Geriatrics Exam.pdf

Geriatrics Exam MCQ What is not characteristic of aging process: Decreased sensitivity of baroreceptors Decreased sweating Decreased vasoconstriction in cold weather Increased protein content, reduced fat content  The Importance of chaos theory of anxiety in clinical practice: It is i...

Geriatrics Exam MCQ What is not characteristic of aging process: Decreased sensitivity of baroreceptors Decreased sweating Decreased vasoconstriction in cold weather Increased protein content, reduced fat content  The Importance of chaos theory of anxiety in clinical practice: It is important for older people to have enough antioxidants in the diet Medicines in old age vary more frequently Diabetes mellitus is an accelerated aging model The formation of macromolecular bonds results in aging tissues What is unsual for older people? An atypical course Failure of the function Use of more than 3 medications Quicker referral to the doctor Which statement is suitable for older people? The body´s water content is increasing The body fat decreases Lower doses of water-soluble medicines are used Shortening the function of fat-soluble drugs  Structural and functional changes of organs of the digestive system in aging are as follows: Chewing muscle atrophy, decreased salivary gland secretion, hypertrophic tongue spinal nerve, increased gastric acid secretion, deterioration of intestinal absorption, decreased pancreatic mass, pancreatic gland atrophy Chewing muscle atrophy, decreased salivary gland secretion, atrophy of the thymus nipples of the tongue, increased gastric acid secretion, deterioration of the intestinal resorption function, pancreatic gland hypertrophy, deterioration of the liver detoxification properties. Atrophy of chewing muscles, increased salivary gland secretion, nasal sprouts of the tongue, loosening of the stomach, increased gastric acid secretion, improvement of intestinal absorption, decreased liver detoxification. Bloating muscle atrophy, decreased salivary gland secretion, atrophy of the tongue spinal nerve, decreased gastric acid secretion, deterioration of intestinal absorption, pancreatic gastric atrophy, inactivated pancreatic enzymes, decreased liver weight, decreased liver detoxification potential. Constipation is a condition in which: The stool lasts longer than 4 days or when it is washed several times a day, but there is no sense of relief. The stool lasts longer than 2-3 days, or when it is washed several times a day after a few stools, but the stomach does not get worse. The stool lasts longer than 2-3 days or when it is cleared with the help of chewing gum. The stool lasts longer than 2-3 days or when the stomach is required during each bowel movement.  Medicines that cause constipation at an advanced age: Diuretics, calcium channel blockers, iron supplements, beta- blockers. Torasemide, verapamil, calcium and iron preparations, opiates, amantadine, diclofenac. Furosemide, ciprofloxacin, tardyferon, ibuprofen, morphine, amantadine. Diuretics, calcium channel blockers, iron and calcium preparations, ace inhibitors. An 86-year-old patient was hospitalized for treatment of pneumonia in the Department of Geriatrics (pneumonia repeated several times during the year). Treatment started with cefalosporin II (cefuroxime / v 7 days). Positive clinical and inflammatory dynamics were obtained. Due to the non-productive cough sputum, the crop is not taken. In the course of the disease, inflammatory parameters (CRB, leu, neutr.) Began to grow again, resulting in antibacterial therapy altered to cefalosporin III (ceftriaxone in / v 3 days). During the course of treatment, the patient started mediating 6-7 times a day with bad breath. The faecal study found Cl. difficile toxin. What is the next treatment tactic for this patient? Cease the administration of ceftriaxone, to apply infusion therapy to metronidazole in / v. Cease the administration of ceftriaxone, move the patient to an infectious disease department, use infusion therapy, to inject metronidazole or vancomycin into the vein. Discontinue the administration of ceftriaxone, move the patient to an infectious disease department, correct electrolyte imbalance, apply infusor therapy, or use metronidazole or vancomycin in p / a.  The development of diverticulosis (pathogenesis) does no affect: Motor dysfunction (thickening of the large intestine wall, abdominal wall and small pelvic tone), pressure differences between the intestine and abdominal cavity, weakening of the wall of the bowel, increased pressure in the intestinal cavity. Motor dysfunction (thickening of the large bowel wall, abdominal wall and small pelvic muscle tone), excessive fiber supply, reduced bowel wall contraction. Motor dysfunction (thickening of the large bowel wall, abdominal wall and lower pelvic tone), lack of fiber, increased contraction of the intestinal wall. Hysterectomy, increased bowel wall contraction, increased pressure in the intestinal cavity, pressure differences between the intestine and abdominal cavity, and lack of fiber nutrition. The development of diverticulosis (pathogenesis) does no affect: Motor dysfunction (thickening of the large bowel wall, abdominal wall and small pelvic tone), pressure differences between the intestine and abdominal cavity, weakening of the wall of the bowel, increase in pressure in the intestinal cavity. Motor dysfunction (enlargement of the large intestine wall, abdominal wall and small pelvic muscle tone), excessive fiber supply, impaired bowel wall contraction. Motor dysfunction (thickening of the large bowel wall, abdominal wall and small pelvic tone), lack of fiber, increased contraction of the intestinal wall. Loss of the hose wall, increased contraction of the intestinal wall, increased pressure in the intestinal cavity, pressure differences between the intestine and abdominal cavity, lack of fiber nutrition.  The need for energy in the elderly is calculated: Peak energy demand × age × body condition Peak energy demand × physical activity × body condition peak energy demand × sex × body condition Peak energy demand × physical activity  The most common diseases/conditions of older age bearing oropharyngeal dysphagia: Stroke, Alzheimer's disease and other dementias, Parkinson's disease, multiple sclerosis, amyotrophic lateral sclerosis, advanced neck or head cancer, head trauma, dry mouth Stroke, Alzheimer's disease and other dementias, Parkinson's disease, multiple sclerosis, amyotrophic lateral sclerosis, advanced neck or head cancer, dry mouth. Stroke, Alzheimer's and other dementias, Parkinson's disease, dry mouth. Stroke, Alzheimer's disease and other dementias, Parkinson's disease, multiple sclerosis, amyotrophic lateral sclerosis, tetanus, head trauma, xerostomy. 81-year-old man complains that he has trouble sleeping: although early in the evening he feels his desire to go to sleep, but he has difficulties falling asleep, he often wakes up at night and he feels sleepy day. What is the cause of sleep disturbance and correction tactics? Sleep apnea; a polysomnography study is required; it is necessary to apply a positive pressure apparatus, which supplies air during a continuous sleep Physiological sleep disorder associated with aging changes; You need to fill out the Epworth profile and the Pittsburgh Sleep Quality Index; Follow the rules of sleep hygiene, light therapy, melatonin. Anxiety Legs Syndrome; a polysomnography study is required; for the treatment of clonazepam or dopamine agonists. Periodic limb movement syndrome; a polysomnography study is required; to treat clonazepam or levodopa. Features of CD clinic at an older age: Asymptomatic onset, followed by thirst, polydipsia, and polyuria, but may also occur with weight gain, arterial hypertension, collapse, nocturia, urinary tract infection, skin problems, or impaired cognitive function; CDs often appear in the background of another acute illness or CD complications. Asymptomatic onset, the classic symptoms are less likely to simply manifest in weight loss, collapse, nocturia, urinary tract infection, skin problems, or impaired cognitive function; CDs often appear in the background of another acute illness or CD complications Physiological changes that occur in an aging person which one does not belong: Slowdown in thinking Progressive memory loss Reduction of enthusiasm Changes in the sleep cycle Which is the most important risk factor for Parkinson´s disease in the elderly: Smoking Genetic factors Age Trauma What are the symptoms of dementia syndrome? Symptoms of fluctuation day by day Disruption of consciousness Abnormal and social activities Expands in a short time What instrument (questionnaire, scale) is most suitable for suspecting and confirming Delirium syndrome: Clock drawing test Mini-mental state examination (MMSE) Confusion evaluation method (CAM) Neuropsychiatric Inventory (NPI)  The causes of an irritable urinary bladder are as follows: Sphincter and/or pelvic muscle weakness, connective tissue features, childbirth, surgery, radiation therapy, estrogen deficiency, radical prostatectomy Mechanical obstruction, autonomic neuropathy, anticholinergic drugs Urinary tract infection, bladder stones, cancer, urethral obstruction, neurological diseases Impairment of the thinking process, disability of the movement as a whole, iatrogenic factors, non-adapted environment / clothing  In the case of reflux with urinary incontinence, the following applies to the prevention of infection: Continuous transurethral catheterization, doses of prophylactic oral antibiotics Proto-catheterization, urinary tract disinfectants Continuous suprapubic catheterization, doses of prophylactic oral antibiotics Prosthetic catheterization, doses of prophylactic oral antibiotics 68 m. old woman complains that suddenly there is an urge to urinate 6- 8 times a day, 2-3 times a night, I can not go to the toilet on time, do not stop urine. During the last two days, burning in the urethra has increased, and the number of urinary episodes has increased. What research will you do first? Blood test, C reactive protein test, urine culture, ultrasound examination Joint urine test, urine culture, C reactive protein test, ultrasound examination Blood test, procalcitonin test, urine culture, ultrasound examination Joint urinalysis, C reactive protein test, procalcitonin test, ultrasound examination  In which cases the chest radiograph will be non informative in the diagnosis of pneumonia: Dehydrated patients at an early stage In the early stages of dehydrated patients with pneumonia caused by neutropenia and gram-negative microorganisms In the early stage of dehydrated patients with pneumonia caused by neutrophilia and gram-negative microorganisms Pneumonia caused by neutropenia and gram-positive microorganisms  Insufficient nutrition checking measures suitable for the elderly: NRS 2002, MNA, MNA-SF, SGA, BLACK NRS 2002, SGA, SNAQ, BLACK NRS 2002, MNA-SF, SGA, BLACK, MMSE NRS 2002, MNA, SGA, MMSE, GDS, BLACK  Nutrition therapy in the case of dementia with bleeding/swallowing disorder or in other cases of oropharyngeal dysphagia: Modified food (cooked food, condensed liquids), sweetened oral nutritional supplements, probed enteric feeding, long-term parenteral nutrition. Pure-bodied food and kissels, drinking nutritional supplements, probed enteric feeding. Modified food (faded food, condensed liquids), megestrol, vitamin B, oral nutrition supplements, probed enteric feeding, parenteral nutrition (briefly). Modified diet (faded food, congested liquids), overweight oral nutritional supplements, probed enteric feeding, parenteral nutrition (briefly).  Menopausal syndrome is characterized by: increase in LDL and TG, decrease in HDL, LDL progression and coronary events, increased insulin resistance, osteoporosis (osteoporosis), decreased skin elasticity, nasal and hair brittleness, dry mucous membrane, increased urinary tract infection risk, dysuria, disorder, urinary incontinence, decreased libido, headache, insomnia, depression / panic flares, hot flashes, sweating, heartbeat, irritability. MTL and TG increase, LDL decrease, LDL progression and coronary events, CD, osteoporosis (osteoporosis), decreased elasticity of the skin, nasal and hair brittleness, dry mucous membrane, increased risk of urinary tract infection, dysuria, urinary incontinence, decreased libido, headache pain, insomnia, depression / panic flares, anemia, arterial hypertension, hot flushes, sweating, heartbeat, irritability.  When there is suspicion of osteoporosis, the patient should be sent to the DXA method for measuring bone mineral density? When a radiologically determined> 3 ruptures or pelvic or thoracic or femur or tibia fractures or a decrease in height. If at least two clinical fracture risk factors and at least one risk of collapse are identified, even in the absence of osteoporosis fracture. Histological changes of the neurological system with aging (non pathological changes): Amyloid accumulation in neurons, degeneration of neurons (dendrites and astrocytes) Accumulation of pigment lipofuscin in brain cells, amyloid accumulation in blood vessels, senile plates and neurofibrillated meshes Degeneration of the spinal cord of the motor neurons in the frontal cortex and the trunk nuclei, a large accumulation of senile plates and neurofibrillary nets Neuronal degeneration and gliosis and lewy bodies in the substantia nigra area.  The neurological motor systems for age- related physiological changes include: Generalized fatigue and a slight decrease in muscle mass Increased muscle tone, fasciculations, involuntary movements Non-target motor activity, falls, arthroplasty Decreased muscle mass and strength, impaired balance and coordination, hyporeflexia. What symptoms are more typical in the late-onset Parkinson´s disease (over 60 years old) than in the younger age? Tremor and rigidity at the beginning of the disease More frequent dementia syndrome More frequent depression Family history In case of vascular dementia, the deterioration of cognitive function is improved by: N-methyl D aspartate (NMDA) receptor antagonists Acetylcholinesterase Inhibitor Atypical neuroleptics There are no effective drugs for improving cognitive function  68 m. old woman complains that suddenly there is an urge to urinate 6-8 times a day, 2-3 times a night, I can not go to the toilet on time, do not stop urine. During the last two days, burning in the urethra has increased, and the number of urinary episodes has increased. What kind of medication in this case will you give you first: Nitrofurantoin Nitrofurantoin100 100mgmgfour fourtimes timesaaday, day,intermittent intermittentcatheterization catheterization Tolterodine 4 mg per os, local estrogens in the vagina Tolterodine 4 mg per os, local estrogens in the vagina Nitrofurantoin (macrocrystalline) 100 mg twice daily per Nitrofurantoin (macrocrystalline) 100 mg twice daily per os, os, tolterodine tolterodine44mg mgininthe theevening eveningper perosos Ciprofloxacin 200 mg twice daily intravenously, tolterodine 4 mg Ciprofloxacin 200 mg twice daily intravenously, tolterodine 4 mg in in the theevening eveningper perosos In case of dementia, urinary incontinence control is first recommended: Pelvic strength exercises, nappies, adaptation of the environment Urination by reminder, adaptation of the environment Catheterization, adaptation of the environment, antibiotic prophylaxis Pelvic Extensor Exercises, Adaptation to the Environment The most common means of penetrating pneumonia in the elderly: The inhalants are inhaled The causative agents are aspirated or hematogenous Prolonged release by inhalation or aspiration The causative agent is inhaled or hematogenous An 82-year-old patient with pneumonia and chronic pyelonephritis, chronic terminal renal disease (anuria) is on dialysis daily. What kind of empirical antibacterial treatment will you give to this patient: Cefuroxime 750 mg three times daily intravenously to HD Ciprofloxacin 200 mg twice daily intravenously over HD Cefuroxime 750 mg three times a day intravenously over HD Cefuroxime 750 mg once daily intravenously in HD Constipation may be: Idiopathic, symptomatic, anorectic Idiopathic-functional, symptomatic Idiopathic, neurogenic, refreshing Idiopathic, symptomatic, neurogenic  The risk of gastrointestinal malaria is exacerbated by the following factors and medications: Older age, glucocorticoids, former gastrointestinal event, digoxin NSAIDs, older age, aspirin, cavitone, orpharin, former gastrointestinal event NSAIDs, aspirin, elderly, glucocorticoids, former gastrointestinal event, orpharin Orfarin, glucocorticoids, NSAIDs, ACE inhibitors An 85-year-old patient is difficult to move due to reciprocal gonarthrosis, diabetes mellitus, osteoporosis, ischemic heart disease, heart failure, chronic obstructive pulmonary disease. Constant use of family doctor's anti-diabetic, anti-icteric and inhaled bronchodilator / hormonal products: diaperl, perindopril, verapamil, torasemide, inh. Seretide, calcium preparations. Recently, constipation is particularly troublesome. What can affect this patient's constipation? Polytheology, polypharmacy, digraph, perindopril Insufficient physical activity, poly pathology, polypharmacy, verapamil, torasemide, calcium preparations Insufficient physical activity, polypathology, polypharmacy, verapamil, torasemide, inh. Seretidi verapamil, diapril, perindopril, calcium preparations, torasemide, polypharmacy What is NOT typical for normal aging? High blood glucose levels Muscle weakness Memory impairment Visual impairment When asking a geriatric patient about a fall, whether he has fallen: During the last 3 months During the last 1 year Last month During the last 6 months What increases the risk of collapse? Decreased proprioception Decreased concentration of the active form of Vitamin D Hypothyroidism All the factors mentioned What is increasing with aging? Resorption area for medicinal products Intestinal blood flow Gastric pH Water in the body What is old age weakness syndrome? Weight loss Thirst Slowing down Fatigue How does the pharmacodynamics of benzodiazepines and beta blockers change in older age? Sensitivity to benzodiazepines and betablockers is increasing The sensitivity to benzodiazepines and beta blockers decreases The sensitivity to benzodiazepines is increasing, while the betablockers are decreasing The sensitivity of their benzodiazepines is decreasing, with the rise of the Beta-blockers An 84-year-old man was found on the floor and unable to get up, after not answering his daughter's call. He complained of the pain of the left knee, was disturbed, and was unable to explain what was happening. The daughter called the ambulance, the man was taken to a hospital and hospitalized. Which statement is wrong about the fall of elderly people? The decline in older people occurs through external and internal factors and medicines. Elderly people should be asked at least once a year about falls. Decreased fatigue due to decreasing agility. Falling risk factors include exacerbations, psychotropic medications, thinking disorders, anemia, and muscle weakness.  What improves the correct use of medication by older patients? Safely closing vials A large number of medicines A detailed explanation by the doctor Long use of medication  Changes in bone marrow with aging: Increasing of collagen and reticulum fibers, obliterating the channels of the osteons, deteriorating bone marrow blood flow, increasing stem cell growth, increasing plasma cells and macrophages, reducing granulocytes. Increasing of collagen and reticulum fibers, obliterating the channels of the osteons, deteriorating bone marrow blood flow, decreasing stem cells of the bloodstream, increasing plasma cells and macrophages, reducing granulocytes. Decreases in collagen and reticulum fibers, obliterates the channels of the osteons, deteriorates bone marrow blood flow, reduces stem cell growth, increases plasma cells and macrophages, decreases granulocytes. Decreased collagen and reticulum fibers, obliterates the channels of the osteons, deteriorates bone marrow blood flow, decreases in the stem cells of the bloodstream, decreases in plasma cells and macrophages, and increases granulocytes.  The diagnosis of microcytic anemia is supported by the following laboratory findings: MCV 127 fl; MCH 31 pg., Decreases Hb concentration, increases serum ferritin, reduces the amount of transferrin. MCV 75 fl; MCH 26 pg., Decreases the Hb concentration and serum ferritin levels, increases transferin levels, increases the plasma capacity of Fe coupled. MCV 86 fl; MCH 27 reduces serum Hb levels, reduces transferin levels, increases plasma capacity associated with Fe, and stores normal serum levels of ferritin. MCV 90 fl; MCH 28 pg., Decrease in plasma capacity in conjugation with Fe, increase serum ferritin concentration.  What symptoms/conditions/diseases are provoked by anemic syndrome in the elderly? weakness, fatigue, paleness of the body, nausea, urinary retention, shortness of breath, heart palpitations, dizziness, blood pressure rise, angina pectoris, congestive heart failure, intermittent stiffness, fainting, fainting. weakness, fatigue, paleness of the body, shortness of breath, heartbeat, dizziness, angina pectoris, congestive heart failure, urinary incontinence, intermittent claudication, fainting, fainting. weakness, fatigue, paleness of the body layers, shortness of breath, heartbeat, dizziness, tension in the chest angina, congestive heart failure, intermittent claudication, fainting, fainting. weakness, fatigue, paleness of the body coating, dizziness, cough, bradycardia, angina pectoris, congestive heart failure, intermittent stiffness, fainting, fainting.  Tactics of CD therapy at and advanced age: The best tactic is gradual (to avoid hypoglycemia); It is necessary to weigh the benefits of strict glycemic control and harm to geriatric patients; individual approach; "Severe" geriatric patients are allowed to use less strict targets for glycemic control. The best tactics are gradual (to avoid hypoglycemia); It is necessary to weigh the benefits of strict glycemic control and harm to geriatric patients; individual approach; "Severe" geriatric patients are allowed to use less strict targets for glycemic control; severe diet and increased physical activity before taking medication.  Hypothyroidism treatment features at an advanced age: Thyroid hormones (thyroxine 50-100 μg / d.), surgical treatment (in the form of a multi-amputee), radioiodine, beta-blockers. Tyrostatics (thiadiazole 20-30-40 mg / d.), surgical treatment (in the form of a multi-amputee), radioiodine, beta-blockers. Thyroid hormones (immediate high dose of thyroxin 100 μg / d) after the detection of autoimmune thyroiditis - glucocorticoids. Thyroid hormones (starting with a low dose of thyroxine 12.5 to 25 μg / day, the dose is carefully increased to 75-100 μg / d or more). The effects of malnutrition at an advanced age: longer hospitalization, complications of illness, re- hospitalization, social exclusion, compliance with restrictive diets, social exclusion, early hospitalization in long-term care or care facilities, reduced life expectancy, deterioration in quality of life, and increased mortality. increased morbidity, longer hospitalization, complications of illness, re-hospitalization, early hospitalization in long-term care or care facilities, reduced life expectancy, deterioration in quality of life, increased mortality.  Hypothyroidism features in advanced age: Prevalence 2-5%; More frequent causes: Hashimoto thyroiditis, Gliw's disease outbreak, radioiodine effects, thyroid gland, idiopathic hypothyroidism; Clinic prisoners, classical symptoms are less common, typical geriatric syndromes, arthralgia, muscle aches and weakness, may accumulate non-inflammatory fluid in the pleura, pericardium, peritoneal cavity, may reduce body temperature, often accompanied by hyponatremia, hyperlipidaemia, anemia, impaired cognitive function. Prevalence of 2-5%; More frequent causes: Hashimot's thyroiditis, Griffith's disease, radioiodine effects, thyroid hormone overdose, thyroid gland, idiopathic hypothyroidism; Clinic prisoners, classical symptoms are less common, characteristic geriatric syndromes, can accumulate non-inflammatory fluid in the pleura, pericardium, peritoneal cavity, may reduce body temperature, tenderness of weight loss, often accompanied by hypernatraemia, anemia. 79 old female patient asked the family physician to test for deteriorating memory. Complaints: In recent years, gradually deteriorating memory, it's harder to remember where things are going, what you need to do, forgetting meetings, names of people who have been well-known before. Claims that it does not interfere with its independence, there is a single and self-assured living.Anamnesis from daughters: Mom has become obsessed with the past few years, but lately confuses the days and the time, which is why it is disputed, she got lost in her second visit to the clinic. At home, it's less manageable, says that because of cataract - poorly seen, no longer wanting to go anywhere because it's no longer interesting, tired. The prescribed medication is used independently.Concomitant diseases: Primary arterial hypertension designated Perindopril Arginine + Indapamide + Amlodipine (5 mg / 1.25 mg / 10 mg). a) What is the diagnosis for the patient? Subjective memory problems Mild cognitive impairment Vascular dementia Alzheimers disease b) Which of the following studies is essential for the study of this patient? EEG Echoscopy of cerebral circulation (transcranial doplergy) Computer tomography of the head (CT) Single pho t on emission computed tomography (SPECT)  c) Patient was tested, and confirmed diagnosis, and a care plan was developed. What do you think the most appropriate care plan for this patient is: Continue treatment with antihypertensive medicines, supplementary medicines to improve the blood circulation, to the center of the day; Continue treatment with antihypertensives, additionally administering acetylcholinesterase inhibitors to the center of the day; Continue treatment with antihypertensives, additionally administering the N-methyl-D-aspartate (NMDA) receptor antagonist to the day center; Continue treatment with antihypertensives, additionally administering acetylcholinesterase inhibitors, to a nursing hospital. d) The patient repeatedly approached you after three months because of anxiety, getting worse in the evening, having bad sleep (difficult to fall asleep, waking up at night). Which of the following medication groups would be the most inappropriate choice: Atypical neuroleptics Benzodiazepines Selective serotonin reuptake inhibitors (SSRIs) Acetylcholinesterase inhibitors.  When will temperature be lower in older patients, mark the wrong answer: Women with menopause, dementia, with functional impairment Aspirin with NSAIDs Tramadol, digoxin When BMI