GERONTOLOGYnHESInTEST
Thencleansingnofnthenstomachnwithnsolutionndeliverednthroughnannasogastri
cntubenisnknownnasnwhat?n
Gavage
Emesis
Lavage
Stomachnpumpingn-ncorrectnanswernLavage
Gastricnlavagenisnusedntoncleansenthenstomachnofnanpoison,noverdosenofn
medication,nornotherntoxicnsubstance.nItnisndeliverednthroughnannasogastric
ntube
Younarenprovidingncarentonanpatientnwhonhasnrecentlynbegunndialysis.nHern
daughter,nwithnwhomnshenlivesnandnwhonpreparesnmanynofnhernmeals,nask
snwhatntypesnofnfoodsnshenshouldnincorporatenintonherndietnandnwhichnsh
enshouldnavoid.nWhichnofnthenfollowingnisnNOTnanfoodnthatnthisnpatientnsh
ouldnbenadvisedntonavoid?
Avocado.
Leannrednmeat.
Driednfruit.
Bananas.n-ncorrectnanswernLeannrednmeat
Dialysisnpatientsnarenencouragedntoneatnleannmeat,nincludingnrednmeat.nHig
hnqualitynproteinsnproducenlessnwastenandnhelpnthenbodynhealnandnmaintai
nnregularnprocesses.nDialysisnpatientsnshouldnavoidnfoodsnhighninnpotassiu
m,nincludingnavocado,nbanana,nandndriednfruit,nandnshouldneatnothernpotas
sium-containingnfoodsninnmoderation.
,Yourn89-year-
oldnpatientnpresentsnwithndyspepsianandnnausea.nAfterntesting,nyoundetermi
nenshenisnpositivenfornPepticnUlcernDisease.nOfnthenfollowing,nwhichnwould
nLEASTnlikelynbenandifferentialndiagnosisnfornPepticnUlcernDisease?
Cholecystitis.
Migraines.
Gastricncarcinoma.
Cardiovascularndisease.n-ncorrectnanswernMigraines
PepticnUlcernDiseasenisnangastrointestinalndisorder.nOtherndifferentialndiagno
sesnofnthenconditionnarenpancreatitisnandnbiliaryntractndisease.
Therenarenangoodnmanyndiseasesnaffectingnthenelderlynthatnarenthenresultn
ofnsmoking.nCounselingnregardingnsmokingncessationnisnpartnofnthenGNP'sn
job.nThencomponentsnofnbriefninterventionnforntreatingntobacconusenare:
Counsel,nDocument,nCaution,nDescribe,nDemonstrate
Advise,nConfer,nDescribe,nDocument,nPrescribe
Advise,nCounsel,nIntervene,nPrescribe,nFollow-up
Ask,nAdvise,nAssess,nAssist,nArrangen-
ncorrectnanswernAsk,nAdvise,nAssess,nAssist,nArrange
Asknaboutntobacconuse,nAdvisentonquit,nAssessnwillingnessntonmakenannatt
emptntonquit,nAssistninnthisnquitnattempt.nArrangenanfollow-up.
Mrs.nFrasier,nann50-year-
oldnpatient,npresentsnwithnanmosquitonbitenthatnshenisnconcernednabout.nH
owndonyoundiagnosenthis?
nCyst.
nBulla.
,nWheal.
nPlaques.n-ncorrectnanswernWheal
Cyst:nencapsulated,nfluid-fillednmassnthatnvariesninnsize.nBulla:nfluid-
filled,nelevated,ncircumscribednlesionnthat'snlargernthann5mm.nWheal:ncircum
scribed,nreddeningnwithntransientnelevationnlesionnthat'sn0.5nton10mmndiame
ter.nPlaques:nusuallynangroupingnofnpapules;nelevatednandnanvarietynofnsha
pes;nlargernthann5mm.
Whichnofnthenfollowingngroupsnshouldnbentestednfornabdominalnaorticnaneu
rysm?
nmalesnagedn65-75nwhonhavenevernsmoked
nfemalesnagedn65-75nwhonhavenhypertension
nmalesnandnfemalesnovern75
nfemalesnovern75n-ncorrectnanswernmalesnagedn65-
75nwhonhavenevernsmoked
Abdominalnaorticnaneurysmn(AAA)nisnmorenprevalentninnmalesnthanninnfema
les.nThenAmericannHeartnAssociationnrecommendsnscreeningnmalesnoncenb
etweennagesn65-
75nifntheynhavenevernsmokednsincenthatnincreasesnthenrisknofnAAA.
Withnangiardianlambliandiagnosis,nthenNPnwouldnMOSTnlikelynprescribenwha
tnmedication?
nMetronidazole.
nErythromycin.
nAmpicillin.
nTrimethoprim-sulfamethoxazole.n-ncorrectnanswernMetronidazole.
, Thenprecedingndrugsnarentypicallynusedninntreatingnthenfollowing:n-
nCampylobacternjejuni:nErythromycinn-nSalmonella:nAmpicillinn-
nShigella:nTrimethoprim-sulfamethoxazolen-nGiardianlamblia:nMetronidazole
An65-year-
oldnCaucasiannmalencallsnyournoffice.nHentellsnyounhenjustncameninnfromnt
henwoodsnandndiscoverednanticknonnhisnuppernrightnthigh.nHenreportsnself
nremovalnofnthenticknandnnownthenareanisnslightlynred.nWhatnshouldnyouna
dvisenhimntondo?
Henshouldncomentonthenofficenfornanceftriaxonen(Rocephin)ninjection.
Henshouldnbenprescribedndoxycycline.
Henneedsnnontreatment.
HenneedsnantopicalnscrubntonpreventnLymenDisease.n-
ncorrectnanswernHenneedsnnontreatment.
TondevelopnLymenDiseasenfromnanticknbite,nmanynfactorsnmustnbenpresent.
nThenticknmustnbelongntonIxodesnspeciesnandnmustnhavenbeennattachednfo
rnatnleastn48nhoursnbeforenthendiseasencannspread.nTherenisnnonneednforn
prophylacticntreatmentninnthisncasenbecausenthenticknhasnnotnbeennpresent
nlongnenough.
Asnpartnofnthentreatmentnplannfornyournelderlynpatient,nyounrecommendnhe
nseenannOphthalmologist.nWhatnbodynpart(s)nwillnthisndoctornevaluate?
nBrainn/nnerves.
nEyes.
nBonesn/nJointsn/nMuscles.
nEarsn/nThroat.n-ncorrectnanswernEyes
Neurologistn-nBrainn/nnervesnOphthalmologistn-nEyesnOrthopedistn-
nBonesn/nJointsn/nMusclesnOtolaryngologistn-nEarsn/nThroat
Thencleansingnofnthenstomachnwithnsolutionndeliverednthroughnannasogastri
cntubenisnknownnasnwhat?n
Gavage
Emesis
Lavage
Stomachnpumpingn-ncorrectnanswernLavage
Gastricnlavagenisnusedntoncleansenthenstomachnofnanpoison,noverdosenofn
medication,nornotherntoxicnsubstance.nItnisndeliverednthroughnannasogastric
ntube
Younarenprovidingncarentonanpatientnwhonhasnrecentlynbegunndialysis.nHern
daughter,nwithnwhomnshenlivesnandnwhonpreparesnmanynofnhernmeals,nask
snwhatntypesnofnfoodsnshenshouldnincorporatenintonherndietnandnwhichnsh
enshouldnavoid.nWhichnofnthenfollowingnisnNOTnanfoodnthatnthisnpatientnsh
ouldnbenadvisedntonavoid?
Avocado.
Leannrednmeat.
Driednfruit.
Bananas.n-ncorrectnanswernLeannrednmeat
Dialysisnpatientsnarenencouragedntoneatnleannmeat,nincludingnrednmeat.nHig
hnqualitynproteinsnproducenlessnwastenandnhelpnthenbodynhealnandnmaintai
nnregularnprocesses.nDialysisnpatientsnshouldnavoidnfoodsnhighninnpotassiu
m,nincludingnavocado,nbanana,nandndriednfruit,nandnshouldneatnothernpotas
sium-containingnfoodsninnmoderation.
,Yourn89-year-
oldnpatientnpresentsnwithndyspepsianandnnausea.nAfterntesting,nyoundetermi
nenshenisnpositivenfornPepticnUlcernDisease.nOfnthenfollowing,nwhichnwould
nLEASTnlikelynbenandifferentialndiagnosisnfornPepticnUlcernDisease?
Cholecystitis.
Migraines.
Gastricncarcinoma.
Cardiovascularndisease.n-ncorrectnanswernMigraines
PepticnUlcernDiseasenisnangastrointestinalndisorder.nOtherndifferentialndiagno
sesnofnthenconditionnarenpancreatitisnandnbiliaryntractndisease.
Therenarenangoodnmanyndiseasesnaffectingnthenelderlynthatnarenthenresultn
ofnsmoking.nCounselingnregardingnsmokingncessationnisnpartnofnthenGNP'sn
job.nThencomponentsnofnbriefninterventionnforntreatingntobacconusenare:
Counsel,nDocument,nCaution,nDescribe,nDemonstrate
Advise,nConfer,nDescribe,nDocument,nPrescribe
Advise,nCounsel,nIntervene,nPrescribe,nFollow-up
Ask,nAdvise,nAssess,nAssist,nArrangen-
ncorrectnanswernAsk,nAdvise,nAssess,nAssist,nArrange
Asknaboutntobacconuse,nAdvisentonquit,nAssessnwillingnessntonmakenannatt
emptntonquit,nAssistninnthisnquitnattempt.nArrangenanfollow-up.
Mrs.nFrasier,nann50-year-
oldnpatient,npresentsnwithnanmosquitonbitenthatnshenisnconcernednabout.nH
owndonyoundiagnosenthis?
nCyst.
nBulla.
,nWheal.
nPlaques.n-ncorrectnanswernWheal
Cyst:nencapsulated,nfluid-fillednmassnthatnvariesninnsize.nBulla:nfluid-
filled,nelevated,ncircumscribednlesionnthat'snlargernthann5mm.nWheal:ncircum
scribed,nreddeningnwithntransientnelevationnlesionnthat'sn0.5nton10mmndiame
ter.nPlaques:nusuallynangroupingnofnpapules;nelevatednandnanvarietynofnsha
pes;nlargernthann5mm.
Whichnofnthenfollowingngroupsnshouldnbentestednfornabdominalnaorticnaneu
rysm?
nmalesnagedn65-75nwhonhavenevernsmoked
nfemalesnagedn65-75nwhonhavenhypertension
nmalesnandnfemalesnovern75
nfemalesnovern75n-ncorrectnanswernmalesnagedn65-
75nwhonhavenevernsmoked
Abdominalnaorticnaneurysmn(AAA)nisnmorenprevalentninnmalesnthanninnfema
les.nThenAmericannHeartnAssociationnrecommendsnscreeningnmalesnoncenb
etweennagesn65-
75nifntheynhavenevernsmokednsincenthatnincreasesnthenrisknofnAAA.
Withnangiardianlambliandiagnosis,nthenNPnwouldnMOSTnlikelynprescribenwha
tnmedication?
nMetronidazole.
nErythromycin.
nAmpicillin.
nTrimethoprim-sulfamethoxazole.n-ncorrectnanswernMetronidazole.
, Thenprecedingndrugsnarentypicallynusedninntreatingnthenfollowing:n-
nCampylobacternjejuni:nErythromycinn-nSalmonella:nAmpicillinn-
nShigella:nTrimethoprim-sulfamethoxazolen-nGiardianlamblia:nMetronidazole
An65-year-
oldnCaucasiannmalencallsnyournoffice.nHentellsnyounhenjustncameninnfromnt
henwoodsnandndiscoverednanticknonnhisnuppernrightnthigh.nHenreportsnself
nremovalnofnthenticknandnnownthenareanisnslightlynred.nWhatnshouldnyouna
dvisenhimntondo?
Henshouldncomentonthenofficenfornanceftriaxonen(Rocephin)ninjection.
Henshouldnbenprescribedndoxycycline.
Henneedsnnontreatment.
HenneedsnantopicalnscrubntonpreventnLymenDisease.n-
ncorrectnanswernHenneedsnnontreatment.
TondevelopnLymenDiseasenfromnanticknbite,nmanynfactorsnmustnbenpresent.
nThenticknmustnbelongntonIxodesnspeciesnandnmustnhavenbeennattachednfo
rnatnleastn48nhoursnbeforenthendiseasencannspread.nTherenisnnonneednforn
prophylacticntreatmentninnthisncasenbecausenthenticknhasnnotnbeennpresent
nlongnenough.
Asnpartnofnthentreatmentnplannfornyournelderlynpatient,nyounrecommendnhe
nseenannOphthalmologist.nWhatnbodynpart(s)nwillnthisndoctornevaluate?
nBrainn/nnerves.
nEyes.
nBonesn/nJointsn/nMuscles.
nEarsn/nThroat.n-ncorrectnanswernEyes
Neurologistn-nBrainn/nnervesnOphthalmologistn-nEyesnOrthopedistn-
nBonesn/nJointsn/nMusclesnOtolaryngologistn-nEarsn/nThroat
