A 69-year-old female presents to your office for routine primary care. Her elder sister was recently diagnosed with Alzheimer's disease, and she wonders what steps she can take to reduce her own risk of developing dementia. Which of the following statements is true about the prevention of dementia?

Correct Answer: C

Rationale: The correct answer is C: There is moderate quality evidence to suggest control of cardiovascular and metabolic risk factors, such as blood pressure, weight, and blood sugar, may reduce the risk of dementia. This statement is true because studies have shown that managing cardiovascular and metabolic risk factors can help reduce the risk of developing dementia. High blood pressure, obesity, and diabetes have been linked to an increased risk of cognitive decline and dementia. By controlling these risk factors through lifestyle changes or medication, individuals can potentially lower their risk of developing dementia. Choice A is incorrect because while vitamin B12 and fish oil may have some benefits for cognitive health, the evidence supporting their use in preventing dementia is not strong. Choice B is incorrect because while genetics and family history play a role in dementia risk, there are behavioral interventions, such as maintaining a healthy lifestyle and managing risk factors, that can help reduce the risk of dementia. Choice D is incorrect because there is not enough strong evidence to support the claim that cannabinoids can reduce rates

Correct Answer: C

Rationale: Correct Answer: C - Suggesting completion of an advance directive at the visit with his goals of care in mind. Rationale: 1. Age and health concerns: At 81 years old with weight loss, fatigue, and a history of falls, addressing end-of-life planning becomes crucial. 2. Advance Directive: Helps the patient make decisions about the care they want if they become unable to communicate their wishes. 3. Goals of care: Understanding his wishes ensures healthcare decisions align with his values, enhancing patient autonomy and quality of care. Summary: - A: Blood pressure is important but not the priority compared to end-of-life planning. - B: Cognitive testing is valuable, but addressing care preferences takes precedence. - D: Colonoscopy report is not urgent compared to ensuring the patient's wishes are known for future care.

Correct Answer: C

Rationale: The correct answer is C: Start a high-calorie supplement twice a day. After an acute ischemic stroke, nutritional support is crucial for recovery and prevention of complications. Malnutrition is common post-stroke due to swallowing difficulties and decreased appetite. High-calorie supplements can help meet the patient's nutritional needs. Choice A (escitalopram) is a selective serotonin reuptake inhibitor used for depression and anxiety, which may not be the immediate priority in this case. Choice B (eszopiclone) is a nonbenzodiazepine hypnotic used for insomnia, which is not directly related to managing the patient's stroke. Choice D (changing the time of physical therapy) may be beneficial, but ensuring adequate nutrition is more critical in the acute phase of stroke recovery.

Correct Answer: A

Rationale: Step 1: The rule of fourths states that one-fourth of geriatric problems are iatrogenic, meaning they are caused by medical treatment. Step 2: This statement is true because iatrogenic problems in the elderly are common due to multiple medications, procedures, etc. Step 3: A careful assessment can indeed identify iatrogenic issues, making this statement accurate. Summary: A is correct because it aligns with the concept of iatrogenic problems in the elderly. B is incorrect because interventions can help prevent many problems of aging. C is incorrect as it does not specifically address iatrogenic problems. D is incorrect as it does not focus on the iatrogenic aspect of geriatric problems.

Correct Answer: D

Rationale: The correct answer is D because each of the choices addresses a different aspect of how racial disparities in healthcare can impact the expectations of older Black Americans. A is correct because unethical studies in the past can lead to reluctance to participate in medical research. B is correct because the underrepresentation of Black physicians may affect the quality of care older Black Americans receive. C is correct because differences in access to healthcare providers can result in cumulative negative effects on health outcomes for older Black Americans. Therefore, the combination of these factors can significantly impact the expectations and experiences of older Black Americans in healthcare.