Jeremiah is a 72 year-old male who came for his annual physical examination. To assess the quality of his gait and balance, you wanted to use the Tinetti Gait and Balance test or Performance oriented Mobility Assessment (POMA). Which of the following statements is true about this test?
A 70-year-old African-American male came to your office for refills on his current medications. He works as a economics professor emeritus at the local university. He takes sertraline 100 mg daily for depression, trazodone 50 mg daily for insomnia, alprazolam 1 mg for anxiety, hydrochlorothiazide 25 mg and metoprolol 100 mg for hypertension, and gabapentin 100 mg for neuropathy. As you assess his risk of falls, which of the following is the most dangerous risk factor for falls in this individual?
An 80-year-old woman was admitted to the hospital 3 days ago after suffering a fall complicated by a right femur fracture. She subsequently fell in her hospital room after she stood from the bed and leaned forward to answer the phone located on the bedside table. On the day of her discharge, which of the following is the most important preventive measure you can advise her to take to reduce her risk of falls in the future?
A 65 year-old female arrives in your office for her annual health checkup. Which of the following is true about the risk of falls in the elderly?
A 62 year-old male was about to be discharged from the hospital. He was diagnosed with a stroke and was started on medications. He regained some of his strength in both upper and lower extremities but still has a visual field defect with loss of vision on the same side of both eyes. He has an outpatient appointment with a neurologist in two weeks. He is a commercial truck driver and the primary breadwinner for his family. You advised him not to drive until he regains full strength and complete vision. However, the patient reports that he cannot afford not to work and expresses strong desire to drive from tomorrow. What is the most appropriate step in the management of this patient regarding his driving?
A 72 year-old male is brought to your office for his annual health check up. He was diagnosed with mild cognitive impairment by his neurologist a few weeks ago. The family is concerned about the patient’s driving in the light of this diagnosis and would like to have your advice because the patient really loves his driving trips around the country especially in summer. What would be the best advice to this patient concerning his driving?
A 75 year-old male Mr Bright comes to your office for his annual health checkup. You advise him to get the influenza vaccine. He insists, ‘every time I take the flu vaccine I get the flu’. After a few weeks, you receive a letter in the mail from his health insurance company which includes a list of ‘unvaccinated seniors’ in your practice. Your office manager calls everyone on the list and encourages them to come in and get vaccinated. Mr.Bright takes the call and becomes very angry, “I told the doctor that I’m not getting that damn vaccine. Why do you keep calling me?”, and hangs up abruptly. What is the best response to this patient?
A 76 year-old female is brought to your office by her caregiver for an annual physical examination. She reports ‘feeling very down’, not sleeping much, not eating much, not taking her medications properly, not asking for refills on time and having difficulty remembering things. She talks more openly when she is alone with you in the room and becomes reticent when her caregiver enters the room. In the physical examination, she has distinct bruises with pale central areas lined on either side by linear ecchymosis on both upper extremities. She also has some bruising around her eyes and ears. You asked the caregiver to leave the room briefly and asked the patient about the bruises. The patient replies that they happened three weeks ago. You asked the patient, ‘has anyone threatened you or harmed you?’ Patient replied, ‘It happened only once. I am praying for him. It will be alright’. What is the most appropriate next step in the management of this patient?
Mrs. Ruth is a mother of three boys of ages 7, 5 and 3. She brings all three kids to your practice for sick visits. You have been educating her on the importance of immunizations to her and her three children. She refused all immunizations because she heard that vaccines can cause genetic defects. You’ve spent considerable time in clearing the misconceptions about immunizations. You’ve explained where the disinformation about vaccines comes from, and emphasized the collective benefits of vaccinations. You showed her clinical trials which showed how vaccinations work and prevent their targeted diseases. Then, one day she brought her 5 year-old unimmunized boy to your office for an illness visit. The boy has a 3 day history of fever, cough, rhinorrhea, rash and watery eyes. On examination, his temperature is 101.5 F. The boy appears ill but is in no acute distress. He has a red raised rash on his face. His conjunctivae are injected. There are small white papules with bluish-white centers on the buccal mucosa. You noticed a blanching, erythematous, palpable rash over his chest, abdomen and back. You diagnosed him with measles. The mother informs you that her other two boys,who are at home with their dad, are also having similar signs and symptoms, though mild. What would be the best approach to this mother who still refuses immunizations?
A 11 year-old boy is brought to your clinic for the management of his ongoing attention deficit hyperactivity disorder. Because he has a history of seizures, his mother has been reluctant to start him on medications for ADHD and had him only on behavioral therapy. Now, she thinks it is time to start him on a medication specific to treat attention deficit hyperactivity disorder. Which of the following medications should be avoided in this boy?
