NR 601 Midterm |300 questions with verified
answers
. You are performing a geriatric assessment on an 82-year-old female. At the end
of the visit, which of the following would require top priority over the others?
Ans✓✓✓ The death of the patient's caregiver
65-74 Ans✓✓✓ "young old"
75-84 Ans✓✓✓ old
85+ Ans✓✓✓ oldest
90-year-old balding farmer who is otherwise healthy and active has diffuse pink,
rough scaly papules on his scalp (Fig. 54.22). Which of the following statements is
most correct about his condition? Ans✓✓✓ One-quarter may spontaneously
regress, especially with aggressive sun protection.
90-year-old Black woman is found to have a uric acid of 13 mg/dL with a
creatinine of 0.6 mg/dL. She does have a history of osteoarthritis and heart failure
and is taking furosemide 80 mg orally daily. She develops acute onset first
metatarsal phalangeal joint pain. The best approach for this patient will be:
Ans✓✓✓ Start colchicine
A 54-year-old Hispanic woman has home BP of 155/95 mmHg, confirmed by
multiple similar readings and office BP of 154/94 mmHg. She exercises, follows a
low-salt diet, and rarely drinks alcohol. Which one of the following medications
would be most appropriate for this patient? Ans✓✓✓ a. Chlorthalidone
,A 65-year-old female is evaluated for dyspnea, chronic cough, and mucoid sputum
for the past 4 months. She has noticed that she has to walk slower than she used
to and has to stop to catch her breath after walking 5 to 6 city blocks. The patient
has a 40 pack-year history of cigarette smoking but quit smoking 1 year ago. She is
otherwise healthy. On physical examination, vital signs are normal. Breath sounds
are decreased, but there is no edema or jugular venous distention. What is the
next best test you would order to make a diagnosis? Ans✓✓✓ Obtain spirometry.
A 65-year-old male is evaluated in a follow-up examination for worsening dyspnea
and chronic cough productive of mucoid sputum for the past 6 months. He is
otherwise healthy but was diagnosed with chronic obstructive pulmonary disease
(COPD) 3 years ago, and uses inhaled albuterol as needed. The patient has a 40
pack-year history of cigarette smoking but quit smoking 8 months ago. On
physical examination, vital signs are normal and the patient is not in any
respiratory distress. Breath sounds are decreased, but there is no edema or
jugular venous distention. Spirometry shows a forced expiratory volume in the
first second (FEV1) of 58% of predicted with no reversibility and an FEV1/forced
vital capacity (FVC) ratio of 65%. His COPD symptoms seem poorly controlled and
he has had one exacerbation in the past year. A chest radiograph is obtained and
shows mild hyperinflation. Which of the following is the most appropriat
Ans✓✓✓ Add a long-acting inhaled bronchodilator.
A 65-year-old man is hospitalized with sudden onset chest pain but has a negative
cardiac workup. You notice pink eroded papules along the left sternum and left
flank that abruptly stop at the midline, where he thinks electrical leads were
placed. He thinks these painful and somewhat itchy bumps are increasing in
number. He is afebrile, otherwise stable, and has no other complaints. Which of
the following is the most appropriate next step? Ans✓✓✓ Empiric valacyclovir.
A 70-year-old man undergoes an upper endoscopy for the evaluation of
dyspepsia. He has a large nonbleeding ulcer and biopsies reveal the present of
,Helicobacter pylori infection. He is given a 10-day course of clarithromycin,
tetracycline, and omeprazole twice daily. His symptoms resolve. A urea breath
test performed 2 weeks later is positive for H. pylori.
Which of the following is the best next step in management of this patient?
Ans✓✓✓ Treatment with bismuth, metronidazole, tetracycline, and omeprazole
for 14 days
A 70-year-old patient has scattered nummular plaques with thick scale on his
shins that are extremely pruritic. He also has very dry skin. Skin scraping is
negative for dermatophyte. He had already completed a course of oral antifungal
medication prescribed to him by an urgent care physician. Assuming this is
nummular eczema, which of the following topical medication and vehicle is the
best choice? Ans✓✓✓ Triamcinolone 0.1% ointment
A 70-year-old postmenopausal female presents to your clinic to discuss treatment
options for her low bone density. She has no prior history of hip or vertebral
fractures. She has type 2 diabetes mellitus and associated chronic kidney disease
(baseline creatinine clearance 29 mL/min). Body mass index (BMI) is 30 kg/m2.
She had a myocardial infarction 1 year ago. She was diagnosed with breast cancer
10 years ago, for which she underwent a mastectomy, chemotherapy, external
beam radiation, and a course of tamoxifen. She takes a daily calcium and vitamin
D supplement. Serum calcium and 25-hydroxyvitamin D levels are normal. She has
a family history of maternal hip fracture.
FRAX 10-year fracture risk score: Major osteoporotic fracture = 12%, hip fracture
= 5%
Which of the following is the best treatment option for this patient? Ans✓✓✓
Denosumab
A 71-year-old male with a past medical history of hypertension presents for
follow-up of his osteoporosis. He was diagnosed with osteoporosis by DXA scan 5
years ago after an ankle fracture and has been on weekly alendronate 70 mg since
, that time. He has no prior history of hip or vertebral fractures. He is active and
performs aerobic and strength-training exercises four times per week. No
kyphosis is noted on examination. BMI is 23 kg/m2. No loss of height while on
alendronate. He has no family history of hip fractures. He takes a daily calcium
and vitamin D supplement. He does not smoke or consume alcohol.
His repeat DXA scan demonstrates a significant increase in his spine bone mass
density (BMD) of 5%. Ans✓✓✓ b. Discuss initiation of drug holiday
A 72-year-old female with progressive fatigue is found to have a hemoglobin of
9.1 g/dL, mean corpuscular volume of 108 fL, and a platelet count of 67×109/L on
a routine laboratory evaluation. She has a normal B12 and folate level. She has
never had a history of anemia and does not have signs or symptoms of bleeding
or hemolysis. She does not use alcohol, and she has no liver disease. Your next
step in management should be: Ans✓✓✓ Refer to hematology for bone marrow
examination.
A 72-year-old man with a history of hypertension recently had acute coronary
syndrome for which he was hospitalized and treated with a stent to one of his
coronary arteries. In addition to antiplatelet therapy, what antihypertensives are
recommended to treat his BP and improve outcomes regarding his ischemic heart
disease? Ans✓✓✓ Lisinopril and metoprolol
A 72-year-old woman with a history of chronic heartburn comes in to discuss
gastroesophageal reflux disease management. She asks whether she should
remain on her proton-pump inhibitor (PPI); she has been on lansoprazole 15 mg
daily for the past 12 years. With the medication, diet, and lifestyle changes, she
has been asymptomatic for almost all of that time. An upper endoscopy
performed 4 years ago revealed a small hiatal hernia and mild erosive esophagitis.
She is concerned about long-term risks of PPIs.
answers
. You are performing a geriatric assessment on an 82-year-old female. At the end
of the visit, which of the following would require top priority over the others?
Ans✓✓✓ The death of the patient's caregiver
65-74 Ans✓✓✓ "young old"
75-84 Ans✓✓✓ old
85+ Ans✓✓✓ oldest
90-year-old balding farmer who is otherwise healthy and active has diffuse pink,
rough scaly papules on his scalp (Fig. 54.22). Which of the following statements is
most correct about his condition? Ans✓✓✓ One-quarter may spontaneously
regress, especially with aggressive sun protection.
90-year-old Black woman is found to have a uric acid of 13 mg/dL with a
creatinine of 0.6 mg/dL. She does have a history of osteoarthritis and heart failure
and is taking furosemide 80 mg orally daily. She develops acute onset first
metatarsal phalangeal joint pain. The best approach for this patient will be:
Ans✓✓✓ Start colchicine
A 54-year-old Hispanic woman has home BP of 155/95 mmHg, confirmed by
multiple similar readings and office BP of 154/94 mmHg. She exercises, follows a
low-salt diet, and rarely drinks alcohol. Which one of the following medications
would be most appropriate for this patient? Ans✓✓✓ a. Chlorthalidone
,A 65-year-old female is evaluated for dyspnea, chronic cough, and mucoid sputum
for the past 4 months. She has noticed that she has to walk slower than she used
to and has to stop to catch her breath after walking 5 to 6 city blocks. The patient
has a 40 pack-year history of cigarette smoking but quit smoking 1 year ago. She is
otherwise healthy. On physical examination, vital signs are normal. Breath sounds
are decreased, but there is no edema or jugular venous distention. What is the
next best test you would order to make a diagnosis? Ans✓✓✓ Obtain spirometry.
A 65-year-old male is evaluated in a follow-up examination for worsening dyspnea
and chronic cough productive of mucoid sputum for the past 6 months. He is
otherwise healthy but was diagnosed with chronic obstructive pulmonary disease
(COPD) 3 years ago, and uses inhaled albuterol as needed. The patient has a 40
pack-year history of cigarette smoking but quit smoking 8 months ago. On
physical examination, vital signs are normal and the patient is not in any
respiratory distress. Breath sounds are decreased, but there is no edema or
jugular venous distention. Spirometry shows a forced expiratory volume in the
first second (FEV1) of 58% of predicted with no reversibility and an FEV1/forced
vital capacity (FVC) ratio of 65%. His COPD symptoms seem poorly controlled and
he has had one exacerbation in the past year. A chest radiograph is obtained and
shows mild hyperinflation. Which of the following is the most appropriat
Ans✓✓✓ Add a long-acting inhaled bronchodilator.
A 65-year-old man is hospitalized with sudden onset chest pain but has a negative
cardiac workup. You notice pink eroded papules along the left sternum and left
flank that abruptly stop at the midline, where he thinks electrical leads were
placed. He thinks these painful and somewhat itchy bumps are increasing in
number. He is afebrile, otherwise stable, and has no other complaints. Which of
the following is the most appropriate next step? Ans✓✓✓ Empiric valacyclovir.
A 70-year-old man undergoes an upper endoscopy for the evaluation of
dyspepsia. He has a large nonbleeding ulcer and biopsies reveal the present of
,Helicobacter pylori infection. He is given a 10-day course of clarithromycin,
tetracycline, and omeprazole twice daily. His symptoms resolve. A urea breath
test performed 2 weeks later is positive for H. pylori.
Which of the following is the best next step in management of this patient?
Ans✓✓✓ Treatment with bismuth, metronidazole, tetracycline, and omeprazole
for 14 days
A 70-year-old patient has scattered nummular plaques with thick scale on his
shins that are extremely pruritic. He also has very dry skin. Skin scraping is
negative for dermatophyte. He had already completed a course of oral antifungal
medication prescribed to him by an urgent care physician. Assuming this is
nummular eczema, which of the following topical medication and vehicle is the
best choice? Ans✓✓✓ Triamcinolone 0.1% ointment
A 70-year-old postmenopausal female presents to your clinic to discuss treatment
options for her low bone density. She has no prior history of hip or vertebral
fractures. She has type 2 diabetes mellitus and associated chronic kidney disease
(baseline creatinine clearance 29 mL/min). Body mass index (BMI) is 30 kg/m2.
She had a myocardial infarction 1 year ago. She was diagnosed with breast cancer
10 years ago, for which she underwent a mastectomy, chemotherapy, external
beam radiation, and a course of tamoxifen. She takes a daily calcium and vitamin
D supplement. Serum calcium and 25-hydroxyvitamin D levels are normal. She has
a family history of maternal hip fracture.
FRAX 10-year fracture risk score: Major osteoporotic fracture = 12%, hip fracture
= 5%
Which of the following is the best treatment option for this patient? Ans✓✓✓
Denosumab
A 71-year-old male with a past medical history of hypertension presents for
follow-up of his osteoporosis. He was diagnosed with osteoporosis by DXA scan 5
years ago after an ankle fracture and has been on weekly alendronate 70 mg since
, that time. He has no prior history of hip or vertebral fractures. He is active and
performs aerobic and strength-training exercises four times per week. No
kyphosis is noted on examination. BMI is 23 kg/m2. No loss of height while on
alendronate. He has no family history of hip fractures. He takes a daily calcium
and vitamin D supplement. He does not smoke or consume alcohol.
His repeat DXA scan demonstrates a significant increase in his spine bone mass
density (BMD) of 5%. Ans✓✓✓ b. Discuss initiation of drug holiday
A 72-year-old female with progressive fatigue is found to have a hemoglobin of
9.1 g/dL, mean corpuscular volume of 108 fL, and a platelet count of 67×109/L on
a routine laboratory evaluation. She has a normal B12 and folate level. She has
never had a history of anemia and does not have signs or symptoms of bleeding
or hemolysis. She does not use alcohol, and she has no liver disease. Your next
step in management should be: Ans✓✓✓ Refer to hematology for bone marrow
examination.
A 72-year-old man with a history of hypertension recently had acute coronary
syndrome for which he was hospitalized and treated with a stent to one of his
coronary arteries. In addition to antiplatelet therapy, what antihypertensives are
recommended to treat his BP and improve outcomes regarding his ischemic heart
disease? Ans✓✓✓ Lisinopril and metoprolol
A 72-year-old woman with a history of chronic heartburn comes in to discuss
gastroesophageal reflux disease management. She asks whether she should
remain on her proton-pump inhibitor (PPI); she has been on lansoprazole 15 mg
daily for the past 12 years. With the medication, diet, and lifestyle changes, she
has been asymptomatic for almost all of that time. An upper endoscopy
performed 4 years ago revealed a small hiatal hernia and mild erosive esophagitis.
She is concerned about long-term risks of PPIs.
