A 78-year-old man has an emergency partial colectomy for lower gastrointestinal bleeding. A localized colonic adenocarcinoma is completely resected. The surgeon did not dissect lymph nodes for metastatic sampling. The patient wants to know if he should have chemotherapy. Should he?

Correct Answer: B

Rationale: The correct answer is B) No because he can be followed with serial carcinoembryonic antigens and CT scans. In this scenario, the patient had a localized colonic adenocarcinoma completely resected without lymph node dissection. Given his age and the absence of lymph node involvement, adjuvant chemotherapy may not be necessary. Instead, close monitoring through serial carcinoembryonic antigen tests and CT scans can be used to detect any recurrence or metastasis early. Option A is incorrect because administering chemotherapy without knowing the complete staging and without clear indication may expose the patient to unnecessary risks and side effects. Option C is incorrect as the presence of severe bleeding does not necessarily indicate advanced disease, especially when the tumor has been completely resected. Option D is incorrect as age alone should not be the sole determinant of treatment decisions, and assuming the patient will not have any problems during his lifetime is not evidence-based. In an educational context, this question highlights the importance of individualized treatment decisions in oncology, considering factors such as tumor characteristics, staging, patient preferences, and risk-benefit analysis. It underscores the significance of regular monitoring and surveillance in cancer care to ensure early detection of any recurrence or progression.

Correct Answer: D

Rationale: The best next step in the management of Mr. Hunter's condition is to perform surgical resection of the prostate (Option D). This is the most appropriate course of action considering his severe voiding symptoms, high impact on quality of life, recurrent UTIs, significant postvoid residual volume, and low urinary flow rate. Surgical resection, such as transurethral resection of the prostate (TURP), is a common and effective treatment for benign prostatic hyperplasia (BPH) when medical therapy (such as tamsulosin and finasteride) is insufficient. Option A (Start tadalafil) is not the best choice in this case because tadalafil is a medication used for erectile dysfunction and pulmonary arterial hypertension, not for the treatment of BPH-related urinary symptoms. Option B (Switch from tamsulosin to silodosin) may not address the severity of Mr. Hunter's symptoms and the need for more definitive intervention like surgery. Option C (Switch from finasteride to dutasteride) involves changing the type of 5-alpha reductase inhibitor, which may not provide significant improvement in symptoms necessitating a more aggressive approach like surgical resection. In an educational context, understanding the progressive nature of BPH and the indications for surgical management is crucial for healthcare providers involved in the care of patients with urinary symptoms. It is important to recognize when conservative measures are no longer sufficient and when surgical intervention is necessary to improve symptoms and prevent complications.

Correct Answer: C

Rationale: In this scenario, the correct answer is C) Shorter length of stay in the hospital. Delirium in older adults, especially in the context of acute illness like gastrointestinal bleeding, is associated with adverse outcomes. A) Higher risk of institutionalization is predisposed by delirium as it may lead to functional decline and inability to manage independently. B) Increased risk of dementia is a potential consequence of delirium, as some cases may transition into a more chronic cognitive impairment. D) Increased mortality is also associated with delirium due to its impact on overall health and vulnerability of older adults. Educationally, understanding the implications of delirium in geriatric patients is crucial for healthcare providers to provide comprehensive care. Delirium is a serious condition that requires prompt recognition and management to improve patient outcomes and prevent complications. Older adults with delirium are at higher risk for negative outcomes, emphasizing the importance of early intervention and appropriate treatment strategies.

Correct Answer: C

Rationale: In pharmacology, understanding the response rates of different patient populations to antidepressant treatments is crucial for effective clinical practice. The correct answer to the question is C) 70%. Elderly patients, particularly those aged 65 years and older, often have unique physiological and pharmacokinetic considerations that can influence their response to antidepressant medications. Research has shown that older adults tend to have higher remission rates to initial antidepressant treatment compared to younger populations. This could be due to factors such as decreased clearance of medications, changes in receptor sensitivity, and comorbid medical conditions affecting drug metabolism. Option A) 30% and B) 40% are lower percentages, which do not align with the generally higher remission rates seen in older patients. Option D) 80% is too high and not typically reported in clinical studies. Educationally, understanding the nuances of pharmacotherapy in different age groups is essential for healthcare professionals to provide tailored and effective treatment to elderly patients. By recognizing the higher remission rates in older adults, clinicians can make informed decisions about medication selection and dosing strategies to optimize outcomes in this population.

Correct Answer: B

Rationale: The best initial course of treatment for Joyce Mitchell, a 73-year-old frail female with vestibular neuritis presenting with nausea, vomiting, sweating, and horizontal nystagmus, is supportive care with anti-nausea and anti-vertigo medication, which is option B. The correct answer is B because anti-nausea and anti-vertigo medications can help alleviate the symptoms experienced by the patient. These medications can provide relief from the discomfort caused by vestibular neuritis, such as nausea, vomiting, and vertigo, thus improving the patient's quality of life. Option A, vestibular rehabilitation, may be beneficial in the long term to improve balance and reduce the risk of falls. However, it is not the best initial treatment for acute symptoms like nausea and vertigo. Option C, fluids, while important for hydration, will not directly address the symptoms of vestibular neuritis. Option D, the Epley maneuver, is a specific treatment for benign paroxysmal positional vertigo (BPPV) and not vestibular neuritis, making it an incorrect choice in this scenario. In an educational context, understanding the appropriate management of vestibular neuritis is crucial for healthcare professionals involved in caring for patients with balance disorders. Recognizing the symptoms and knowing the initial steps in treatment can lead to better outcomes for patients like Joyce Mitchell.