ECHO-AGE Knowledge Evaluation Please circle your role: MD NP RN Have you had any prior formal geriatric training?

Yes No If yes, what did this entail. _____________________________________________ 1. 79 year old man with past medical history significant for coronary artery disease, hypertension, depression, and mild cognitive impairment is admitted to a rehabilitation facility following hospitalization for elective knee replacement. On admission, he is alert and oriented x3, interacts appropriately with staff, and is able to provide a detailed medical history. During the early evening two days following his admission, he is noted to be agitated by staff. On evaluation, he denies pain or other concerns but has obvious difficulty focusing on questions being asked. He keeps attempting to get out of bed and insists that he must go home to wash his car. Vital signs are normal. Physical exam is unchanged from admission including a non-focal neurologic exam. There are no signs of infection at the surgical site. Which of the following diagnoses most likely accounts for the patients agitation and other cognitive changes? a. b. c. d. e. Mild cognitive impairment Dementia Stroke Delirium Major depression with psychotic features

2. In the above case, which of the following is most likely the primary contributing factor for the patients change in mental status? a. b. c. d. e. Age Unfamiliar environment Medications Pain Urinary Tract Infection

3. An 81 year old long term care resident with past medical history significant for osteoporosis, severe osteoarthritis, and mild dementia is noted to be more lethargic than baseline. She falls asleep during breakfast and requires multiple attempts to arouse her before she can safely take her medications. When she is awake, the patient gazes out the window and seems unable to focus on the events around her. Vital signs are normal. Physical exam is unremarkable. Given a history of recurrent urinary track infections, a urinalysis is checked. It shows moderate leukocytes, positive nitrites, and many bacteria.

Which of the following would be the most helpful in establishing the diagnosis that accounts for her mental status change? a. Evaluation of orientation b. Evaluation of clock drawing c. Evaluation of ability to recite the months of the year or days of the week backward d. Order a TSH, RPR, and vitamin B12 level e. Lumbar puncture f. Order a non-contrast CT of the patients brain 4. An 86 year old nursing home resident with past medical history significant for moderate Alzheimers disease (recent Mini-Mental State Examination score of 18), stroke, and wet macular degeneration is admitted to the hospital following a fall with left hip fracture. On initial labs, the patients BUN to creatinine ratio is elevated and she is mildly anemic. The admitting physician recognizes that this patient is at high risk for the development of delirium due to her age, dementia, past stroke, acute trauma, visual impairment, and elevated BUN to creatinine ratio. Which of the following prevention methods have been proven to reduce the incidence of delirium among hospitalized elders? a. Nonpharmacologic programs (Hospital Elder Life Program, proactive geriatric consultation) b. Haloperidol c. Donepezil d. Rivastigmine e. None of the above 5. A 74 year old man with past medical history significant for BPH, depression, Parkinsons disease, and memory troubles is admitted to rehab following hospitalization for aspiration pneumonia. He is cooperative with care on admission. However, his wife reports that he became agitated overnight in the hospital. She attributes this to his memory. She states that he needs assistance with all IADLs at home, has very poor short term memory, has times when he is not able to maintain attention, and occasionally sees visions small animals in the house. The agitation was treated with an unknown medication in the hospital that his wife reports made him worse by increasing his agitation and making his walking less stable. Which of the following medications would be the best first choice if the patient developed agitation and pharmacologic therapy was required? a. Haloperidol b. Quetiapine c. Rivastigmine

d. Lorazepam 6. A 78 year old lady with past medical history significant for rheumatoid arthritis and Alzheimers dementia has been living at a long term care facility for three years. Over that time, behavioral problems associated with her dementia have become more pronounced. She often takes items from other residents and hides them in her room, hoards food from the dining room under her mattress, and disrobes in public. Which of the following treatment options would be most effective in addressing this patients behavioral symptoms? a. b. c. d. Donepezil Citalopram Trazodone Nonpharmacologic interventions

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