Free practice quiz
ABIM Geriatric Medicine Prep Course (Geriatrics): free quiz
10 questions from the program. See your score right away, then unlock the explanation of every answer.
- Question 1 of 10
An 82-year-old woman has persistent morning somnolence and unsteady gait after receiving diazepam the prior evening for MRI-related anxiety. She lives independently and previously walked 1 mile daily. History includes hypertension and osteoarthritis. Examination shows normal vital signs, no focal neurologic deficits, and a cautious gait. Creatinine and liver aminotransferases are normal. Which normal age-related physiologic change best explains her prolonged medication effect?
Normal Aging Physiology
Increased adipose tissue with aging enlarges distribution of lipophilic benzodiazepines, prolonging elimination and causing sedation and falls; therefore C is correct. D is tempting because phase I metabolism may decline, but the key pharmacokinetic aging change for diazepam persistence is lipid storage. A affects hydrophilic drugs, not diazepam. A alters absorption of selected drugs but does not explain delayed recovery.
Diagnose medication sensitivity after low-dose lipophilic sedatives; order medication and renal-hepatic review; treat by avoiding long-acting benzodiazepines; escalate for falls, delirium, or respiratory depression. - Question 2 of 10
An 88-year-old woman has experienced a decline in mobility but remains cognitively able to participate in her care decisions. She lives in a second-floor apartment accessible only by a long staircase and now requires assistance when climbing stairs. Her daughter requests discharge directly back to the apartment. Which factor requires the most immediate clarification before determining whether the living arrangement is appropriate?
A. Incorrect. Familiarity with a neighborhood does not establish whether the current home environment is safe or accessible.
B. Correct. Comprehensive geriatric assessment includes examining living arrangements and environmental barriers. Assessing stair accessibility and available assistance helps determine whether the patient's present needs can be met safely at home.
C. Incorrect. A family member's preference does not replace an assessment of environmental suitability and support needs.
D. Incorrect. Previous independence does not establish current safety after a change in mobility.
- Question 3 of 10
A 78-year-old woman is brought by her daughter for 8 months of missed bill payments and repeated questions. She completed 5 years of school, primarily speaks Spanish, and forgot her hearing aids. In a noisy English-language clinic visit, her MMSE score is 22/30. Neurologic examination is nonfocal; basic activities of daily living are intact. Which is the most appropriate interpretation or next step?
Cognitive screening interpretation
B is correct. Screening scores reflect cognition plus test conditions; language, education, hearing, and vision can falsely lower performance. C is incorrect because dementia requires acquired cognitive decline with functional impairment, not one biased MMSE cutoff. D is incorrect because serial testing helps only when the instrument and conditions are valid and comparable. A is incorrect because Mini-Cog is useful but still affected by education, language, vision, and motor ability.
DIAGNOSE with history, function, and unbiased testing; ORDER validated language-appropriate screening and sensory correction; TREAT reversible contributors; REFER/ESCALATE for progressive decline or atypical findings. - Question 4 of 10
Two older adults are evaluated in a cognitive disorders clinic. Patient 1 has experienced several distinct declines in cognition separated by stable intervals, whereas Patient 2 has developed progressively inappropriate social behavior and loss of customary restraint. Which pairing best identifies the syndrome suggested by each patient's most distinctive clinical feature?
A: This pairing reverses the key clinical associations. Stepwise decline suggests vascular involvement, whereas disinhibition suggests frontotemporal disease.
B: Patient 1 does not have a language-predominant presentation, and Patient 2 lacks the characteristic stepwise trajectory supporting vascular dementia.
C: Correct. Patient 1 demonstrates the stepwise pattern associated with vascular cognitive impairment. Patient 2 demonstrates behavioral disinhibition, a characteristic presentation of frontotemporal dementia.
D: The designation for Patient 1 is appropriate, but Patient 2 has behavioral rather than language-predominant manifestations of frontotemporal disease.
- Question 5 of 10
An 82-year-old hospitalized patient with delirium develops severe agitation and repeatedly attempts to strike staff members providing essential medical care. Environmental optimization and treatment of the suspected precipitating illness have been initiated, but the patient's behavior continues to pose an immediate safety threat. Which additional intervention is most appropriate?
A. Correct. Antipsychotics may be considered when delirium produces severe agitation that threatens safety. Their use does not replace treatment of the underlying cause or environmental optimization.
B. Incorrect. Treating the underlying cause remains a central priority even when behavioral symptoms require immediate intervention.
C. Incorrect. Benzodiazepines are mainly used for withdrawal-related delirium and are not the preferred routine intervention for non-withdrawal delirium.
D. Incorrect. Although routine medication for delirium is discouraged, severe agitation posing an immediate safety threat is the circumstance in which an antipsychotic may be appropriate.
- Question 6 of 10
An 80-year-old woman is preparing for discharge from a rehabilitation facility. A cane has been selected based on her balance needs and upper-extremity strength, and its height has been adjusted appropriately. She has never used a cane before and states that she plans to learn how to walk with it independently after returning home. What is the most appropriate action before discharge?
A: Correct. Training is an important component of safe assistive-device implementation. Confirming that the patient can use the selected and properly fitted cane helps prevent falls associated with improper technique.
B: Incorrect. Correct height does not ensure correct use. A properly fitted cane can still contribute to falls when used incorrectly.
C: Incorrect. Limiting use based on another person's availability does not teach the patient proper technique or establish safe independent device use.
D: Incorrect. Lack of prior experience is an indication for training, not an independent reason to select a different device when the cane otherwise matches the patient's functional needs.
- Question 7 of 10
An 83-year-old woman presents for a comprehensive geriatric assessment. Over the past year, she has developed slower walking speed, reduced muscle strength, persistent exhaustion, and unintentional weight loss. Her physician is considering a frailty screening assessment. Which interpretation of these findings is most appropriate?
A: Incorrect. Although functional changes may affect medication management, the described findings are specifically recognized as classic clues to frailty.
B: Correct. Slowness, weakness, exhaustion, and weight loss are characteristic clinical features used in phenotype-based frailty assessment. Recognizing this constellation is important because frailty is associated with poor outcomes.
C: Incorrect. A deficit-based approach evaluates accumulated deficits, but the phenotype approach recognizes characteristic physical and symptomatic features without requiring the question to establish multiple chronic diseases.
D: Incorrect. Frailty screening has prognostic significance beyond identifying an acute illness. Both phenotype-based and deficit-based approaches predict poor outcomes.
- Question 8 of 10
An 83-year-old woman returns to her primary care physician 5 days after hospitalization. Her discharge medication list excludes a medication she had been taking regularly before admission, but the discharge summary does not document a reason for discontinuation. She reports that she has stopped taking it because it was not listed on her discharge instructions. What is the most appropriate next step?
A: Incorrect. Hospital discharge is a transition during which medication omissions can occur. Accepting the discharge list without investigating the discrepancy may perpetuate an error.
B: Incorrect. Automatically restarting the medication assumes the omission was unintended. The clinician must first determine whether discontinuation was deliberate.
C: Correct. Comparing preadmission and discharge medications and clarifying unexplained differences is essential to identifying transition-related omissions and establishing the intended regimen.
D: Incorrect. Removing the medication without determining why it disappeared from the regimen conceals a potentially important reconciliation discrepancy.
- Question 9 of 10
An 82-year-old woman develops increasing confusion, dry mouth, and intermittent blurry vision several days after starting a medication with anticholinergic properties. Her family reports that she had been cognitively stable before the medication was added. Which explanation best accounts for this combination of findings?
A: Incorrect. An isolated visual disorder does not adequately explain the simultaneous confusion and dry mouth following exposure to an anticholinergic medication.
B: Correct. Anticholinergic medications can produce confusion, dry mouth, blurry vision, constipation, and urinary retention. The appearance of several characteristic effects after medication initiation supports a medication-related syndrome.
C: Incorrect. An isolated oral condition does not provide a coherent explanation for the concurrent cognitive and visual manifestations.
D: Incorrect. Although the patient is older, the temporal association and characteristic symptom cluster warrant consideration of anticholinergic drug effects rather than automatic attribution to aging.
- Question 10 of 10
An 83-year-old woman presents for evaluation of urinary leakage that has become more frequent over the past 3 months. She reports that several of her chronic medications were recently adjusted, but she cannot recall which medications were changed. She has not undergone a structured assessment of potential contributors to her incontinence. Which action is the most appropriate component of her initial evaluation?
A: Incorrect. Urinary incontinence in an older adult warrants assessment of potentially reversible contributors rather than automatic attribution to aging.
B: Correct. Medication assessment is a key component of lower urinary tract evaluation. Reviewing the complete medication regimen and recent changes helps identify potentially modifiable contributors before determining subsequent management.
C: Incorrect. The evaluation should not focus exclusively on infection. Urinalysis is not required for every chronic incontinence complaint, and medication, functional, cognitive, bowel, and fluid-related factors also deserve consideration.
D: Incorrect. Medication review is appropriate, but discontinuing every recently changed medication without evaluating its indication or potential contribution is not a justified initial approach.
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