Nokea
A 78-year-old male was recently diagnosed with Alzheimer’s disease. He scored 23/30 on his Montreal Cognitive Assessment (MoCA) and his clinical presentation is consistent with mild disease. Which of the following is NOT a common side effect of donepezil?
- A. Thrombocytopenia
- B. Bradycardia
- C. Vivid dreams
- D. Gastrointestinal distress
Correct Answer: A
Rationale: Thrombocytopenia is not a common side effect of donepezil, while bradycardia, vivid dreams, and gastrointestinal distress are.
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Why is it important to consider intracranial hemorrhage when a patient presents with epistaxis?
- A. It indicates a possible allergic reaction.
- B. It may suggest a more serious underlying condition.
- C. It is a common cause of nasal congestion.
- D. It usually resolves without treatment.
Correct Answer: B
Rationale: Epistaxis can be a symptom of intracranial hemorrhage, especially if the bleeding is sudden or severe.
On admission to the hospital, an 85-year-old woman was found to have a fungating mass on her right breast. The mass is 9 cm in diameter, partially ulcerated, and associated with edema of the arm and obvious pain. The patient has no children and had lived alone until recently, when a neighbor became concerned for what appeared to be a progressive loss of memory and neglect of the house. A nephew living in another city eventually came to take care of the situation and arranged for the admission. The patient appears confused and withdrawn; her appearance is disheveled, but she seems to be independent in her ADLs. The medical history is negative for any serious illnesses. She was able to drive her own car until shortly before this admission. The nephew does not wish to authorize hospice “right now.” A positron-emission tomography scan was negative for metastatic disease. In addition to determining the cause of her delirium, which of the following is the best way to address the breast mass?
- A. Tamoxifen should be initiated immediately. If no response is seen in 3 months, the patient should receive chemotherapy.
- B. The mass should be biopsied to study hormone receptor and HER2/neu antigen status.
- C. The patient should undergo surgery as initial treatment.
- D. The initial treatment should be radiation therapy.
Correct Answer: E
Rationale: Given the patient's age and condition, the best approach is to avoid aggressive treatment and focus on symptom management.
Which of the following is the most appropriate description of “personhood” as it relates to people with dementia?
- A. Personhood is a universal concept that is defined the same way in all cultures.
- B. The ability to relate to others as people, rather than preserving cognitive independence, is an important aspect of “personhood.”
- C. The ability to recognize family members by name is an important aspect of “personhood.”
- D. A deterioration in cognitive function demonstrates the decreasing value of older adults in society.
Correct Answer: B
Rationale: Personhood focuses on maintaining human connections, even when cognitive decline occurs.
What further diagnostic steps are required for the seven patients receiving atypical antipsychotics?
- A. All patients should receive 1 week of actigraphy monitoring both on and off their current antipsychotic.
- B. All patients should be immediately referred for cognitive behavioral therapy for insomnia (CBTI).
- C. All patients should receive referral to both psychiatry and neurology, neuroimaging, and screening polysomnography to identify underlying sleep disorder.
- D. Unless there is an underlying suspicion of obstructive sleep apnea (OSA) or other sleep disorder, these patients already meet criteria for irregular sleep-wake phase disorder, and no further diagnostic steps are required.
Correct Answer: C
Rationale: Comprehensive diagnostic steps involving psychiatry, neurology, and neuroimaging are necessary to assess underlying conditions and ensure proper management.
Recommended combination therapy for uncomplicated anorectal and pharyngeal gonorrhea is?
- A. Ceftriaxone and benzathine penicillin
- B. Benzathine penicillin and doxycycline
- C. Doxycycline and ciprofloxacin
- D. Ceftriaxone and azithromycin
Correct Answer: D
Rationale: The recommended treatment for gonorrhea is ceftriaxone and azithromycin for uncomplicated infections.