Gastroscopy

UCLA Geriatrics Knowledge Test
DIRECTIONS: Each of the questions or incomplete statements below is followed by suggested
answers or completions. Select the ONE that is BEST in each case.


1. One day after operative repair of a left intertrochanteric fracture of the femur, an 83-year-
old man is agitated, confused, and appears to be having visual hallucinations. He has
accused the nursing staff of trying to kill him. He is a widower and has lived alone for 11
years. He has been forgetful for the past year but can perform all activities of daily living
without assistance. On mental status examination he is easily distracted, perseverates, and
does not respond coherently to questions about orientation and memory. The most likely
diagnosis is
(A) Alzheimers disease (B) delirium (C) functional psychosis (D) mania (E) organic delusional syndrome
2. The percentage of community-dwelling individuals older than 65 years who require
assistance with bathing, dressing, walking within their homes, using the toilet, or eating is
closest to
(A) 10% (B) 30% (C) 50% (D) 70%
3. A 78-year-old nursing home resident has mild dementia associated with Alzheimers
disease. She is disoriented to time and place but knows family members and regular nurse
aides by name. This patients capacity to make decisions regarding her health care is best
determined by
(A) mental status test (B) her ability to understand treatment options (C) probate court decision (D) psychiatric examination 4. Which of the following instruments is most appropriate to assess physical functional
abilities in a 75-year-old nursing home resident?
(A) Activities of Daily Living Scale (B) Face/Hand Test (C) Instrumental Activities of Daily Living Scale (D) Zung Self-Rating Depression Scale
5. An 85-year-old man has a 4x7-cm Shea stage 3 pressure ulcer over the sacrum. He has
been confined to bed since sustaining a hip fracture three months ago and has lost 10 lb
during this time. Examination shows a foul-smelling wound, necrotic tissue covering 50%
of the ulcer, and purulent drainage at the base. There is no cellulitis. In addition to
surgical debridement, the most appropriate initial management is
(A) topical application of neomycin/polymyxin/bacitracin ointment (B) topical application of sodium hypochlorite solution (C) application of an adhesive polyurethane dressing (D) myocutaneous flap (E) none of the above
6. An 82-year-old nursing home resident has had a 7-lb weight loss over the past two months.
She had a stroke seven years ago that resulted in aphasia. She is bed bound and needs
assistance when eating. The staff reports that she often clamps her teeth and refuses to eat.
Physical examination shows no abnormalities. The most appropriate next step in
management is
(A) observation (B) contact the family (C) begin nasogastric tube feeding (D) admit to the hospital (E) perform percutaneous endoscopic gastrostomy
7. A 78-year-old woman has right hemiplegia and dysarthria after a cerebral infarction in the
left pons three weeks ago. She has been fed through a gastrostomy tube for two weeks
because of pneumonia of the left lower lobe, presumed to be secondary to aspiration. She
is depressed and would like to begin oral feedings. Examination shows a decreased gag
reflex and mild dysarthria. The most appropriate management is
(A) continued tube feedings until gag reflex returns to normal (B) encouragement to eat an appetizing diet (C) ice chips orally and antidepressant therapy (D) supervised oral feeding of pureed foods (E) swallowing videofluoroscopy 8. The memory deficit that is most commonly caused by depression is
(A) amnesia for traumatic events (B) difficulty with free recall (C) difficulty with multiple choice (D) disorientation to person, place, and time (E) symmetrical loss of multiple cognitive functions
9. Which of the following is best used for routine evaluation of nutritional status in older
persons?
(A) Delayed skin testing (B) Serial weight measurements (C) Serum albumin level measurement (D) Serum transferrin level measurement (E) Total lymphocyte count
10. The most common community-acquired infection that results in hospitalization in older persons is
(A) infected pressure ulcers (B) influenza (C) pneumonia (D) tuberculosis (E) urosepsis
11. Approximately what percentage of the cost of long-term care is paid for directly by elderly persons or their families?
(A) 30% (B) 50% (C) 70% (D) 90%
12. An 82-year-old man has worsening of urge incontinence, urinary frequency, and nocturia three months after transurethral resection of the prostate for benign prostatic hyperplasia.
Symptoms of obstruction, including hesitancy, straining, and intermittent urinary stream,
have improved. He is otherwise healthy and takes no medications. Urinalysis shows
normal findings. After voiding 220 mL without straining, postvoid residual volume is 40
mL. The most appropriate next step in management is
(A) oxybutynin 2.5 mg three times daily for a two-week trial (B) terazosin 0.5 mg twice daily for a two-week trial (C) cystoscopy (D) cystometrography 13. An 82-year-old woman with Alzheimers disease sustains a displaced fracture of the femoral neck in a fall. She resides in a nursing home because of her cognitive deficits.
Prior to the injury, she was independent in ambulation, feeding, toileting, and transferring,
but needed cueing to bathe and dress. Her score on the Mini-Mental State Examination is
11/30. The most appropriate management of the fracture is
(A) use of crutches and limited mobility (B) traction and bed rest (C) open reduction and internal fixation (D) prosthetic replacement of the femoral head
14. A 70-year-old man with diabetes mellitus and emphysema comes to your office in December for influenza vaccination. You have cared for this patient for the past six
months and no additional medical records are available. He reports that prior to your care,
his last visit to a physician was 10 years ago. He also reports that he received a tetanus
shot in the emergency department four years ago because of a laceration. Which of the
following is the most appropriate schedule for immunization?
(A) Influenza vaccine only at this visit (B) Influenza and pneumococcal vaccines at this visit (C) Influenza vaccine at this visit and pneumococcal vaccine in eight weeks (D) Pneumococcal vaccine at this visit and influenza vaccine in eight weeks
15. A 76-year-old woman has pain in the right hip and is unable to walk without support three days after a fall. Passive motion of the right hip produces pain in the groin. Plain
radiographs of the pelvis show no abnormalities. The most likely cause of her symptoms is
(A) muscle strain (B) occult fracture of the hip (C) osteoarthrosis (D) referred pain from the spine
16. Which of the following is required for eligibility for the Medicare Hospice Benefit?

(A) Diagnosis of a terminal malignancy (B) Enrollment in Medicare Part A (C) Forfeiture of all Veterans benefits (D) Supplemental insurance policy (E) Verification of need by two independent physicians 17. What percentage of persons who are age 65 years and older will require nursing home care at some time during their life?
(A) 5% (B) 25% (C) 45% (D) 65% (E) 85%
18. A 79-year-old woman has had confusion since admission to the hospital for pneumonia one week ago. Her prior cognitive status is unknown; she appeared malnourished and unkempt
on admission. She has responded well to antibiotic therapy and is currently afebrile. She
is pleasant and attentive to questions. Mental status examination reveals disorientation,
memory impairment, and language abnormalities; she is unable to draw the face of a clock.
The remainder of the physical and neurologic examination shows no abnormalities. The
most likely diagnosis is
(A) age-associated memory loss (B) delirium (C) dementia (D) depression (E) paraphrenia
19. A 68-year-old man has a moderate left hemiparesis and severe neglect six days after a right hemispheric stroke. He appears to be in denial about his degree of impairment and states
that he hopes to be discharged from the acute hospital to his home where he has lived alone
for the past 10 years. During physical therapy sessions, he is apathetic and tires easily after
30 minutes. Further evaluation shows no abnormalities. Which of the following is the
most appropriate site for rehabilitation?
(A) Home-care program (B) Outpatient physical therapy program (C) Acute inpatient rehabilitation program (D) Nursing home (E) Inpatient geropsychiatric unit 20. An 84-year-old man is fitted for and trained in the use of a hearing aid. Three months later, he reports that he has stopped using the hearing aid because, although he can hear better, he
still cannot understand what people are saying. He states that background noise is also a
problem. He has hypertension but is otherwise healthy. His score on the Mini-Mental
State Examination is 30/30. The most likely cause of the hearing difficulty is
(A) central auditory processing disorder (B) early signs of dementia (C) improper fit of the hearing aid (D) Menieres disease (E) noncompliance
21. An otherwise healthy 73-year-old man with Parkinsons disease has difficulty walking. He has had many changes in his antiparkinsonian medication and feels that the present
regimen is the best he has ever had. Analysis of gait reveals very slow step initiation,
decreased stride length with shuffling, and moderate retropulsion. Which of the following
devices is most likely to improve his gait?
(A) A straight cane (B) A four-prong quad cane (C) A walker with arm troughs attached (D) A pick-up four-legged walker (E) A front-wheeled walker
Items 22-23
For each patient, select the most appropriate management (A-L). (A) Pelvic muscle exercises (B) Prompted voiding (C) Biofeedback (D) Urodynamic assessment (E) Oxybutynin 2.5 mg three times daily (F) Phenylpropanolamine 75 mg twice daily (G) Vaginal estrogen daily (H) Terazosin 0.5 mg twice daily (I) Bethanechol 10 mg three times daily (J) Bladder neck suspension (K) Intermittent catheterization (L) Chronic indwelling catheterization
22. An 82-year-old woman is admitted to a nursing home two weeks after operative repair of a hip fracture. She has an indwelling catheter for recurring postoperative urinary retention.
23. An 89-year-old woman with Alzheimers disease, mild congestive heart failure, and glaucoma has urinary incontinence several times daily, occurring both day and night and
without residual urine. She is wheelchair-bound and resides in a nursing home.

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