lato 2019 Flashcards
Which of the following has been shown to increase drug adherence in the eldery?
physycian explanation
Which of the following opioids are available in Poland in transdermal patch?
fentanyl
buprenorphine
Long acting NSAIDs can have all of the following effects on the elderly except
hypotension
How long after applying a transdermal fentanyl patch can an analgesic effect be observed:
12h
Which of the following patients with break through pain should not be treated with transmucosal fentanyl (TIRF):
a 40 yo patient with advanced lung cancer who has been treated with a transdermal fentanyl patch (12,5ug/h) for the past 2 months
A patient with lung cancer is experiencing severe pain resulting from infiltration of the chest wall (NRS 7-8). Therapy is initiated and optimal pain relief is achieved with the paitent receiving 40 mg of oxycodone in a controlled released tablet every 12 hours (6:00 and 18:00). Occasionally, the patient reports exacerbations of pain reaching 9 on the NRS scale, lasting 20 minutes, without any clear cause. Please determine the type of pain:
spontaneous breaktrough pain
Which of the following increases with age:
gastric pH
Please read the following excerpt of a conversation and choose the best ending:
- How did you sleep last night?
- Poorly, I couldn’t fall asleep (blablabla)
- Yes
- What is it?
- I am worried.
- You’re worried?
- Yes. I don’t know what will come next.
- Did you talk about this with your doctor?
- If only the doctor had been listening, I would have told him what i really feel
Why do you think the doctor wasn’t listening?
72 yo man with hypertension controlled with 2,5mg indapamide had a 6-month history of dyspnoea on walking his dog and when gardening. His echocardiogram showed mild concentric hypertrophy of the left ventricular, RF of 40%. Which of the following would be the most likely to improve his life expectancy:
ACEI
Secondary gastroparesis occurs due to all of the following except:
generalized artherosclerosis
The drug of choice in the treatment of diarrhea due to Clostridium difficile infection:
Vancomycin p.o.
A smooth and red surface of the tongue (atrophy of lingual papillae) with disturbances of taste is characteristic for which form of mycosis:
chronic atrophic
The reason of an impaired communication with an older patient (hearing impairment) is not:
hypersensitivity to the high frequency sounds
A 30yo patient with metastatic colon cancer asks his doctor “Am i dying?” What should the doctor respond?
Please tell me, why are you asking?
Multiple brain metastases most frequently occur in
Small cell lung carcinoma
A feature of the clinical course supporting the differentiation between dementia with Lewy bodies and dementia in the course of Alzheimer’s disease is:
a fluctuating course of cognitive processes with variability of attention and wakefulness
hypersensitivity to neuroleptisc
visual hallucinations
Which of the following statements regarding the use of opioids in the treatment of dyspnea is false
opioids increase the sensitivity of the central respiratory zone to increased levels of CO2
The most frequent cause of seizures in patients with advanced neoplasms:
primary or secondary brain tumor electrolyte disturbances (hyponatremia)
80- year- old woman with a history of hypertension and congestive heart failure complaints of frequent episodes of incontinence. She says that these episodes happen without warning, usually in the context of coughing or sneezing. Which of following interventions is the most likely to help with her incontinence:
pelvic muscle exercises
Choose the best answer of five major components of a comprehensive assessment of the older adult patient:
medical, cognitive, functional, nutritional, social aspects
Which of the following neoplasms most frequently cause recurrent pleural effusion:
lung cancer
breast cancer
Which of the following regarding spinal cord compression syndrome is false:
it occurs in the cervical spine in 70% of cases
In differentiating Alzheimer’s disease with vascular dementia, vascular dementia is indicated by:
jumping course of symptoms
prevalent numerous strokes
The frequency of resting dyspnea in patients with advanced bronchial carcinoma is:
80%
A 75-year-old woman with multiple health problems complains of having “no energy” and feeling increasingly weak. She has had a 6kg loss over the last 3 months. Choose the other components use to recognize frailty syndrome:
physical activity
muscle strenght
walk speed
In 80% of patients with spinal cord compression of a few-weeks duration the first symptom is:
radicular pain
78 y-o man presents to the primary care clinic with complaints of dryness of mouth, constipation, increased heart rate, falls without obvious reason, confusion. Which of the following types of drugs might be to blame:
anticholinergics
A patient with sarcoma of the left thigh complains of mixed pain (nociceptive-neuropathic) localized in the region of the left thigh with radiation to the hip. The intensity of the pain NRS 8-9/10 and is worst when the patient is standing. Until now, the patient has been receiving tramadol 400mg/d, paracetamol 3g/d and ketoprofen 200mg/d. Please choose the best course of action:
withdraw tramadol; administer controlled- release morphine 40mg/d, immediate- release morphine as needed and pregabalin 75mg/ d; continue administration of paracetamol and ketoprofen
Which of the following type of dressing will be optimal to apply for pressure ulcer in stage III with slough and complicated by local infection:
gase
Which type of exercise would you advise to a person aged 65+ to improve endurance:
nordic walking
Which of the following drugs are most useful in the treatment of pain with a neuropathc component:
valproic acid
gabapentin
pregabalin
What pharmacodynamic changes are seen in the elderly with regard to ACE-inhibitors and beta-blockers:
ACEI decreased B-blockers ?
Pregabalin and gabapentin act by:
inhibiting the alpha-2-delta of voltage-dependent calcium channels
Which of the following is true of urge incontinence:
decreased innervation and loss of bladder function resulting in bladder atrophy
Which of the following statements about tramadol is false:
simultaneous administration of tramadol and paroxetine does not increase the risk of serotonin syndrome
What immunization is recommended to all older people:
none of the answers above is true
In the patient with cancer pain till now not having taken opioids, we decide to introduce the treatment of morphine. We start titration, administer intravenously 1 mg of morphine every 5 minutes and we obtain pain relief with a dose of 10 mg. Please indicate the daily \demand of the drug:
60 mg .v. daily
75-y-o woman with osteoporosis presents to the primary care clinic with a urinary tract infection. She is currently taking alendronate, vit. D, and calcium. Which of the following drugs may be less effective, considering the drugs she is currently taking, especially calcium:
ciprofloxacin
A 79 year old woman with dementia was recovering from a fall when she developed a left ileofemoral deep vein trombosis. The occupational therapist is considering the suitability for care services. Which of the following is NOT included in the Bartel Index:
cognition
A 74 year old woman has pressure ulcer on heel stage III with slough and small exudate. No signs of local infection, indicate the optimal metod of debridement of the pressure ulcer:
hydrogel or hydrocoloid dressing
A 70 year old man who lives in assisted living is admitted to hospital with several hand fractures related to fall. His family notes that he has 2-yr history of progressive memory impairment. On examination, the patient is phisically agitated and appears anxious. He is verbal but cannot recall where he is or why. His score on the MMSE is 15/30 and his attention span is normal. He sleeps poorly in the hospital at nights and tend to sleep during the day, but he is easily aroused. Physical examination, brain imaging and laboratory examinations do not identify reversible cause of his impairments. Which of the following is the most likely cause of this patient’s agitation.
Alzheimer’s disease
In the patient with severe pain (NRS=9) after titration of morphine we obtained a pain relief with a 24 hour dose of 40 mg of this opioid given s.c. After laboratory tests the patient was diagnosed with renal failure. Taking into consideration coexisting pain and renal insufficiency the best choice of opioid in this case will be:
transdermal buprenorphine 35ug/ h
Which of the following items is not a component of Mini Mental State Examination:
proverb interpretation
A 94-y-l nursing home resident with Alzheimer’s disease is evaluated because she has been disturbing other patients by screaming for help and banging on the nurse throughout a day for the past 4 weeks. Which of the following drug group is the most likely to reduce the patient’s agitation:
second generation antipsychotics
Which of the following statements regarding megestrol acetate is false:
it worsens appetite
Polyuria is urination:
greater than 7 times per day and 2 times during the night
Which of the following drugs act as anti-emetics by blocking D2 receptors in the chemoreceptor trigger zone and may effectively decrease nausea and vomiting due to hypercalcemia?
Haloperidol
Side effect to expect from anticholinergic (parasympatholitic) agents include all of the following exept
increased sweating
diarrhea
Differences in the presentation of depression in elderly compared to the younger age groups include
more frequent psychotic symptoms
the difference in the expression of anxiety in the form of excessiwe worrying, concentration disorders, memory impairment
