An 81-year-old transgender female with a history of depression and hyperlipidemia presents to your clinic for routine care. She endorses a history of smoking, currently smoking 1 pack per day, and occasionally drinks a glass of wine, although she denies illicit drug use. She reports she takes atorvastatin 20 mg and subcutaneous estrogen therapy.

Correct Answer: C

Rationale: The correct answer is C: Counseling on smoking cessation. Smoking is a major risk factor for numerous health issues such as cardiovascular disease, respiratory problems, and cancer. Given the patient's age, history of smoking, and other risk factors like depression and hyperlipidemia, counseling on smoking cessation is crucial to improve her overall health and reduce the risk of future complications. Choice A: Counseling on starting aspirin may be appropriate for some individuals based on their cardiovascular risk profile, but in this case, smoking cessation is a more urgent priority due to the direct impact of smoking on health. Choice B: Counseling on alcohol cessation is important, but in this scenario, smoking cessation takes precedence due to the immediate and significant health risks associated with smoking. Choice D: Counseling on mammogram is important for breast cancer screening, but addressing smoking cessation should be the primary focus given the patient's current health risks. In summary, counseling on smoking cessation is the most critical intervention for this patient to improve her overall health

Correct Answer: C

Rationale: The correct answer is C. In this scenario, the patient had a radical prostatectomy and external beam radiation therapy, indicating aggressive treatment. Despite this, the PSA level is high (24.5 ng/mL), suggesting biochemical recurrence and possible metastasis. The positive bone scan and enlarged pelvic lymph node indicate disease progression beyond the prostate. Chemical or surgical castration, such as androgen deprivation therapy, can help delay disease progression and prolong survival by reducing the levels of testosterone that fuel prostate cancer growth. Summary: A: In advanced dementia and metastatic bone disease, castration is unlikely to impact survival as the disease is already advanced. B: A rising PSA level post-radical prostatectomy with negative imaging indicates biochemical recurrence, but without evidence of metastasis, making castration less beneficial. D: Prostate cancer limited to the prostate with a Gleason score of 6 is low risk and may not benefit significantly from castration as it is less likely to progress rapidly.

Correct Answer: D

Rationale: The correct answer is D: Either vancomycin or fidaxomicin are recommended for the first episode of C. difficile infection. 1. Choice A is incorrect because metronidazole is no longer recommended as first-line treatment due to increasing resistance. 2. Choice B is incorrect because there is no evidence suggesting older adults require a longer duration of treatment with vancomycin for their first episode. 3. Choice C is incorrect because while fecal transplantation can be used in refractory cases, it is not typically the first-line treatment. 4. The rationale for D being correct is that both vancomycin and fidaxomicin are recommended as first-line treatments for the initial episode of C. difficile infection based on current guidelines. This allows for flexibility in selecting the appropriate antibiotic based on individual patient factors.

Correct Answer: C

Rationale: The correct next step is C: Lifestyle modifications. Given the patient's history of mild voiding symptoms and benign prostatic hyperplasia, the first approach should be conservative management. Lifestyle modifications, such as reducing caffeine intake from coffee and diet cola, can help alleviate urinary symptoms. Additionally, optimizing fluid intake and bladder habits can also improve symptoms. Urinalysis (choice A) may be considered later if symptoms persist or worsen. Cystoscopy (choice B) is invasive and not indicated at this stage. Tamsulosin (choice D) is a medication for BPH, but since the patient's symptoms are mild and bother score is low, starting with lifestyle modifications is more appropriate.

Correct Answer: C

Rationale: The correct answer is C: Approximately 25% better quit rates than younger individuals. Older adults tend to have higher quit rates compared to younger individuals due to factors like increased motivation, life experience, and health concerns. Older adults often have more resources and support systems in place to help them quit smoking successfully. Choice A is incorrect because older adults do not necessarily have the same quit rates as younger individuals. Choice B is also incorrect as the difference in quit rates is not as high as 50%. Choice D is incorrect as older adults do not generally have much lower quit rates than younger individuals.