lato 2019

Question 1

Which of the following has been shown to increase drug adherence in the eldery?

Answer 1

physycian explanation

Question 2

Which of the following opioids are available in Poland in transdermal patch?

Answer 2

fentanyl

buprenorphine

Question 3

Long acting NSAIDs can have all of the following effects on the elderly except

Answer 3

hypotension

Question 4

How long after applying a transdermal fentanyl patch can an analgesic effect be observed:

Answer 4

12h

Question 5

Which of the following patients with break through pain should not be treated with transmucosal fentanyl (TIRF):

Answer 5

a 40 yo patient with advanced lung cancer who has been treated with a transdermal fentanyl patch (12,5ug/h) for the past 2 months

Question 6

A patient with lung cancer is experiencing severe pain resulting from infiltration of the chest wall (NRS 7-8). Therapy is initiated and optimal pain relief is achieved with the paitent receiving 40 mg of oxycodone in a controlled released tablet every 12 hours (6:00 and 18:00). Occasionally, the patient reports exacerbations of pain reaching 9 on the NRS scale, lasting 20 minutes, without any clear cause. Please determine the type of pain:

Answer 6

spontaneous breaktrough pain

Question 7

Which of the following increases with age:

Answer 7

gastric pH

Question 8

Please read the following excerpt of a conversation and choose the best ending:

• How did you sleep last night?
• Poorly, I couldn’t fall asleep (blablabla)
• Yes
• What is it?
• I am worried.
• You’re worried?
• Yes. I don’t know what will come next.
• Did you talk about this with your doctor?
• If only the doctor had been listening, I would have told him what i really feel

Answer 8

Why do you think the doctor wasn’t listening?

Question 9

72 yo man with hypertension controlled with 2,5mg indapamide had a 6-month history of dyspnoea on walking his dog and when gardening. His echocardiogram showed mild concentric hypertrophy of the left ventricular, RF of 40%. Which of the following would be the most likely to improve his life expectancy:

Answer 9

ACEI

Question 10

Secondary gastroparesis occurs due to all of the following except:

Answer 10

generalized artherosclerosis

Question 11

The drug of choice in the treatment of diarrhea due to Clostridium difficile infection:

Answer 11

Vancomycin p.o.

Question 12

A smooth and red surface of the tongue (atrophy of lingual papillae) with disturbances of taste is characteristic for which form of mycosis:

Answer 12

chronic atrophic

Question 13

The reason of an impaired communication with an older patient (hearing impairment) is not:

Answer 13

hypersensitivity to the high frequency sounds

Question 14

A 30yo patient with metastatic colon cancer asks his doctor “Am i dying?” What should the doctor respond?

Answer 14

Please tell me, why are you asking?

Question 15

Multiple brain metastases most frequently occur in

Answer 15

Small cell lung carcinoma

Question 16

A feature of the clinical course supporting the differentiation between dementia with Lewy bodies and dementia in the course of Alzheimer’s disease is:

Answer 16

a fluctuating course of cognitive processes with variability of attention and wakefulness
hypersensitivity to neuroleptisc
visual hallucinations

Question 17

Which of the following statements regarding the use of opioids in the treatment of dyspnea is false

Answer 17

opioids increase the sensitivity of the central respiratory zone to increased levels of CO2

Question 18

The most frequent cause of seizures in patients with advanced neoplasms:

Answer 18

primary or secondary brain tumor
electrolyte disturbances (hyponatremia)

Question 19

80- year- old woman with a history of hypertension and congestive heart failure complaints of frequent episodes of incontinence. She says that these episodes happen without warning, usually in the context of coughing or sneezing. Which of following interventions is the most likely to help with her incontinence:

Answer 19

pelvic muscle exercises

Question 20

Choose the best answer of five major components of a comprehensive assessment of the older adult patient:

Answer 20

medical, cognitive, functional, nutritional, social aspects

Question 21

Which of the following neoplasms most frequently cause recurrent pleural effusion:

Answer 21

lung cancer

breast cancer

Question 22

Which of the following regarding spinal cord compression syndrome is false:

Answer 22

it occurs in the cervical spine in 70% of cases

Question 23

In differentiating Alzheimer’s disease with vascular dementia, vascular dementia is indicated by:

Answer 23

jumping course of symptoms

prevalent numerous strokes

Question 24

The frequency of resting dyspnea in patients with advanced bronchial carcinoma is:

Answer 24

80%

Question 25

A 75-year-old woman with multiple health problems complains of having “no energy” and feeling increasingly weak. She has had a 6kg loss over the last 3 months. Choose the other components use to recognize frailty syndrome:

Answer 25

physical activity muscle strenght walk speed

Question 26

In 80% of patients with spinal cord compression of a few-weeks duration the first symptom is:

Answer 26

radicular pain

Question 27

78 y-o man presents to the primary care clinic with complaints of dryness of mouth, constipation, increased heart rate, falls without obvious reason, confusion. Which of the following types of drugs might be to blame:

Answer 27

anticholinergics

Question 28

A patient with sarcoma of the left thigh complains of mixed pain (nociceptive-neuropathic) localized in the region of the left thigh with radiation to the hip. The intensity of the pain NRS 8-9/10 and is worst when the patient is standing. Until now, the patient has been receiving tramadol 400mg/d, paracetamol 3g/d and ketoprofen 200mg/d. Please choose the best course of action:

Answer 28

withdraw tramadol; administer controlled- release morphine 40mg/d, immediate- release morphine as needed and pregabalin 75mg/ d; continue administration of paracetamol and ketoprofen

Question 29

Which of the following type of dressing will be optimal to apply for pressure ulcer in stage III with slough and complicated by local infection:

Answer 29

gase

Question 30

Which type of exercise would you advise to a person aged 65+ to improve endurance:

Answer 30

nordic walking

Question 31

Which of the following drugs are most useful in the treatment of pain with a neuropathc component:

Answer 31

valproic acid gabapentin pregabalin

Question 32

What pharmacodynamic changes are seen in the elderly with regard to ACE-inhibitors and beta-blockers:

Answer 32

ACEI decreased B-blockers ?

Question 33

Pregabalin and gabapentin act by:

Answer 33

inhibiting the alpha-2-delta of voltage-dependent calcium channels

Question 34

Which of the following is true of urge incontinence:

Answer 34

decreased innervation and loss of bladder function resulting in bladder atrophy

Question 35

Which of the following statements about tramadol is false:

Answer 35

simultaneous administration of tramadol and paroxetine does not increase the risk of serotonin syndrome

Question 36

What immunization is recommended to all older people:

Answer 36

none of the answers above is true

Question 37

In the patient with cancer pain till now not having taken opioids, we decide to introduce the treatment of morphine. We start titration, administer intravenously 1 mg of morphine every 5 minutes and we obtain pain relief with a dose of 10 mg. Please indicate the daily \demand of the drug:

Answer 37

60 mg .v. daily

Question 38

75-y-o woman with osteoporosis presents to the primary care clinic with a urinary tract infection. She is currently taking alendronate, vit. D, and calcium. Which of the following drugs may be less effective, considering the drugs she is currently taking, especially calcium:

Answer 38

ciprofloxacin

Question 39

A 79 year old woman with dementia was recovering from a fall when she developed a left ileofemoral deep vein trombosis. The occupational therapist is considering the suitability for care services. Which of the following is NOT included in the Bartel Index:

Answer 39

cognition

Question 40

A 74 year old woman has pressure ulcer on heel stage III with slough and small exudate. No signs of local infection, indicate the optimal metod of debridement of the pressure ulcer:

Answer 40

hydrogel or hydrocoloid dressing

Question 41

A 70 year old man who lives in assisted living is admitted to hospital with several hand fractures related to fall. His family notes that he has 2-yr history of progressive memory impairment. On examination, the patient is phisically agitated and appears anxious. He is verbal but cannot recall where he is or why. His score on the MMSE is 15/30 and his attention span is normal. He sleeps poorly in the hospital at nights and tend to sleep during the day, but he is easily aroused. Physical examination, brain imaging and laboratory examinations do not identify reversible cause of his impairments. Which of the following is the most likely cause of this patient’s agitation.

Answer 41

Alzheimer’s disease

Question 42

In the patient with severe pain (NRS=9) after titration of morphine we obtained a pain relief with a 24 hour dose of 40 mg of this opioid given s.c. After laboratory tests the patient was diagnosed with renal failure. Taking into consideration coexisting pain and renal insufficiency the best choice of opioid in this case will be:

Answer 42

transdermal buprenorphine 35ug/ h

Question 43

Which of the following items is not a component of Mini Mental State Examination:

Answer 43

proverb interpretation

Question 44

A 94-y-l nursing home resident with Alzheimer’s disease is evaluated because she has been disturbing other patients by screaming for help and banging on the nurse throughout a day for the past 4 weeks. Which of the following drug group is the most likely to reduce the patient’s agitation:

Answer 44

second generation antipsychotics

Question 45

Which of the following statements regarding megestrol acetate is false:

Answer 45

it worsens appetite

Question 46

Polyuria is urination:

Answer 46

greater than 7 times per day and 2 times during the night

Question 47

Which of the following drugs act as anti-emetics by blocking D2 receptors in the chemoreceptor trigger zone and may effectively decrease nausea and vomiting due to hypercalcemia?

Answer 47

Haloperidol

Question 48

Side effect to expect from anticholinergic (parasympatholitic) agents include all of the following exept

Answer 48

increased sweating | diarrhea

Question 49

Differences in the presentation of depression in elderly compared to the younger age groups include

Answer 49

more frequent psychotic symptoms the difference in the expression of anxiety in the form of excessiwe worrying, concentration disorders, memory impairment