NR 509
1. Which of the following changes are expected in vision as part of the normal aging process?
A) Cataracts
B) Glaucoma
C) Macular degeneration
D) Blurring of near vision - ANSWER: Ans: D
The lens loses its elasticity over time as part of the normal aging process, and the eye is less able to
accommodate and focus on near objects; therefore, the patient will be expected to have blurring of near
vision.
2. A 72-year-old retired truck driver comes to the clinic with his wife for evaluation of hearing loss. He has
noticed some decreased ability to hear what his wife and grandchildren are saying to him. He admits to lip-
reading more. He has a history of noise exposure in his young adult years: He worked as a sound engineer at a
local arena and had to attend a lot of concerts. Based on this information, what is the most likely finding
regarding his hearing acuity?
A) Loss of acuity for middle-range sounds
B) Increase of acuity for low-range sounds
C) Loss of acuity for high-range sounds
D) Increase of acuity for high-range sounds - ANSWER: Ans: A
Human speech is considered to be a middle-range sound. During the aging process there is a loss of acuity,
starting with high-pitched sounds but extending to the middle range and then into the low range.
3. A 79-year-old retired banker comes to your office for evaluation of difficulty with urination; he gets up five
to six times per night to urinate and has to go at least that often in the daytime. He does not feel as if his
bladder empties completely; the strength of the urinary stream is diminished. He denies dysuria or hematuria.
This problem has been present for several years but has worsened over the last 8 months. You palpate his
prostate. What is your expected physical examination finding, based on this description?
A) Normal size, smooth
B) Normal size, boggy
C) Enlarged size, smooth
D) Enlarged size, boggy - ANSWER: Ans: C
This is the expected physical examination finding in benign prostatic hyperplasia (BPH).
, 4. A 70-year-old retired auto mechanic comes to your office because his neighbor is concerned about his
memory. The patient himself admits to misplacing his keys more often and forgets what he is supposed to buy
from the grocery store and where he has parked the car. He denies getting lost in familiar places. Upon further
questioning, he states that his wife of 40 years died 8 months ago; his three children live in three different
states; and he has limited his activities because the people he interacted with were "his wife's friends, not
his." He drinks a six-pack of beer daily; he does not smoke or use illicit drugs. You perform a mini-mental state
examination and obtain a total score of 24 out of 28. Based on this information, what is your most likely
diagnosis?
A) Benign forgetfulness
B) Dementia
C) Meningitis
D) Depression - ANSWER: Ans: D
The patient has symptoms of depression: His wife died, he has no real social support system, and he has
isolated himself from his usual activities. He also drinks a considerable amount of alcohol on a daily basis,
which can further depress his mood. Depression can masquerade as dementia in the elderly and must be
considered in a patient with memory loss.
5. An 85-year-old retired teacher comes to your office for evaluation of weakness. You obtain a complete
history, perform a thorough physical examination, and order laboratory tests. You diagnose her with
hyperthyroidism. Based on her age, which of the atypical symptoms of hyperthyroidism is more likely to be
seen?
A) Fatigue
B) Weight loss
C) Tachycardia
D) Anorexia - ANSWER: Ans: D
This is an atypical symptom of hyperthyroidism that is more likely to be seen in the older patient.
6. A 78-year-old retired seamstress comes to the office for a routine check-up. You obtain an ECG
(electrocardiogram) because of her history of hypertension. You diagnose a previous myocardial infarction and
ask her if she had any symptoms related to this. Which of the following symptoms would be more common in
this patient's age group for an acute myocardial infarction?
A) Chest pain
B) Syncope
C) Pain radiating into the left arm
D) Pain radiating into the jaw - ANSWER: Ans: B
1. Which of the following changes are expected in vision as part of the normal aging process?
A) Cataracts
B) Glaucoma
C) Macular degeneration
D) Blurring of near vision - ANSWER: Ans: D
The lens loses its elasticity over time as part of the normal aging process, and the eye is less able to
accommodate and focus on near objects; therefore, the patient will be expected to have blurring of near
vision.
2. A 72-year-old retired truck driver comes to the clinic with his wife for evaluation of hearing loss. He has
noticed some decreased ability to hear what his wife and grandchildren are saying to him. He admits to lip-
reading more. He has a history of noise exposure in his young adult years: He worked as a sound engineer at a
local arena and had to attend a lot of concerts. Based on this information, what is the most likely finding
regarding his hearing acuity?
A) Loss of acuity for middle-range sounds
B) Increase of acuity for low-range sounds
C) Loss of acuity for high-range sounds
D) Increase of acuity for high-range sounds - ANSWER: Ans: A
Human speech is considered to be a middle-range sound. During the aging process there is a loss of acuity,
starting with high-pitched sounds but extending to the middle range and then into the low range.
3. A 79-year-old retired banker comes to your office for evaluation of difficulty with urination; he gets up five
to six times per night to urinate and has to go at least that often in the daytime. He does not feel as if his
bladder empties completely; the strength of the urinary stream is diminished. He denies dysuria or hematuria.
This problem has been present for several years but has worsened over the last 8 months. You palpate his
prostate. What is your expected physical examination finding, based on this description?
A) Normal size, smooth
B) Normal size, boggy
C) Enlarged size, smooth
D) Enlarged size, boggy - ANSWER: Ans: C
This is the expected physical examination finding in benign prostatic hyperplasia (BPH).
, 4. A 70-year-old retired auto mechanic comes to your office because his neighbor is concerned about his
memory. The patient himself admits to misplacing his keys more often and forgets what he is supposed to buy
from the grocery store and where he has parked the car. He denies getting lost in familiar places. Upon further
questioning, he states that his wife of 40 years died 8 months ago; his three children live in three different
states; and he has limited his activities because the people he interacted with were "his wife's friends, not
his." He drinks a six-pack of beer daily; he does not smoke or use illicit drugs. You perform a mini-mental state
examination and obtain a total score of 24 out of 28. Based on this information, what is your most likely
diagnosis?
A) Benign forgetfulness
B) Dementia
C) Meningitis
D) Depression - ANSWER: Ans: D
The patient has symptoms of depression: His wife died, he has no real social support system, and he has
isolated himself from his usual activities. He also drinks a considerable amount of alcohol on a daily basis,
which can further depress his mood. Depression can masquerade as dementia in the elderly and must be
considered in a patient with memory loss.
5. An 85-year-old retired teacher comes to your office for evaluation of weakness. You obtain a complete
history, perform a thorough physical examination, and order laboratory tests. You diagnose her with
hyperthyroidism. Based on her age, which of the atypical symptoms of hyperthyroidism is more likely to be
seen?
A) Fatigue
B) Weight loss
C) Tachycardia
D) Anorexia - ANSWER: Ans: D
This is an atypical symptom of hyperthyroidism that is more likely to be seen in the older patient.
6. A 78-year-old retired seamstress comes to the office for a routine check-up. You obtain an ECG
(electrocardiogram) because of her history of hypertension. You diagnose a previous myocardial infarction and
ask her if she had any symptoms related to this. Which of the following symptoms would be more common in
this patient's age group for an acute myocardial infarction?
A) Chest pain
B) Syncope
C) Pain radiating into the left arm
D) Pain radiating into the jaw - ANSWER: Ans: B
