geriatrics- ROSH UPDATED ACTUAL Questions and CORRECT Answers
1. A 57-year-old woman presents to the clinic to establish B. Carcinoid Tumor
care and reports seven months duration of sudden, Carcinoid Syndrome
abrupt onset of diarrhea. She also reports occasionally Patient will be com-
experiencing a "fluttery feeling" in her chest accompa- plaining of skin flushing,
nied with facial flushing. Her medical history includes wheezing, and diarrhea
hypertension and a significant cough that has been Diagnosis is made
present for two years. She has a 25 pack year tobacco by 24-hour excretion
use history. Chest X-ray reveals left lower lobe atelecta- of 5-hydroxyindoleacetic
sis. Which of the following is the most likely diagnosis? acid (5-HIAA) in the pa-
A. Angioedema tient's urine
B Carcinoid tumor Most commonly caused
C Cardiac dysrhythmia by carcinoid tumors (neu-
D Irritable bowel syndrome roendocrine tumors that
secrete vasoactive mate-
rial such as serotonin,
histamine, catecholamine,
prostaglandins, and pep-
tides)
2. A 68-year-old man presents to the clinic with a past D. Liver ultrasound every
medical history of hepatitis B infection and hepatic six months
cirrhosis. Which of the following is the best choice for
surveillance of development of hepatocellular carcino-
ma in this patient?
A. Abdominal CT scan every 12 months
B. Abdominal CT scan every two years
C. Liver ultrasound every 12 months
D. Liver ultrasound every six months
3. A woman presents to the clinic complaining of pedal Diabetes Mellitus
edema. Which of the following would be most sugges-
tive of congestive heart failure as the likely etiology?
,4. A 50-year-old man with a body mass index of 52 kg/m² B. Nocturnal continuous
presents to the clinic complaining of daytime sleepi- positive airway pressure
ness and dyspnea on exertion. His peripheral oxygen
saturation on room air is 93%. Further testing reveals
obesity hypoventilation syndrome with concurrent ob-
structive sleep apnea. The patient is put on a weight
loss regimen which includes diet and exercise. In addi-
tion, which of the following is the best choice for initial
therapy in this patient?
A. Nocturnal bilevel positive airway pressure
B. Nocturnal continuous positive airway pressure
C. Oral theophylline dosed every twelve hours
D. Twenty-four hour supplemental oxygen
5. A 62-year-old man presents reporting urinary hesitan- D. Rubbery consistency of
cy, dribbling, and feeling of incomplete voiding. He the prostate
states his symptoms have been progressively wors-
ening for the last six months. He denies hematuria,
pain with urination, or scrotal swelling. Which of the
following physical exam findings is most consistent
with the diagnosis of benign prostatic hypertrophy?
A. Asymmetry of the prostate
B. Boggy consistency of the prostate
C. Decreased anal sphincter tone
D. Rubbery consistency of the prostate
6. You are treating a 62-year-old man who is seven days B. Heparin-induced
status-post coronary angiogram and stent placement, thrombocytopenia
following an acute myocardial infarction. He has been
on a heparin drip for five days. Lab calls to notify
, you that his previously normal platelet count is now
48,000/mcL. Which of the following is the most likely
diagnosis?
A. Disseminated intravascular coagulation
B. Heparin-induced thrombocytopenia
C. Immune thrombocytopenia
D. Thrombotic thrombocytopenic purpura
7. A 65-year-old woman presents to the ED with sudden C.Gonioscopy
onset of right eye pain and blurred vision. Physical Gonioscopy is considered
examination reveals circumcorneal injection, a 7 mm the gold standard in the
right pupil that is unresponsive to light and an intraoc- diagnosis of acute angle
ular pressure of 35 mm Hg. Which of the following is closure glaucoma, an ocu-
the gold standard test to confirm the diagnosis? lar emergency that this pa-
A. Dark room provocation tient is experiencing. This
B. Dilated fundus examination method allows the exam-
C. Gonioscopy iner to examine the an-
D. Slit lamp grading gle that is formed between
the cornea's posterior sur-
face and the iris' anteri-
or surface. An experienced
provider, such as an oph-
thalmologist, should per-
form this test. Care must
be taken to not shine light
directly onto the pupil as
the angle could widen and
create an error in mea-
surement.
8. Sildenafil is prescribed for an otherwise healthy B. Cyanopsia
54-year-old man who is diagnosed with erectile dys-
, function. Which of the following is a potential adverse Cyanopsia, or blue dis-
effect of this medication? coloration of vision, is
A. Constipation a potential side effect
B. Cyanopsia of sildenafil. The effect
C. Prostate specific antigen elevatin may be more likely with
D. Urinary Retention higher dosages of med-
ication and is usually
temporary. Sildenafil in-
hibits phosphodiesterase
type five (PDE-5), thereby
increasing nitric oxide lev-
els and cyclic guanosine
monophosphate, which
results in smooth mus-
cle relaxation. Sildenafil is
used most commonly for
erectile dysfunction, how-
ever, it may also be used
to treat pulmonary hy-
pertension. Cyanopsia is
hypothesized to be re-
lated to the vascular ef-
fects of the inhibition
of phosphodiesterase type
five, the effects of phos-
phodiesterase type six
on the retina, and po-
tentially to retinal ex-
posure to elevated lev-
els of cyclic guanosine
monophosphate. Cyanop-
sia is uncommon but is
1. A 57-year-old woman presents to the clinic to establish B. Carcinoid Tumor
care and reports seven months duration of sudden, Carcinoid Syndrome
abrupt onset of diarrhea. She also reports occasionally Patient will be com-
experiencing a "fluttery feeling" in her chest accompa- plaining of skin flushing,
nied with facial flushing. Her medical history includes wheezing, and diarrhea
hypertension and a significant cough that has been Diagnosis is made
present for two years. She has a 25 pack year tobacco by 24-hour excretion
use history. Chest X-ray reveals left lower lobe atelecta- of 5-hydroxyindoleacetic
sis. Which of the following is the most likely diagnosis? acid (5-HIAA) in the pa-
A. Angioedema tient's urine
B Carcinoid tumor Most commonly caused
C Cardiac dysrhythmia by carcinoid tumors (neu-
D Irritable bowel syndrome roendocrine tumors that
secrete vasoactive mate-
rial such as serotonin,
histamine, catecholamine,
prostaglandins, and pep-
tides)
2. A 68-year-old man presents to the clinic with a past D. Liver ultrasound every
medical history of hepatitis B infection and hepatic six months
cirrhosis. Which of the following is the best choice for
surveillance of development of hepatocellular carcino-
ma in this patient?
A. Abdominal CT scan every 12 months
B. Abdominal CT scan every two years
C. Liver ultrasound every 12 months
D. Liver ultrasound every six months
3. A woman presents to the clinic complaining of pedal Diabetes Mellitus
edema. Which of the following would be most sugges-
tive of congestive heart failure as the likely etiology?
,4. A 50-year-old man with a body mass index of 52 kg/m² B. Nocturnal continuous
presents to the clinic complaining of daytime sleepi- positive airway pressure
ness and dyspnea on exertion. His peripheral oxygen
saturation on room air is 93%. Further testing reveals
obesity hypoventilation syndrome with concurrent ob-
structive sleep apnea. The patient is put on a weight
loss regimen which includes diet and exercise. In addi-
tion, which of the following is the best choice for initial
therapy in this patient?
A. Nocturnal bilevel positive airway pressure
B. Nocturnal continuous positive airway pressure
C. Oral theophylline dosed every twelve hours
D. Twenty-four hour supplemental oxygen
5. A 62-year-old man presents reporting urinary hesitan- D. Rubbery consistency of
cy, dribbling, and feeling of incomplete voiding. He the prostate
states his symptoms have been progressively wors-
ening for the last six months. He denies hematuria,
pain with urination, or scrotal swelling. Which of the
following physical exam findings is most consistent
with the diagnosis of benign prostatic hypertrophy?
A. Asymmetry of the prostate
B. Boggy consistency of the prostate
C. Decreased anal sphincter tone
D. Rubbery consistency of the prostate
6. You are treating a 62-year-old man who is seven days B. Heparin-induced
status-post coronary angiogram and stent placement, thrombocytopenia
following an acute myocardial infarction. He has been
on a heparin drip for five days. Lab calls to notify
, you that his previously normal platelet count is now
48,000/mcL. Which of the following is the most likely
diagnosis?
A. Disseminated intravascular coagulation
B. Heparin-induced thrombocytopenia
C. Immune thrombocytopenia
D. Thrombotic thrombocytopenic purpura
7. A 65-year-old woman presents to the ED with sudden C.Gonioscopy
onset of right eye pain and blurred vision. Physical Gonioscopy is considered
examination reveals circumcorneal injection, a 7 mm the gold standard in the
right pupil that is unresponsive to light and an intraoc- diagnosis of acute angle
ular pressure of 35 mm Hg. Which of the following is closure glaucoma, an ocu-
the gold standard test to confirm the diagnosis? lar emergency that this pa-
A. Dark room provocation tient is experiencing. This
B. Dilated fundus examination method allows the exam-
C. Gonioscopy iner to examine the an-
D. Slit lamp grading gle that is formed between
the cornea's posterior sur-
face and the iris' anteri-
or surface. An experienced
provider, such as an oph-
thalmologist, should per-
form this test. Care must
be taken to not shine light
directly onto the pupil as
the angle could widen and
create an error in mea-
surement.
8. Sildenafil is prescribed for an otherwise healthy B. Cyanopsia
54-year-old man who is diagnosed with erectile dys-
, function. Which of the following is a potential adverse Cyanopsia, or blue dis-
effect of this medication? coloration of vision, is
A. Constipation a potential side effect
B. Cyanopsia of sildenafil. The effect
C. Prostate specific antigen elevatin may be more likely with
D. Urinary Retention higher dosages of med-
ication and is usually
temporary. Sildenafil in-
hibits phosphodiesterase
type five (PDE-5), thereby
increasing nitric oxide lev-
els and cyclic guanosine
monophosphate, which
results in smooth mus-
cle relaxation. Sildenafil is
used most commonly for
erectile dysfunction, how-
ever, it may also be used
to treat pulmonary hy-
pertension. Cyanopsia is
hypothesized to be re-
lated to the vascular ef-
fects of the inhibition
of phosphodiesterase type
five, the effects of phos-
phodiesterase type six
on the retina, and po-
tentially to retinal ex-
posure to elevated lev-
els of cyclic guanosine
monophosphate. Cyanop-
sia is uncommon but is
