Geriatrics 14Mar2009 DO NOT DISTRIBUTE - 1 - Geriatrics #1 – Aging Impacts on Health Care (Demographics) 1) In 1900, the elderly population (>65) was approximately 1 in 24. Approximately what number of the U.S. population (2005) is elderly now? a) 1 in 2 b) 1 in 4 c) 1 in 8 d) 1 in 12 e) 1 in 24 2) The elderly population (>65) is expected to increase by what percentage by the year 2030, when compared to the 35-million in 2000? a) 5% b) 15% c) 24% d) 36% e) 44% 3) The population of adults older than 85 is expected to increase by what percentage by the year 2030, when compared to 2000? a) 5% b) 15% c) 24% d) 36% e) 44% 4) Which of the following represents the largest percentage? a) Men living with spouse b) Men living alone c) Women living with spouse d) Women living alone e) Other 5) Which of the following is NOT currently a state with a significant elderly population? a) Pennsylvania b) California c) New York d) Florida e) Minnesota 6) For the average 75-year-old, approximately what percentage has at least one disability? a) 25% b) 20% c) 15% d) 10% e) 5% 7) According to JAMA in December 2001, what percentage of elderly patients is receiving inappropriate prescriptions? a) 5% b) 10% c) 15%
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Geriatrics 14Mar2009
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Geriatrics #1 – Aging Impacts on Health Care (Demographics)
1) In 1900, the elderly population (>65) was approximately 1 in 24. Approximately what
number of the U.S. population (2005) is elderly now?
a) 1 in 2
b) 1 in 4
c) 1 in 8
d) 1 in 12
e) 1 in 24
2) The elderly population (>65) is expected to increase by what percentage by the year
2030, when compared to the 35-million in 2000?
a) 5%
b) 15%
c) 24%
d) 36%
e) 44%
3) The population of adults older than 85 is expected to increase by what percentage by
the year 2030, when compared to 2000?
a) 5%
b) 15%
c) 24%
d) 36%
e) 44%
4) Which of the following represents the largest percentage?
a) Men living with spouse
b) Men living alone
c) Women living with spouse
d) Women living alone
e) Other
5) Which of the following is NOT currently a state with a significant elderly population?
a) Pennsylvania
b) California
c) New York
d) Florida
e) Minnesota
6) For the average 75-year-old, approximately what percentage has at least one
disability?
a) 25%
b) 20%
c) 15%
d) 10%
e) 5%
7) According to JAMA in December 2001, what percentage of elderly patients is
receiving inappropriate prescriptions?
a) 5%
b) 10%
c) 15%
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d) 20%
e) 25%
8) The average 75-year-old has at least how many chronic conditions?
a) 1
b) 2
c) 3
d) 4
e) 5
9) Which of the following is true of the elderly?
a) Make up 13% of the population
b) Make up 36% of hospital stays
c) Make up 49% of all days of hospital care
d) Make up 50% of all physician hours
e) All of the above
10) What percentage of all hospital admissions are caused by inappropriate drug
prescribing?
a) 3%
b) 7%
c) 13%
d) 17%
e) 23%
11) Which of the following would be paid by Part B of Medicare?
a) Hospitals
b) Nursing homes
c) Ambulances
d) Home-care agencies
e) Hospice programs
12) Which of the following is currently the most common scenario for patients 65 or
older who are eligible for Part B?
a) If entitled to Part A (e.g. paid taxes for 10 years), Part B is free
b) Part B has a monthly cost and is usually paid by personal check
c) Part B has a monthly cost and is usually paid by credit card
d) Part B has a monthly cost and is usually deducted from a monthly pay check
e) Part B has a monthly cost and is usually deducted from a social security check
13) An 86-year-old white female presents to the ER with chief complaint of shortness of
breath. The patient is admitted to the hospital medical floor for bilateral pneumonia.
During the stay, it was noted that the patient has been falling at home. The patient
received IV antibiotics for 48-hours and was switched to PO antibiotics on the third day
of admission. The patient was seen by her primary care physician during her stay. The
primary care physician consulted a geriatric service for rehabilitation evaluation and was
recommended to start in-patient physical therapy. It was also recommended that the
patient be transferred to a Transitional Care Unit (Short-Term Skilled Nursing Facility)
for 7-10 days of rehabilitation for ambulatory dysfunction and strengthening. The patient
has Medicare Part A and Part B with Highmark Blue Cross insurance for secondary. Who
pays for the acute hospital stay?
a) Medicare Part A
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b) Medicare Part B
c) Highmark Blue Cross
d) Medicare Part B and Highmark Blue Cross
e) Patient (out of pocket)
14) In the above 86-year-old patient, who pays for the majority of the physician’s fees?
a) Medicare Part A
b) Medicare Part B
c) Highmark Blue Cross
d) Medicare Part B and Highmark Blue Cross
e) Patient (out of pocket)
15) In the above 86-year-old patient, who pays for in-patient physical therapy?
a) Medicare Part A
b) Medicare Part B
c) Highmark Blue Cross
d) Medicare Part B and Highmark Blue Cross
e) Patient (out of pocket)
16) In the above 86-year-old patient, who pays for the short-term rehabilitation stay?
a) Medicare Part A
b) Medicare Part B
c) Highmark Blue Cross
d) Medicare Part B and Highmark Blue Cross
e) Patient (out of pocket)
17) What chronic condition has the highest prevalence among persons aged 65 and over?
a) Arthritic symptoms
b) Heart disease
c) Hypertension
d) Chronic obstructive pulmonary disease
e) Cancer
18) Who has the lowest life expectance to age 65 in the United states?
a) White males
b) White females
c) Black males
d) Black females
19) What is the most common cause of death in patients aged 65 or older?
a) Diseases of the heart
b) Malignant neoplasms
c) Cerebrovascular disease
d) Chronic lower respiratory disease
e) Influenza and pneumonia
20) Which of the following insurance plans covers all traditional Medicare benefits plus
additional services but restricts the patient to a single network?
a) Fee-For-Service Medicare
b) Medicaid
c) Medigap insurance
d) Medicare Advantage plan
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Geriatrics #2 – Cellular Aging & Tissue (Biology)
1) Earl Stadtman of the National Institute of Health (NIH) said which of the following is
the cause of aging as a disease?
a) Atrophy of cells
b) Free radical damage to cells
c) Programmed cell apoptosis
d) Spontaneous loss of cellular function
e) Decreased cell production due to enzymes
2) Which of the following is associated with primary aging (senescence)?
a) Heart disease
b) Diabetes
c) Hypertension
d) Osteoporosis
e) Presbycusis
3) Which of the following refers to aging where deleterious effects are minimized?
a) Normal aging
b) Senescence
c) Healthy aging
d) Disease
4) Which of the following is NOT part of normal aging?
a) Glucose intolerance
b) Memory impairment
c) Chronic alcohol abuse
d) Vision impairment
e) Muscle strength loss
5) Which of the following involves the transfer of electrons and can lead to altered gene
expression, altered enzyme activity, and altered signaling pathways?
a) Redox
b) Oxidation
c) Glycation
d) Cross-linking
6) Which of the following is a common area for cells to be lost due to apoptosis and
necrosis with aging, as this area has many non-dividing cells?
a) Bone
b) Liver
c) Spleen
d) Brain
e) GI tract
7) Which of the following describes the Hayflick phenomenon (e.g. in fibroblasts)?
a) Loss of chromosome ends over time
b) Loss of cell division due to telomere loss
c) A limited doubling capacity of cells
d) A decrease in free radical damage over time
e) p53 recognition of cell damage
8) What is the common vertebrate telomere sequence added to the 3’ end of DNA by
active telomerase?
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a) TTAGGG
b) AATCCC
c) GGGATT
d) CCCTAA
9) What is the hallmark of cell necrosis?
a) Cell DNA fragmentation
b) Cell atrophy
c) Decreased cell replication
d) Storage of lipids
e) Loss of ion gradients
10) What is the hallmark of cell apoptosis, such as in Alzheimer disease?
a) Cell DNA fragmentation
b) Cell atrophy
c) Decreased cell replication
d) Storage of lipids
e) Loss of ion gradients
Geriatrics #3 – Theories on Aging (Immunology)
1) Which of the following is an endogenous form of DNA damage?
a) Oxidative deamination
b) Ultraviolet radiation
c) Thermal disruption
d) Plant toxins
e) Mutagenic chemicals
2) Non-enzymatic attachment of which of the following to proteins increases with age,
which is probably responsible for many disorders such as cataracts?
a) Sodium
b) Iron
c) Glucose
d) Zinc
e) Lipids
3) Which of the following has been shown to slow the degenerative changes of aging in
renal vessels and the heart?
a) Ubiquinone
b) Lipofuscin
c) Gingko biloba
d) Aminoguanidine
e) Glycation
4) Darkened skin spots that develop with age, “aging spots,” are due to free radicals
attacking structures of the cell membrane, creating what metabolic waste product?
a) Ubiquinone
b) Lipofuscin
c) Gingko biloba
d) Aminoguanidine
e) Glucose
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5) Which of the following free radicals is converted to water and oxygen via glutathione
peroxidase?
a) Superoxide ion
b) Hydrogen radial
c) Singlet oxygen
d) Hydrogen peroxide
e) Hypochlorous acid
6) Which of the following has NOT been shown to prevent the harmful effects of
oxidation?
a) Selenium
b) Beta carotene
c) Vitamin C
d) Vitamin D
e) Vitamin E
7) Advanced glycation end (AGE) products are engulfed by macrophages, enter the blood
stream, and are eventually filtered out by what organ?
a) Spleen
b) Liver
c) Kidney
d) Biliary tract
e) They are not filtered
8) Which of the following symptoms of progeroid (e.g. Hutchinson-Gilford Syndrome
mutation of Lamin A gene) is NOT similar to normal changes observed in the elderly?
a) Decreased gonadal activity
b) Dry, wrinkled skin
c) Osteoporosis
d) Baldness
9) What gene is affected in autosomal recessive Werner syndrome?
a) Lamin A
b) DNA helicase
c) Topoisomerase
d) Dystrophin
e) Fibrillin
10) Which of the following is also known as neonatal progeroid syndrome?
a) Hutchinson-Gilford syndrome
b) Werner syndrome
c) Wiedemann-Rautenstrauch syndrome
d) Down syndrome
11) Which of the following shares pathology with Alzheimer patients and could have
CNS that stains apple-green with Congo red stain?
a) Hutchinson-Gilford syndrome
b) Werner syndrome
c) Wiedemann-Rautenstrauch syndrome
d) Down syndrome
12) Which of the following are most affected by thymic involution due to aging?
a) T-cells
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b) B-cells
c) NK cells
d) RBCs
e) Platelets
13) Which of the following is true in the elderly when comparing the ratio of naïve T-
cells to memory T-cells?
a) The ratio is high
b) The ratio is about 1
c) The ratio is low
14) Which of the following is true of CD markers on aged T-cells?
a) CD28 and CD69 markers are high
b) CD28 marker is high and CD69 marker is low
c) CD28 marker is low and CD69 marker is high
d) CD28 and CD69 markers are low
15) A decrease in which of the following in T-cells with age effectively halts signal
transduction by failing to stimulate enzymes (e.g. protein kinase C) and can also impair
production of cytokines?
a) Sodium
b) Potassium
c) Glucose
d) Zinc
e) Calcium
16) What immunoglobulin is the first class of antibodies to respond to infection and
decreases in production with aging?
a) IgA
b) IgD
c) IgE
d) IgG
e) IgM
17) Long-term deficiency of which of the following in the elderly causes a decrease in
cytokine production and impaired regulation of helper T-cell activity?
a) Sodium
b) Potassium
c) Glucose
d) Zinc
e) Calcium
18) What vitamin has been implicated as a possible treatment for Alzheimer disease?
a) Vitamin A
b) Vitamin B9
c) Vitamin B12
d) Vitamin D
e) Vitamin E
Geriatrics #4 – Physiology of Aging
1) Which of the following is true of basal metabolic rate (BMR) and growth hormone
with age, which can account for 80% of the change in cardiac output (CO)?
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a) BMR increases with age and growth hormone decreases BMR
b) BMR increases with age and growth hormone increases BMR
c) BMR decreases with age and growth hormone decreases BMR
d) BMR decreases with age and growth hormone increases BMR
e) BMR does not change with age
2) Which of the following is NOT seen with aging?
a) Decreased thermogenesis
b) Reduced cold-induced vasoconstriction
c) Decreased fat mass and increased protein mass
d) Reduced sweating
e) Decreased ability to radiate heat
3) What is the approximate occurrence of atherosclerosis in those who live to their 6th or
7th decade of life in the United States, leading to increased systolic pressure with a
normal diastolic pressure?
a) 50%
b) 66%
c) 75%
d) 90%
e) 100%
4) Which of the following has been shown to be the most effective in treating isolated