Internal-Medicine

292 14: Comprehensive Review
For each of the following side effects, select the
most likely medication to cause them.
106. Disinterest in food with protein/calorie malnutrition
(SELECT ONE)
(A)
(B)
(C)
(D)
(E)
CT scan of head
CT scan of head with enhancement
CXR
MRI of head
spiral CT of chest
107. Zinc deficiency (SELECT ONE)
108. Vitamin B 6
deficiency (SELECT ONE)
109. Impaired calcium absorption (SELECT ONE)
110. Altered vitamin D metabolism (SELECT ONE)
Questions 111 through 113
(A) sleep more than younger adults
(B) increased arousals during the night
(C) increased slow-wave sleep
(D) sleep improved with alcohol
(E) most common cause of excessive daytime
sleepiness in the elderly
(F) breakdown of normal temporal organization
of sleep-wake cycling
For each of the following situations, select the
most likely sleep disturbance.
111. A common change in sleep as people age
(SELECT ONE)
112. Common in a 73-year-old woman with
Alzheimer’s disease (SELECT TWO)
113. Sleep apnea syndrome (SELECT ONE)
DIRECTIONS (Questions 114 through 118): Each
of the numbered items in this section is followed
by answers. Select the ONE lettered answer that is
BEST in each case.
114. A 73-year-old man is brought into the hospital
by his family. He is very confused, but collateral
history reveals that this is new. Physical
examination reveals crackles in his lungs, some
abdominal distension, and bilateral asterixis.
Which of the following is the most appropriate
initial diagnostic test?
115. A 69-year-old woman is brought to the hospital
under an order of medical evaluation after
she was found confused in an unkempt apartment
with five cats. Extensive investigation
does not reveal a specific cause of confusion in
this woman, and the medical service wonders
whether the true diagnosis is dementia. Which
of the following cognitive or behavioral impairments
is more typical of delirium than dementia?
(A)
(B)
(C)
(D)
(E)
impaired long-term memory
paranoid behavior
language impairment
impaired attention
fluctuating performance
116. A 77-year-old man is brought to the hospital by
his granddaughter for evaluation of confusion.
He has no focal findings and his neuro-imaging
studies are normal. Further investigations
reveal a urinary tract infection, and the man
improves somewhat after treatment, but still
exhibits poor judgment and bizarre behavior.
Pressing the family for information, the intern
unearths a history of 8 years of progressive
bizarre behavior. The man has undressed himself
and made sexual advances to young female
relatives, has urinated in hallways, and pushed
food into his mouth with alarming speed. Which
of the following is the most likely diagnosis?
(A)
(B)
(C)
(D)
(E)
Alzheimer’s disease
frontotemporal dementia
dementia with diffuse Lewy bodies
vascular dementia
benign frontal tumor
117. A 68-year-old woman with frontotemporal
dementia is being cared for at home by a supportive
family. Which of the following is the
most common reason for considering nursing
home placement in this individual?