Family Practice Exam Geriatric Care 2 — Questions and Answers
Question 1: An 82-year-old woman is brought to your office by her daughter who reports the patient has fallen three times in the past month. Which assessment tool is most appropriate to evaluate her fall risk?
- Mini-Mental State Examination (MMSE)
- Timed Up and Go (TUG) test (Correct answer)
- Geriatric Depression Scale
- Katz Index of Independence
Correct answer: Timed Up and Go (TUG) test
The Timed Up and Go (TUG) test measures functional mobility and is the standard tool for assessing fall risk in older adults.
Question 2: A 78-year-old man with moderate Alzheimer's disease becomes increasingly agitated and combative in the late afternoon. This pattern is best described as:
- Delirium superimposed on dementia
- Sundowning (Correct answer)
- Lewy body dementia behavioral variant
- Pseudodementia
Correct answer: Sundowning
Sundowning refers to increased confusion, agitation, and behavioral disturbances occurring in late afternoon or evening in patients with dementia.
Question 3: Which medication class is most commonly associated with falls in elderly patients due to orthostatic hypotension?
- Beta-blockers
- ACE inhibitors
- Alpha-1 blockers (Correct answer)
- Thiazide diuretics
Correct answer: Alpha-1 blockers
Alpha-1 blockers (e.g., terazosin, doxazosin) cause significant orthostatic hypotension, making them a leading pharmacologic fall risk in elderly men often prescribed them for BPH.
Question 4: A 75-year-old woman is diagnosed with osteoporosis (T-score -2.8). She has no prior fractures. Which pharmacotherapy is first-line treatment?
- Raloxifene
- Teriparatide
- Denosumab
- Alendronate (Correct answer)
Correct answer: Alendronate
Oral bisphosphonates such as alendronate are first-line therapy for osteoporosis due to their proven fracture reduction and favorable safety profile.
Question 5: An 80-year-old patient's laboratory results show a serum creatinine of 1.1 mg/dL. What is the most accurate statement about his kidney function?
- His GFR is likely normal since creatinine is within the normal range
- His GFR may be significantly reduced due to decreased muscle mass in older adults (Correct answer)
- Creatinine is the most reliable marker of GFR in elderly patients
- He likely has stage 3 chronic kidney disease
Correct answer: His GFR may be significantly reduced due to decreased muscle mass in older adults
In elderly patients, decreased muscle mass results in lower creatinine production, so serum creatinine can appear normal despite significantly reduced GFR.
Question 6: Which of the following is the most common cause of urinary incontinence in community-dwelling elderly women?
- Overflow incontinence from bladder outlet obstruction
- Functional incontinence due to immobility
- Stress urinary incontinence
- Urge incontinence (overactive bladder) (Correct answer)
Correct answer: Urge incontinence (overactive bladder)
Urge incontinence (overactive bladder) is the most prevalent type of urinary incontinence in older women, characterized by a sudden strong urge to void.
Question 7: A 77-year-old man with COPD and heart failure is found to have a serum sodium of 128 mEq/L. He is asymptomatic and euvolemic. What is the most appropriate next step?
- Administer 3% hypertonic saline immediately
- Restrict free water intake and review medications (Correct answer)
- Initiate hemodialysis
- Give a bolus of normal saline
Correct answer: Restrict free water intake and review medications
Asymptomatic euvolemic hyponatremia in an elderly patient is often medication-related (e.g., thiazides, SSRIs) or SIADH; fluid restriction and medication review are the initial steps.
Family Practice Exam Geriatric Care 2
An 82-year-old woman is brought to your office by her daughter who reports the patient has fallen three times in the past month.
Which assessment tool is most appropriate to evaluate her fall risk?