GERIATRICS EXAM QUESTIONS AND CORRECT DETAILED ANSWERS
,A COMPLETE SOLUTION THAT COVERS 2024/2025 BEST RATED TO
SCORE A+ FOR SUCCESS
Absorption changes - CORRECT ANSWERS Iron, vitamin B12, antifungal and calcium are
decreased with decreased stomach acid scretion
Slower gastric emptying increases risk of ulceration from NSAIDS, bisphosphonates and Kcl
tabs
Most drugs are absorbed by passive diffusion without significant age related changes
TD formulations require SQ fat layer to form drug reservoir for absorption (caution if
cachectic)
Distribution during aging - CORRECT ANSWERS Lipid-soluble meds (diazepam) have
increased half life
Highly albumin bound drugs (phenytoin) can have larger fraction of free (active) drug
PGP (efflux transporter) decreases with aging, which can lead to higher brain concentrations
of meds (opioids)
Metabolism in aging - CORRECT ANSWERS Morphine and propranolol clearance are reduced
because of reduction in first pass metabolism, similar to other drugs with high first pass
metabolism
Phase I (oxidative reactions by CYP450 enzymes) can change based on age, genetics, sex and
other drugs
Ativan, oxazepam, temazepam depend on phase II metabolism and are less affected by aging
Excretion in aging - CORRECT ANSWERS Need to look at GFR (Cockcroft-Gault). Dabigatran,
dofetilide, and xarelto are dosed on ABW and not IBW
Some clinicians round Scr up to 1 mg/dL because older adults have lower muscle mass which
produces less creatinine which could overestimate renal function (controversial) or using
AdjBW if obese
Pharmacodynamic changes: Increased sensitivity - CORRECT ANSWERS BDZ and opioids:
increased sensitivity to CNS effects
Antipsychotic and metoclopramide: EPS and tardive dyskinesia
TCA, Alpha-blockers, anti-HTN: OH
Warfarin: greater inhibition of synthesis of Vitamin K-dependent clotting factors, increased
bleeding risk
Nsaid: GI bleeding
,GERIATRICS EXAM QUESTIONS AND CORRECT DETAILED ANSWERS
,A COMPLETE SOLUTION THAT COVERS 2024/2025 BEST RATED TO
SCORE A+ FOR SUCCESS
Anticholinergic agent : increased confusion, dry mouth, constipation
Pharmacodynamic changes: Decreased sensitivity - CORRECT ANSWERS B blocker:
downregulation of Beta-1 receptors (reduced effect)
B agonist: Decreased response to inhaled beta agonist, require continuous /scheduled
treatment instead of PRN
Impaired homeostasis - CORRECT ANSWERS Diuretics, ACE: sodium and electrolytes
Diuretics: hydration status
Overuse of meds - CORRECT ANSWERS Unnecessary meds: GI, CNS agents, vitamins,
minerals
Underused meds - CORRECT ANSWERS Anticoagulant, statins, antihypertensive
Withdrawal symptoms - CORRECT ANSWERS Antihypertensives, antidepressant, anxiolytic,
pain meds
BEERS criteria - CORRECT ANSWERS A list of medications that are generally considered
inappropriate when given to elderly people
anticholinergic, BDZ, sedative-hypnotics, older antipsychotic, hypoglycemic, NSAIDS, PPI
Medication Appropriateness Index (MAI) - CORRECT ANSWERS questions to ask about each
individual medication
in there an indication
is the med effective
is the dose correct
is the sig correct
etc.
Does no assess allergies, AE, or compliance
,GERIATRICS EXAM QUESTIONS AND CORRECT DETAILED ANSWERS
,A COMPLETE SOLUTION THAT COVERS 2024/2025 BEST RATED TO
SCORE A+ FOR SUCCESS
Choosing Wisely Criteria - CORRECT ANSWERS 10 things to question in older adults (7/10
questions are drug related)
Antipsychotics in dementia should be avoided
Target A1c should be 7.5% or higher
Avoid BDZ or sedative-hypnotics for insomnia, agitation, delirium
Do not start ABX for bacteriuria without symptoms
Assess risk/benefit of cholinesterase inhibitor
Appetite stimulant are not helpful for anorexia or cachexia
What are some possible etiologies of falls in the elderly? - CORRECT ANSWERS Psychoactive
medications, polypharmacy, orthostatic hypotension, hypoglycemia, hyponatremia,
myocardial infarction, urinary tract infection
What are some risk factors for falls in the elderly? - CORRECT ANSWERS Vitamin D
deficiency, poor balance, muscle weakness, poor vision, environmental factors
What are the key features of delirium in the elderly? - CORRECT ANSWERS Disturbance in
attention and awareness developing over hours to days with fluctuation
What are some risk factors for delirium in the elderly? - CORRECT ANSWERS Age, underlying
dementia, functional impairment, medical comorbidity, psychoactive meds, polypharmacy,
hypoglycemia, hyponatremia, MI, infection
What are some contributing risk factors for delirium in the elderly? - CORRECT ANSWERS
Dementia, stroke, vitamin B12 deficiency, poor hearing, lack of sleep, constipation, pain,
thyroid disorder
Dementia definition - CORRECT ANSWERS Decreased cognitive ability, memory, or function,
with intact consciousness that interferes with work or social function. rule out delirium first
Delirium - CORRECT ANSWERS A disturbance in attention and awareness. Onset is a rapid
and course tends to fluctuate. Includes a cognitive disturbance. Specifiers: substance
intoxication delirium, substance withdrawal delirium, medication induced delirium, delirium
due to another medical condition, and delirium due to multiple etiologies. Common causes
include infections, metabolic disorders (low blood sugar, renal disease), post-operative
, GERIATRICS EXAM QUESTIONS AND CORRECT DETAILED ANSWERS
,A COMPLETE SOLUTION THAT COVERS 2024/2025 BEST RATED TO
SCORE A+ FOR SUCCESS
states, and substance intoxication. The majority recover fully, with or without treatment;
early intervention shortens the duration of the delirium. Untreated delirium may progress to
coma, seizures, or death.
Meds: sedative-hypnotics, antidepressant, anticholinergic, opioid, anticonvulsant,
antiparkinson drugs
Mild cognitive impairment (MCI) - CORRECT ANSWERS a slight but noticeable and
measurable decline in cognitive abilities, including memory and thinking skills.
Alzheimer's is most common type of dementia - CORRECT ANSWERS cholinergic, B-amyloid
plaques, tau protein (neurofibrillary tangles), genetics (apolipoprotein E4) and inflammation
(cytokines, prion)
Comparison of memory impairment and dementia with Alzheimer's disease - CORRECT
ANSWERS
Assessment tools for Dementia - CORRECT ANSWERS MMSE: 30 point scale, high score
means better function, untreated AD decreases 3 or 4 points every year, relies on verbal and
language skills
SLUMS exam: 30 point scale, with higher score indicating better function, includes
adjustment of score based on educational status
Montreal cognitive assessment: 30 point scale, higher score indicates better function, less
reliant on verbal or language skills, requires training
Minicog assessment: 5 point scale, higher score indicates better function, easiest to
administer and takes 3 minutes
New guidelines for diagnosing dementia - CORRECT ANSWERS 3 phases: preclinical,
asymptomatic phase, symptomatic predementia phase (MCI), Dementia phase
Can diagnose with biomarkers but mainly used for research purposes (increased tau or
decreased B-amyloid concentration in CSF, or atrophy of specific brain areas in MRI)
Preclinical and predementia phases are often used in investigational phase to halt
progression
Stages of Alzheimer's dementia - CORRECT ANSWERS
,A COMPLETE SOLUTION THAT COVERS 2024/2025 BEST RATED TO
SCORE A+ FOR SUCCESS
Absorption changes - CORRECT ANSWERS Iron, vitamin B12, antifungal and calcium are
decreased with decreased stomach acid scretion
Slower gastric emptying increases risk of ulceration from NSAIDS, bisphosphonates and Kcl
tabs
Most drugs are absorbed by passive diffusion without significant age related changes
TD formulations require SQ fat layer to form drug reservoir for absorption (caution if
cachectic)
Distribution during aging - CORRECT ANSWERS Lipid-soluble meds (diazepam) have
increased half life
Highly albumin bound drugs (phenytoin) can have larger fraction of free (active) drug
PGP (efflux transporter) decreases with aging, which can lead to higher brain concentrations
of meds (opioids)
Metabolism in aging - CORRECT ANSWERS Morphine and propranolol clearance are reduced
because of reduction in first pass metabolism, similar to other drugs with high first pass
metabolism
Phase I (oxidative reactions by CYP450 enzymes) can change based on age, genetics, sex and
other drugs
Ativan, oxazepam, temazepam depend on phase II metabolism and are less affected by aging
Excretion in aging - CORRECT ANSWERS Need to look at GFR (Cockcroft-Gault). Dabigatran,
dofetilide, and xarelto are dosed on ABW and not IBW
Some clinicians round Scr up to 1 mg/dL because older adults have lower muscle mass which
produces less creatinine which could overestimate renal function (controversial) or using
AdjBW if obese
Pharmacodynamic changes: Increased sensitivity - CORRECT ANSWERS BDZ and opioids:
increased sensitivity to CNS effects
Antipsychotic and metoclopramide: EPS and tardive dyskinesia
TCA, Alpha-blockers, anti-HTN: OH
Warfarin: greater inhibition of synthesis of Vitamin K-dependent clotting factors, increased
bleeding risk
Nsaid: GI bleeding
,GERIATRICS EXAM QUESTIONS AND CORRECT DETAILED ANSWERS
,A COMPLETE SOLUTION THAT COVERS 2024/2025 BEST RATED TO
SCORE A+ FOR SUCCESS
Anticholinergic agent : increased confusion, dry mouth, constipation
Pharmacodynamic changes: Decreased sensitivity - CORRECT ANSWERS B blocker:
downregulation of Beta-1 receptors (reduced effect)
B agonist: Decreased response to inhaled beta agonist, require continuous /scheduled
treatment instead of PRN
Impaired homeostasis - CORRECT ANSWERS Diuretics, ACE: sodium and electrolytes
Diuretics: hydration status
Overuse of meds - CORRECT ANSWERS Unnecessary meds: GI, CNS agents, vitamins,
minerals
Underused meds - CORRECT ANSWERS Anticoagulant, statins, antihypertensive
Withdrawal symptoms - CORRECT ANSWERS Antihypertensives, antidepressant, anxiolytic,
pain meds
BEERS criteria - CORRECT ANSWERS A list of medications that are generally considered
inappropriate when given to elderly people
anticholinergic, BDZ, sedative-hypnotics, older antipsychotic, hypoglycemic, NSAIDS, PPI
Medication Appropriateness Index (MAI) - CORRECT ANSWERS questions to ask about each
individual medication
in there an indication
is the med effective
is the dose correct
is the sig correct
etc.
Does no assess allergies, AE, or compliance
,GERIATRICS EXAM QUESTIONS AND CORRECT DETAILED ANSWERS
,A COMPLETE SOLUTION THAT COVERS 2024/2025 BEST RATED TO
SCORE A+ FOR SUCCESS
Choosing Wisely Criteria - CORRECT ANSWERS 10 things to question in older adults (7/10
questions are drug related)
Antipsychotics in dementia should be avoided
Target A1c should be 7.5% or higher
Avoid BDZ or sedative-hypnotics for insomnia, agitation, delirium
Do not start ABX for bacteriuria without symptoms
Assess risk/benefit of cholinesterase inhibitor
Appetite stimulant are not helpful for anorexia or cachexia
What are some possible etiologies of falls in the elderly? - CORRECT ANSWERS Psychoactive
medications, polypharmacy, orthostatic hypotension, hypoglycemia, hyponatremia,
myocardial infarction, urinary tract infection
What are some risk factors for falls in the elderly? - CORRECT ANSWERS Vitamin D
deficiency, poor balance, muscle weakness, poor vision, environmental factors
What are the key features of delirium in the elderly? - CORRECT ANSWERS Disturbance in
attention and awareness developing over hours to days with fluctuation
What are some risk factors for delirium in the elderly? - CORRECT ANSWERS Age, underlying
dementia, functional impairment, medical comorbidity, psychoactive meds, polypharmacy,
hypoglycemia, hyponatremia, MI, infection
What are some contributing risk factors for delirium in the elderly? - CORRECT ANSWERS
Dementia, stroke, vitamin B12 deficiency, poor hearing, lack of sleep, constipation, pain,
thyroid disorder
Dementia definition - CORRECT ANSWERS Decreased cognitive ability, memory, or function,
with intact consciousness that interferes with work or social function. rule out delirium first
Delirium - CORRECT ANSWERS A disturbance in attention and awareness. Onset is a rapid
and course tends to fluctuate. Includes a cognitive disturbance. Specifiers: substance
intoxication delirium, substance withdrawal delirium, medication induced delirium, delirium
due to another medical condition, and delirium due to multiple etiologies. Common causes
include infections, metabolic disorders (low blood sugar, renal disease), post-operative
, GERIATRICS EXAM QUESTIONS AND CORRECT DETAILED ANSWERS
,A COMPLETE SOLUTION THAT COVERS 2024/2025 BEST RATED TO
SCORE A+ FOR SUCCESS
states, and substance intoxication. The majority recover fully, with or without treatment;
early intervention shortens the duration of the delirium. Untreated delirium may progress to
coma, seizures, or death.
Meds: sedative-hypnotics, antidepressant, anticholinergic, opioid, anticonvulsant,
antiparkinson drugs
Mild cognitive impairment (MCI) - CORRECT ANSWERS a slight but noticeable and
measurable decline in cognitive abilities, including memory and thinking skills.
Alzheimer's is most common type of dementia - CORRECT ANSWERS cholinergic, B-amyloid
plaques, tau protein (neurofibrillary tangles), genetics (apolipoprotein E4) and inflammation
(cytokines, prion)
Comparison of memory impairment and dementia with Alzheimer's disease - CORRECT
ANSWERS
Assessment tools for Dementia - CORRECT ANSWERS MMSE: 30 point scale, high score
means better function, untreated AD decreases 3 or 4 points every year, relies on verbal and
language skills
SLUMS exam: 30 point scale, with higher score indicating better function, includes
adjustment of score based on educational status
Montreal cognitive assessment: 30 point scale, higher score indicates better function, less
reliant on verbal or language skills, requires training
Minicog assessment: 5 point scale, higher score indicates better function, easiest to
administer and takes 3 minutes
New guidelines for diagnosing dementia - CORRECT ANSWERS 3 phases: preclinical,
asymptomatic phase, symptomatic predementia phase (MCI), Dementia phase
Can diagnose with biomarkers but mainly used for research purposes (increased tau or
decreased B-amyloid concentration in CSF, or atrophy of specific brain areas in MRI)
Preclinical and predementia phases are often used in investigational phase to halt
progression
Stages of Alzheimer's dementia - CORRECT ANSWERS
