontotemporal dementia

c) Vascular dementia

d) Alzheimer disease

e) Parkinson disease

4) How did Roger, Neil’s friend, pass away?

a) Heart attack

b) Stroke

c) Liver failure

d) Pneumonia

e) Diabetes

5) During a mental status examination, a social worker asks Neil to take a piece of paper

in his right hand, fold it in half, and place it on the floor. Which of the following

describes the action that Neil performed incorrectly?

a) Neil did not fold the paper

b) Neil folded the paper twice

c) Neil used only his left hand James Lamberg

d) Neil placed the paper in his lap

e) Neil handed the paper to the social worker

f) Neil threw the paper at Tammy, his medical aid



AnswerKey

Ger #1

1) C

2) D

3) E

4) A

5) E

6) A

7) D

8) C

9) E

10) D

11) C

12) E

13) A

14) B

15) A

16) A

17) C

18) C

19) A

20) D

Ger #2

1) B

2) E

3) C

4) C

5) A

6) D

7) C

8) A

9) E

10) A

Ger #3

1) A

2) C

3) D

4) B

5) D

6) D

7) C

8) A

9) B

10) C

11) D

12) A

13) C

14) D

15) E

16) E

17) D

18) E

Ger #4

1) D

2) C

3) E

4) B

5) D

6) A

7) E

8) C

9) C

10) E

11) D

Ger #5

1) B

2) D

3) A

4) C

5) B

6) C

7) E

8) D

9) C

10) D

11) A

12) B

13) C

Ger #6

1) D

2) C

3) E

4) B

5) B

Ger #7

1) E

2) B

3) D

4) E

5) B

6) A

7) A

8) C

9) D

10) C

11) B

12) E

Ger #8

1) C

2) B

3) C

4) E

5) B

6) A

7) B

8) D

9) E

10) B

11) A

12) B

13) D

14) C

15) D

16) E

Ger #9

1) C

2) A

3) E

4) D

5) C

6) D

7) B

8) C

9) C

10) B

11) A

12) B

13) E

14) D

15) E

16) H

17) A

Ger #10-11

1) C

2) E

3) B

4) A

5) D

6) B

7) A

8) E

9) D

10) C

11) C

12) B

13) A

14) C

15) D

16) D

17) E

18) C

19) D

Ger #12-13

1) C

2) D

3) A

4) E

5) D

6) B

7) C

8) D

9) A

10) A

Ger #14

1) C

2) C

3) A

4) E

5) A

6) D

7) B

Ger #15

1) C

2) C

3) B

4) D

5) D

6) C

7) D

8) E

9) C

10) D

Ger #16

1) D

2) B

3) D

4) A

5) E

Quiz Geriatrics

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