PRITE - GERIATRICS
A. Absorption - ANS-Which of the following physiologic measures affecting pharmacokinetics
remains the most stable in individuals over the age of 65 years when compared to younger
people?
A. Absorption
B. Gastric emptying
C. Hepatic circulation
D. Volume of distribution (VD)
E. Glomerular Filtration rate (GFR)
A. Apathy - ANS-A 71 year old patient who was diagnosed with Parkinson's disease 3 years
ago is brought to the clinic for changes in mood and thinking. The patient's motor symptoms
are well controlled on carbidopa/levodopa. The patient's spouse states that the patient has
trouble getting up and motivated to do anything, and the patient does not express interest in
attending social events. There has also been a recent "slowness" of sadness,
worthlessness, or suicidal ideation. Cognitive evaluation is unremarkable except for slow
processing. Which of the following is the most likely explanation for these symptoms?
A. Apathy
B. Anxiety
C. Catanoia
D. Psychosis
E. Depression
A. Attempt to decrease or stop the patient's medication dose at - ANS-A 75 year old patient
with a history of moderate Alzheimer's Dementia resides in a nursing home. Several months
prior, the patient became very agitated and hit several staff members. The primary care
physician started Quetiapine 12.5mg BID. Since the medication was started, the patient has
had no further outbursts. According to the Omnibus Budget Reconciliation Act of 1987, the
physician must do which of the following?
A. Attempt to decrease or stop the patient's medication dose at least every 3 months
B. Obtain consultation about the patient's condition from a board-certified Geriatric
Psychiatrist
C. Discontinue the medication immediately, since the patient has demonstration
improvement
D. Change the patient to a less expensive, "Medicare preferred" pharmacological agent.
E. Change to a pharmacological
A. Changes in renal clearance make lithium problematic to use - ANS-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 .
A. Dementia with Lewy Bodies - ANS-A 72 year old patient with early dementia is paranoid
and has visual hallucinations. The patient's caretaker reports that the patient seems
lightheaded and is socially inappropriate. After 2 days of treatment with Risperidone 0.25mg,
the caretaker reports that the patient is more confused and sedated. On examination, the
patient has a new-onset rigidity. Which of the following is the most likely cause of the
patient's psychosis?
A. Dementia with Lewy Bodies
B. Binswanger Disease
C. Creutzfeldt - Jakob Disease
D. Progressive Supranuclear Palsy
E. Normal Pressure Hydrocephalus
A. Discontinue Haloperidol - ANS-A 75 years old patient is admitted for confusion. The
patient is disoriented to time and place, easily distracted and unable to recall any of the 3
words after 5 minutes. The patient is somnolent much of the day and is often up at night,
repeatedly asking, "Where am I?" The current symptoms are new and different from the
baseline mild dementia. Workup for the patient's confusion is negative thus far, and
Haloperidol is started. After 3 days the patient is much improved, with minimal somnolence.
The patient continues to be disoriented and is surprised when informed he is in a hospital.
Which of the following is the best pharmacological treatment approach to take next with this
patient?
A. Discontinue Haloperidol
B. Continue Haloperidol until the disorientation resolves
C. Increase the dose of Haloperidol until the disorientation resolves
D. Switch from Haloperidol to Risperidone
E. Switch from Haloperidol to Lorazepam
A. Electrolytes - SSRI cause SIADH and hyponatremia, which increase thirst drive and
intake of hypotonic fluids, further worsening hyponatremia. Check Na+ - ANS-A 70 year old
patient with mild early Alzheimer disease who lives with a family member has recently been
prescribed an SSRI for depression. The patient also has HTN, adult onset DM and
rheumatoid arthritis, which have been stable and well-controlled with medication. The patient
develops acute confusion but no other medical or psychiatric symptoms. Which of the
follwoign tests should be ordered first to determine the etiology of the patient's confusion?
A. Electrolytes
B. Cardiac enzymes
C. Liver function tests
D. Thyroid function tests
E. ESR
A. less common
D. associated with more serious adverse consequences - ANS-As compared to alcohol
dependence in younger patients, alcohol dependence in patients over age 65 is:
, A. less common
B. more stigmatized
C. more responsive to behavioral treatments
D. associated with more serious adverse consequences
A. more mixed episodes - ANS-Patients over the age of 65 years of age with Bipolar
Disorder differ from younger patients with the same dx in that they experience:
A. more mixed episodes
B. more manic episodes
C. poorer response to lithium
D. Fewer acute affective episodes
E. more comorbidity with substance abuse
A. Nihilistic delusions - ANS-Which of the following is more common in patient experiencing
a first episode of psychotic depression at old age compared to onset at a younger age?
A. Nihilistic delusions
B. Grandiose Delusions
C. Visual hallucinations
D. Olfactory Hallucinations
E. Auditory Hallucinations
A. Nocturia - ANS-Which of the following is the most common explanation given by
individuals over the age of 65 for difficulty maintaining sleep?
A. Nocturia
B. Joint pain
C. Headaches
D. Shortness of breath
E. Restless leg syndrome
A. Oxybutynin - is an anticholinergic medication for urge incontinence, that can block the
cholinergic (Ach) effects of Donepezil and decrease its efficacy. - ANS-The psychiatrist is
considering prescribing Donepezil for an 87-year old patient. Which of the following
medications would most significantly interfere with its efficacy?
A. Oxybutynin
B. Loratidine
C. Metoprolol
D. Omeprazole
E. Warfarin
A. Prednisone - ANS-A 72 year old patient presents to the office with complaint of left-sided
headache and jaw pain which is worse with eating. Lab testing reveals an elevated ESR of
75 mm/hr. Which of the following would be the treatment of the choice?
A. Prednisone
B. Gabapentin
C. Amitriptyline
D. Sumatriptan
E. Carbamazepine
A. Absorption - ANS-Which of the following physiologic measures affecting pharmacokinetics
remains the most stable in individuals over the age of 65 years when compared to younger
people?
A. Absorption
B. Gastric emptying
C. Hepatic circulation
D. Volume of distribution (VD)
E. Glomerular Filtration rate (GFR)
A. Apathy - ANS-A 71 year old patient who was diagnosed with Parkinson's disease 3 years
ago is brought to the clinic for changes in mood and thinking. The patient's motor symptoms
are well controlled on carbidopa/levodopa. The patient's spouse states that the patient has
trouble getting up and motivated to do anything, and the patient does not express interest in
attending social events. There has also been a recent "slowness" of sadness,
worthlessness, or suicidal ideation. Cognitive evaluation is unremarkable except for slow
processing. Which of the following is the most likely explanation for these symptoms?
A. Apathy
B. Anxiety
C. Catanoia
D. Psychosis
E. Depression
A. Attempt to decrease or stop the patient's medication dose at - ANS-A 75 year old patient
with a history of moderate Alzheimer's Dementia resides in a nursing home. Several months
prior, the patient became very agitated and hit several staff members. The primary care
physician started Quetiapine 12.5mg BID. Since the medication was started, the patient has
had no further outbursts. According to the Omnibus Budget Reconciliation Act of 1987, the
physician must do which of the following?
A. Attempt to decrease or stop the patient's medication dose at least every 3 months
B. Obtain consultation about the patient's condition from a board-certified Geriatric
Psychiatrist
C. Discontinue the medication immediately, since the patient has demonstration
improvement
D. Change the patient to a less expensive, "Medicare preferred" pharmacological agent.
E. Change to a pharmacological
A. Changes in renal clearance make lithium problematic to use - ANS-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 .
A. Dementia with Lewy Bodies - ANS-A 72 year old patient with early dementia is paranoid
and has visual hallucinations. The patient's caretaker reports that the patient seems
lightheaded and is socially inappropriate. After 2 days of treatment with Risperidone 0.25mg,
the caretaker reports that the patient is more confused and sedated. On examination, the
patient has a new-onset rigidity. Which of the following is the most likely cause of the
patient's psychosis?
A. Dementia with Lewy Bodies
B. Binswanger Disease
C. Creutzfeldt - Jakob Disease
D. Progressive Supranuclear Palsy
E. Normal Pressure Hydrocephalus
A. Discontinue Haloperidol - ANS-A 75 years old patient is admitted for confusion. The
patient is disoriented to time and place, easily distracted and unable to recall any of the 3
words after 5 minutes. The patient is somnolent much of the day and is often up at night,
repeatedly asking, "Where am I?" The current symptoms are new and different from the
baseline mild dementia. Workup for the patient's confusion is negative thus far, and
Haloperidol is started. After 3 days the patient is much improved, with minimal somnolence.
The patient continues to be disoriented and is surprised when informed he is in a hospital.
Which of the following is the best pharmacological treatment approach to take next with this
patient?
A. Discontinue Haloperidol
B. Continue Haloperidol until the disorientation resolves
C. Increase the dose of Haloperidol until the disorientation resolves
D. Switch from Haloperidol to Risperidone
E. Switch from Haloperidol to Lorazepam
A. Electrolytes - SSRI cause SIADH and hyponatremia, which increase thirst drive and
intake of hypotonic fluids, further worsening hyponatremia. Check Na+ - ANS-A 70 year old
patient with mild early Alzheimer disease who lives with a family member has recently been
prescribed an SSRI for depression. The patient also has HTN, adult onset DM and
rheumatoid arthritis, which have been stable and well-controlled with medication. The patient
develops acute confusion but no other medical or psychiatric symptoms. Which of the
follwoign tests should be ordered first to determine the etiology of the patient's confusion?
A. Electrolytes
B. Cardiac enzymes
C. Liver function tests
D. Thyroid function tests
E. ESR
A. less common
D. associated with more serious adverse consequences - ANS-As compared to alcohol
dependence in younger patients, alcohol dependence in patients over age 65 is:
, A. less common
B. more stigmatized
C. more responsive to behavioral treatments
D. associated with more serious adverse consequences
A. more mixed episodes - ANS-Patients over the age of 65 years of age with Bipolar
Disorder differ from younger patients with the same dx in that they experience:
A. more mixed episodes
B. more manic episodes
C. poorer response to lithium
D. Fewer acute affective episodes
E. more comorbidity with substance abuse
A. Nihilistic delusions - ANS-Which of the following is more common in patient experiencing
a first episode of psychotic depression at old age compared to onset at a younger age?
A. Nihilistic delusions
B. Grandiose Delusions
C. Visual hallucinations
D. Olfactory Hallucinations
E. Auditory Hallucinations
A. Nocturia - ANS-Which of the following is the most common explanation given by
individuals over the age of 65 for difficulty maintaining sleep?
A. Nocturia
B. Joint pain
C. Headaches
D. Shortness of breath
E. Restless leg syndrome
A. Oxybutynin - is an anticholinergic medication for urge incontinence, that can block the
cholinergic (Ach) effects of Donepezil and decrease its efficacy. - ANS-The psychiatrist is
considering prescribing Donepezil for an 87-year old patient. Which of the following
medications would most significantly interfere with its efficacy?
A. Oxybutynin
B. Loratidine
C. Metoprolol
D. Omeprazole
E. Warfarin
A. Prednisone - ANS-A 72 year old patient presents to the office with complaint of left-sided
headache and jaw pain which is worse with eating. Lab testing reveals an elevated ESR of
75 mm/hr. Which of the following would be the treatment of the choice?
A. Prednisone
B. Gabapentin
C. Amitriptyline
D. Sumatriptan
E. Carbamazepine
