Nokea
Joyce Mitchell is a 73-year-old frail female with a history of frequent falls, presenting with nausea, vomiting, sweating, and horizontal nystagmus. She is diagnosed with vestibular neuritis. What is the best initial course of treatment?
- A. Vestibular rehabilitation
- B. Supportive care with anti-nausea and anti-vertigo medication
- C. Fluids
- D. Epley maneuver
Correct Answer: B
Rationale: Supportive care with anti-nausea and anti-vertigo medication is appropriate for vestibular neuritis.
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Barriers to detecting elder mistreatment include all except:
- A. The tendency for many older adults to falsely claim they are being abused
- B. The fear that one might be institutionalized if one admits to being abused
- C. The shame that older adults feel if they have been a victim of abuse
- D. The difficulty that healthcare providers have making a determination regarding abuse if the victim has dementia
Correct Answer: A
Rationale: Many older adults do not falsely claim abuse, so this is not a significant barrier.
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.
Which of the following findings could indicate a need for further evaluation of the cardiac patient?
- A. Hematocrit 42%
- B. Potassium 4.2 mg/dl
- C. Sodium 140 mEq/dl
- D. Low-density lipoprotein of 190 mg/dl
Correct Answer: D
Rationale: LDL levels over 160 mg/dl warrant further evaluation for cardiovascular risk.
Explain why late inspiratory crackles in the lower third of the chest are indicative of heart failure rather than other respiratory conditions.
- A. They indicate airway obstruction typical of asthma.
- B. They suggest fluid accumulation in the alveoli due to heart failure.
- C. They are a sign of chronic bronchial inflammation.
- D. They are associated with hyperinflation of the lungs in COPD.
Correct Answer: B
Rationale: Late inspiratory crackles indicate fluid in the alveoli, a hallmark of heart failure.
Several years later, Mr. Hunter, who is now 75 years old, seeks additional intervention for his urinary symptoms that have progressed further. He now experiences slow urinary stream, hesitancy, straining, and a feeling of incomplete emptying in addition to the previous urinary urgency and frequency. At times, he has noted blood in his urine. He has had five urinary tract infections (UTIs) in the past 2 years. His current IPSS is 24, with a bother score of 5 indicating severe voiding symptoms with high impact on his quality of life. Mr. Hunter’s updated medical history includes hypertension, coronary artery disease, benign prostatic hyperplasia, cataract surgery 4 years ago, and two falls within the past year while rushing to the bathroom during the night. Current medications are aspirin, metoprolol, finasteride, and tamsulosin. Physical examination reveals an enlarged, nontender prostate, about 50 g in size without discrete nodules. Upon further evaluation, the intermittent hematuria is attributed to BPH. Postvoid residual volume is 110 mL. Uroflowmetry reveals urinary flow rate of 12 mL/s. Which of the following is the best next step in management?
- A. Start tadalafil.
- B. Switch from tamsulosin to silodosin.
- C. Switch from finasteride to dutasteride.
- D. Perform surgical resection of prostate.
Correct Answer: D
Rationale: Given the severity of his symptoms and the failure of medical therapy, surgical resection of the prostate is the best option.