Efficacy and Safety of Canagliflozin by Frailty Status
Canagliflozin is associated with improved cardiovascular mortality in frail patients with Type 2 Diabetes Mellitus.
- True
- False
Geriatrics
Vertebral Compression Fractures
Which one of the following statements about vertebral compression fractures is false?
- Obesity is a risk factor.
- They are predominantly asymptomatic.
- There is annual mortality of up to 15% in older women.
- The Closed-Fist Percussion test is a highly sensitive and specific test used for evaluation.
Volume 41.4 - Question 5
Inappropriate Sexual Behaviour in Persons with Dementia
Which one of the following statements about inappropriate sexual behaviour in persons with dementia is false?
- The behaviour is less common in people with Parkinson’s disease dementia after treatment with dopaminergic agents.
- Non-pharmacological interventions are effective.
- Hormonal therapies can decrease the behaviours in males.
- Antiandrogens are most associated with adverse side effects.
Volume 41.2 - Question 15
Falls
Integration of a fall prevention program (comprised of balance and functional exercises and community-engaged health education) in a primary care system has been associated with a significant reduction in the risk of self-reported falls among rural older people.
- True
- False
Volume 41.2 - Question 7
Risk of Fall with Gabapentin vs Duloxetine
In older patients with diabetic neuropathy, postherpetic neuralgia, or fibromyalgia, treatment with gabapentin is associated with increased fall-related inpatient or outpatient visits compared to treatment with duloxetine.
- True
- False
Volume 40.6 - Question 7
The Dual Framework
Clinicians often are challenged when patients seem disconnected in their prognostic awareness. The dual framework is a theory that explains how people cope with overwhelming existential information.
- True
- False
Volume 40.6 - Question 6
Behavioural and Psychological Symptoms of Dementia
When comparing behavioural and psychological symptoms of dementia with delirium, attention impairment is usually greatly impaired in delirium but not seen until late in the trajectory of dementia.
- True
- False
Volume 40.6 - Question 5
Prescribing Physical Activity for Older Adults
Lower volumes of physical activity (between 83 and 166 minutes of moderate activity per week) reduce the risk of morbidity and mortality in older adults.
- True
- False
Volume 40.5 - Question 7
Hypothyroidism
Which one of the following statements regarding subclinical hypothyroidism in older individuals (>65 years) is false?
- The reference range for TSH is shifted towards higher values with the 97.5th percentile of the confidence interval for serum TSH being around 7.5 mIU/L.
- It is not associated with an increased risk of cardiovascular mortality.
- Treatment has been shown to improve fatigue.
- Treatment has not been shown to improve neurocognitive function.
Volume 40.3 - Question 28
Risk of Dementia Diagnosis After Injurious Falls in Older Adults
New dementia diagnoses are more likely to occur in older adults who sustain falls versus those who sustain other mechanisms of injury.
- True
- False
Volume 40.3 - Question 27
Effect of Home Exercise on Muscle Mass
A simple home exercise program has no impact on appendicular lean muscle mass among healthy, physically active adults aged 70 years or older.
- True
- False
Volume 40.3 - Question 6
Alzheimer Disease Treatment
Which one of the following statements about the treatment of Alzheimer Disease (AD) is false?
- Lower dosages of donepezil (10 mg daily) demonstrate comparable effectiveness to higher dosages.
- Memantine is used in moderate to severe AD.
- Brexpiprazole may help improve AD-associated agitation.
- Rivastigmine is associated with lower risk of gastrointestinal adverse effects.
Volume 40.3 - Question 4
Treatment Resistant Depression in Older Adults
A 72-year-old, retired immigrant engineer returns to your clinic with his wife to follow up on the efficacy of the second antidepressant prescribed for his depression. Symptoms first started about nine months ago. He started to see you seven months ago. He tried an SSRI at a therapeutic dose daily for three months and, when asked to rate his progress at that time, indicated an improvement in his symptoms of about 25%. After taking another SSRI at therapeutic dose daily for a little more than another three months, the couple reported that the second drug improved symptoms about 25%. You feel the patient meets the criteria for treatment resistant late life depression given his age. You inform them that the diagnosis is referred to as treatment-resistant late-life depression. The couple is not familiar with the diagnosis and risk factors.
Volume 40.21 - Question 5
Frailty in Older Adults
When assessing frailty, different screening tools (e.g. FRAIL, Fried frailty phenotype) should be used on subsequent visits to help provide a comprehensive assessment.
- True
- False
Volume 40.2 - Question 14
CT Scanning for Head Injury
Which one of the following statements about CT scanning for head injury is false?
- Patients who have sustained falls associated with loss of consciousness were found to have increased risk of traumatic intracranial hemorrhage.
- They are mandatory for older patients on antiplatelet medications who sustained ground-level fall-related head trauma.
- The cutaneous impact location may help clinicians identify patients at risk of traumatic intracranial hemorrhage.
- Older patients on anticoagulants or antiplatelets who sustain ground-level fall-related Traumatic Brain Injury and are at their baseline neurological status do not require a follow-up scan if the first head CT scan is normal.
Volume 40.1 - Question 17
Falls
An 85-year-old female patient was brought in by her daughter today to discuss her mother’s recent falls in her current residence. This patient lives alone in a house with 2 staircases for the 2 floors and basement. She has fallen multiple times in her house recently. She is experiencing pains in various parts of her body.
Volume 39.6 - Question 42
Blunt Head Injury in the Elderly
Older patients are at risk of sustaining serious intracranial injuries with ground level falls.
- True
- False
Volume 39.6 - Question 23
Lumbar Spinal Stenosis
Which one of the following statements about lumbar spinal stenosis is false?
- Loss of balance associated with low back pain has a 70% sensitivity for lumbar spinal stenosis.
- A wide-based gait with a positive Romberg sign has a 90% specificity for lumbar spinal stenosis.
- Computed tomography myelography is recommended over MRI to provide diagnostic information for patients with lumbar spinal stenosis symptoms.
- Symptoms are aggravated by walking and relieved by bending forward.
Volume 39.6 - Question 22
Non–ST-segment Elevation Myocardial Infarction (NSTEMI) & Frailty
In patients with frailty, management of non-ST elevation myocardial infarction with coronary angiography and revascularization did not improve outcomes compared to medical management.
- True
- False
Volume 39.6 - Question 21
Association Between Periodontitis and Mild Cognitive Impairment
There is an association between periodontitis and mild cognitive impairment.
- True
- False
Volume 39.6 - Question 20
MOCA Cutoff Scores in Diverse Settings
Current Montreal Cognitive Assessment (MoCA) cutoff scores are appropriate for diverse populations in an urban setting.
- True
- False
Volume 39.5 - Question 20
Age Related Hearing Loss
Patients who continue to have difficulty with understanding speech despite the use of hearing aids may be candidates for a cochlear implant.
- True
- False
Volume 39.5 - Question 19
Brexpiprazole in Alzheimer Disease
Brexpiprazole improves agitation scores in adults with Alzheimer disease and agitated behaviors.
- True
- False
Volume 39.5 - Question 18
Chlorhexidene Decolonization
In nursing homes, universal decolonization with chlorhexidine and nasal iodophor leads to a significantly lower risk of transfer to a hospital due to infection than routine care.
- True
- False
Volume 39.4 - Question 24
Orthostatic Hypotension in Older Adults
When assessing for orthostatic hypotension in older adults, an orthostatic drop detected at 4 minutes after going from supine to standing is a greater predictor of falls than a drop detected immediately.
- True
- False
Volume 39.4 - Question 15
Opioid-Induced Neurotoxicity
You see an 86-year-old patient who is admitted to the hospital with hypoactive delirium. His head CT is normal and no infectious cause is found. His creatinine level is 130 umol/L (baseline 95 umol/L), the rest of the blood results is unremarkable. He is followed for chronic lumbar pain for which he takes long-acting morphine 30 mg twice a day, the dose has been the same for many years. He also takes verapamil for hypertension. According to his family, he also has a history of recurrent falls, associated with involuntary muscle movements that cause him to fall without warning symptoms. On physical examination, he is irritable and inattentive. You also notice myoclonus without any focal neurological deficits. You suspect opioid-induced neurotoxicity (OIN).
Volume 38.21 - Question 20
Calcium Intake in Aged Care Residents
Using dairy foods to improve calcium and protein intake in aged care residents reduces each of the following except:
- Overall fracture risk
- Hip fracture risk
- Risk of falls
- Overall mortality
Volume 38.21 - Question 12
Treatment Resistant Depression in Older Adults
A 72-year-old, retired immigrant engineer returns to your clinic with his wife to follow up on the efficacy of the second antidepressant prescribed for his depression. Symptoms first started about nine months ago. He started to see you seven months ago. He tried an SSRI at a therapeutic dose daily for three months and, when asked to rate his progress at that time, indicated an improvement in his symptoms of about 25%. After taking another SSRI at therapeutic dose daily for a little more than another three months, the couple reported that the second drug improved symptoms about 25%. You feel the patient meets the criteria for treatment resistant late life depression given his age. You inform them that the diagnosis is referred to as treatment-resistant late-life depression. The couple is not familiar with the diagnosis and risk factors.
Volume 39.3 - Question 41
Inappropriate Sexual Behaviour in Long-Term Care
In the pharmacologic management of inappropriate sexual behaviour in long-term care residents with dementia, each of the following drugs, alone or in combination, could be considered as first-line agents except:
- Sertraline
- Finasteride
- Aripiprazole
- Estrogen
Volume 39.3 - Question 19
Falls
When combined with functional and balance training in older adults, resistance training can reduce the number of falls.
- True
- False
Volume 39.3 - Question 18
Nutrition for Osteoporosis Prevention
For people who are consuming a balanced diet and not receiving pharmacotherapy for osteoporosis, supplementation with calcium, vitamin D and protein is likely to have little to no effect on fractures.
- True
- False
Volume 39.3 - Question 16
NSTEMI in Older Patients
Patients over the age of 80 experiencing an NSTEMI benefit from an invasive strategy involving early coronary angiography with immediate evaluation for revascularization and optimal medical therapy over optimal medical therapy alone.
- True
- False
Volume 39.3 - Question 15
Cataracts and Dementia
Cataract extraction has a significant association with lower risk of developing dementia among adults 65 years of age or older.
- True
- False
Volume 37.3 - Question 9
Opioid-Induced Neurotoxicity
You see an 86-year-old patient who is admitted to the hospital with hypoactive delirium. His head CT is normal and no infectious cause is found. His creatinine level is 130 umol/L (baseline 95 umol/L), the rest of the blood results is unremarkable. He is followed for chronic lumbar pain for which he takes long-acting morphine 30 mg twice a day, the dose has been the same for many years. He also takes verapamil for hypertension. According to his family, he also has a history of recurrent falls, associated with involuntary muscle movements that cause him to fall without warning symptoms. On physical examination, he is irritable and inattentive. You also notice myoclonus without any focal neurological deficits.
Volume 37.6 - Question 39
Memory Decline with Coronary Revascularization
Among older adults undergoing coronary revascularization the type of procedure was not significantly associated with differences in the change of rate of memory decline.
- True
- False
Volume 36.6 - Question 9
ASA and Cancer in Older Adults
New evidence suggests that in adults aged 70 years or older, a daily low dose of aspirin (100mg) is associated with an increased risk of incident solid cancers presenting at an advanced stage:
- True
- False
Volume 36.6 - Question 8
Falls Prevention
Which one of the following statements about falls prevention is false?
- The Timed Get Up and Go test is a useful component of an assessment for falls risk.
- Antidepressants are not associated with an increased falls risk.
- Assessing orthostatic vitals during a falls risk assessment is recommended.
- Exercise helps to prevent future falls.
Volume 36.5 - Question 9
Stroke Prevention with Nonvalvular Atrial Fibrillation
In very elderly Japanese patients with nonvalvular atrial fibrillation who are not appropriate candidates for a standard oral anticoagulation regimen, a once-daily 15-mg dose of edoxaban is superior to placebo in preventing stroke or systemic embolism.
- True
- False
Volume 36.4 - Question 8
Thyroid Dysfunction and Cognitive Function
Subclinical hypothyroidism is associated with the development of cognitive decline in older adults.
- True
- False
Volume 37.1 - Question 32
Mild Cognitive Impairment and Suicide
Older men with a recent diagnosis of mild cognitive impairment are at increased risk of attempting suicide.
- True
- False
Volume 37.2 - Question 26
Intracranial Hemorrhage and Anticoagulation
The risk of intracranial hemorrhage after a head injury for patients 65 years and older on a direct oral anticoagulant is significantly higher compared with patients not on anticoagulation.
- True
- False
Volume 37.4 - Question 40
Distal Radius Fracture
In patients aged 60 years and older with unstable distal radius fractures, there are no clinically meaningful patient-reported outcome differences 24 months after injury between patients choosing surgical treatment and those opting for closed reduction and casting.
- True
- False
Volume 37.4 - Question 18
Calcium Intake in Aged Care Residents
Using dairy foods to improve calcium and protein intake in aged care residents reduces each of the following except:
- Overall fracture risk
- Hip fracture risk
- Risk of falls
- Overall mortality
Volume 37.4 - Question 4
Community-Acquired Bacterial Meningitis
Which one of the following statements about community-acquired bacterial meningitis in patients of 80 years and older is false?
- Diabetes is a common pre-disposing condition.
- More than 70% of patients had the triad of fever, neck stiffness and altered consciousness.
- Streptococcus pneumoniae is the most common causative organism.
- Atypical causative pathogens should be considered when starting empirical antimicrobial therapy in this age group.
Volume 37.5 - Question 18
Effect of Low-Dose Aspirin on Incidence of Anemia
Daily low dose aspirin increases the risk of incident anemia in community-dwelling adults 70 years and older.
- True
- False
Volume 39.1 - Question 23
The MIND Diet to Prevent Cognitive Decline
The Mediterranean-DASH Intervention for Neurodegenerative Delay (the MIND diet) slows cognitive decline in cognitively unimpaired elderly adults with a family history of dementia.
- True
- False
Volume 39.1 - Question 22
Menopausal Hormone Therapy and Dementia
Which one of the following statements about the relationship between hormonal replacement therapy and dementia is false?
- The use of vaginal estrogen is not associated with increased risk.
- Cyclic menopausal estrogen-progestin therapy is associated with decreased risk.
- Short-term menopausal estrogen-progestin in women younger than 55 years is associated with increased risk.
- Progestin only treatment is not associated with increased risk.
Volume 39.1 - Question 21
Statins in Primary Prevention in People Over 80 Years
Which one of the following statements regarding the impacts of cholesterol and the use of statins in primary prevention in people over age 80 is false?
- Total cholesterol levels are not associated with an increased rate of major cardiovascular events.
- Statins have not been shown to reduce mortality.
- A significant increase of side effects with the use of statins in this population has not been demonstrated.
- There is an increased risk of cognitive issues with statin use.
Volume 38.4 - Question 1
Low-Dose Aspirin Treatment
In a primary prevention setting among healthy older (> 70 years old) patients with no cardiovascular disease, long-term daily low-dose aspirin treatment reduces ischemic stroke.
- True
- False
Volume 39.2 - Question 30
Hypertension in Hospitalized Elderly Patients
Intensive inpatient treatment of asymptomatic hypertension in older adults admitted for non-cardiac conditions is associated with better outcomes.
- True
- False
Volume 39.2 - Question 12
Intervention in Early Dementia
Compared to usual care, an intensive exercise and functional activity therapy intervention in adults with early dementia improves activities of daily living.
- True
- False
Volume 39.2 - Question 11
Consumption of Coffee
Moderate consumption of coffee is associated with a reduced risk of cognitive disorders.
- True
- False
Volume 39.2 - Question 3
Treatment-Resistant Geriatric Depression
Which one of the following statements about adjusting medications for the management of treatment-resistant depression in adults over 60 years of age is false?
- Switching to bupropion is less effective than augmentation with aripiprazole.
- Augmentation with aripiprazole causes more falls than augmentation with bupropion.
- Augmentation with lithium is effective.
- Switching to nortriptyline is effective.
Volume 38.6 - Question 18
NSTEMI in Frail Older Patients
In frail older patients with non-ST-elevation myocardial infarction (NSTEMI) and stable clinical conditions at admission, a routine invasive strategy “consisting of coronary angiography within 72 hours of admission” with coronary revascularization if deemed appropriate increases the number of “days alive out of hospital” 1 year after discharge.
- True
- False