AND ANSWERS 100% CORRECT!!!
,D. Frequent small sips of water - ANSWER A 91 year old hospice patient with severe
cachexia, end-stage dementia, renal impairment has stopped eating and drinking.
Which of the following comfort measures would be most appropriate?
A. Total Parenteral nutrition
B. IV hydration
C. Nasogastric tube feeding
D. Frequent small sips of water
E. Appetite-inducing medications
A. Sex education - ANSWER A 75 year old man and his 72 year old wife present
requesting marital therapy. They describe interesting conflict beginning about a decade
ago when the wife began refusing sexual activity. The husband explains that he still
desires an intimate relationship and is frustrated and hurt that his wife refuses him. She
says that she does not see herself as "sexy" and cannot understand how her husband
could still desire her. She has occasionally suggested he find "some younger woman."
He is insulted by these suggestions, saying that he would never stray from the
marriage. In treating this couple, the initial approach should incorporate which of the
following interventions?
A. Sex education
B. Sildenafil treatment
C. Sensate focus exercises
D. Testosterone replacement therapy
E. Cognitive Behavioral therapy
E. Information processing speed - ANSWER Which of the following neurocognitive
functions is most likely to show a decline in people over age 65?
A. Attention span
B. Language
C. Long-term memory
D. Simple pattern recognition
E. Information processing speed
B. has a ceiling effect for well-educated persons - ANSWER A 62 yea old patient is
referred for complaints of memory problems. The patient reports feeling more forgetful
and give example of "losing my keys, handbag, or forgetting the names of
acquaintances." The patient denies any other neurocognitive symptoms. Family
member confirm the patient's report, and feel that this has been a gradual change over
the last year. Family members report that the patient is a former history professor who
, continues to enjoy intellectual activities, and they need to prepare if the patient is going
to lose these capabilities as a result of dementia. The standard MMSE would be a
relatively insensitive instrument for this patient because it:
A. has not been validate in people of the same age
B. has a ceiling effect for well-educated persons
C. requires considerable training and is not practical in the clinical setting
D. was designed to be a diagnostic tool rather than a general cognitive assessment
E. focuses on attention and immediate recall, which are not the primary complaints
A. Changes in renal clearance make lithium problematic to use - ANSWER Valproate is
more commonly used than Lithium for Bipolar Disorder in adults over age 65 and this
treatment preference is best justified by:
A. Changes in renal clearance make lithium problematic to use
B. Valproate appears to be superior to lithium in comparison to trials
C. Lithium is more likely to interact with other drugs commonly used
D. The half-life of valproate is less affected by the physiological changes
E. Blood serum Valproate levels more accurately reflect the active quantity available to
the brain .
D. MDD with psychosis - ANSWER A 79 year old man presents to the doctor c/o
possibly having a "venereal disease", explaining that he had an affair and these he
contracted an STD. The patient reports poor appetite, sleep, and energy for the last
month, but claims these are only because "I feel miserable and guilty, and cannot stop
thinking about it." The patient's spouse, who is present, seems surprised by the patient's
concerns, saying that the affair the patient describes occurred many years ago and the
spouse has long since forgiven the patient. Physical exam shows no evidence of
infection. MSE is significant for sad affect, and cognitive exam is WNL. Which of the
following is the most likely diagnosis for this patient?
A. Hypochondriasis
B. Delusional Disorder
C. Adjustment Disorder
D. MDD with psychosis
E. OCD
A. Vascular Dementia - ANSWER A 74 year old, right hand patient presents with
significant memory loss, expressive aphasia, and left plantar extensor response. The
most likely diagnosis is: