Family Practice Exam Geriatric Care 4

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?

Accepted Answer

Low-dose doxepin

Answer

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?

Accepted Answer

Decreased hepatic blood flow reduces first-pass metabolism, increasing bioavailability of some drugs

Answer

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?

Accepted Answer

No further PSA screening; discuss palliative care goals

Answer

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?

Accepted Answer

Switch to a different antihypertensive class such as an ACE inhibitor

Answer

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?

Accepted Answer

Less than 8.0%

Answer

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.

Family Practice Exam Practice Test

Family Practice Exam Practice Test

Family Practice Exam Geriatric Care 4