Family Practice Exam Geriatric Care 3 — Questions and Answers
Question 1: A 79-year-old woman with no prior psychiatric history presents with acute onset confusion, disorientation, and visual hallucinations over 24 hours. What is the most likely diagnosis?
- Alzheimer's disease
- Delirium (Correct answer)
- Lewy body dementia
- Vascular dementia
Correct answer: Delirium
Delirium is characterized by acute onset, fluctuating course, inattention, and altered consciousness, distinguishing it from chronic dementias.
Question 2: Which of the following is the MOST common precipitant of delirium in hospitalized elderly patients?
- New antidepressant initiation
- Urinary tract infection (Correct answer)
- Mild anemia
- Hip fracture pain
Correct answer: Urinary tract infection
Infection, particularly urinary tract infection, is the most frequently identified precipitant of delirium in hospitalized older adults.
Question 3: An 84-year-old nursing home patient has a Stage III pressure ulcer on his sacrum. What is the most important factor in promoting wound healing?
- Applying antibiotic ointment daily
- Adequate nutritional support including protein intake (Correct answer)
- Twice-daily whirlpool debridement
- Keeping the wound completely dry with gauze
Correct answer: Adequate nutritional support including protein intake
Adequate protein intake (1.2–1.5 g/kg/day) is the most critical nutritional factor for pressure ulcer healing and tissue repair.
Question 4: A 72-year-old man presents with symmetric proximal muscle weakness and difficulty rising from a chair. ESR is 85 mm/hr. Creatine kinase is normal. What is the most likely diagnosis?
- Polymyositis
- Polymyalgia rheumatica (PMR) (Correct answer)
- Amyotrophic lateral sclerosis
- Hypothyroid myopathy
Correct answer: Polymyalgia rheumatica (PMR)
PMR classically presents in patients over 50 with proximal muscle pain/stiffness, elevated ESR, and normal CK, distinguishing it from inflammatory myopathies.
Question 5: Which screening test is recommended for abdominal aortic aneurysm (AAA) in primary care according to USPSTF guidelines?
- One-time abdominal ultrasound in men aged 65-75 who have ever smoked (Correct answer)
- Annual CT angiography in all men over 60
- Abdominal ultrasound in all adults over 65
- One-time ultrasound in women aged 65-75 with smoking history
Correct answer: One-time abdominal ultrasound in men aged 65-75 who have ever smoked
USPSTF recommends a one-time abdominal ultrasound screening for AAA in men aged 65–75 who have ever smoked (at least 100 cigarettes lifetime).
Question 6: A 76-year-old woman taking warfarin for atrial fibrillation has an INR of 6.2 but no active bleeding. What is the most appropriate management?
- Administer 4-factor prothrombin complex concentrate (PCC)
- Hold warfarin and administer oral vitamin K 2.5 mg (Correct answer)
- Continue warfarin and recheck INR in 1 week
- Administer fresh frozen plasma
Correct answer: Hold warfarin and administer oral vitamin K 2.5 mg
For supratherapeutic INR without bleeding, holding warfarin and giving low-dose oral vitamin K rapidly corrects INR with minimal rebound anticoagulation.
Question 7: A 68-year-old man presents for his annual wellness visit. Which preventive intervention has the strongest evidence for reducing cardiovascular mortality in this age group?
- Routine aspirin therapy for primary prevention
- Statin therapy if 10-year ASCVD risk ≥10% (Correct answer)
- Annual ECG screening
- Omega-3 supplementation
Correct answer: Statin therapy if 10-year ASCVD risk ≥10%
Statin therapy for patients with 10-year ASCVD risk ≥10% has strong RCT evidence for reducing cardiovascular events and mortality in older adults.
Family Practice Exam Geriatric Care 3
A 79-year-old woman with no prior psychiatric history presents with acute onset confusion, disorientation, and visual hallucinations over 24 hours.
What is the most likely diagnosis?