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A 65-year-old patient presents with confusion, tremors, and bradykinesia. What is the most likely diagnosis?
- A. Alzheimer's disease
- B. Huntington's disease
- C. Parkinson's disease
- D. Multiple sclerosis
Correct Answer: C
Rationale: The correct diagnosis is C: Parkinson's disease. The symptoms of confusion, tremors, and bradykinesia are classic features of Parkinson's disease, a neurodegenerative disorder affecting movement. The typical onset age aligns with the patient's age. Alzheimer's disease (A) primarily affects memory and cognition, Huntington's disease (B) presents with involuntary movements and cognitive decline, and Multiple sclerosis (D) involves the immune system attacking the central nervous system causing a variety of symptoms. Parkinson's is the most appropriate choice based on the symptom presentation and age of the patient.
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Even though older adults are less likely to get counseled for smoking cessation, they have which one of the following?
- A. The same quit rates as younger individuals
- B. Approximately 50% better quit rates than younger individuals
- C. Approximately 25% better quit rates than younger individuals
- D. Much lower quit rates than younger individuals
Correct Answer: C
Rationale: The correct answer is C: Approximately 25% better quit rates than younger individuals. Older adults tend to have higher quit rates compared to younger individuals due to factors like increased motivation, life experience, and health concerns. Older adults often have more resources and support systems in place to help them quit smoking successfully. Choice A is incorrect because older adults do not necessarily have the same quit rates as younger individuals. Choice B is also incorrect as the difference in quit rates is not as high as 50%. Choice D is incorrect as older adults do not generally have much lower quit rates than younger individuals.
Mr. Hunter, a 69-year-old man, complains of urinary frequency and urgency that have increased over the past several months. There is no dysuria, hematuria, or sensation of incomplete voiding. He drinks 2 cups of coffee daily and diet cola multiple times a day. His International Prostate Symptom Score (IPSS) is 6, with a bother score of 1 indicating mild voiding symptoms with low impact on his quality of life. His medical history includes hypertension, coronary artery disease, and benign prostatic hyperplasia. Current medications are aspirin, metoprolol, and hydrochlorothiazide. Physical examination reveals normal sized prostate. Which of the following is the best next step?
- A. Urinalysis
- B. Cystoscopy
- C. Lifestyle modifications
- D. Tamsulosin
Correct Answer: C
Rationale: The correct next step is C: Lifestyle modifications. Given the patient's history of mild voiding symptoms and benign prostatic hyperplasia, the first approach should be conservative management. Lifestyle modifications, such as reducing caffeine intake from coffee and diet cola, can help alleviate urinary symptoms. Additionally, optimizing fluid intake and bladder habits can also improve symptoms. Urinalysis (choice A) may be considered later if symptoms persist or worsen. Cystoscopy (choice B) is invasive and not indicated at this stage. Tamsulosin (choice D) is a medication for BPH, but since the patient's symptoms are mild and bother score is low, starting with lifestyle modifications is more appropriate.
Which of the following is the most common presenting sign of substance abuse in adolescents?
- A. Poor school performance
- B. Change in sleep habits
- C. Increased blood pressure
- D. Changes in behavior
Correct Answer: D
Rationale: The correct answer is D: Changes in behavior. This is the most common presenting sign of substance abuse in adolescents because substance use often leads to noticeable changes in behavior, such as irritability, mood swings, aggression, and withdrawal from family and friends. These behavioral changes are typically the first noticeable signs of substance abuse.
A: Poor school performance may be a consequence of substance abuse, but it is not necessarily the most common presenting sign.
B: Change in sleep habits can be a sign of substance abuse, but changes in behavior are more prominent and common.
C: Increased blood pressure is a physical symptom of substance abuse, but changes in behavior are usually more readily apparent and commonly observed in adolescents with substance abuse issues.
An 82-year-old woman receives oral amoxicillin-clavulanate for a skin abscess on her leg. She develops new onset of frequent watery stool that persists for several days after the antibiotic is stopped. You obtain a stool for Clostridium difficile antigen, toxin, and polymerase chain reaction (PCR). The antigen and PCR are both positive. She has never had C. difficile infection before. What one statement is the best answer regarding her management?
- A. Metronidazole is the treatment of choice for C. difficile infection.
- B. Older adults with their first episode of C. difficile require a longer duration of treatment with vancomycin.
- C. Fecal transplantation is the treatment of choice for C. difficile infection.
- D. Either vancomycin or fidaxomicin are recommended for the first episode of C. difficile infection.
Correct Answer: D
Rationale: The correct answer is D: Either vancomycin or fidaxomicin are recommended for the first episode of C. difficile infection.
1. Choice A is incorrect because metronidazole is no longer recommended as first-line treatment due to increasing resistance.
2. Choice B is incorrect because there is no evidence suggesting older adults require a longer duration of treatment with vancomycin for their first episode.
3. Choice C is incorrect because while fecal transplantation can be used in refractory cases, it is not typically the first-line treatment.
4. The rationale for D being correct is that both vancomycin and fidaxomicin are recommended as first-line treatments for the initial episode of C. difficile infection based on current guidelines. This allows for flexibility in selecting the appropriate antibiotic based on individual patient factors.
Which one of the following is most true about the rule of fourths?
- A. One-fourth of geriatric problems are iatrogenic.
- B. Little can be done to prevent three-fourths of the problems of aging.
- C. For every medical complaint a patient presents with, a careful assessment can identify three other diagnoses.
- D. What used to be called normal aging can be largely explained by processes that are not normal.
Correct Answer: A
Rationale: Step 1: The rule of fourths states that one-fourth of geriatric problems are iatrogenic, meaning they are caused by medical treatment.
Step 2: This statement is true because iatrogenic problems in the elderly are common due to multiple medications, procedures, etc.
Step 3: A careful assessment can indeed identify iatrogenic issues, making this statement accurate.
Summary:
A is correct because it aligns with the concept of iatrogenic problems in the elderly.
B is incorrect because interventions can help prevent many problems of aging.
C is incorrect as it does not specifically address iatrogenic problems.
D is incorrect as it does not focus on the iatrogenic aspect of geriatric problems.