Geri III

Question 1

Which lab test listed below is used primarily to assess hydration status?

Answer 1

BUN

Question 2

In evaluating a patient with shortness of breath, which test would be most helpful in differentiating cardiac from pulmonary causes?

Answer 2

brain natriuretic peptide

Question 3

Heart failure can be due to many causes. To evaluate the structure and function of the heart, you would order:

Answer 3

echocardiogram

Question 4

Heart failure with preserved left ventricular function is known as:

Answer 4

diastolic heart failure (HFpEF)

Question 5

An 89 year old male is admitted for heart failure. He has fluid overload, an ejection fraction of 25%, and is very short of breath. He can not walk 10 feet without resting. He has been maximized on his oral medicines at home and this is his third admission in six months. According to the American College of Cardiology, what is his level of heart failure?

Answer 5

Stage D

Question 6

Which of these illnesses is the most common cause of cor pulmonale and right ventricular failure in old age?

Answer 6

COPD

Question 7

Which of the following is the primary mechanism through which atrial fibrillation significantly decreases cardiac output in the elderly?

Answer 7

decreased ventricular filling

Question 8

The most common causes of heart failure are:

Answer 8

hypertension and coronary heart disease

Question 9

Hyperhomocysteinemia is now known to be associated with:

Answer 9

Hyperhomocysteinemia is now known to be associated with:

Question 10

What would be the first step in the treatment of diastolic heart failure?

Answer 10

What would be the first step in the treatment of diastolic heart failure?

Question 11

What would be the first step in the treatment of diastolic heart failure?

Answer 11

apnea means complete but temporary cessation of respiration

Question 12

Sleep Disordered Breathing (SDB) can present with complaints of:

Answer 12

nighttime urination

loud snoring

daytime somnolence

insomnia

Question 13

Approximately 50% of community-dwelling elders have some form of sleep difficulty. While researchers are investigating sleep-related changes associated with aging, elderly clearly have:

Answer 13

a reduced ability to sleep

Question 14

Mrs. Clare is 58 years old. She has complaints of a crawling sensation affecting her legs during the night. She states she will awaken and feel so uncomfortable that she has to get out of bed and walk around for awhile before she can resume sleep. This sensation only occurs at night. Her diagnosis is likely:

Answer 14

Restless Leg Syndrome

Question 15

Mrs. Fried wants you to refer her to the Sleep Clinic. She states that every night she wakes up about midnight and has trouble falling back asleep. This has been occurring for many months and she feels she needs a sleep study to find out what’s wrong. She states she exercises daily, eats a healthy diet, which includes two glasses of red wine at dinnertime. Before you agree to refer her you advise her to:

Answer 15

discontinue the wine drinking, due to rebound insomnia

Question 16

Mrs. Watson was diagnosed with sleep apnea many years ago. She wears her CPAP nightly. She was diagnosed with diabetes about 5 years ago and became serious about losing weight. Since then, she has lost 30 pounds and her sugars are now diet-controlled. She complains of worsened sleep quality. She wakes up frequently, but she does not know why. She has daytime somnolence as well. What evaluation could you order that would help to identify her problem?

Answer 16

polysomnogram

Question 17

Each of us has an internal circadian clock. As we age, biological rhythms change and our sleep-wake cycle can advance. The most powerful external zeitgeber (the German word for “timegiver”) for our sleep-wake cycle is:

Answer 17

exposure to bright light

Question 18

Which medication would be contraindicated for a patient with central sleep apnea (due to respiratory drive depression)?

Answer 18

a benzodiazepine

Question 19

You receive a call from the Westward Meadow Assisted Living Facility. Your patient, Mr. Jay, is a resident there. The staff is calling you requesting a sleep medicine for him. They state he is up most of the night and appears to suffer from insomnia. They state another resident was prescribed risperidone by their doctor to help them sleep at night. The next most appropriate step for you to take is to:

Answer 19

ask for a detailed report about his sleep habits, including daytime naps

Question 20

Sleep disorders are more common in adults who live in nursing homes. We know that there are age-related changes that cause sleep disorders. Which of the following diseases may cause an increased risk for developing a sleep disorder?

Answer 20

dementia

Question 21

A 72 year old patient comes to clinic with complaints of an irregular heartbeat. He states that three days ago his heart was beating fast for about ten minutes and then suddenly went back to normal. He did not feel short of breath or experience any chest pain. He reports this happened once before about 2 weeks ago and was similar in length and how it felt. When you examine him today his heart is beating regularly without any murmurs or irregular beats noted. The best way to evaluate his complaint would be to order:

Answer 21

an event monitor

Question 22

Which of the following lab tests is specifically indicated in the evaluation of a patient with possible congestive heart failure (CHF)?

Answer 22

Brain natriuretic peptide (BNP)

Question 23

You see a patient with known heart disease in clinic who describes a recent change in her physical limitations. She used to be able to walk 20 level yards to her mailbox with only mild shortness of breath and chest pain. She no longer can do so without becoming severely short of breath and experiencing a sense of chest heaviness. Which of the following changes in her New York Heart Association functional classifications has occurred?

Answer 23

From Class II to Class III

Question 24

With normal oxygen availability to tissues, glucose is metabolized to carbon dioxide and water. When oxygen to the tissues is diminished anaerobic metabolism of glucose occurs. What substance is formed (instead of carbon dioxide and water) during this hypoxic state?

Answer 24

lactic acid

Question 25

Which of these is most likely to be the symptom that indicates heart failure in the elder patient?

Answer 25

Profound fatigue

Question 26

An 82 year old patient is found to have progressive fibrosis of the sinoatrial node. He experiences dizziness and recently had a syncopal episode resulting in a fall with trauma to his head. He is not on any medications. His pulse today is 48 and regular. His blood pressure is 116/74. His EKG shows third-degree AV block. The most important thing you can to do manage his care is to:

Answer 26

refer him for pacemaker implantation

Question 27

You see a 66 year old as a new patient and notice he has an irregular heart rate. You perform the EKG and find the patient in atrial fibrillation. The patient is on hydrochlorothiazide for blood pressure and a full-strength aspirin. He has no history of bleeding problems, such as peptic ulcer disease. To manage this patient, you should:

Answer 27

begin warfarin

Question 28

According to Dr. Cheng and her colleagues, as written in the JAMA article assigned in Module 3, patients with prolonged PR interval or first-degree atrioventricular block, are at increased risk for developing:

Answer 28

atrial fibrillation or need for pacemaker

Question 29

You are managing a patient on warfarin. The patient is on this drug for atrial fibrillation. He has never had any thrombotic event. Your goal for his INR (international normalized ratio) should be:

Answer 29

2.0-3.0

Question 30

Mrs. Chavez is homebound and has a visiting nurse. The nurse paged you today with the result for the (PT)INR, which was 4.0. Mrs. Chavez has been taking 5 mg of warfarin every day at 6 pm. She is not having any signs of bleeding or bruising. You instruct the nurse to tell her:

Answer 30

hold the dose x 2 days, then recheck the INR on day 2

Question 31

George is 69 years old. He is complaining of wheezing and shortness of breath. He has smoked for 25 years, 1 pack per day. He states he has a morning cough with whitish sputum. He has not had fever or chills. His vitals today are all within normal range. Oxygen saturation is 90% on room air. His oxygen usually runs around 92%. Differentiating between asthma and COPD in his age group is more difficult compared to younger patients because:

Answer 31

Olders patients have higher prevalence of comorbidities that cloud the clinical picture.

Question 32

Extrapulmonary manifestations of COPD represent systemic effects of the disease. The most principal extrapulmonary manifestation that impacts these patients is:

Answer 32

skeletal muscle dysfunction

Question 33

You see a nonsmoking 32 year old patient in clinic with the abrupt onset of low grade fever (100 deg F), nonproductive cough, mild wheezing, and generalized muscle aches and pains over the past two days. What is the most likely type of causative agent?

Answer 33

virus

Question 34

Mr. Howard is 68 years old and has a diagnosis of COPD. He is recently retired and admits to decreased activity, watching television most all day. He complains of increased shortness of breath that began about one week ago. He does not feel like he has an infection and thinks the worsened breathing was present when he got up one morning. He is afebrile and his weight is unchanged. He has no other complaints at this time. Which one of the following should be ruled out urgently as a possible cause for his worsened breathing symptom?

Answer 34

pulmonary embolus

Question 35

You work in a rural health clinic in a frontier community. One of your patients is dying of advanced COPD and you stop in to see that he is comfortable. You find that he is experiencing shortness of breath and “air hunger” which makes him quite uncomfortable. In addition to starting O2 therapy, which of the following could you use to relieve this person’s symptom of “air hunger”?

Answer 35

Morphine sulfate

Question 36

Which of the following is the single most common etiology for COPD?

Answer 36

tobacco smoking

Question 37

Which symptom is a clinical hallmark of a patient with chronic bronchitis?

Answer 37

chronic, copious sputum production

Question 38

COPD and asthma can present with similar symptoms. The most common way to differentiate between the two is:

Answer 38

spirometry with pre- and post bronchodilator

Question 39

According to Dr. Sethi in his article assigned in Module 3, approximately 50% of COPD exacerbations are caused by:

Answer 39

bacteria

Question 40

There are expected changes in lung function as a person ages, regardless of whether they have smoked during their life. Which of the following is one of the expected changes?

Answer 40

lower diffusing capacity