A 78-year-old man with multi-infarct dementia, chronic kidney disease, congestive heart failure, and uncontrolled hypertension develops confusion, restlessness, and combativeness. Which of the pharmacologic agents would be the best choice for treating the agitation associated with his delirium?

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Question 1 of 5

A 78-year-old man with multi-infarct dementia, chronic kidney disease, congestive heart failure, and uncontrolled hypertension develops confusion, restlessness, and combativeness. Which of the pharmacologic agents would be the best choice for treating the agitation associated with his delirium?

Correct Answer: B

Rationale: The correct answer is B: Haloperidol. Haloperidol is a first-line antipsychotic commonly used to manage agitation in delirium due to its rapid onset and minimal sedative effects. It acts by blocking dopamine receptors in the brain, which helps to reduce agitation and combativeness. Melatonin (A) is not effective for acute agitation. Diazepam (C) can worsen confusion in elderly patients and is not recommended for delirium. Gabapentin (D) is not indicated for managing agitation in delirium and may not be effective in this scenario.

Question 2 of 5

Which of these statements about frailty are false?

Correct Answer: C

Rationale: The correct answer is C because clinical diagnosis of anxiety or depression can indeed have an effect on frailty rates. Anxiety and depression can contribute to the development and progression of frailty through various mechanisms such as decreased physical activity, poor nutrition, and social isolation. This can lead to a higher risk of frailty in individuals with mental health issues. Choices A, B, and D are incorrect because both prominent frailty models (e.g., Fried's phenotype model and Rockwood's accumulation of deficits model) do consider age as a component for defining frailty, individuals who are prefrail are at a higher risk of progressing to frailty rather than becoming robust, and frailty diagnosis has been shown to be valuable in preoperative assessment as it helps identify patients who may not do well with surgical interventions.

Question 3 of 5

An 85-year-old man with newly diagnosed nonvalvular atrial fibrillation comes to the office for a follow-up. Which medication change would be most appropriate for reducing his stroke risk?

Correct Answer: C

Rationale: The correct answer is C: Stop aspirin and begin apixaban 5 mg twice a day. The rationale is that for stroke risk reduction in nonvalvular atrial fibrillation, anticoagulation therapy with direct oral anticoagulants (DOACs) like apixaban is preferred over antiplatelet therapy like aspirin. DOACs have been shown to be more effective in reducing stroke risk with a lower bleeding risk compared to warfarin. Choice A is incorrect as aspirin alone is not sufficient for stroke prevention in atrial fibrillation. Choice B is incorrect as warfarin has more monitoring requirements and potential drug interactions compared to DOACs like apixaban. Choice D is incorrect as aspirin and apixaban together are not recommended due to increased bleeding risk.

Question 4 of 5

Treatment for early PD in an otherwise healthy older patient without significant functional impairment should begin with:

Correct Answer: B

Rationale: The correct answer is B: Dopamine agonist. In early PD, dopamine agonists are preferred due to their lower risk of motor complications compared to levodopa. Dopamine agonists help improve motor symptoms by directly stimulating dopamine receptors. COMT inhibitors are usually used in combination with levodopa to prolong its effects. Levodopa is effective but can lead to motor complications with long-term use. Careful observation is not a treatment strategy and delays symptom management. Therefore, starting with a dopamine agonist is the most suitable option for early PD to manage symptoms effectively with minimal risk of motor complications.

Question 5 of 5

Which of the following is true about cultural humility?

Correct Answer: C

Rationale: The correct answer is C because cultural humility emphasizes recognizing power imbalances and fostering interpersonal sensitivity through partnerships with and learning from patients. This approach encourages self-awareness, openness, and willingness to engage in respectful dialogues. Option A is incorrect because cultural humility is not solely achieved through professional development courses. Option B is incorrect as anyone, regardless of their background, can practice cultural humility. Option D is incorrect as cultural humility does consider the impacts of structural factors on health disparities, including biological, socioeconomic, and racial influences.

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