Geriatric screening protocols US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Geriatric screening protocols. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Geriatric screening protocols US Medical PG Question 1: A 68-year-old female presents to your office for her annual check-up. Her vitals are HR 85, T 98.8 F, RR 16, BP 125/70. She has a history of smoking 1 pack a day for 35 years, but states she quit five years ago. She had her last pap smear at age 64 and states all of her pap smears have been normal. She had her last colonoscopy at age 62, which was also normal. Which of the following is the next best test for this patient?
- A. Pap smear
- B. Chest radiograph
- C. Abdominal ultrasound
- D. Colonoscopy
- E. Chest CT scan (Correct Answer)
Geriatric screening protocols Explanation: ***Chest CT scan***
- This patient is a 68-year-old female with a **35-pack-year smoking history** who quit 5 years ago, placing her in a high-risk group for lung cancer.
- **Low-dose computed tomography (LDCT)** for lung cancer screening is recommended annually for individuals aged 50-80 with a 20-pack-year smoking history who currently smoke or have quit within the past 15 years.
*Pap smear*
- A Pap smear is not indicated as she had her last one at age 64 and all previous results were normal.
- Guidelines recommend discontinuing Pap smears at age 65 if there is no history of moderate or severe dysplasia and three consecutive negative results within the last 10 years.
*Chest radiograph*
- A chest radiograph is a less sensitive and specific tool for detecting early lung cancer compared to LDCT.
- It misses a significant proportion of early-stage lung cancers and is not recommended for lung cancer screening.
*Abdominal ultrasound*
- An abdominal ultrasound is generally used to screen for conditions like abdominal aortic aneurysm in specific high-risk populations (males 65-75 who have ever smoked).
- There is no indication from the provided history for an abdominal ultrasound in this patient.
*Colonoscopy*
- This patient had a normal colonoscopy at age 62.
- Current guidelines recommend repeating colonoscopy every 10 years if the previous one was normal, so she is not due for another one yet.
Geriatric screening protocols US Medical PG Question 2: A 62-year-old man comes to his primary care physician with a 3-month history of insomnia and severe work anxiety. He says that he is unable to retire because he has no financial resources; however, the stress level at his work has been causing him to have worsening performance and he is afraid of being fired. He thinks that he would be able to resume work normally if he was able to decrease his level of anxiety. His physician prescribes him a trial 1-month regimen of benzodiazepine therapy and schedules a follow-up appointment to see whether this treatment has been effective. Three weeks later, the patient's wife calls and says "My husband was fired from work and it's your fault for prescribing that medication! I know he must have been taking too much of that drug. Don't you know that he had a horrible problem with drug abuse in his 30s?" Which of the following is the most appropriate first action for the physician to take?
- A. Discharge the patient for inappropriate use of medication
- B. Contact the physician's medical practice insurance company regarding a potential claim
- C. Refer the patient to a substance abuse program
- D. Contact the patient directly to discuss the situation (Correct Answer)
- E. Inform the patient's wife that patient information cannot be disclosed to her due to HIPAA
Geriatric screening protocols Explanation: ***Contact the patient directly to discuss the situation***
- The physician's immediate priority is to address the patient's well-being and medication use directly with the patient, as the patient-doctor relationship is paramount and confidential.
- This allows the physician to gather information directly from the patient, assess the current situation, and plan appropriate next steps, which may include medication adjustment, referral, or relapse prevention depending on the patient's account.
*Discharge the patient for inappropriate use of medication*
- Discharging the patient based solely on a third-party report, especially without direct communication with the patient, would be premature and could be interpreted as **patient abandonment**.
- This action does not prioritize the patient's immediate medical and psychological needs and could worsen their situation by removing them from care.
*Contact the physician's medical practice insurance company regarding a potential claim*
- While potential legal implications exist, contacting the insurance company is not the **first and most appropriate medical action** to take.
- The immediate priority is the patient's health and safety, and managing potential legal risks can be addressed after ensuring the patient's well-being.
*Refer the patient to a substance abuse program*
- Although the patient's history and the wife's concerns suggest a potential for substance abuse, a direct referral without first assessing the patient and confirming misuse would be premature.
- The physician needs to **personally evaluate the patient** to determine the appropriate course of action, which might include such a referral, but it shouldn't be the very first step based on indirect information.
*Inform the patient's wife that patient information cannot be disclosed to her due to HIPAA*
- While the physician can listen to the wife's concerns (HIPAA does not prohibit receiving information from third parties), the physician **cannot discuss the patient's care or confirm treatment details** without the patient's authorization.
- However, simply informing the wife about confidentiality restrictions without taking action to contact and assess the patient is not the most appropriate first step—the priority is patient care, not just explaining privacy rules.
Geriatric screening protocols US Medical PG Question 3: A 66-year-old man is brought into the emergency department by his daughter for a change in behavior. Yesterday the patient seemed more confused than usual and was asking the same questions repetitively. His symptoms have not improved over the past 24 hours, thus the decision to bring him in today. Last year, the patient was almost completely independent but he then suffered a "series of falls," after which his ability to care for himself declined. After this episode he was no longer able to cook for himself or pay his bills but otherwise had been fine up until this episode. The patient has a past medical history of myocardial infarction, hypertension, depression, diabetes mellitus type II, constipation, diverticulitis, and peripheral neuropathy. His current medications include metformin, insulin, lisinopril, hydrochlorothiazide, sodium docusate, atorvastatin, metoprolol, fluoxetine, and gabapentin. On exam you note a confused man who is poorly kept. He has bruises over his legs and his gait seems unstable. He is alert to person and place, and answers some questions inappropriately. The patient's pulse is 90/minute and his blood pressure is 170/100 mmHg. Which of the following is the most likely diagnosis?
- A. Normal aging
- B. Lewy body dementia
- C. Vascular dementia (Correct Answer)
- D. Pseudodementia (depression-related cognitive impairment)
- E. Alzheimer's dementia
Geriatric screening protocols Explanation: ***Vascular dementia***
- This diagnosis is strongly supported by the patient's **stepwise decline** in cognitive function following a "series of falls" (likely small strokes or transient ischemic attacks) and his extensive history of **vascular risk factors** including hypertension, diabetes, and previous myocardial infarction.
- The acute worsening of confusion over 24 hours, coupled with pre-existing impaired executive function (inability to cook or pay bills), is characteristic of **vascular dementia's fluctuating course** and presentation often linked to new cerebrovascular events.
*Incorrect: Normal aging*
- **Normal aging** involves a very gradual and mild decline in cognitive functions, primarily affecting processing speed and memory recall, without significant impairment in daily activities.
- This patient's rapid, stepwise decline and inability to perform instrumental activities of daily living (IADLs) such as cooking and managing finances go beyond what is considered normal cognitive changes with aging.
*Incorrect: Lewy body dementia*
- **Lewy body dementia** is characterized by prominent **fluctuations in attention and alertness**, recurrent visual hallucinations, and spontaneous parkinsonism, none of which are explicitly mentioned as primary features in this patient's presentation.
- While fluctuations in confusion are present, the history of a clear stepwise decline post-falls and significant vascular risk factors points away from Lewy body dementia as the most likely primary cause.
*Incorrect: Pseudodementia (depression-related cognitive impairment)*
- **Pseudodementia** refers to cognitive impairment that occurs in the context of **major depression**, where patients may exhibit poor concentration, memory difficulties, and psychomotor slowing that mimics dementia.
- While this patient is on fluoxetine for depression, the **stepwise decline** after clear vascular events (falls), multiple vascular risk factors, and impaired executive function point to a true neurodegenerative process rather than depression-induced cognitive changes, which typically improve with treatment of the underlying mood disorder.
*Incorrect: Alzheimer's dementia*
- **Alzheimer's dementia** typically presents with a **gradual and progressive decline** in memory, particularly episodic memory, followed by other cognitive domains over several years.
- The patient's history of a clear **stepwise decline** in function after acute events (falls) and the strong presence of **vascular risk factors** make vascular dementia a more fitting diagnosis than Alzheimer's, which is not typically associated with such a sudden, step-like progression.
Geriatric screening protocols US Medical PG Question 4: An investigator conducts a case-control study to evaluate the relationship between benzodiazepine use among the elderly population (older than 65 years of age) that resides in assisted-living facilities and the risk of developing Alzheimer dementia. Three hundred patients with Alzheimer dementia are recruited from assisted-living facilities throughout the New York City metropolitan area, and their rates of benzodiazepine use are compared to 300 controls. Which of the following describes a patient who would be appropriate for the study's control group?
- A. A 73-year-old woman with coronary artery disease who was recently discharged to an assisted-living facility from the hospital after a middle cerebral artery stroke
- B. An 86-year-old man with well-controlled hypertension and mild benign prostate hyperplasia who lives in an assisted-living facility (Correct Answer)
- C. A 64-year-old man with well-controlled hypertension and mild benign prostate hyperplasia who lives in an assisted-living facility
- D. An 80-year-old man with well-controlled hypertension and mild benign prostate hyperplasia who lives in an independent-living community
- E. A 68-year-old man with hypercholesterolemia, mild benign prostate hyperplasia, and poorly-controlled diabetes who is hospitalized for pneumonia
Geriatric screening protocols Explanation: ***An 86-year-old man with well-controlled hypertension and mild benign prostate hyperplasia who lives in an assisted-living facility***
- This patient meets all criteria stipulated for the control group: **older than 65 years of age**, and **resides in an assisted-living facility**.
- They also have no mention of dementia, making them suitable as a **healthy control** for the study.
*A 73-year-old woman with coronary artery disease who was recently discharged to an assisted-living facility from the hospital after a middle cerebral artery stroke*
- Although this patient is over 65 and in an assisted-living facility, a recent **middle cerebral artery stroke** could lead to **vascular cognitive impairment**, which might confound the assessment of Alzheimer's dementia.
- Controls should ideally be free of conditions that could mimic or predispose to dementia, complicating the analysis of the association with benzodiazepine use.
*A 64-year-old man with well-controlled hypertension and mild benign prostate hyperplasia who lives in an assisted-living facility*
- This patient does not meet the specified age criterion of being **older than 65 years of age**.
- All participants in the study, including controls, must be 65 years or older to maintain the integrity of the study population.
*An 80-year-old man with well-controlled hypertension and mild benign prostate hyperplasia who lives in an independent-living community*
- This patient does not reside in an **assisted-living facility**, which is a crucial inclusion criterion for all participants in this study.
- The study specifically focuses on the elderly population residing in **assisted-living facilities** to ensure a uniform study environment.
*A 68-year-old man with hypercholesterolemia, mild benign prostate hyperplasia, and poorly-controlled diabetes who is hospitalized for pneumonia*
- This patient is currently **hospitalized for pneumonia**, indicating an acute illness that would make them unsuitable for selection into a control group for a chronic disease study.
- Controls should be relatively healthy and stable; acute hospitalization suggests a compromised health state not representative of the target control population.
Geriatric screening protocols US Medical PG Question 5: A 77-year-old Caucasian woman presents to her primary care provider for a general checkup. The patient is with her daughter who brought her to this appointment. The patient states that she is doing well and has some minor joint pain in both hips. She states that sometimes she is sad because her husband recently died. She lives alone and follows a vegan diet. The patient's daughter states that she has noticed her mother struggling with day to day life. It started 2 years ago with her forgetting simple instructions or having difficulty running errands. Now the patient has gotten to the point where she can no longer pay her bills. Sometimes the patient forgets how to get home. The patient has a past medical history of obesity, hypertension, gastroesophageal reflux disease (GERD) controlled with pantoprazole, and diabetes mellitus. Her temperature is 99.5°F (37.5°C), blood pressure is 158/108 mmHg, pulse is 90/min, respirations are 17/min, and oxygen saturation is 98% on room air. Which of the following will most likely help with this patient's presentation?
- A. Vitamin B12 and discontinue pantoprazole
- B. No intervention needed
- C. Donepezil (Correct Answer)
- D. Fluoxetine and cognitive behavioral therapy
- E. Lisinopril and metoprolol
Geriatric screening protocols Explanation: ***Correct: Donepezil***
- This patient presents with **progressive dementia**, most consistent with **Alzheimer's disease**: gradual cognitive decline over 2 years, short-term memory loss (forgetting instructions), executive dysfunction (unable to pay bills), impaired navigation (getting lost), and functional decline in activities of daily living (ADLs).
- **Donepezil**, an **acetylcholinesterase inhibitor**, is first-line pharmacotherapy for mild-to-moderate Alzheimer's disease, improving cognitive function by increasing acetylcholine availability in the brain.
- Key differentiator: The **progressive, global cognitive impairment** with functional decline over years distinguishes this from reversible causes or mood disorders.
*Incorrect: Vitamin B12 and discontinue pantoprazole*
- While **vitamin B12 deficiency** can cause cognitive impairment and this patient has risk factors (vegan diet, chronic PPI use with pantoprazole), the **severity, duration, and progressive nature** of her symptoms indicate a **neurodegenerative process** rather than a reversible nutritional deficiency.
- B12 deficiency typically presents with more prominent neurological signs (peripheral neuropathy, subacute combined degeneration) and would be expected to show improvement with supplementation.
- Though checking B12 levels would be part of the dementia workup, it would not be the **primary treatment** for this presentation.
*Incorrect: No intervention needed*
- This patient has **significant functional impairment** with safety concerns (getting lost, inability to manage finances), requiring immediate intervention.
- Progressive cognitive decline causing loss of independence in ADLs is never "normal aging" and always warrants medical evaluation and treatment.
- Failure to intervene risks patient safety and further deterioration.
*Incorrect: Fluoxetine and cognitive behavioral therapy*
- While the patient reports sadness related to her husband's death (suggesting **grief** or possible **depression**), her **predominant symptoms are cognitive and functional**, not primarily mood-related.
- **Key differentiation**: Depression can cause "pseudodementia" with cognitive complaints, but true dementia shows objective functional decline (inability to pay bills, getting lost) that progresses regardless of mood, whereas depression-related cognitive symptoms typically improve with mood treatment.
- The **2-year progressive course** with worsening executive function points to **organic dementia**, not a primary mood disorder.
- Fluoxetine and CBT target depression but would not address the underlying neurodegenerative process.
*Incorrect: Lisinopril and metoprolol*
- The patient's blood pressure is elevated (158/108 mmHg), indicating uncontrolled **hypertension** that should be managed.
- While controlling vascular risk factors is important in dementia management (to prevent vascular dementia progression), treating hypertension would not address her **current cognitive symptoms** or provide symptomatic relief.
- The **primary issue** is dementia requiring acetylcholinesterase inhibitor therapy; blood pressure management is secondary.
Geriatric screening protocols US Medical PG Question 6: A 26-year-old primigravida woman comes to her primary care physician for the second prenatal visit. She is 10 weeks pregnant. She has no current complaint except for occasional nausea. She does not have any chronic health problems. She denies smoking or alcohol intake. Her family history is positive for paternal colon cancer at the age of 55. Vital signs include a temperature of 37.1°C (98.8°F), blood pressure of 120/60 mm Hg, and pulse of 90/min. Physical examination discloses no abnormalities. According to the United States Preventive Services Task Force (USPSTF), which of the following screening tests is recommended for this patient?
- A. Colonoscopy for colorectal cancer at the age of 40
- B. HbA1C for type 2 diabetes mellitus
- C. Colonoscopy for colorectal cancer at the age of 50
- D. Glucose tolerance test for gestational diabetes mellitus
- E. Urine culture for asymptomatic bacteriuria (Correct Answer)
Geriatric screening protocols Explanation: ***Urine culture for asymptomatic bacteriuria***
- The **USPSTF** recommends **screening pregnant individuals for asymptomatic bacteriuria** with a urine culture at the first prenatal visit or at 12-16 weeks' gestation to prevent pyelonephritis and other adverse pregnancy outcomes.
- This patient is in her second prenatal visit at 10 weeks, making this a timely and recommended screening.
*Colonoscopy for colorectal cancer at the age of 40*
- Although the patient has a **family history of paternal colon cancer at age 55**, the general recommendation for earlier screening due to family history typically starts 10 years before the youngest affected relative's diagnosis, but not earlier than age 40, and is not a routine screening for a 26-year-old.
- This screening is not universally recommended at age 40 for everyone, and current guidelines often suggest individualized approaches based on specific family history details that are not fully met by this patient at this age.
*HbA1C for type 2 diabetes mellitus*
- The patient has **no risk factors for type 2 diabetes**, such as obesity, history of gestational diabetes, or strong family history of diabetes, that would warrant early screening with HbA1c.
- Routine screening for type 2 diabetes for an individual of her age and health status is not typically recommended by the USPSTF.
*Colonoscopy for colorectal cancer at the age of 50*
- The **USPSTF recommends screening for colorectal cancer in average-risk individuals beginning at age 45-50**.
- This patient is only 26 years old and is not in the appropriate age group for this general screening recommendation.
*Glucose tolerance test for gestational diabetes mellitus*
- Screening for **gestational diabetes mellitus (GDM)** typically occurs much later in pregnancy, usually between **24 and 28 weeks of gestation**.
- Performing a glucose tolerance test at 10 weeks pregnant is too early for GDM screening based on standard guidelines.
Geriatric screening protocols US Medical PG Question 7: A 27-year-old woman presents for her routine annual examination. She has no complaints. She has a 3-year-old child who was born via normal vaginal delivery with no complications. She had a Pap smear during her last pregnancy and the findings were normal. Her remaining past medical history is not significant, and her family history is also not significant. Recently, one of her close friends was diagnosed with breast cancer at the age of 36, and, after reading some online research, she wants to be checked for all types of cancer. Which of the following statements would be the best advice regarding the most appropriate screening tests for this patient?
- A. “Your last Pap smear 3 years ago was normal. We can repeat it after 2 more years.”
- B. “Remember that information on the internet is vague and unreliable. You don't need any screening tests at this time.”
- C. “Yes, you are right to be concerned. Let us do a mammogram and a blood test for CA-125.”
- D. “You need HPV (human papillomavirus) co-testing only.”
- E. “We should do a Pap smear now. Blood tests are not recommended for screening purposes.” (Correct Answer)
Geriatric screening protocols Explanation: ***We should do a Pap smear now. Blood tests are not recommended for screening purposes.***
- The current guidelines recommend Pap smears every 3 years for women aged 21-29. Although her last Pap smear was 3 years ago, it was done during pregnancy, and a **repeat Pap smear is indicated now** as she is at the end of the 3-year interval.
- **Blood tests like CA-125 are not recommended for routine cancer screening** in asymptomatic women due to their low specificity and sensitivity, which can lead to false positives and unnecessary invasive procedures.
*“Your last Pap smear 3 years ago was normal. We can repeat it after 2 more years.”*
- While a 3-year interval is generally appropriate, her last Pap smear was done 3 years ago and was performed during pregnancy, making a **repeat Pap smear indicated now** to remain within current screening guidelines.
- Delaying the Pap smear for another two years would exceed the recommended 3-year interval for cervical cancer screening in her age group.
*“Remember that information on the internet is vague and unreliable. You don't need any screening tests at this time.”*
- While caution about internet information is valid, it is **inaccurate to suggest no screening tests are needed** as the patient is due for a Pap smear based on her age and last screening date.
- Dismissing a patient's concerns outright without acknowledging valid screening needs can harm patient-doctor trust and lead to missed opportunities for preventive care.
*“Yes, you are right to be concerned. Let us do a mammogram and a blood test for CA-125.”*
- **Routine mammograms are not recommended for women under 40** without specific risk factors (e.g., strong family history, genetic mutations), which are not present here.
- **CA-125 is primarily used for monitoring ovarian cancer treatment** or evaluating women with symptoms, not for general population screening due to its low specificity.
*“You need HPV (human papillomavirus) co-testing only.”*
- **HPV co-testing (HPV test + Pap smear) is recommended for women aged 30 and older**, or as a follow-up to abnormal Pap smear results.
- For women aged 21-29, **primary Pap smear screening alone is recommended** every 3 years.
Geriatric screening protocols US Medical PG Question 8: A 72-year-old man is brought to the physician by his wife for memory issues over the last 7 months. The patient's wife feels that he has gradually become more forgetful. He commonly misplaces his car keys and forgets his children's names. He seems to have forgotten how to make dinner and sometimes serves uncooked noodles or raw meat. One night he parked his car in a neighbor's bushes and was found wandering the street. He has a history of hypertension, hyperlipidemia, and COPD. Current medications include atorvastatin, metoprolol, ipratropium, and fluticasone. Vital signs are within normal limits. He is alert and oriented to person and place only. Neurologic examination shows no focal findings. His Mini-Mental State Examination score is 19/30. A complete blood count and serum concentrations of electrolytes, urea nitrogen, creatinine, thyroid-stimulating hormone, liver function tests, vitamin B12 (cobalamin), and folate are within the reference range. Which of the following is the most appropriate next step in diagnosis?
- A. Electroencephalography
- B. PET scan
- C. MRI of the brain (Correct Answer)
- D. Lumbar puncture
- E. Neuropsychologic testing
Geriatric screening protocols Explanation: ***MRI of the brain***
- An **MRI of the brain** is crucial for evaluating **structural causes of cognitive impairment**, such as tumors, strokes, hydrocephalus, or significant atrophy that might explain the patient's rapidly progressing memory loss and functional decline.
- Given the patient's age, rapidly worsening dementia symptoms, and normal initial lab work, imaging is essential to rule out **reversible or treatable causes** and to characterize the extent of neurodegeneration.
*Electroencephalography*
- **EEG** is primarily used to detect **seizure activity** or to evaluate for rapidly progressive encephalopathies like Creutzfeldt-Jakob disease, which is not indicated by the patient's presentation.
- The patient's symptoms are consistent with a dementia syndrome, not acute encephalopathy or seizures.
*PET scan*
- A **PET scan** (e.g., FDG-PET or amyloid-PET) can provide information about metabolic activity or amyloid plaques, useful for **differentiating types of dementia** (e.g., Alzheimer's disease).
- However, it is an advanced test typically considered after structural imaging has ruled out other causes and when the diagnosis remains unclear.
*Lumbar puncture*
- **Lumbar puncture** is performed to analyze **cerebrospinal fluid (CSF)** for biomarkers (e.g., tau, Aβ42 levels) to help diagnose specific neurodegenerative diseases like Alzheimer's or to rule out infectious/inflammatory causes.
- It's usually reserved for cases where other investigations are inconclusive or specific conditions are strongly suspected, and structural imaging has been performed.
*Neuropsychologic testing*
- **Neuropsychologic testing** provides a detailed assessment of various cognitive domains and can help to **characterize the pattern and severity of cognitive impairment**.
- While valuable, it is usually performed after initial medical workup and structural imaging to understand the functional impact of any identified brain changes or to further delineate the type of cognitive disorder.
Geriatric screening protocols US Medical PG Question 9: A 33-year-old woman comes to the physician because of vision impairment in her right eye for the past 2 weeks. During this period, she was unable to distinguish colors with her right eye. She also reports pain with eye movement. She has no double vision. She occasionally has headaches that are relieved by ibuprofen. One year ago, she had a similar episode that affected her left eye and resolved spontaneously. She has no history of serious illness. She works at a library and enjoys reading, even in poor lighting conditions. Her vital signs are within normal limits. The pupils are equal, round, and reactive to light and accommodation. Without correction, visual acuity is 20/50 in the left eye, and 20/100 in the right eye. With spectacles, the visual acuity is 20/20 in the left eye and 20/100 in the right eye. Slit lamp examination shows no abnormalities. A CT scan of the head shows no abnormalities. Which of the following is the most likely diagnosis?
- A. Narrow-angle glaucoma
- B. Retinal detachment
- C. Macular degeneration
- D. Retinitis pigmentosa
- E. Optic neuritis (Correct Answer)
Geriatric screening protocols Explanation: ***Optic neuritis***
- This condition presents with **acute monocular vision loss**, **pain with eye movement**, and **dyschromatopsia** (inability to distinguish colors), which are classic symptoms of optic neuritis.
- The recurrent nature affecting different eyes (**recurrent episodes in each eye**) and the spontaneous resolution are highly suggestive of **demyelinating disease**, such as **multiple sclerosis**, of which optic neuritis is often the initial presentation.
*Narrow-angle glaucoma*
- **Narrow-angle glaucoma** typically presents with **sudden, severe eye pain**, blurred vision, headache, and halos around lights due to acutely elevated intraocular pressure.
- The examination would reveal a **mid-dilated pupil** and **conjunctival injection**, which are not described in this patient.
*Retinal detachment*
- Patients with **retinal detachment** usually report a sudden onset of **floaters**, **flashes of light**, and a **"curtain" or "shadow" obscuring part of their vision**.
- **Pain with eye movement** and **dyschromatopsia** are not typical features of retinal detachment.
*Macular degeneration*
- **Macular degeneration** primarily affects central vision, causing **blurred or distorted vision**, particularly reading difficulty, and difficulty recognizing faces.
- It usually presents in **older individuals** and is not characterized by pain with eye movement or sudden, recurrent episodes of vision loss with dyschromatopsia.
*Retinitis pigmentosa*
- **Retinitis pigmentosa** is a group of inherited eye diseases that cause progressive vision loss, beginning with **night blindness** and then gradual **peripheral vision loss** (tunnel vision).
- The patient's acute monocular vision loss with pain and dyschromatopsia is not typical of the slow, progressive nature of retinitis pigmentosa.
Geriatric screening protocols US Medical PG Question 10: A 28-year-old asymptomatic pregnant woman at 12 weeks gestation presents for prenatal care. She has no personal or family history of diabetes. Her BMI is 32 kg/m². She had a random glucose of 118 mg/dL at her first visit. She asks about gestational diabetes screening. Considering her risk factors and current pregnancy, what is the most appropriate screening approach?
- A. Perform 3-hour oral glucose tolerance test at 16 weeks
- B. Diagnose gestational diabetes based on random glucose and begin treatment
- C. Perform 1-hour glucose challenge test now
- D. Perform fasting glucose and hemoglobin A1c now to assess for preexisting diabetes (Correct Answer)
- E. Defer screening until 24-28 weeks gestation per routine protocol
Geriatric screening protocols Explanation: ***Perform fasting glucose and hemoglobin A1c now to assess for preexisting diabetes***
- A **BMI ≥ 30 kg/m²** is a major risk factor necessitating early screening at the first prenatal visit to identify **pre-existing (overture) diabetes**.
- Identifying hyperglycemia early in pregnancy allows for immediate management to reduce the risk of **congenital anomalies** associated with pre-gestational diabetes.
*Perform 1-hour glucose challenge test now*
- While the **1-hour GCT** is a valid tool for early screening, standard biomarkers like **fasting plasma glucose** or **HbA1c** are also appropriate for detecting overt diabetes at the initial visit.
- The goal in the first trimester for high-risk patients is often to rule out **Type 2 Diabetes mellitus** that existed prior to pregnancy.
*Defer screening until 24-28 weeks gestation per routine protocol*
- Routine screening at **24-28 weeks** is reserved for women without significant risk factors; this patient's **obesity** mandates earlier evaluation.
- Delayed screening in obese patients may miss a window for intensive **glycemic control** during critical fetal organogenesis.
*Diagnose gestational diabetes based on random glucose and begin treatment*
- A **random glucose of 118 mg/dL** is within the normal range and is not diagnostic of either GDM (which requires >200 mg/dL with symptoms) or overt diabetes.
- Diagnosis requires structured testing such as an **HbA1c ≥ 6.5%**, fasting glucose ≥ 126 mg/dL, or a formal **oral glucose tolerance test (OGTT)**.
*Perform 3-hour oral glucose tolerance test at 16 weeks*
- The **3-hour OGTT** is typically the second step of a two-step screening process and is not indicated as an initial screening tool at 16 weeks.
- High-risk patients should be screened as soon as possible, often at the **first prenatal visit** (12 weeks in this case), rather than waiting until the second trimester.
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