Barriers to detecting elder mistreatment include all except: - -ANS---The tendency for many
older adults to falsely claim they are being abused
A 66-year-old man complains of nocturia (three to four times a night), hesitancy, and
incomplete emptying of the bladder. Physical examination reveals an enlarged, nontender
prostate, about 40 g in size without discrete nodules. Urinalysis reveals hematuria without
leukocyte esterase. Upon further evaluation, the hematuria is attributed to his BPH. The patient
declines surgical options at this time. Which of the following medications would be most
appropriate? - -ANS---Finasteride
Which of the following is true about tolterodine? - -ANS---It has greater risk of adverse effects
with its twice-daily formulation.
An 82-year-old man, Mr. A, complains of worsening nocturia, occurring four times per night. His
other lower urinary tract symptoms are slow stream, occasional urgency, and urgency-related
leakage once weekly. Medical problems include poorly controlled hypertension, diastolic heart
failure, hyperlipidemia, osteoarthritis, and prediabetes. His medications include lisinopril 20 mg
daily, metoprolol succinate 75 mg daily, atorvastatin 10 mg daily, metformin 500 mg twice
daily, hydrocodone-acetaminophen as needed, and aspirin 81 mg daily. Amlodipine 5 mg daily
,was recently added by his cardiologist. On review of systems, Mr. A complains that nocturia is
causing daytime fatigue, and he is more constipated. Physical examination is notable for blood
pressure 162/83 mmHg, heart rate 60 beats per minute, clear lungs, soft abdomen, enlarged
prostate, and 21 pretibial edema. Your next step in management should be: - -ANS---Stop
amlodipine and increase lisinopril.
The daughter of a 79-year-old woman notes that her mother, who has dementia and lives with
her, is wetting herself when she attends her new day program. Program staff have requested
that "something be done" as she is requiring a clothes change nearly every time she is there.
She cannot describe the circumstances of leakage, saying "it just comes." Leakage is uncommon
at home. Her medications include donepezil and acetaminophen. Physical examination is
normal. Initial treatment approach will require intervention by which of the following? - -ANS---
Day program staff
Ms. J, who is 82 years old, complains of urine leakage while playing golf. This has gotten worse
over the past year, and she rarely makes it through nine holes without feeling like she needs to
"run into the bushes and go." Leakage is usually small volume, but causes her extreme
embarrassment because she is afraid she will smell of urine. She has tried limiting caffeine in
the morning before she golfs and avoiding drinking water while playing, to no effect. She also
tried "those Kegler" exercises in the past without success. Which of the following is the most
appropriate recommendation for Ms. J? - -ANS---Bladder training
What is the most common cause of erectile dysfunction in older men? - -ANS---Atherosclerosis
A 72-year-old woman reports vaginal dryness that interferes with coitus. Her medical history
includes type 2 diabetes, hypertension, and osteoarthritis. Medications are glyburide,
chlorthalidone, and acetaminophen. What would be your first step in therapy? - -ANS---Stop
chlorthalidone
A 70-year-old woman reports sexual pain with deep penetration only. What is the most likely
cause of her problem? - -ANS---High-tone pelvic floor dysfunction
, A 79-year-old woman with a 1.5-cm breast cancer underwent lumpectomy. Pathology revealed
ductal carcinoma that is hormone receptor negative (estrogen receptor 0%, progesterone
receptor 1%) and HER2/neu negative. Surgical margins were adequate and uninvolved with
cancer. Sentinel lymph node sampling was negative for lymph node involvement. She has good
performance status and no activities of daily living (ADL) or instrumental (IADL) dependencies.
What treatment would you recommend? - -ANS---Hormonal therapy only
An 86-year-old man with no ADL deficits who has stopped driving because of macular
degeneration is evaluated for a urinary tract infection associated with urinary retention. The
consulting urologist places a Foley catheter and sends a prostate-specific antigen (PSA) level
that comes back 12 ng/mL. Three months later after the Foley has been removed and he has
had a good response to tamsulosin, his PSA is still 10 ng/mL. What is the appropriate next step
in managing this man's prostate problem? - -ANS---Repeat PSA in 6 months
An 84-year-old male with history of stroke without residual deficit, systolic heart failure, and
type 2 diabetes presents to clinic for follow-up. He is independently living in a retirement
community and still works part time on a golf course. He currently takes aspirin 81 mg,
metoprolol tartrate 25 mg BID (twice a day), furosemide 20 mg BID, and lisinopril 10 mg daily.
He reports his last colonoscopy was 8 years ago, with no abnormality. He reports he is sexually
active with men and women, engaging in receptive oral, receptive anal, and penetrative sex. He
states he has had over three sexual partners in the last year with intermittent condom use.
What sexually transmitted infection testing should be offered? - -ANS---Urine testing, blood
testing, anal swab, and oropharyngeal swab
In which of the following patients is chemical or surgical castration likely to prolong survival? - -
ANS---A 78-year-old man who had a radical prostatectomy and external beam radiation therapy
10 years earlier now has a PSA level of 24.5 ng/mL. A CT scan of the pelvis shows an enlarged
pelvic lymph node, and a bone scan is positive in the pelvis.
Which is the most reasonable first step in the treatment of older men with erectile
dysfunction? - -ANS---Sildenafil
On admission to the hospital, an 85-year-old woman was found to have a fungating mass on her
right breast. The mass is 9 cm in diameter, partially ulcerated, and associated with edema of
the arm and obvious pain. The patient has no children and had lived alone until recently, when
a neighbor became concerned for what appeared to be a progressive loss of memory and
older adults to falsely claim they are being abused
A 66-year-old man complains of nocturia (three to four times a night), hesitancy, and
incomplete emptying of the bladder. Physical examination reveals an enlarged, nontender
prostate, about 40 g in size without discrete nodules. Urinalysis reveals hematuria without
leukocyte esterase. Upon further evaluation, the hematuria is attributed to his BPH. The patient
declines surgical options at this time. Which of the following medications would be most
appropriate? - -ANS---Finasteride
Which of the following is true about tolterodine? - -ANS---It has greater risk of adverse effects
with its twice-daily formulation.
An 82-year-old man, Mr. A, complains of worsening nocturia, occurring four times per night. His
other lower urinary tract symptoms are slow stream, occasional urgency, and urgency-related
leakage once weekly. Medical problems include poorly controlled hypertension, diastolic heart
failure, hyperlipidemia, osteoarthritis, and prediabetes. His medications include lisinopril 20 mg
daily, metoprolol succinate 75 mg daily, atorvastatin 10 mg daily, metformin 500 mg twice
daily, hydrocodone-acetaminophen as needed, and aspirin 81 mg daily. Amlodipine 5 mg daily
,was recently added by his cardiologist. On review of systems, Mr. A complains that nocturia is
causing daytime fatigue, and he is more constipated. Physical examination is notable for blood
pressure 162/83 mmHg, heart rate 60 beats per minute, clear lungs, soft abdomen, enlarged
prostate, and 21 pretibial edema. Your next step in management should be: - -ANS---Stop
amlodipine and increase lisinopril.
The daughter of a 79-year-old woman notes that her mother, who has dementia and lives with
her, is wetting herself when she attends her new day program. Program staff have requested
that "something be done" as she is requiring a clothes change nearly every time she is there.
She cannot describe the circumstances of leakage, saying "it just comes." Leakage is uncommon
at home. Her medications include donepezil and acetaminophen. Physical examination is
normal. Initial treatment approach will require intervention by which of the following? - -ANS---
Day program staff
Ms. J, who is 82 years old, complains of urine leakage while playing golf. This has gotten worse
over the past year, and she rarely makes it through nine holes without feeling like she needs to
"run into the bushes and go." Leakage is usually small volume, but causes her extreme
embarrassment because she is afraid she will smell of urine. She has tried limiting caffeine in
the morning before she golfs and avoiding drinking water while playing, to no effect. She also
tried "those Kegler" exercises in the past without success. Which of the following is the most
appropriate recommendation for Ms. J? - -ANS---Bladder training
What is the most common cause of erectile dysfunction in older men? - -ANS---Atherosclerosis
A 72-year-old woman reports vaginal dryness that interferes with coitus. Her medical history
includes type 2 diabetes, hypertension, and osteoarthritis. Medications are glyburide,
chlorthalidone, and acetaminophen. What would be your first step in therapy? - -ANS---Stop
chlorthalidone
A 70-year-old woman reports sexual pain with deep penetration only. What is the most likely
cause of her problem? - -ANS---High-tone pelvic floor dysfunction
, A 79-year-old woman with a 1.5-cm breast cancer underwent lumpectomy. Pathology revealed
ductal carcinoma that is hormone receptor negative (estrogen receptor 0%, progesterone
receptor 1%) and HER2/neu negative. Surgical margins were adequate and uninvolved with
cancer. Sentinel lymph node sampling was negative for lymph node involvement. She has good
performance status and no activities of daily living (ADL) or instrumental (IADL) dependencies.
What treatment would you recommend? - -ANS---Hormonal therapy only
An 86-year-old man with no ADL deficits who has stopped driving because of macular
degeneration is evaluated for a urinary tract infection associated with urinary retention. The
consulting urologist places a Foley catheter and sends a prostate-specific antigen (PSA) level
that comes back 12 ng/mL. Three months later after the Foley has been removed and he has
had a good response to tamsulosin, his PSA is still 10 ng/mL. What is the appropriate next step
in managing this man's prostate problem? - -ANS---Repeat PSA in 6 months
An 84-year-old male with history of stroke without residual deficit, systolic heart failure, and
type 2 diabetes presents to clinic for follow-up. He is independently living in a retirement
community and still works part time on a golf course. He currently takes aspirin 81 mg,
metoprolol tartrate 25 mg BID (twice a day), furosemide 20 mg BID, and lisinopril 10 mg daily.
He reports his last colonoscopy was 8 years ago, with no abnormality. He reports he is sexually
active with men and women, engaging in receptive oral, receptive anal, and penetrative sex. He
states he has had over three sexual partners in the last year with intermittent condom use.
What sexually transmitted infection testing should be offered? - -ANS---Urine testing, blood
testing, anal swab, and oropharyngeal swab
In which of the following patients is chemical or surgical castration likely to prolong survival? - -
ANS---A 78-year-old man who had a radical prostatectomy and external beam radiation therapy
10 years earlier now has a PSA level of 24.5 ng/mL. A CT scan of the pelvis shows an enlarged
pelvic lymph node, and a bone scan is positive in the pelvis.
Which is the most reasonable first step in the treatment of older men with erectile
dysfunction? - -ANS---Sildenafil
On admission to the hospital, an 85-year-old woman was found to have a fungating mass on her
right breast. The mass is 9 cm in diameter, partially ulcerated, and associated with edema of
the arm and obvious pain. The patient has no children and had lived alone until recently, when
a neighbor became concerned for what appeared to be a progressive loss of memory and
