Final Exam: NR601/ NR 601 Primary Care of the Maturing & Aged Family Practicum Final Exam| Questions and Verified Answers| Rated A| 2023/
... [Show More] 2024
QUESTION
In which of the following patients is chemical or surgical castration likely to prolong survival?
a. A 78-year-old man with advanced dementia and prostate cancer metastatic to the bone.
b. A 78-year-old man who had a radical prostatectomy 10 years earlier and now has a PSA level of 5.7 ng/mL. A year ago it was 0.1 ng/mL. A bone scan is negative and an abdomen-pelvis computed tomography (CT) is negative.
c. 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.
d. A 78-year-old man with prostate cancer limited to the prostate with a Gleason score of 6.
e. None of the above.
Answer: c. 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.
QUESTION
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 neglect of the house. A nephew living in another city eventually came to take care of the situation and arranged for the admission. The patient appears confused and withdrawn; her appearance is disheveled, but she seems to be independent in her ADLs. The medical history is negative for any serious illnesses. She was able to drive her own car until shortly before this admission. The nephew does not wish to authorize hospice "right now." A positron-emission tomography scan was negative for metastatic disease. In addition to determining the cause of her delirium, which of the following is the best way to address the breast mass?
a. Tamoxifen should be initiated immediately. If no response is seen in 3 months, the patient should receive chemotherapy.
b. The mass should be biopsied to study hormone receptor and HER2/neu antigen s
Answer: b. The mass should be biopsied to study hormone receptor and HER2/neu antigen status.
QUESTION
A 78-year-old man has an emergency partial colectomy for lower gastrointestinal bleeding. A localized colonic adenocarcinoma is completely resected. The surgeon did not dissect lymph nodes for metastatic sampling. The patient wants to know if he should have chemotherapy. Should he?
a. Yes because without knowing his complete staging it would be safer.
b. No because he can be followed with serial carcinoembryonic antigens and CT scans.
c. Yes because the severe bleeding indicates advanced disease.
d. No because he is too old and will not likely have any problems during his lifetime.
e. No because the chemotherapy is too toxic
Answer: b. No because he can be followed with serial carcinoembryonic antigens and CT scans.
QUESTION
An 80-year-old woman has no weight loss, no pain, and no distention but over 2 years increasingly complains of constipation despite adequate medical treatment. A colonoscopy is negative. An abdominal CT is performed. It reveals well-circumscribed pelvic masses, the largest adherent to the ovarian ligament. The best first step is:
a. Referral to a gynecological oncologist.
b. Transcutaneous CT guided biopsy.
c. Because it is unrelated to her symptoms advise observation.
d. Refer to hospice because massive ovarian cancer is unlikely to be curable.
e. Invite her to return with a family member and have a long talk about the diagnostic and
therapeutic options.
Answer: e. Invite her to return with a family member and have a long talk about the diagnostic and
therapeutic options.
QUESTION
An 85-year-old man with chronic obstructive pulmonary disease presents to your office with his daughter with the complaint of new onset chest pain, shortness of breath, and cough. He is clearly tachypneic and has tactile fremitus and egophany and crackles heard at the right lung base. His daughter just wants you to give him an antibiotic pill so that she can take him home. You are concerned that he might need to be hospitalized and require IV antibiotics. What statement is true?
a. All older adults with pneumonia must be treated for methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas infection.
b. Treatment decisions for pneumonia are based on its severity, the presence of comorbid
illnesses, and a prior history of MRSA or Pseudomonas respiratory infection.
c. All older adults with pneumonia must be treated in hospital.
d. Pulse oximetry, respiratory rate, and chest radiography would not be helpful for the diagnosis and management of pneumonia in older adults.
Answer: b. Treatment decisions for pneumonia are based on its severity, the presence of comorbid
illnesses, and a prior history of MRSA or Pseudomonas respiratory infection.
QUESTION
An 80-year-old woman that you follow in a nursing home has an acute decline in her mental status. She has a fever >100° F, but no other focal complaints or findings on physical examination except for a chronic indwelling urinary catheter. What statement is true?
a. Fever in an older adult with an indwelling urinary catheter is an appropriate indication to start
empiric antibiotic therapy.
b. Older adults with an indwelling urinary catheter are less likely to have bloodstream infection than older adults without a catheter.
c. It is not necessary to obtain a urine culture; empiric antibiotic treatment is sufficient.
d. She only needs antibiotic treatment for 3 days.
Answer: a. Fever in an older adult with an indwelling urinary catheter is an appropriate indication to start
empiric antibiotic therapy.
QUESTION
An 82-year-old woman receives oral amoxicillin-clavulate for a skin abscess on her leg. She develops new onset of frequent watery stool that persists for several days after the antibiotic is stopped. You obtain a stool for Clostridium difficile antigen, toxin, and polymerase chain reaction (PCR). The antigen and PCR are both positive. She has never had C. difficile infection before. What one statement is the best answer regarding her management?
a. Metronidazole is the treatment of choice for C. difficile infection.
b. Older adults with their first episode of C. difficile require a longer duration of treatment with vancomycin. [Show Less]