1. How to conduct Mini-Cog-
2. Causes of delirium in elderly-
3. Agnosia
4. ADA criteria for diagnosing DM-
5.   Urinary incontinence-
6. Differentials as cause for erectile dysfunction-
7. Elder abuse
8. Differentials as cause for hematuria-
9. Terazosin use(s)-
10. UTIs in men and women
11. UTI treatment guidelines
12. BPH-  
13. Acanthosis nigricans
14. Delirium treatment- (Kennedy p. 560).
15. Essential tremor vs. Parkinson’s Disease
16. Seizure causes
17. Hospice & palliative care-
18. Pain-
    1. Pain assessment tools:
    2. Types of pain:
    3. Framework for pharmacological interventions for pain:
    4. The WHO Step Ladder
    5. Adjuvant meds:
19. Pain management in elderly
20. Delirium vs. dementia-
    1. Delirium-
    2. Dementia-
21. Steps of the grieving process
    1. Types of grief:
    2. Stages of Grief:
    3. Tasks of grieving:
    4. Kennedy p. 631
22. Alzheimer’s treatment
    1. Signs and symptoms-
    2. First line pharmacological treatment-
    3. Kennedy p 567-568
23. Sexuality sundowning metformin side effects-
    1. Mechanism of Action.
    2. Preparations.
    3. Dosing.
    4. Efficacy.
    5. Adverse Effects.
    6. Patient Selection.
24. ACC 2017 Guideline for High Blood Pressure in Adults-
25. Acute prostatitis kennedy 380.
26. Beta blocker side effects in diabetics-
27.  How to diagnosis HF and COPD via CXR findings- 

OA

1. HF stages-
   1. ACCF/AHA STAGES:
   2. New York Heart Association classes-
2. Causes for insomnia –
3. Prescription for insomnia –
4. GOLD criteria- Malone 207)
5. Arrhythmia evaluation
6. SIG-E-CAPS-
7. DEXA scan results findings- (Pg 499)
8. Anxiety treatment-

**************************************************************************************************

FINAL EXAM NR 601

The test covers weeks 1-8 content.  25% is weeks 1-4. 75% is weeks 5-8

1. Week 1 topics include:
2. Week 2 topics include:
3. Week3 topics include:
4. Week 4 topics include:
5. Week 5 topics include:
6. Week 6 topics include:
7. Week 7 topics include:
8. Week 8 topics include:

Week 1 video & lesson notes (taken directly from videos- refer to lesson videos for sources):

1. GOLD COPD stage Spirometry classification (2014)
2. Pulmonary Differential Diagnoses for COPD/ other:
3. Non-Pulmonary Differential Diagnoses for COPD/ other:
4. Med management of COPD:
5. Spirometry measures:
6. Spirometry Results and GOLD classifications:
7. Interpreting PFT results
8. TYPICAL PNEUMONIA SYNDROME-
9. ATYPICAL PNEUMONIA-

Week 2 Notes:

1. BPH and BP: Alpha blockers
2. NR 601 Week 2 Quiz Review

Week 3: SIG E CAPS”, for Sleep, Interest, Guilt, Energy, Concentration & Appetite, Psychomotor and Suicidal ideation

1. Asthma and COPD inhalers
2. Chronic bronchitis > 3 months x 2 years, s/s R heart failure
3. Gold 1. 80% 2. 50-79% 3. 30-49% 4. < 30%

Week 4:

1. Osteoporosis:
2. Osteopenia:
3. Fragility fractures
4. Fragility fractures-
5. Modifiable risk factors-
6. DXA – > or = 65 years old get bone density
7. Drugs:
8. Bisphosphonate drug holidays
9. DO NOT bisphosphonate holiday:
10. Monoclonal antibodies:
11. SERM
12. Drug holidays do NOT
13. Chronic pain:
14.  Off label neuropathic pain meds:
15. Tricyclic antidepressants
16. SNRI:
17. Duloxetine (Cymbalta
18. Tramadol
19. Tapentadol
20. muscle pain:
21. Inflammatory pain:
22. Mechanical/compressive pain
23. nociceptive pain:
24. Mild-to-moderate pain:
25. moderately severe to severe pain:
26. NSAIDs:

Week 5:

1. Men Alpha 1 adrenergic antagonists’ better choice with BPH. Not used for women

Week 7 Notes:

1. Parkinson’s Disease AKA Paralysis Agitans
2. Pathophysiology of PD:
3. PD Diagnosis: diagnosis of exclusion
4. PD Differential Diagnoses to rule out:
5. PD Staging:
6. PD Management: (incurable and progressive)
7. PD Med management:
8. Dopamine Replacement Drugs:
   1. Dopamine Agonists:
   2. Ergot-derived dopamine agonists:
   3. Newer ergot-derivative dopamine receptor agonists
9. PD Complications:
10. Managing Motor Complications of PD:
11. Meds in advanced PD:
12. Advanced PD Medications can include:
13. Miscellaneous neuro:

Week 8 video notes:

1. Hospice
2. Hospice
3. Hospice-
4. Admission to hospice:
5. Palliative care
6. Primary palliative care
7. Secondary, or specialty palliative care,
8. Palliative care
9. PCP role in palliative care
10. Advanced Care Planning (ACP)
11. DPOA-
12. POLST
13. SPIKES approach

Practice Questions:

1. Question: 6mo ago an elderly pt was dx'd with subclinical hypothyroidism. Today the pt returns and has a TSH of 11 and c/o fatigue. He has taken Synthroid 25mcg daily as prescribed. What is the best course of action for you?: 
2. Question: 48yo female presents for annual exam. A1C is 6.2%. You interpret this result as:
3. Question: 52yo Caucasian woman comes in for annual exam. She has mitral valve prolapse, no symptoms. PE reveals clear/equal breath sounds, midsystolic click. You know her stage of HF is:
4. Question: 55yo Caucasian man follows up w/you after referral to cardio. He reports that he thinks the med is causing a cough and sometimes he has dyspnea. Which of the following meds was most likely prescribed?
5. Question: 55yo Caucasian man w/T2DM presents as new pt. Take metformin 500mg BID. Labs reveal albuminuria and A1C was 7%. He's current on eye/foot exams. BP today is 136/84. According to 2017 ACC Guidelines, the most appropriate med for his current status is:
6. Question: yo post-menopausal woman with h/o HTN c/o jaw pain on heavy exertion. There were no c/o CP.    MGHJKLL
7. Question: 55yo woman presents with somatic complaints. You suspect anxiety. You know that somatic symptoms of anxiety include:
8. Question: 55yo woman w/BMI of 28, has 20yr h/o primary HTN, has been on HCTZ 25mg for years w/excellent response. During this follow up visit, she reports that for the last 6mo she has felt thirsty all of the time even though she drinks at least 10 glasses of water/day. Previous fasting BGL was 136. No further testing was done at that time. You check random BGL now, is 210. What is the next appropriate step?
9. Question: 59yo female c/o pain when she urinates. She has been seen three times for this in the last 3mo. Each time, dx'd with UTI, given abx. She carefully followed instructions, but has no relief of symptoms. Last UA:
10. Question: 59yo woman presents w/following: h/o MI, new onset SOB, especially w/exertion, an occasional rapid fluttering heartbeat and swollen feet. You know this pt's stage of HF is:
11. Question: 60yo obese male has T2DM and lipid panel of TC 250, HDL 32, LDL 165. You teach the pt about his modifiable cardiac risk factors, which include?: 
12. Question: 60yo woman w/30-pack year hx presents for eval of persistent, daily cough w/increased sputum production, worse in the AM, occurring over past 3mo. She says, "I have the same thing year after year." Which of the following choices would you consider strongly in your critical thinking process?
13. Question: 62yo female c/o fatigue and lack of energy. Constipation has increased and the pt has gained 10lbs in the past 3mo. Depression is denied although she reports lack of interest in usual hobbies. VS are WNL and her skin is dry and cool. Which of the following must be included in the DD?:
14. Question: 62yo male has chronic kidney dz that has been relatively stable. He has h/o hyperlipidemia, OA, HTN. He is compliant w/meds, BP has been well-controlled on a CCB. Last lipids showed TC 201, HDL 40, TG 180, LDL 98. He currently takes Crestor 20mg daily. Today his BP is 188/90 and urine dip shows significant proteinuria. He denies any changes in dietary habits or med regimen. What would be the best med change for him at this point?: 
15. Question: 65yo Caucasian female presents with h/o mitral valve stenosis, PE unremarkable. You know the stage of HF is:
16. Question: 65yo female presents to the clinic for the first time and c/o urinary incontinence and dyspareunia. She went through menopause 10yrs ago w/out any hormone replacement therapy and had hysterectomy for a fibroid. Her mom had hip fx at 82. Pt's most recent mammo was 5yrs ago, no known fam h/o breast ca. She is not taking any meds. Exam is unremarkable except for findings consistent w/atrophic vaginitis. You decide to begin topical hormone replacement therapy. Which of the following evals would be necessary prior to initiating HRT?:
17. Question: 65yo man presents for eval of CP and L-sided shoulder pain, begins after strenuous activity, including walking. Characterized by dull, aching, 8/10 during activity, otherwise 0/10. Began few months ago, intermittent, aggravated by exercise, relieved by rest. Occasional nausea. Pain is retrosternal, radiating to L shoulder, affects QOL by limiting activity. Pain is worse today, did not go away with rest. BP 120/80, HR 72 regular. Normal heart sounds, S1/2, no murmurs. Which of the following diff dx would be most likely?
18. Question: 65yo woman w/BMI 29, 15yr h/o HTN, on HCTZ 25mg for years w/excellent response. Follow up visit: reports that for last 1-2mo, she has been thirsty, increased urination. Last fasting BGL was 118. What action should you take next?
19. Question: 66yo dx'd with acute prostatitis, afebrile w/out severe pain, deemed appropriate to be managed outpt. An appropriate initial treatment option for mild case is:
20. Question: 68yo male, retired Air Force pilot, has been dx'd w/prostate ca in the past wk. He's never had surgery and seeks clarification on availability of tx's for prostate ca. He asks you to tell him the SE of radical prostatectomy. Which of the following is NOT a potential SE of this procedure?: Selected low back pain
21. Question: 68yo man presents for physical, has had T2DM x5yrs, diet controlled. BMI 32. H/o HTN, smoker 10cigs/day x20yrs. Fam h/o CAD, CABG x4 for father, now deceased; CHF, T2DM, HTN for mother. He is asymptomatic today, exam is normal, EKG NSR. According to AHA/ACC guidelines, he is at risk for what stage of HF?
22. Question: 72yo female has been dx'd w/gout. She also has a long h/o chronic HF. The most likely contributing factor to development of gout in this pt is:: 
23. Question: 72yo woman and husband are on cross-country driving vacation. After long day of driving, they stop for dinner. Midway through meal, she gets very SOB, w/CP and a feeling of panic. Which of the following problems is most likely?: 
24. Question: 76yo man seen for c/o UI. You should explore which of these causes of UI in men?
25. Question: 77yo Caucasian female has h/o breast ca. She's been in remission for 6yrs. As her PCP, you are seeing her for follow up of her recent c/o intermittent abd pain x3mo and general malaise. Given the hx above, what will you direct your assessment at during the exam?: 
26. Question: 78yo female presents w/sz that occurred over the weekend. In selecting the most important diagnostics for this presentation, it is important to know that the least common site of sz's in the elderly is:: 
27. Question: 78yo man w/PD is being care for in a nursing home. The nurses observe that he coughs at mealtime; he has the ability to feed himself w/adaptive equipment. He has had no aspirations. Oral exam is normal, except during swallow eval you note there is slight delayed elicitation. You assess that he has only mild dysphagia. You recommend which of the following as the next step in his care?: 
28. Question: 79yo man is being eval'd for frequent urinary dribbling w/out burning. Physical exam reveals smooth but slightly enlarged prostate. His PSA is 3.3. He undergoes formal urodynamic studies and findings are as follows: decreased bladder capacity of 370mL, few involuntary detrusor contractions at a low bladder volume of 246mL, increased postvoid residual urine volume of 225mL, and slightly decreased urinary flow rate. Which of the following is not consistent with normal age-associated change?: 
29. Question: 87yo female has been taking 100mcg of Synthroid x10yrs. She comes to your office for routine follow-up, feeling well. Her HR is 90. Your first response is to:: Order TSH
30. 2017 HTN guidelines categorize a healthy 54yo African American woman with a BMI of 23 and consistent BP readings of 120-128/76-78 as:
31. Question: You are reviewing a pt chart before the exam. You note that the pt is using topical capsaicin. You know that topical capsaicin is often used for tx of:
32. Question: Acanthosis Nigricans is associated with all of the following except:
33. Question: ACC 2017 guidelines for high BP in adults, adults w/stage 1 HTN and high ASCVD risk should be managed w/both nonpharm and antihypertensive drug therapy. You know the pt should return for a follow up appointment which includes BP check in:
34. Question: ACC 2017 Guidelines for High BP in adults discusses screening/management of other CVD risk factors for hypertensive pts. According to the guideline, basic testing for primary HTN includes fasting BGL, CBC, lipids, BMP, TSH, UA, EKG w/optional echo, uric acid, and urinary albumin-to-creatinine ratio.
35. Question: According to 2017 ACC HTN guidelines, normal BP is:
36. Question: According to 2017 ACC HTN guidelines, the recommended BP goal for 65yo African American woman w/a h/o HTN and DM and no h/o chronic kidney dz is:
37. Question: According to 2017 Guidelines for HTN in adults, recommended BP goal for 68yo Asian American woman w/no h/o DM and a h/o CKD is:
38. Question: According to ADA guidelines, which of the following are appropriate screening tests for T2DM?
39. Question: According to the GU presentation, #1 risk factor for urinary incontinence is:
40. Question: A drug that can be used to treat two very common symptoms in a dying pt (pain and dyspnea) is:: 
41. Question: A fluoroquinolone (Cipro) is prescribed for a male pt w/a UTI. What should you teach the pt regarding taking this med?: 
42. Question: A form of syncope that is more common in elderly than younger adults is:: 
43. Question: Age-related changes in the bladder, urethra, and ureters include all of the following in older women except:: 
44. Question: Aging process causes what normal physiological changes in the heart?
45. Question: A key symptoms of ischemic heart dz is CP. However, angina equivalents may include exertional dyspnea. Angina equivalents are important because:: 
46. Question: Ali is 72yo man who recently came to US from Nigeria. He reports having BCG (bacille Calmette-Guerin) vaccinations as a child. Which of the following is correct regarding TB skin test?:
47. Question: All of the following antimicrobials may be indicated in chronic bacterial prostatitis except:: 
48. Question: All of the following are considered as contributors to dysphagia except:: 
49. Question: All of the following are true about lab values in older adults except:
50. Question: All of the following may be reasons associated w/an elevated PSA besides prostate ca except:: 
51. Question: All of the following pts have a risk of adverse reaction from Metformin except:
52. Question: Question: All of the following statements about tremor are true except::
53. Question: All of the following statements are false about drug absorption except:
54. Question: All of the following statements are true about drug absorption in the elderly except:
55. Question: All of the following statements are true about interventions in working w/the bereaved except:: 
56. Question: All of the following statements are true regarding anxiety except:
57. Question: Anal wink reflex is used to test:: 
58. Question: An effective exercise therapy for RA is:
59. Question: An elderly nursing home pt is maintained on phenytoin tx for h/o sz. In addition to periodic serum drug concentrations, which of the following are needed for annual eval?: 
60. Question: An elderly pt has had a CVA in the anterior cerebral circulatory system (frontal lobe). What symptoms are most likely expressed?: 
61. Question: An elderly pt presents w/a new onset of feeling heart race and fatigue. EKG reveals afib w/rate >100. Pt also has a newfound tremor in both hands. Which of the following would you suspect?: 
62. Question: An example of secondary prevention you could recommend/order for elderly would be to:
63. Question: An older adult female pt had a stroke. What symptoms are not usually expressed by pt's who have had a vertebrobasilar stroke?: 
64. Question: An older adult w/a h/o sz disorder comes into the clinic for routine checkup. Although sz-free, the pt continues on long-term phenytoin tx. You would assess for which of the following long-term effects?: 
65. Question: An older male pt is experiencing acute onset of R-sided weakness, slurred speech, and confusion. What should you do promptly?: 
66. Question: Aortic regurgitation requires medical tx for early s/s of HF with:
67. A pelvic mass in a post-menopausal woman:: 
68. Question: Atypical presentation of acute coronary syndrome is:: 
69. Question: Atypical presentation of dz in elderly is reflected by all of the following except:
70. Question: Beers criteria are appropriate for use in evaluating use of certain meds in pts:
71. Question: Best method of verifying a dx of gout in a joint is:: 
72. Question: Best recommendation for pt who state they have no equipment to exercise would be:: 
73. Question: Best way to diagnose structural heart dz non-invasively is:
74. Question: Biochemical individuality is best described as:: 
75. Question: Bordetella pertussis is best characterized by:: 
76. Question: CC, 62yo male, new to your practice. Previously dx'd w/Stage B HF. According to week 2 HF lecture, you'll look for the following med classes to ensure appropriate tx of HF:
77. Question: Chronic fatigue syndrome is best described as:: 
78. Question: Chronic pain can have major impact on pt's ability to function and have profound impact on overall QOL. Ongoing pain may be linked to:
79. Question: Common auscultatory finding in CHF is:: 
80. Question: Consistent finding in delirium, regardless of cause, is:: 
81. Question: Delirium is typically characterized by all of the following except:: 
82. Question: Diabetic pt presents w/the c/o R foot pain but denies recent known injury. He states it has gotten progressively worse over the past few months. On exam, vibratory sense as well as sensation tested w/a monofilament was abnormal. Pt's foot is warm, edematous, misshapen. You suspect Charcot foot. What intervention is indicated?: 
83. Question: Distinguishing delirium from dementia can be problematic since they may co-exist. The primary consideration in the DD is::
84. Question: Drug-induced pruritis is distinguished because it:: 
85. During routine exam of 62yo female, you ID xanthelasma around both eyes. What is significant about this?: 
86. Question: Elderly are at high risk for delirium because of:: 
87. Question: ERV: 
88. Question: Evidence reflects the primary obstacle to implementing palliative care in the long-term care setting include all of the following except:: 
89. Question: Evidence shows that the most important predictor of a fall is::
90. Question: Example of active strategy of health promotion for an individual to accomplish would be:: 
91. Question: Exercise recommended for older adults should include activities that:: 
92. Question: Feeding gastrostomy tubes at end-of-life Alzheimer's pts have been associated with:: 
93. Question: FEV1: 
94. Question: Foot problems are a major concern for diabetics due to vascular insufficiency and neuropathy. Part of the annual exam for detection of neuropathy should include:
95. Question: Four main domains of clinical preventive services that you will provide are:: 
96. Question: FRC: 
97. Question: Functional abilities are best assessed by:
98. Question: FVC: 
99. Question: GOLD 1 Class: 
100. Question: GOLD 2 Class: 
101. Question: GOLD 3 Class: 
102. Question: GOLD 4 Class: 
103. Question: Hospice care differs from palliative care in that:: 
104. Question: How does women's anatomy make them more susceptible to UTIs?
105. Question: How do you manage minor or no symptoms of BPH?: 
106. Question: How is a relapsing UTI treated?: 
107. Question: How is urethritis in men treated?: 
108. Question: How long are uncomplicated female UTIs treated for?: 
109. Question: How long should first-line UI management be tried before using pharm therapy?: 
110. Question: How often do you recheck BPH during watchful waiting?: 
111. Question: How often do you recheck BPH if they're on meds?: 
112. Question: IC: 
113. Question: If dizziness has a predictable patter associated w/it, the clinician should first consider:: 
114. Question: In acute prostatitis, an exam of the prostate may find it to be::
115. Question: In chronic bacterial prostatitis, what is the organism most commonly associated with the dz?: 
116. Question: In considering the specificity of lab data, the most reliable diagnostic test listed below would be:: 
117. Question: In differentiating OA from chronic gout, pseudogout, or septic arthritis, the most valuable diagnostic study would be:: 
118. Question: In differentiating OA from chronic gout, pseudogout, or septic arthritis, the most valuable diagnostic study would be:
119. Question: In dx'ing acute bacterial prostatitis, a midstream urine cx is of benefit. To be diagnostic, the specimen should reveal how many WBCs per high-power field?: 
120. Question: In late stages of dementia, a phenomenon called "sun downing" occurs, in which cognitive disturbances tend to:: 
121. Question: In mitral stenosis, p waves may suggest:: 
122. Question: In providing health teaching related to dietary restrictions, you should advise a pt w/gout to avoid which of the following dietary items:: 
123. Question: In reviewing labs for pts suspected w/PMR, you realize there is no definitive test to dx PMR, rather clinical response to tx. Results you would expect to see include:: 
124. Question: In review of a nursing home pt's chart, you discover that the neuro consult ID'd that the pt has a homonymous hemianopsia. Which of the following statements accurately describes these findings?: 
125. Question: IRV: 
126. Question: Ischemic heart dz is:: 
127. Question: Is chronic bacterial prostatitis more common in younger or older males?: 
128. Question: Is nonbacterial prostatitis more common in younger or older males?: 
129. Question: IW is 65yo man who is new to your practice. He has h/o COPD, CAD, HTN, T2DM. He has had no immunizations since his discharge from the military at 25yo. Childhood dz's include chickenpox, measles, mumps, and German measles. He presents for dz management visit. Which immunizations would you recommend for him?
130. Question: JK, 60yo woman, returns for eval of management plan for insomnia. You saw her 2wks ago, dx'd primary insomnia and recommended melatonin. JK reports she is taking it nightly, avoiding caffeine/ETOH, and is falling asleep but not staying asleep. She wakes up after about 4hrs and cannot return to sleep. Next step is:
131. Question: JM, 68yo males, presents for physical. He has T2DM x5yrs, smokes 1/2PPD, BMI 30.