Nokea
An 80-year-old man is being evaluated for recent episodes of incontinence and confusion. His family states that he is usually independent with no altered mental issues but has become forgetful within the last 2 weeks. Which medication is most likely associated with these symptoms?
- A. Cimetidine (Tagamet)
- B. Warfarin (Coumadin)
- C. Ramipril (Altace)
- D. Vitamin B12
Correct Answer: A
Rationale: Cimetidine can cause confusion and altered mental status in the elderly.
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Which of the following best describes the components included in a patient's Social History (SH)?
- A. A summary of the patient's medical history and family background
- B. Lifestyle factors, social habits, and living conditions
- C. The patient's current medications and allergies
- D. Details about the patient's physical examination findings
Correct Answer: B
Rationale: Social History (SH) includes lifestyle factors, social habits, and living conditions, which impact overall health.
Headache warning signs that need prompt investigation include all of the following except:
- A. New onset after 50
- B. Aggravated or relieved by change of position
- C. Precipitated by Valsalva maneuver
- D. Headaches relieved with mild recurrent use of analgesics
Correct Answer: D
Rationale: Headaches relieved with mild, infrequent analgesic use typically don’t require urgent investigation.
Mr. B is an 82-year-old enrolled in your primary care clinic panel. His wife is his primary caregiver and feels stressed and overwhelmed. What option would be appropriate for Mr. B except:
- A. Adult day program
- B. Assisted living
- C. Skilled nursing facility
- D. In-home paid care provider
Correct Answer: C
Rationale: Skilled nursing facilities are typically for patients who require higher levels of medical care, which may not be needed for Mr. B.
A nurse practitioner examines the skin of an elderly patient. Which finding below is NOT a benign lesion associated with the aging process?
- A. Xerosis
- B. Cherry angiomas and senile purpura
- C. Senile keratosis and senile lentigines
- D. Dermatophytosis
Correct Answer: D
Rationale: Dermatophytosis is a fungal infection and is not a normal aging change.
A 72-year-old woman reports vaginal dryness that interferes with coitus. Her medical history includes type 2 diabetes, hypertension, and osteoarthritis. Medications are glyburide, chlorthalidone, and acetaminophen. What would be your first step in therapy?
- A. Stop glyburide
- B. Stop chlorthalidone
- C. Stop acetaminophen
- D. Start topical vaginal lubricant
Correct Answer: D
Rationale: Topical vaginal lubricants can help alleviate vaginal dryness and improve sexual function.