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Last four digits of your social security #:___ ___ ___ ___ Your birth month:___ ___
Chief Resident Immersion Training (CRIT) 2010 in the Care of Older Adults
Post-Test
DIRECTIONS: Each of the questions or incomplete statements below is followed by suggested answers
or completions. Check the ONE that is BEST in each case. Take your best guess if you are not sure.
Please complete this test on your own. Hand in along with your Post Survey. THANK YOU.
1. A 78-year-old nursing home resident has mild dementia associated with Alzheimer's disease. She is
disoriented to time and place but knows family members and regular nurse aides by name. This
patient's capacity to make decisions regarding her health care is BEST determined by-___(1)
Folstein Mini-Mental State Exam
___(2)
EXIT test of executive function
___(3)
Her ability to understand treatment options
___(4)
Probate court decision
___(5)
Psychiatry consult
2. An 82-year-old man falls, sustains a right intertrochanteric fracture, and is admitted to the orthopedic
service. The patient has dementia and systolic HTN and resides in a long-term-care facility. He had
an uncomplicated myocardial infarction 10 years ago but has had no clinical manifestations of CAD
subsequently. Current medications are an angiotensin-converting enzyme inhibitor and aspirin. He
ambulates without assistance, and his nutritional status is good. His advance directive requests active
treatment of all medical conditions.
The patient is agitated and confused. Pulse rate is 84 per minute, and respirations are 16 per minute.
BP is 150/90 mm Hg. Findings on physical examination are normal except for severe pain on rotation
of the right lower extremity. Routine laboratory studies and chest radiograph also are normal. EKG
shows normal sinus rhythm and no ischemic changes; findings are unchanged from previous
tracings. The orthopedic surgeon plans internal fixation and interoperative reduction of the fracture.
What intervention would be LEAST appropriate to do before the patient goes to surgery?
___(1)
___(2)
Start atenolol 25 mg daily
Order a dobutamine stress echo
___(3)
Order a urinalysis and urine culture
___(4)
Start intermittent IV morphine for pain
3. Which of the following instruments is MOST appropriate to assess physical functional abilities in a 75year-old nursing home resident?
___(1)
Activities of Daily Living Scale
___(2)
Face/Hand Test
___(3)
Instrumental Activities of Daily Living Scale
___(4)
Zung Self-Rating Depression Scale
CRIT Post-Test 2010, page 1
Last four digits of your social security #:___ ___ ___ ___ Your birth month:___ ___
4. One day after operative repair of a left intertrochanteric fracture of the femur, an 83-year-old man is
agitated, confused, and appears to be having visual hallucinations. He has accused the nursing staff
of trying to kill him. He is a widower and has lived alone for 11 years. He has been forgetful for the
past year but can perform all activities of daily living without assistance. On mental status
examination he is easily distracted, perseverates, and does not respond coherently to questions
about orientation and memory. The MOST likely diagnosis is
___(1)
Dementia
___(2)
Delirium
___(3)
Acute psychosis in the setting of schizophrenia
___(4)
Mania
___(5)
Acute mental status change
5. An assessment of instrumental activities of daily living (IADLs) typically includes which ONE of the
following?
___(1)
Urinary incontinence
___(2)
Ability to take medications
___(3)
Recreational activities
___(4)
Use of assistive devices
___(5)
Social supports
6. An 83-year-old man who has Alzheimer’s disease of moderate severity has lived in a skilled nursing
facility for 2 years. He has had intermittent delusional thoughts and anxiety, but these have not been
particularly distressing or persisted for prolonged periods. Medical history includes mild chronic renal
failure and anemia; he also has had a fractured hip but now ambulates well. He takes no
psychotropic medications and sleeps well. During the past 2 weeks, however, he has spent
increasing amounts of time wandering the halls. Several times, he has entered another patient’s
room and rummaged through belongings. He also was found outside the building on one occasion.
Which of the following is the MOST appropriate treatment strategy?
7.
___(1)
Prescribe an acetylcholinesterase inhibitor, such as Aricept.
___(2)
Use a vest restraint in a chair intermittently during the day.
___(3)
Prescribe risperidone 1 mg orally daily.
___(4)
Provide structured physical activity and outdoor walks.
___(5)
Transfer patient to another skilled nursing facility with a dementia unit.
Which one of the following is TRUE?
___(1)
Medicare A will pay 100% of nursing home care for 100 days.
___(2)
Medicare B will pay for 100% of home physical therapy after a hip
fracture.
___(3)
Medicare B will pay for 100% of a physician home visit.
___(4)
Medicaid will pay 100% for homemaker services.
___(5)
Medicare A will pay for 100% of home physical therapy after a stroke.
CRIT Post-Test 2010, page 2
Last four digits of your social security #:___ ___ ___ ___ Your birth month:___ ___
8. A 79-year-old woman has had confusion since admission to the hospital for pneumonia one week
ago. Her prior cognitive status is unknown; she appeared malnourished and unkempt on admission.
She has responded well to antibiotic therapy and is currently afebrile. She is pleasant, alert, and
attentive to questions. Mental status examination reveals disorientation, memory impairment, and
language abnormalities; she is unable to draw the face of a clock. The remainder of the physical and
neurological examination shows no abnormalities.
The NEXT step in her diagnostic evaluation is-___(1)
PET scan
___(2)
MRI
___(3)
Serum APOE test
___(4)
Neuropsych testing
___(5)
No further testing is needed
9. All of the following statements are true about polypharmacy EXCEPT:
___(1)
Prescribing even one drug that is not indicated is defined as polypharmacy.
___(2)
Polypharmacy is caused by health providers and patients.
___(3)
Prescribing more than 10 medications is defined as polypharmacy.
___(4)
Adverse drug events are a major complication of polypharmacy.
10. A 75-year-old man is intubated and receiving mechanical ventilation following CABG. Current
medications are nitroglycerine paste, ranitidine, and digoxin. He has no history of psychiatric illness
and has not used ETOH or sedative drugs in the recent past. Two days postoperatively, the patient
becomes agitated. His hands must be restrained to prevent attempts to remove the endotracheal tube
and other catheters. The patient is awake and fearful. He is unable to respond to “yes/no” questions
consistently or to follow simple commands. Temperature is 37.4C (99.3F). Pulse rate is 112 per
minute, and BP is 110/64 mm Hg. The abdomen is nontender. All four extremities move
spontaneously. CXR reveals a possible RLL infiltrate.
Lab studies:
Leukocyte count
Plasma glucose
BUN
Serum Na
Serum digoxin
UA
12,000/microliter
150 mg/dL
20 mg/dL
142 mEq/L
0.7 ng/mL (normal)
1+ bacteria
Which of the following is the MOST appropriate initial step to manage this patient’s agitation?
___(1)
Administer lorazepam, 2 mg IV
___(2)
Administer ceftriaxone, 2 mg IV
___(3)
Administer haloperidol, 1 mg IV
___(4)
Administer midazolam, 2 mg hourly by continuous IV infusion
___(5)
Non-pharmacologic management
CRIT Post-Test 2010, page 3
Last four digits of your social security #:___ ___ ___ ___ Your birth month:___ ___
11. A 68-year-old man has a moderate left hemiparesis and severe neglect six days after a right
hemispheric stroke. He appears to be in denial about his degree of impairment and states that he
hopes to be discharged from the acute hospital to his home where he has lived alone for the past 10
years. During physical therapy sessions, he is apathetic and tires easily after 30 minutes. Further
evaluation shows no abnormalities.
Which of the following is the MOST appropriate site for rehabilitation?
___(1)
Home-care program
___(2)
Outpatient physical therapy program
___(3)
Acute inpatient rehabilitation program
___(4)
Skilled nursing facility
___(5)
Inpatient geropsychiatric unit
12. Which ONE of the following statements about medication nonadherence is TRUE?
___(1)
10% of older patients are nonadherent.
___(2)
Age is the most important factor associated with nonadherence.
___(3)
Nonadherence correlates most strongly with number of medications.
___(4)
5% of medication-related admissions result from nonadherence.
CRIT Post-Test 2010, page 4