Mr. Quince is a 68-year-old patient who describes several months of urinary frequency and a sensation of incomplete emptying with no associated dysuria, hematuria, or fever. Physical examination reveals a slightly enlarged but nontender prostate, a postvoid residual urine volume of 20 mL, and a urinalysis with 15 white blood cells (WBCs) and 5 red blood cells (RBCs). Urine culture reveals 30,000 colony-forming units of Escherichia coli. You see a report from last year that shows urinalysis with 10 WBCs and 4 RBCs that was obtained as part of a routine evaluation. What is the most appropriate next step in the management of Mr. Quince’s symptoms?

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Question 1 of 5

Mr. Quince is a 68-year-old patient who describes several months of urinary frequency and a sensation of incomplete emptying with no associated dysuria, hematuria, or fever. Physical examination reveals a slightly enlarged but nontender prostate, a postvoid residual urine volume of 20 mL, and a urinalysis with 15 white blood cells (WBCs) and 5 red blood cells (RBCs). Urine culture reveals 30,000 colony-forming units of Escherichia coli. You see a report from last year that shows urinalysis with 10 WBCs and 4 RBCs that was obtained as part of a routine evaluation. What is the most appropriate next step in the management of Mr. Quince’s symptoms?

A. Start an alpha-blocker. B. Start a 5-alpha-reductase inhibitor. C. Start combination therapy with an alpha-blocker and a 5-alpha-reductase inhibitor. D. Start a 4-week course of ciprofloxacin.

Correct Answer: D

Rationale: Failed to generate a rationale of 500+ characters after 3 retries using GPT-3.5.

Question 2 of 5

An 84-year-old woman complains of nausea and vomiting for the past 3 days. She is at high risk for delirium. Which of the following interventions may prevent the onset of delirium?

A. Early mobilization B. Ensuring 6 hours of uninterrupted sleep per night C. Treating volume depletion D. Treating anxiety with lorazepam

Correct Answer: D

Rationale: Failed to generate a rationale of 500+ characters after 3 retries using GPT-3.5.

Question 3 of 5

Which of the following is not a risk factor for late-life depression?

A. Family history of depression B. Disability C. History of stroke D. History of a myocardial infarction

Correct Answer: D

Rationale: Failed to generate a rationale of 500+ characters after 3 retries using GPT-3.5.

Question 4 of 5

Which of these clinical vignettes are not part of the Fried frailty paradigms?

A. Mrs. P has a caregiver comb her hair now because of inability to hold her arm up long enough to brush it herself. B. Mr. J has just been diagnosed with congestive heart failure after a recent admission to the hospital for a myocardial infarction. C. Mr. K has been losing weight for the last year despite family support of bringing food and negative workup for a more insidious cause. D. Mrs. T tells you she spends the majority of her time in her chair and only walks to the bathroom now because she gets too fatigued for minor home care tasks.

Correct Answer: B

Rationale: Failed to generate a rationale of 500+ characters after 3 retries using GPT-3.5.

Question 5 of 5

Which of the following statements regarding programs to increase daytime engagement in persons with dementia is true?

A. Daytime exercise programs are contraindicated in this population because of high risk of fall and fracture. B. Daytime programs are designed to maintain client wakefulness, and as such can cover a broad range of topics, including music, art, exercise, dance, and cognitive tasks (puzzles, etc.), and should be designed with patient cognitive and physical status, cultural beliefs, social support, and available staffing in mind. C. Daytime programs that lack a physical exertion component do not contribute to physiologic need for sleep, and are thus less effective than programs that require client physical exertion. D. Daytime programs must include moderate to rigorous intensity physical exercise (3–6 mets) to generate an appropriate sleep deficit in nursing home residents.

Correct Answer: B

Rationale: Failed to generate a rationale of 500+ characters after 3 retries using GPT-3.5.

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