ASIPP Geriatrics Questions

Question 1

1738.A 67-year-old musician presents with a long history
of low back pain, Pain is worsened with prolonged
standing and with exercise, For the last several months,
the patient has noticed that the back pain comes on with
walking less than one block and radiates to the buttocks,
The pain is relieved by sitting for several minutes, On
physical examination, there are no neurologic defi cits
and bilateral straight-leg raising maneuvers are normal.
Peripheral pulses are strong and bilaterally equal. Which
of the following is the most likely diagnosis?
A. Lumbar spinal stenosis
B. Peripheral vascular disease
C. Lumbosacral sprain
D. Disk herniation
E. Diffuse idiopathic skeletal hyperostosis

Answer 1

1738. Answer: A
      Explanation:
      (Tierney, 42/e, p 796.)
      The patient is describing pseudoclaudication, which is
      characteristic of lumbar spinal stenosis. This arises from
      compression of the exiting nerve roots by a disk,
      osteophyte, or narrow canal. The leg pain is most
      pronounced when walking downhill or descending stairs
      and takes several minutes of sitting or fl exing f
      orward before resolution. Often patients who
      continue to walk with pain will stoop over to relieve the
      symptoms (stoop sign). Claudication is seen in peripheral
      vascular disease, but the pain that occurs with walking
      resolves immediately upon stopping or standing without
      sitting. Peripheral pulses may be compromised. Diffuse
      idiopathic skeletal hyperostosis (DISH) causes
      calcifi cation of the longitudinal ligaments of the spine and
      is usually found in patients with diabetes mellitus

Question 2

1739.The initial starting dose for a geriatric patient requiring
nortriptyline is:
A. 10 mg
B. 25 mg
C. 50 mg
D. 100 mg
E. 200 mg

Answer 2

1739. Answer: A

Source: Jackson KC. Board Review 2003

Question 3

1740. The leading cause of death in the elderly population is
A. Heart disease
B. Malignancies
C. Cerebrovascular disease
D. Pulmonary disease
E. Trauma (e.g., Harley accidents)

Answer 3

1740. Answer: A

Source: Day MR, Board Review 2003

Question 4

1741.Which of the following is true regarding hepatic changes
in the elderly:
A. Conjugation changes little with age.
B. Demethylation increases with age.
C. Liver mass decrease starting at age 40.
D. Serum albumin levels remain the same.
E. Serum blood levels of drugs with high fi rst pass metabolism
remain the same.

Answer 4

1741. Answer: A

Source: Day MR, Board Review 2005

Question 5

1742. Exercise in the geriatric population has been found to
A. reduce falls.
B. increase strength
C. reduce depression
D. all of the above
E. none of the above

Answer 5

1742. Answer: D

Source: Arch Phys Med Rehabil Vol 85, Suppl 3, July 2004

Question 6

1743. An elderly old woman presents with a new onset, severe
      right-sided headache for 1 day. She states that the vision
      in her right eye has diminished, and she complains of
      claudication of her jaw when she is chewing food. On
      physical examination, her right temple is tender to
      palpation. The most likely diagnosis is:
      A. Acute frontal sinusitis
      B. Giant cell arteritis
      C. Migraine headache
      D. Cluster headache
      E. Trigeminal neuralgia

Answer 6

1743. Answer: A
      Explanation:
      (Tierney, 42/e, pp 820-822.)
      Giant cell arteritis or temporal arteritis usually
      appears after the age of 55 and is more common
      in women than men. Patients typically present with
      severe headache, malaise, fever, and tenderness
      over the involved temporal artery. Patients may
      have ocular symptoms due to ischemic optic neuropathy
      (blindness is an irreversible complication) and complain
      of jaw pain when chewing (jaw claudication). Polymyalgia
      rheumatica (limb girdle stiffness and pain, weight loss,
      malaise) may be seen in up to 30% of patients with
      temporal arteritis. Patients suspected of having temporal arteritis require immediate corticosteroids; diagnosis is
      confi rmed by temporal artery biopsy. Trigeminal neuralgia
      (tic douloureux) causes severe unilateral facial pain but is
      not associated with vision changes or claudication. Cluster
      headaches occur mostly in men and are characterized by
      periorbital or temporal pain lasting up to 2 h and
      accompanied by lacrimation and ptosis. Patients complain
      of several attacks a day for several weeks followed by a
      period of remission.

Question 7

1744.An elderly woman being treated for spinal stenosis,
presents with a new problem with the sudden onset of
severe left-sided chest pain that radiates in a bandlike
fashion to her left side and back. Pain is excruciating and
area is hyperesateric. Heart and lung examinations are
normal. No rash is visible. Electrocardiogram is normal.
The most likely diagnosis is:
A. Gastroesophageal refl ux disease
B. Myocardial infarction
C. Herpes zoster
D. Costochondritis
E. Dissecting aortic aneurysm

Answer 7

1744. Answer: C
      Explanation:
      (Tierney, 42/e, pp 105-106.)
      Herpes zoster is due to reactivation of latent
      varicella virus; patients typically present with a
      history of pain, tingling, or itching of the affected
      area followed by an eruption of vesicles overlying
      an erythematous base. Although the disease can
      disseminate and produce diffuse eruptions, it typically
      presents with involvement of a single dermatome. The
      disease is not limited to adults or immunocompromised
      patients and may be seen in children.

Question 8

1745.A 66-year-old man has the chief complaint of pain and
numbness over the lateral aspect of the right thigh. He has
no back pain or diffi culty ambulating. The symptoms are
relieved by sitting. Physical examination is normal except
for impaired cutaneous sensation over the affected lateral
aspect of the right thigh. There is a negative straight-leg
raise maneuver; motor strength and deep tendon refl exes
are normal. Romberg test is negative. Which of the
following is the most likely diagnosis?
A. Peroneal nerve palsy
B. Meralgia paresthetica
C. Vitamin B12 defi ciency
D. Sciatic nerve palsy
E. Femoral neuropathy

Answer 8

1745. Answer: B
      Explanation:
      (Tierney, 42/e, p 997.)
      The patient describes symptoms due to compression of the
      lateral femoral cutaneous nerve arising from the L2 and L3
      roots (meralgia paresthetica). Entrapment of the nerve at
      any point from hyperextension of the hip may cause
      symptoms. Symptoms are usually mild, but patients may
      require hydrocortisone injections medial to the iliac spine.
      Patients with femoral neuropathy present with weakness
      and wasting of the quadriceps muscle, sensory
      impairment,and an absent patellar refl ex. The
      Romberg test is performed by having the patient
      stand with feet together, head erect, and eyes open.
      The patient is then examined for steadiness and
      then asked to close his or her eyes. A positive test
      occurs when the patient displays increased unsteadiness
      with the eyes closed but not with the eyes open.
      A positive Romberg test may be seen in diseases that
      affect the dorsal columns, such as tabes dorsalis and
      vitamin B12 defi ciency

Question 9

1746.An elderly woman presents with paresthesias of the
feet and an unsteady gait for several months. Other
than a previous history of anemia, the patient has no
past medical history. She takes no medications and
does not smoke cigarettes or drink alcohol. On physical
examination, the patient is alert and oriented but cannot
recall three objects after 5 min. Her gait is unsteady and
broad-based, and she has increased muscle tone in the
lower extremities. Muscle strength is normal, but the
patient has diminished sensation to vibration from the
midcalf areas to the feet. Patellar and ankle refl exes are
absent bilaterally. The patient has bilateral extensor
Babinski refl exes and a positive Romberg test. Laboratory
data reveal a macrocytic anemia. Which of the following
is the most likely diagnosis?
A. Vitamin B12 defi ciency
B. Tabes dorsalis
C. Lead poisoning
D. Vitamin B6 defi ciency
E. Vitamin E defi ciency

Answer 9

1746. Answer: A
      Explanation:
      (Tierney, 42/e, pp 474-475.)
      The patient most likely has vitamin B12 defi ciency due to
      pernicious anemia (lack of intrinsic factor). Patients show
      loss of posterior column sensation (vibration and position
      sense), positive Romberg test, mild spasticity, and
      bilateral extensor plantar refl exes (upper motor neuron).
      Patients may also present with mild dementia or
      psychiatric symptoms. The polyneuropathy associated
      with B6 (pyridoxine) defi ciency is associated with
      isoniazid use. Lead poisoning causes a motor neuropathy (i.e., wristdrop, footdrop) and requires chronic exposure
      to lead as an adult. Tabes dorsalis due to tertiary syphilis
      causes progressive sensory loss, ataxia, and a positive
      Romberg test, but patients complain of severe lancinating
      leg pain. Patients are not spastic and do not have a positive
      Babinski sign. Vitamin E defi ciency is seen in liver disease,
      cystic fi brosis, and other malabsorption syndromes;
      patients present with ataxia and peripheral neuropathy.

Question 10

1747.Compared with young adult patients undergoing stroke
rehabilitation, geriatric patients require
A. more medication to prevent recurrent stroke.
B. longer rehabilitation hospitalization.
C. more nasogastric tube feedings.
D. bladder catheterizations more frequently.
E. lesser rehabilitation hospitalization.

Answer 10

1747. Answer: B

Source: Arch Phys Med Rehabil Vol 85, Suppl 3, July 2004

Question 11

1748.A 70-year-old woman presents with poorly articulated
phrases but understands commands. Choose correct
diagnosis:
A. Upper motor neuron disease
B. Lower motor neuron disease
C. Myelopathy
D. Radiculopathy
E. Broca’s aphasia

Answer 11

1748. Answer: E
      Explanation:
      (Seidel, 5/e, p 798.)
      Upper motor neuron (UMN) disease (above the level of
      the corticospinal synapses in the gray matter) is
      characterized by spastic paralysis, hyperrefl exia,
      and a positive Babinski refl ex (everything is up in UMN
      disease). Lower motor neuron (LMN) disease (below the
      level of synapse) is characterized by fl accid paralysis,
      signifi cant atrophy, fasciculations, hyporefl exia, and a
      fl exor (normal) Babinski refl ex (everything is down in
      LMN disease). A radiculopathy occurs with root
      compression from a protruded disk that causes sensory
      loss, weakness, and hyporefl exia in the distribution of the
      nerve root. Myelopathy causes severe sensory loss 0
      posterior column sensation (position sense and vibration),
      spasticity, hyperrefl exia, and positive Babinski refl exes.
      Broca’s aphasia (left inferior frontal gyrus) is a nonfl uent
      expressive aphasia (Broca’s should remind you of broken
      speech); Wernicke’s aphasia (left posterior-superior
      temporal gyri) is a receptive aphasia because patients lack
      auditory comprehension (Wernicke’s should remind you
      of wordy speech that makes no sense).

Question 12

1749.During evaluation of an elderly woman with severe
arthritic pain, it is noted that she has a poor appetite,
insomnia, and anxiety. A likely secondary consequence
of her pain in this setting that should also be treated
includes:
A. Acute delirium
B. Clinical depression
C. Dementia
D. Failure to thrive
E. Generalized anxiety diseases

Answer 12

1749. Answer: B
      Explanation:
      Clinical depression is a common consequence of untreated
      or undertreated pain. Signs and symptoms may include
      insomnia, amxiety, agitation, aggression, loss of appetite,
      and refusal of care.
      Source: Arch Phys Med Rehabil Vol 85, Suppl 3, July 2004

Question 13

1750.Independent of bone mineral density, in elderly women,
the factor contributing to an increased risk of fracture
secondary to a fall includes:
A. Obesity
B. Daily wine consumption
C. Poor visual acuity
D. Use of coumadin
E. Height

Answer 13

1750. Answer: C
      Explanation:
      (a) Kanis JA. Diagnosis of osteoporosis ad assessment of
      fracture risk. Lancet 2002;359:1929-36.
      (b) Dargent-Molina P, favier F, Grandjean H, et al. Fallrelated
      factors and risk of hip fracture: the EPIDOS
      prospective study [published erratum]

Question 14

1751.Which of the following abnormality is most common in
the disabled elderly population?
A. Epilepsy
B. Movement disorders
C. Transient ischemic attacks
D. Dementia
E. Stroke

Answer 14

1751. Answer: B

Question 15

1752.Which of the following agents would be best tolerated
in a medically debilitated patient for post-herpetic
neuralgia?
A. Amitriptyline
B. Desipramine
C. Maprotiline
D. Doxepin
E. Trazodone

Answer 15

1752. Answer: B

Question 16

1753.The major factor causing poor compliance with medical
advice by the elderly is
A. Drug costs
B. Race issues
C. Number of drugs
D. Communication
E. Insurance

Answer 16

1753. Answer: C

Question 17

1754.In managing pain in the elderly patients, it is best to use
drugs in the following manner:
A. Start low and go slow for all medications.
B. Use high-dose, short-acting narcotics initially to get the
pain under control.
C. Avoid use of acetaminophen, due to liver toxicity.
D. Start with aspirin, which is safe and effective.
E. Start with transdermal fentanyl

Answer 17

1754. Answer: A
      Explanation:
      Physiologic changes with aging, including slowed
      absorption, metabolism, and elimination of medications,
      may lead to excess sedation, confusion, constipation, and
      urinary retention in geriatric patients. Thus, low initial
      doses are indicated, with slow upward titration.
      Acetaminophen is safe and effective for moderate pain.
      Aspirin in higher doses is associated with bleeding
      complications.
      Source: Arch Phys Med Rehabil Vol 85, Suppl 3, July 2004

Question 18

1755.In general, patients who have chronic obstructive
pulmonary disease and are undergoing pulmonary
rehabilitation should maintain an arterial oxygenation
level no less than
A. 95%
B. 93%
C. 88%
D. 85%
E. 90%

Answer 18

1755. Answer: C

Source: Arch Phys Med Rehabil Vol 85, Suppl 3, July 2004

Question 19

1756.The exercise program benefi cial for patients with
rheumatoid arthritis is:
A. High intensity progressive resistance exercises
B. Low-load, high-reception resistance exercise
C. Walking 3 to 4 times per week.
D. A program incorporating any of the above
E. None of the above programs

Answer 19

1756. Answer: D

Source: Arch Phys Med Rehabil Vol 85, Suppl 3, July 2004

Question 20

1757.A 67-year-old man presents with an episode of right
face, arm, and leg weakness that resolved on arrival to the
emergency room. Choose appropriate diagnosis:
A. Basilar artery stroke
B. Middle cerebral stroke
C. Anterior cerebral stroke
D. Transient ischemic attack
E. Posterior cerebral stroke

Answer 20

1757. Answer: D
      Explanation:
      (Tierney, 42/e, pp 962-963.)
      Basilar artery stroke causes quadriplegia, sensory loss,
      and cranial nerve involvement; patients may present
      with coma or locked-in syndrome. Wallenberg
      syndrome or lateral medullary syndrome causes
      an ipsilateral weakness of the palate and vocal cords,
      ipsilateral ataxia, ipsilateral Horner syndrome, and
      ipsilateral loss of facial pain and temperature but
      contralateral loss of body pain and temperature sensation.
      There is no limb weakness in Wallenberg syndrome.
      Anterior cerebral stroke causes unilateral leg weakness and
      sensory loss. Posterior cerebral artery stroke causes an
      occipital stroke and a homonymous hemianopsia. Middle
      cerebral artery stroke causes hemiplegia or hemiparesis
      greater in the arm than the leg, aphasia, unilateral sensory
      loss, and eyes that deviate to the side of the hemispheric
      lesion. Patients with lacunar infarcts may present with
      different syndromes, such as dysarthria and mild
      hemiparesis (clumsy-hand dysarthria). Lacunar infarcts
      represent small artery occlusions; hypertension and
      diabetes are risk factors for these infarcts. Patients in a
      vegetative state from diffuse cortical damage have
      spontaneous eye opening and movement without evidence
      of awareness.

Question 21

1758. In the elderly, scopolamine-induced delirium is
      A. Absent with doses less than 0.4 mg
      B. Decreased by physostigmine
      C. Reversible with diazepam
      D. Reversible with pyridostigmine
      E. Similar to that produced by glycopyrrolate

Answer 21

1758. Answer: B
      Source: American Board of Anesthesilogy, In-trainnig
      examination

Question 22

1759.An elderly female has swelling and pain in several
of the interphalangeal (IP) joints of her hand. X-ray
examination reveals arthritic changes. Which agent
should not be prescribed?
A. Indomethacin
B. Acetaminophen
C. Tolmetin
D. Naproxen
E. Piroxicam

Answer 22

1759. Answer: B
      Explanation:
      Reference: Hardman, pp 631-633.
      All of the drugs listed, except acetaminophen, are usually considered NSAIDs, a large group of structurally
      dissimilar compounds. These drugs share the
      pharmacologic properties of the prototype compound,
      aspirin, in that all have analgesic, antipyretic, and antiinfl
      ammatory effects. The mechanism of action that is
      responsible for the effect of NSAIDs is reduction in the
      formation of eicosanoids (e.g., prostaglandins,
      thromboxanes) by inhibiting the enzyme cyclooxygenase.
      Acetaminophen differs from the other drugs in that it is a
      very weak anti-infl ammatory agent; however, it is an
      effective analgesic and antipyretic
      Source: Stern - 2004

Question 23

1760.A 71-year-old woman presents with aphasia and severe
right-sided hemiparesis greater in the arm than the
leg. Her eyes deviate to the left. Choose appropriate
diagnosis:
A. Basilar artery stroke
B. Middle cerebral stroke
C. Anterior cerebral stroke
D. Transient ischemic attack
E. Posterior cerebral stroke

Answer 23

1760. Answer: B
      Explanation:
      (Tierney, 42/e, pp 962-963.)
      Basilar artery stroke causes quadriplegia, sensory
      loss, and cranial nerve involvement; patients may
      present with coma or locked-in syndrome.
      Wallenberg syndrome or lateral medullary syndrome
      causes an ipsilateral weakness of the palate and vocal
      cords, ipsilateral ataxia, ipsilateral Horner syndrome, and
      ipsilateral loss of facial pain and temperature but
      contralateral loss of body pain and temperature sensation.
      There is no limb weakness in Wallenberg syndrome.
      Anterior cerebral stroke causes unilateral leg weakness and
      sensory loss. Posterior cerebral artery stroke causes an
      occipital stroke and a homonymous hemianopsia. Middle
      cerebral artery stroke causes hemiplegia or hemiparesis
      greater in the arm than the leg, aphasia, unilateral sensory
      loss, and eyes that deviate to the side of the hemispheric
      lesion. Patients with lacunar infarcts may present with
      different syndromes, such as dysarthria and mild
      hemiparesis (clumsy-hand dysarthria). Lacunar infarcts
      represent small artery occlusions; hypertension and
      diabetes are risk factors for these infarcts. Patients in a
      vegetative state from diffuse cortical damage have
      spontaneous eye opening and movement without evidence
      of awareness.

Question 24

1761.An eldery woman presents with back pain for several
months. She denies recent trauma. She has no weight
loss or loss of appetite. She has no fever, chills, or night
sweats. Physical examination reveals a dowager hump
and mild kyphotic bowing of the spine. Serum calcium,
phosphorus, alkaline phosphatase, and parathyroid hormone levels are normal. The following is the most
appropriate next step in diagnosis of this patient:
A. Lumbar spine radiographs
B. MRI of the spine
C. CT densitometry of the lumbar spine
D. Dual-energy x-ray absorptiometry
E. Bone scan

Answer 24

1761. Answer: D
      Explanation:
      (Tierney, 42/e, pp 1114-1115.)
      Risk factors for osteoporosis include white, Asian-Pacifi c
      Islander, and Native American race; Northwestern
      European descent; blonde or red hair; freckles;
      thin body frame; nulliparity; early menopause;
      family history of osteoporosis; postmenopause;
      constant dieting; calcium intake

Question 25

1762.What is the most common cause of dementia in the
elderly?
A. Parkinson’s disease
B. Neoplasm
C. Stroke
D. Depression
E. Alzheimer’s disease

Answer 25

1762. Answer: E

Source: Day MR, Board Review 2005

Question 26

1763.An elderly man presents with the chief complaint of
leg pain, associated with headache and defi ciency with
walking. On physical examination, the patient has
bowing of the lower extremities and the right lower
extremity is longer than the left lower extremity. The
physical examination is normal, except for hearing loss
and war legs. Laboratory data reveal an isolated elevated
serum alkaline phosphatase level. The fo11owing is the
most likely diagnosis in this patient.
A. Vitamin D defi ciency
B. Paget’s disease
C. Cerebral vascular accident
D. Parkinson’s disease
E. Metastatic bone disease

Answer 26

1763. Answer: B
      Explanation:
      (Tierney, 42/e, pp 1119-1120.)
      Paget’s disease of bone
      (osteitis deformans) is a disorder in which normal bone is
      replaced by disorganized trabecular bone. Patients may be
      asymptomatic but may present with increased hat size
      (skull enlargement), hearing loss (involvement of the
      ossicles of the inner ear), facial pain, headache, backache,
      leg pain, growth of the lower extremities (one leg may be
      longer than the other), tibial bowing, and increased blood
      fl ow to the involved areas of bone growth. Alkaline
      phosphatase may be elevated, and a bone scan will detect
      the lytic lesions. A complication of paget’s disease is
      osteosarcoma (

Question 27

1764.The most commonly prescribed analgesic in the elderly
chronic pain population is:
A. Tramadol
B. Acetaminophen
C. Non-steroidal anti-infl ammatory drugs
D. Opioids
E. Anti-epileptic drugs

Answer 27

1764. Answer: C

Source: Day MR, Board Review 2005

Question 28

1765.Polymyalgia rheumatica is:
A. Twice as common in males as females
B. Responds only to high dose steroids
C. Affects distal muscle groups
D. More common in people of southern European decent
E. Almost exclusively found in Caucasians

Answer 28

1765. Answer: E

Source: Day MR, Board Review 2005

Question 29

1766.In patients undergoing a rehabilitation program after a
hip fracture, benefi t from weight-bearing exercises can
A. improve walking velocity
B. decrease incidence of hip dislocation
C. decrease risk of prosthetic failure
D. improve pain control.
E. improve sleeping pattern

Answer 29

1766. Answer: A

Source: Arch Phys Med Rehabil Vol 85, Suppl 3, July 2004

Question 30

1767. Post-hepatic neuralgia is:
A. More common in women
B. Most often involves lumbar dermatomes
C. Incidence increases with age
D. Gradually worsens with time
E. Pain that persists for 12 month

Answer 30

1767. Answer: C

Source: Day MR, Board Review 2005

Question 31

1768.Proportion of institutionalized elderly persons is
estimated to suffer from chronic pain is:
A. 20%
B. 50%
C. 80%
D. Less than 5%
E. 90%

Answer 31

1768. Answer: C
      Explanation:
      Chronic pain is estimated to affect 80% of institutionalized
      elderly people. Causes include skeletal pain related to
      osteoporosis, rheumatoid arthritis, cervical and lumbar
      spondylosis, osteoporosis, and fractures with resultant
      deformities. Neuropathic pain related to peripheral
      neuropathy from diabetes mellitus, previous stroke, and
      postherpetic neuralgia also occurs. Pain with peripheral
      vascular and cardiovascular diseases, skin ulcers, and
      cancer also occur with greater frequencies in this
      population.
      Source: Arch Phys Med Rehabil Vol 85, Suppl 3, July 2004

Question 32

1769. Which of the following CNS changes are associated with
      aging?
1770. Absent or decreased ankle jerk refl exes
1771. High frequency hearing loss
1772. Reduced information retrieval
1773. Decreased muscle tone

Answer 32

1769. Answer: A (1, 2 & 3)

Source: Day MR, Board Review 2005

Question 33

1770. GI changes associated with the elderly include:
1771. Decreased gastric acid production
1772. Increased lower esophageal sphincter tone
1773. Decreased esophageal transit time
1774. Increased intestinal blook flow

Answer 33

1770. Answer: B (1 & 3)

Source: Day MR, Board Review 2005

Question 34

1771. True statement/s regarding temporal arteritis include/s:
1772. More common in men
1773. Vision changes is the leading symptom
1774. Sedimentation rate is normal
1775. Requires a biopsy to prove diagnosis

Answer 34

1771. Answer: D (4 only)

Source: Day MR, Board Review 2005

Question 35

1772. Hepatic changes associated with aging include:
1773. Decrease in conjugation
1774. Decrease in demethylation
1775. Increase in oxidation
1776. Decrease in liver mass

Answer 35

1772. Answer: C (2 & 4)

Source: Day MR, Board Review 2005

Question 36

1773.The objective/s of physical therapy and rehabilitation
is/are:
1. Stabilize the primary disorder
2. Prevent secondary disabilities
3. Decrease pain perception
4. Treat functional defi cits

Answer 36

1773. Answer: E (All)

Source: Day MR, Board Review 2005

Question 37

1774.An elderly woman is being discharged from the acute
rehabilitation unit after a stroke that resulted in right
hemiparesis. When ordered by a physician and medically
justifi ed. Which service is covered under Medicare?
1. Transportation for medical appointments
2. Spasticity medications
3. Dressing assistance in the morning.
4. Front-wheeled walker

Answer 37

1774. Answer: D (4 Only)

Source: Arch Phys Med Rehabil Vol 85, Suppl 3, July 2004

Question 38

1775. Characteristics of Azheimer’s disease include:
1776. Increase in acetyltransferase
1777. Affects aging populations equally
1778. A rapidly progressive disorder
1779. Mostly affects the Nucleus basalis of Meynert

Answer 38

1775. Answer: C

Source: Day MR, Board Review 2005

Question 39

1776.Pharmacodynamic change/s associated with aging is/
are:
1. Increased sensitivity to opiods
2. Decreased sensitivity to adrenergic specifi c drugs
3. Decreased sensitivity to cholinergic specifi c drugs
4. Decreased sensitivity to benzodiazepines

Answer 39

1776. Answer: A (1, 2 & 3)

Source: Day MR, Board Review 2005

Question 40

1777.Appropriate strategies to manage polypharmacy in
elderly persons include the following:
1. Person-to person patient and family education
2. Use of clinical decision support systems and protocols
3. Assessment of potential drug interactions when starting
a new medication
4. Maintenance of chronic medication regimens despite an
acute medical change

Answer 40

1777. Answer: A (1, 2, & 3)

Source: Arch Phys Med Rehabil Vol 85, Suppl 3, July 2004

Question 41

1778.Ventilatory function is impaired in the elderly for which
of the following reasons?
1. Decreased intercostal and diaphragmatic muscle mass
and function
2. Loss of alveolar spaces and septa, which resembles emphysematous
changes
3. Decreased pulmonary parenchymal and chest wall
elasticity
4. Diminished hypoxic drive

Answer 41

1778. Answer: E (All)
      Explanation:
      (Miller, 4/e. 2151-2152.)
      Hypoxic and carbon dioxide drive is not lost in the elderly,
      but it may be diminished. Therefore, the elderly are at
      great risk for hypoxia and hypercarbia from anesthetic
      drugs that cause respiratory depression. Another factor
      adding to potential pulmonary failure in the elderly is
      complex mechanical changes that involve the chest wall,
      diaphragm, and pulmonary parenchyma.
      Source: Curry S.

Question 42

1779.Changes in cardiac physiology that occur in the elderly
include
1. a decrease in beta receptor responsiveness but no change
in receptor density
2. increased responsiveness of the geriatric heart to indirect-
acting beta mimetics such as ephedrine
3. degenerative changes of the SA node, AV node, and cardiac
conduction system
4. higher resting heart rates

Answer 42

1779. Answer: B (1 & 3)
      Explanation:
      (Miller, 4/e, pp 2150-2151.)
      There is no change in beta receptor density in the elderly;
      however, function is diminished, which affects inotropicity
      and chronotropicity. Also, as a result of diminished
      function, there is diminished responsiveness in both direct
      and indirect beta sympathomimetic drugs. There are
      degenerative fi brotic changes throughout the conduction
      system, which can lead to heart blocks. Resting heart rate is
      decreased
      Source: Curry S.

Question 43

1780. Age changes in the hepatic system include a reduction in
1781. First pass metabolism
1782. Microsomal oxidation
1783. Demethylation
1784. Glucuronidation

Answer 43

1780. Answer: B (1 & 3)

Question 44

1781.Which of the following regarding Polymyalgia
Rheumatic are true?
1. More common over the age 55 yrs
2. Elevated erythrocyte sedimentation rate
3. Associated with temporal arteritis
4. Elevated creatine kinase

Answer 44

1781. Answer: A (1, 2, & 3)

Question 45

1782. In the elderly, drug effects are infl uenced by:
1783. Decreased renal function
1784. Increased volume of distribution
1785. Reduced hepatic function
1786. Decreased relative body fat

Answer 45

1782. Answer: B (1 & 3)

Question 46

1783. Age changes in the renal system include a reduction in
1784. Creatinine clearance
1785. Renal blood fl ow
1786. Glomerular fi ltration
1787. Free water clearance

Answer 46

1783. Answer: A (1, 2, & 3)

Question 47

1784.Grapefruit juice increases serum levels of all of the
following medications
1. warfarin.
2. thoephylline.
3. cyclosporine.
4. nonsteroidal anti-infl ammatory drugs

Answer 47

1784. Answer: A (1, 2, & 3)
      Explanation:
      Grapefruit juice inhibits hepatic enzyme metabolism and
      increases the serum levels of certain medications, for
      example, warfarin, theophylline, and cyclosporine.
      Source: Source: Podrazik PM, Schwarts JB. Cardiovascular
      pharmacology of aging. Cardiol Clin 1999;17:17-34.

Question 48

1785. Changes in the central nervous system (CNS) that occur
      in the geriatric population include
1786. a progressive decline in CNS function with a loss of
      cerebral cortex neurons
1787. decreased cerebral metabolic rate and decreased cerebral
      blood fl ow
1788. a decrease in the synthesis of neurotransmitters and
      receptor sites for them
1789. a need for increased doses of local anesthetics when
      epidural anesthesia is performed

Answer 48

1785. Answer: A (1, 2, & 3)
      Explanation:
      (Miller, 4/e. pp 2147-2148.)
      There is a generalized decline in the CNS with aging. MAC
      decreases as a result. Local anesthetic requirements
      decrease as well as for all nerve blocks.
      Source: Curry S.

Question 49

1786.Changes in cardiac output in the elderly are correctly
characterized by which of the following statements?
1. Cardiac output declines more with age in women than
in men
2. Increases in cardiac output that occur with stress decline
with aging
3. Coronary blood fl ow needs are decreased in the elderly
for a given cardiac output
4. Persons who maintain physical aerobic fi tness may have
unchanged cardiac output from the third to the sixth
decade

Answer 49

1786. Answer: C (2 & 4)
      Explanation:
      (Miller, 4/e. pp 2150-2151.)
      Cardiac output does not necessarily decline with aging.
      Persons who maintain aerobic fi tness may have unchanged
      cardiac output well into the seventh decade, at which point
      cardiac output will fall off. In the elderly there is a loss of
      an increase in cardiac output in response to stress, but this
      is attenuated somewhat in the elderly who are fi t.
      Source: Curry S

Question 50

1787. Considerations in elderly patients include that
1788. body fat decreases, as does the half-life of fat-soluble
      drugs
1789. impaired hypothalamic function, which mediates heat
      control, is the primary reason the elderly become hypothermic
      more easily than do the young
1790. right bundle branch blocks are common in healthy,
      asymptomatic elderly patients and in most cases should
      be considered a normal fi nding
1791. they have widened pulse pressure

Answer 50

1787. Answer: D (4 Only)
      Explanation:
      (Stoelting, Anesthesia and Co-Existing Disease, 3/e. pp
      631-633.)
      Body fat increases (in women more than in men) and fatsoluble
      drugs have a longer elimination half-life in the
      elderly. Hypothalamic dysfunction may be one factor that
      contributes to a greater degree of heat loss in elderly
      patients, but the primary reason for a propensity to
      hypothermia is impaired cutaneous vasoconstriction and
      reduced heat production (basal metabolic rate declines
      from 42 kcal/h in a 20-year-old to 32 kcal/h in an 80-yearold
      person). Healthy, asymptomatic elderly patients have a
      high incidence of supraventricular and ventricular ectopic
      beats. A right bundle branch block is not a normal
      fi ndings and should prompt a search for organic heart
      disease. Systolic blood pressure increases in the elderly as
      the aorta and large arteries lose distensibility. Diastolic
      pressure normally does not change much with age.
      Source: Curry S.

Question 51

1788. The type(s) of exercise training widely accepted as the
      optimal way to enhance and maintain function in older
      adults include:
1789. Endurance
1790. Flexibility
1791. Balance
1792. Resistance

Answer 51

1788. Answer: D (4 Only)
      Explanation:
      Endurance exercises have effects on cardiovascular
      impairment, leading to improvements in morbidity and
      mortality, but their effect on function is limited. Resistance
      training enhances function and is accepted as the optimal
      means to maintain function in older adults. Flexibility and
      balance probably also contribute to function but adequate
      studies designed for the purpose of evaluating disability
      are lacking.
      Source: Arch Phys Med Rehabil Vol 85, Suppl 3, July 2004

Question 52

1789.Regarding interdisciplinary assessment, the following
benefi ts apply to the geriatric population.
1. It allows the development of specifi c, targeted interventions.
2. It allows reliable testing of persons over time.
3. It allows better reimbursement and insurance coverage
for outpatient and home-based interventions.
4. It allows care providers to develop independent treatment
plans.

Answer 52

1789. Answer: A (1, 2, & 3)

Source: Arch Phys Med Rehabil Vol 85, Suppl 3, July 2004

Question 53

1790.Which physiologic factor in the elderly exacerbates
orthostasis?
1. Decreased creatinine clearance
2. Decreased peripheral resistance
3. Decrease in arterial stiffness
4. Decreased baroreceptor response

Answer 53

1790. Answer: D (4 Only)
      Explanation:
      As many as 20% of persons over the age of 65 years and
      30% of those over age 75 have orthostatic hypotension.
      Orthostasis is often exacerbated because of an increase in
      arterial stiffness, increased peripheral resistance, decreased
      baroreceptor response, and low plasma rennin activity.
      Source: Arch Phys Med Rehabil Vol 85, Suppl 3, July 2004

Question 54

1791.True statements regarding pain in the elderly persons
are as follows:
1. Elderly persons feel pain as much as younger people.
2. Pain can commonly be localized to a single site.
3. Approximately one third of elderly individuals have
chronic joint pain and arthritis.
4. Pain results in less functional impairment in the elderly
compared with the younger population.

Answer 54

1791. Answer: B (1 & 3)

Question 55

1792.True statements regarding falls in the geriatric
population include the following:
1. Most falls are considered accidental, rather than related
to underlying diseases or functional impairments.
2. The timed “Get up & Go” test is an appropriate way to
assess someone who presents with frequent falls.
3. Dynamic balance training activities such as Tai Chi have
no effect on fall risk or fear of falling.
4. Fall risk assessment should evaluate both intrinsic and
extrinsic risk factors.

Answer 55

1792. Answer: D (4 Only)

Source: Arch Phys Med Rehabil Vol 85, Suppl 3, July 2004

Question 56

1793.The factor(s) improving bowel transit time in persons
with chronic constipation include:
1. Bedrest
2. Bulking agents
3. Fluid restriction
4. High fiber diet

Answer 56

1793. Answer: C (2 & 4)
      Explanation:
      Schiller LR. Constipation and fecal incontinence in the
      elderly. Gastroenterol Clin North Am 2001; 30:497-515.

Question 57

1794. Drugs used in the treatment of dementias include which
of the following?
1. Nonsteroidal antiinfl ammatory drugs
2. Anticholinesterase drugs
3. Antioxidant agents
4. Muscarinic antagonists

Answer 57

1794. Answer: A (1, 2, & 3)

Question 58

1795.Which of the following changes in renal function will
occur in the geriatric population?
1. An increase in renal cortical blood fl ow versus renal
medullary blood fl ow occurs
2. Decreased muscle mass in the elderly leads to decreased
creatinine levels
3. There are no changes in urine concentrating ability
4. Decreased renal blood fl ow occurs because of decreased
cardiac output and a decrease in size of the renal vascular
bed

Answer 58

1795. Answer: C (2 & 4)
      Explanation:
      (Miller, 4/e. pp 2146-2147.
      )
      Renal blood fl ow decreases in the elderly because of a
      decrease in cardiac output and a decrease in the size of the
      renal vasculature, particularly the cortex. This leads to
      reduced renal cortical blood fl ow and decreased
      glomerular fi ltration rate (GFR), concentrating ability, and
      creatinine clearance. With the decrease in creatinine
      clearance, there is also a decrease in muscle mass and
      production of creatinine. This explains why serum
      creatinine levels do not decrease in the elderly. Any
      increase in creatinine in the elderly signifi es a large
      decrease in an already diminished GFR.
      Source: Curry S.

Question 59

1796.Endocrinologic changes that occur in the elderly
include
1. a greater incidence of primary hyperparathyroidism
2. increased incidence of diabetes mellitus
3. increased incidence of Graves’ disease
4. increased incidence of hypothyroidism

Answer 59

1796. Answer: C (2 & 4)
      Explanation:
      ( Stoelting, Anesthesia and Co-Existing Disease, 3/e. pp
      633-636.)
      Primary hyperparathyroidism and Graves’ disease do not
      have an increased incidence in the elderly. Adult-onset
      diabetes occurs with greater frequency in the sixth and
      seventh decades. Circulating insulin levels are normal. It is
      believed that the cause of diabetes in this age group may
      be
      insulin receptor dysfunction. Thirteen percent of the
      elderly population have hypothyroidism; the vast majority
      are asymptomatic. The only abnormal measure of thyroid function may be an elevated level of thyroid stimulating
      hormone. The most common cause of hypothyroidism is
      Hashimoto’s thyroiditis.
      Source: Curry S.

Question 60

1797.Regarding foot care, compared with the general
population, diabetic patients
1. are 15 to 17 times more likely to require an amputation.
2. have a 10-year survival rate of 25% to 50% after an
amputation.
3. are less likely to be noncompliant with foot checks.
4. Have a 15% rate of amputation if a chronic ulcer is
present.

Answer 60

1797. Answer: B (1 & 3)

Source: Arch Phys Med Rehabil Vol 85, Suppl 3, July 2004

Question 61

1798.Activities associated with a reduced risk of dementia
include:
1. Playing musical instruments
2. Dancing
3. Playing board games
4. Bowling

Answer 61

1798. Answer: A (1, 2, & 3)

Source: Arch Phys Med Rehabil Vol 85, Suppl 3, July 2004

Question 62

1799. True statements about the hepatobiliary system in the
      geriatric age group include
1800. hepatic blood fl ow decreases as a result of decreased
      cardiac output
1801. a decrease in activity of hepatic microsomal enzymes
      occurs
1802. production of albumin is decreased
1803. hepatic vein blood fl ow decreases

Answer 62

1799. Answer: E (All)
      Explanation:
      (Miller, 4/e. pp 2145-2146.)
      The reduction in hepatic blood fl ow is commensurate with
      the decrease in cardiac output that occurs in the elderly.
      Hepatic microsomal enzyme activity also decreases in the
      ages. Drug clearance and metabolism are reduced in the
      elderly, but the cause of this is probably the decrease in
      cardiac output rather than diminished enzyme activity.
      Hepatic vein blood fl ow and albumin levels are
      diminished in the elderly.
      Source: Curry S

Question 63

1800.The benefi ts of hiring older workers (compared with
younger colleagues) in medical industry include
1. fewer workers compensation claims.
2. less use of health care benefi ts.
3. decreased rate of burns.
4. lower absentee rates.

Answer 63

1800. Answer: D (4 Only)

Source: Arch Phys Med Rehabil Vol 85, Suppl 3, July 2004

Question 64

1801. Dementias are characterized by
1802. Generalized limitation of cognitive function
1803. Cholinergic dysfunction
1804. Progressive decline in function
1805. Depression of consciousness

Answer 64

1801. Answer: A (1, 2, & 3)

Question 65

1802.Elderly patients generally show increased sensitivity to
which of the following drugs?
1. Phenylephrine
2. Diazepam
3. Oxycodone
4. Morphine

Answer 65

1802. Answer: C (2 & 4)

Question 66

1803.In the general geriatric population, the factor(s)
associated with an increased risk of driving accidents
are as follows:
1. Hemodialysis
2. Chronic Pain
3. Myopia
4. Stroke

Answer 66

1803. Answer: D (4 Only)

Source: Arch Phys Med Rehabil Vol 85, Suppl 3, July 2004

Question 67

1804.In elderly patients, conditions contraindicating to
starting an exercise program are:
1. End-stage congestive heart failure
2. Recent ophthalmologic surgery
3. severe behavioral disturbance
4. Stable 3-cm abdominal aortic aneurysm

Answer 67

1804. Answer: A (1, 2, & 3)
      Explanation:
      The condition that is not a contraindication to starting an
      exercise program in an elderly patient from the listed
      choices is a small or stable abdominal aortic aneurysm. All
      the other conditions warrant further investigation and
      stabilization before initiating an exercise program.
      Source: Arch Phys Med Rehabil Vol 85, Suppl 3, July 2004

Question 68

1805.Which statement concerning osteoarthritis (OA) is true?
1. Exercise in patients with OA contributes to pain reduction.
2. Group exercise programs are much more effective than
individual programs in reducing disability
3. High-intensity progressive resistance exercises in patients
with OA causes the disease to progress.
4. Exercise in patients with OA contributes to pain reduction.

Answer 68

1805. Answer: D (4 Only)
      Explanation:
      Exercises for patients with osteoarthritis (OA) is
      considered to be safe and to contribute to the reduction of
      pain. Exercise programs have not been associated with
      disease progression. No clear difference has been noticed
      in the reduction of disability when comparing group,
      individual, and home-based exercise programs. Aerobic
      exercise is effective in correcting reductions in aerobic
      capacity in patients with OA.
      Source: Arch Phys Med Rehabil Vol 85, Suppl 3, July 2004

Question 69

1806.Which physiologic changes related to aging is included
among factors that necessitate decreased loading doses
for water soluble medications?
1. Increased fat mass
2. Decreased muscle mass
3. Decreased total body water
4. Decreased cardiac output

Answer 69

1806. Answer: A (1, 2, & 3)
      Explanation:
      Increased fat mass, decreased muscle mass, and decreased
      total body water affect the distribution of medications.
      Normal pshsiologic changes of aging include decreased
      intestinal motility, decreased cardiac output, and decreased
      creatinine clearance.
      Source:Fulop T Jr, Worum I, Csongor J, Foris G, Leovey A.
      Body composition in elderly people. I.Determination of
      body composition by multiisotope method and the
      elimination kinetics of these isotopes in healthy elderly
      subjects. Gerontology 1985; 31:6-14.

Question 70

1807. Pharmacokinetic changes in the elderly include
1808. Increased volume of distribution
1809. Deceased lean body mass
1810. Increased lipid content
1811. Longer beta elimination

Answer 70

1807. Answer: E (All)

Question 71

1808.A 75-year-old sedentary man with a history of
hypertension, type II diabetes mellitus, and mild sensory
neuropathy who is currently a nonsmoker wishes to
begin an exercise program. The safest initial modality of
exercise includes the following:
1. Treadmill walking at 1.5mph on level surface
2. Stair stepper for 15 minutes without resistance
3. Machine-based quadriceps extensions at 80% maximum
weight
4. Lifting 1- to 3-pond weights overhead while seated

Answer 71

1808. Answer: D (4 Only)
      Explanation:
      Bean JF, Vora A, Frontera WR. The benefi ts of exercise for
      community-dwelling older adults. Arch Phys Med Rehabil
      2004;85(Suppl 3):S31-42.

Question 72

1809.Risk factor(s) for erectile dysfunction in elderly men
include the following:
1. Recurrent inguinal hernia.
2. pharmacologic side effects.
3. hypothyroidism
4. Low testestrone levels

Answer 72

1809. Answer: C (2 & 4)

Source: Arch Phys Med Rehabil Vol 85, Suppl 3, July 2004

Question 73

1810.Important pharmacologic considerations in the elderly
include that
1. the dose of thiopental in elderly patients should be decreased
primarily because of altered pharmacokinetics
2. the elimination half-life of diazepam in hours approximates
the patient’s age in years
3. the dose of atracurium need not be adjusted for age
4. the MAC for isofl urane in a 40-year-old is 1.15 and in an
80-year-old is 0.97

Answer 73

1810. Answer: E (All)
      Explanation:
      (Miller, 4/e. pp 2143-2146.)
      The initial volume of distribution for thiopental is
      decreased, which causes higher serum concentrations in
      older compared with younger patients. Elderly and
      younger patients respond to similar serum concentrations
      of thiopental. The clearance of diazepam is reduced in the
      elderly, which accounts for its longer duration of action.
      Cognitive impairment can continue for a very long time
      after administration of this drug in the elderly. Unlike all
      other nondepolarizing muscle relaxants, attacurium is
      independent of age-related changes. Decreases in MAC
      occur with age for isofl urane and the other potent
      inhalational agents.
      Source: Curry S.

Question 74

1811.True statements concerning the elderly include
1. there is a direct correlation between biologic age and
chronologic age
2. the fi ve most frequently performed surgical procedures
are cataract extraction, transurethral, prostatectomy,
herniorrhaphy, cholecystectomy, and reduction of a
hip fracture
3. geriatric patients are arbitrarily defi ned as those older
than 75 years of age
4. generalized osteoporosis may be an important factor in
the increased incidence of hip fractures in the elderly

Answer 74

1811. Answer: C (2 & 4)
      Explanation:
      (Stoelting, Anesthesia and Co-Existing Disease, 2/e, pp
      633 – 637.)
      There is no defi nite correlation between biologic age and
      chronologic age. In patients who maintain aerobic fi tness,
      there may be no changes in cardiac output until well into
      the seventh decade. Physical fi tness will even decrease
      osteoporosis and may cause a decrease in the incidence of
      hip fractures. Patients who do not maintain aerobic fi tness
      may show signs of osteroporosis and decreases in cardiac
      output that make them biologically older than those who
      do. Geriatric patients are arbitrarily defi ned as those over
      65 years of age.
      Source: Curry S.

Question 75

1812.Major anatomic changes seen in the cardiovascular
system in the elderly include
1. an increase in left ventricular wall thickness
2. myocardial fi brosis
3. valvular fi brocalcifi cations
4. loss of elasticity of the peripheral circulation

Answer 75

1812. Answer: E (All)
      Explanation:
      (Miller, 4/e. pp 2150 – 2151.)
      Explanation: All the listed changes are normal parts of the
      aging process. Atherosclerosis superimposed on these
      changes only exacerbates the decrease in cardiovascular
      function, particularly a decrease in cardiac output.
      Source: Curry S.

Question 76

1813.Parkinson’s Disease is noted to include which of the
following clinical fi ndings?
1. Painful dystonias
2. On/Off phenomena (freezing)
3. Cognitive dysfunction
4. Tremors

Answer 76

1813. Answer: E (All)

Question 77

1814. An 85-year-old, 300-pound man underwent right upper
      lobectomy. Which of the following would be acceptable
      techniques to provide adequate postoperative pain relief?
1815. Cryoneurolysis of the right intercostal nerves at multiple
      levels
1816. Continuous segmental epidural analgesia with local
      anesthetic
1817. Intercostal blocks with long-acting local anesthetic on
      the right at multiple levels
1818. Intercostal blocks with long-acting local anesthetic bilaterally
      at multiple levels

Answer 77

1814. Answer: A (1, 2, & 3)
      Explanation:
      (Capan, p 691.)
      In elderly patients with high body mass
      indices, bilateral intercostal nerve blocks at T5-T11 were
      found to change the relationship between closing capacity
      and functional residual capacity, leading to hypoxemia and
      hypercarbia. This did not occur in younger patients with
      normal body mass indices. Cyroneurolysis, unilateral
      intercostal nerve blocks, and epidural analgesia are
      acceptable techniques for providing postoperative
      analgesia and decreasing pulmonary dysfunction.
      Source: Kahn and Desio

Question 78

1815. In the elderly population
1816. Cold pressor response is decreased
1817. Nociceptors demonstrate increased sensitivity
1818. Cutaneous electrical current threshold decreases
1819. Mechanical pressure threshold decreases

Answer 78

1815. Answer: E (All)

Question 79

1816.Your suspect that your elderly patient is being abused
by a family caregiver. To assess this risk, the element
evaluated include:
1. Stress
2. Alcoholism
3. Violence
4. Driving

Answer 79

1816. Answer: A (1, 2, & 3)

Source: Arch Phys Med Rehabil Vol 85, Suppl 3, July 2004