Family Practice Exam Geriatric Care 4 — Questions and Answers
Question 1: A 74-year-old woman reports difficulty sleeping, waking at 3 AM nightly. She asks for a sleeping pill. Which is the safest first-line pharmacologic option if non-pharmacologic therapy fails?
- Diphenhydramine (Benadryl)
- Zolpidem (Ambien)
- Diazepam (Valium)
- Low-dose doxepin (Correct answer)
Correct answer: Low-dose doxepin
Low-dose doxepin (3–6 mg) is FDA-approved for sleep maintenance insomnia and is preferred in elderly patients due to its favorable safety profile compared to benzodiazepines or antihistamines.
Question 2: Which of the following best characterizes the pharmacokinetic changes of aging that affect drug dosing in elderly patients?
- Increased first-pass metabolism increases drug bioavailability
- Increased renal clearance requires higher doses
- Decreased hepatic blood flow reduces first-pass metabolism, increasing bioavailability of some drugs (Correct answer)
- Decreased body fat reduces volume of distribution of lipophilic drugs
Correct answer: Decreased hepatic blood flow reduces first-pass metabolism, increasing bioavailability of some drugs
Aging reduces hepatic blood flow and CYP enzyme activity, decreasing first-pass metabolism and increasing oral bioavailability of drugs such as propranolol and morphine.
Question 3: An 81-year-old man is found to have a PSA of 5.2 ng/mL. He has a life expectancy of 4 years due to comorbidities. What is the most appropriate next step?
- Refer for immediate prostate biopsy
- Repeat PSA in 6 months
- No further PSA screening; discuss palliative care goals (Correct answer)
- Start dutasteride to reduce PSA
Correct answer: No further PSA screening; discuss palliative care goals
PSA screening is not recommended for men with less than 10 years of life expectancy, as treatment is unlikely to provide survival benefit and may cause harm.
Question 4: A 70-year-old woman develops bilateral leg edema after starting amlodipine for hypertension. What is the most appropriate management?
- Add a loop diuretic to manage the edema
- Switch to a different antihypertensive class such as an ACE inhibitor (Correct answer)
- Reassure her that this is harmless and continue amlodipine
- Order echocardiogram to rule out heart failure
Correct answer: Switch to a different antihypertensive class such as an ACE inhibitor
Calcium channel blocker-induced leg edema is due to precapillary vasodilation and does not respond to diuretics; switching to an alternative antihypertensive is the appropriate response.
Question 5: A 77-year-old man with type 2 diabetes has an HbA1c of 9.4%. He lives alone and has had two episodes of hypoglycemia. What is the most appropriate HbA1c target for this patient?
- Less than 6.5%
- Less than 7.0%
- Less than 8.0% (Correct answer)
- Less than 9.0%
Correct answer: Less than 8.0%
For older adults with multiple comorbidities, hypoglycemia history, and limited social support, ADA guidelines recommend a less stringent HbA1c target of <8.0% to minimize hypoglycemia risk.
Question 6: Which of the following is the most common cause of new-onset hypothyroidism in elderly patients in the United States?
- Radioactive iodine therapy for prior hyperthyroidism
- Hashimoto's thyroiditis (chronic autoimmune thyroiditis) (Correct answer)
- Surgical thyroidectomy
- Iodine deficiency
Correct answer: Hashimoto's thyroiditis (chronic autoimmune thyroiditis)
Hashimoto's thyroiditis is the most common cause of hypothyroidism in iodine-sufficient countries, including in elderly patients.
Question 7: An 83-year-old woman with advanced dementia has stopped eating and drinking. Her family asks about placing a feeding tube. What does the evidence support?
- Feeding tubes significantly extend life and improve comfort in advanced dementia
- Feeding tubes reduce aspiration pneumonia in advanced dementia
- Feeding tube placement is not recommended as it does not improve survival or comfort (Correct answer)
- Hand feeding should be replaced by tube feeding to ensure adequate calories
Correct answer: Feeding tube placement is not recommended as it does not improve survival or comfort
Evidence consistently shows that feeding tubes do not prolong life, reduce aspiration, or improve comfort in patients with advanced dementia; careful hand feeding is preferred.
Family Practice Exam Geriatric Care 4
A 74-year-old woman reports difficulty sleeping, waking at 3 AM nightly.
She asks for a sleeping pill.
Which is the safest first-line pharmacologic option if non-pharmacologic therapy fails?