Nokea
A 72-year-old man with colonic diverticulosis was admitted to the hospital with gastrointestinal bleeding and abdominal pain. The following day, the patient was positive on the Confusion Assessment Method (CAM) performed by geriatric consultation services. Which of the following is NOT predisposed by delirium in this patient?
- A. Higher risk of institutionalization
- B. Increased risk of dementia
- C. Shorter length of stay in the hospital
- D. Increased mortality
Correct Answer: C
Rationale: Delirium is associated with increased mortality and risk of dementia, but it generally leads to longer hospital stays.
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A 78-year-old man has an emergency partial colectomy for lower gastrointestinal bleeding. 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?
- A. Yes because without knowing his complete staging it would be safer.
- B. No because he can be followed with serial carcinoembryonic antigens and CT scans.
- C. Yes because the severe bleeding indicates advanced disease.
- D. No because he is too old and will not likely have any problems during his lifetime.
Correct Answer: B
Rationale: Follow-up with serial carcinoembryonic antigens and CT scans is appropriate after resection of localized disease.
A 70-year-old man has bothersome lower urinary tract syndrome (LUTS) associated with benign prostatic hyperplasia (BPH). His symptoms are no longer well managed with lifestyle modifications. He is interested in medication to reduce his urinary symptoms but is concerned about possible side effects. He notes that he is recently married and sexual activity is very important to him. Which of the following medications would be most appropriate for this patient?
- A. Alfuzosin
- B. Ditropan
- C. Dutasteride
- D. Tamsulosin
Correct Answer: D
Rationale: Tamsulosin is an alpha-1 blocker that helps alleviate urinary symptoms without significantly impacting sexual function.
Which immunization reduces a patient’s risk for infection with the virus that causes painful localized blistering rash?
- A. Smallpox vaccine
- B. Varicella vaccine (chicken pox)
- C. Shingles (herpes zoster) vaccine
- D. Meningococcal vaccine
Correct Answer: C
Rationale: Shingles vaccine reduces the risk of herpes zoster, which causes painful rash.
A 67-year-old woman with a history of A-fib and an ejection fraction of 48% has had normal digoxin levels. Which can cause a decrease in digoxin level?
- A. Decrease creatinine clearance
- B. Weight loss
- C. Increase exercise
- D. Regular use of antacid
Correct Answer: D
Rationale: Regular use of antacids can decrease the absorption of digoxin, potentially lowering its levels.
An older woman who is cared for by a concerned family is particularly likely to suffer from which of the following complications after an episode of gastroenteritis?
- A. Immobility related to overconcern
- B. Continued vomiting caused by too-rapid feeding
- C. Diarrhea resulting from administration of milk products
- D. Constipation related to overtreatment of diarrhea
Correct Answer: D
Rationale: Overtreatment of diarrhea can lead to constipation, especially in older adults.