USMLE Step 2 Quiz: Geriatric Syndromes And Functional Assessment
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Geriatric Syndromes And Functional AssessmentQuestion 1 of 4

A physician is assessing an 82-year-old patient for frailty. As part of the physical performance evaluation, the physician measures the patient's usual walking speed over a 4-meter course. The patient's gait speed is calculated to be 0.6 m/s.

What is the primary clinical significance of this measurement?

It is diagnostic of peripheral neuropathy
It is a strong predictor of future adverse health outcomes
It is mainly used to determine the need for a walking aid
It is a direct measure of cardiopulmonary fitness
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USMLE Step 2 Quiz

USMLE Step 2 Quiz: Geriatric Syndromes And Functional Assessment

Practice Geriatric Syndromes And Functional Assessment in USMLE Step 2 with focused quiz questions that help you check what you know, review explanations, and build confidence with test-style prompts.

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Question 1

A physician is assessing an 82-year-old patient for frailty. As part of the physical performance evaluation, the physician measures the patient's usual walking speed over a 4-meter course. The patient's gait speed is calculated to be 0.6 m/s.

What is the primary clinical significance of this measurement?

  1. It is diagnostic of peripheral neuropathy
  2. It is a strong predictor of future adverse health outcomes (correct answer)
  3. It is mainly used to determine the need for a walking aid
  4. It is a direct measure of cardiopulmonary fitness
Explanation: Gait speed is often considered the 'sixth vital sign' in geriatrics. A slow gait speed (typically defined as <0.8 m/s) is a core component of the frailty syndrome and is a powerful, independent predictor of a wide range of adverse outcomes, including future falls, disability, hospitalization, and mortality. While it may be influenced by neuropathy or cardiac fitness, its main clinical utility is as an integrative measure of overall health and a robust prognostic marker.

Question 2

A 77-year-old man reports several episodes of lightheadedness and one fall that occurred immediately after standing up from a seated position. His medical history includes hypertension and type 2 diabetes. His medications are lisinopril and metformin. His blood pressure is 148/88 mm Hg while supine. After he stands for 3 minutes, his blood pressure is 122/80 mm Hg and he reports feeling lightheaded. His heart rate increases from 72/min to 88/min.

What is the most likely cause of his symptoms and fall?

  1. Benign paroxysmal positional vertigo (BPPV)
  2. Orthostatic hypotension (correct answer)
  3. Vasovagal syncope
  4. Cardiac arrhythmia
Explanation: This patient meets the diagnostic criteria for orthostatic hypotension, which is a drop in systolic blood pressure of ≥20 mm Hg or diastolic blood pressure of ≥10 mm Hg within 3 minutes of standing. His systolic blood pressure dropped by 26 mm Hg upon standing, which reproduced his symptoms of lightheadedness. This is a common cause of falls in older adults, often exacerbated by antihypertensive medications like lisinopril. BPPV is triggered by changes in head position, not postural changes from sitting to standing. Vasovagal syncope typically has a prodrome of nausea and diaphoresis. An arrhythmia is less likely to be consistently triggered only by standing.

Question 3

An 89-year-old woman with severe Alzheimer dementia is ready for discharge from the hospital following treatment for pneumonia. A functional assessment by physical and occupational therapy finds that she is dependent for all Activities of Daily Living (ADLs), including feeding, bathing, dressing, and toileting. She is non-ambulatory and requires a mechanical lift for transfers.

What is the most appropriate discharge disposition for this patient?

  1. Home with home health aide services for 4 hours per day
  2. An assisted living facility
  3. A skilled nursing facility (correct answer)
  4. Home with her elderly husband and a weekly visiting nurse
Explanation: A patient who is dependent for all basic ADLs and requires a mechanical lift for transfers needs 24-hour care and supervision, including skilled nursing services. This level of care cannot be safely provided at home with intermittent help or in an assisted living facility, which is designed for individuals who need assistance primarily with IADLs and some ADLs but not total care. A skilled nursing facility (nursing home) provides the necessary round-the-clock nursing care and support for a patient with this degree of functional dependency.

Question 4

A 78-year-old man undergoes coronary artery bypass grafting. On postoperative day 3, he becomes disoriented to time and place, is agitated, and has a fluctuating level of consciousness. His temperature is 37.1°C (98.8°F), blood pressure is 110/70 mm Hg, heart rate is 115/min, and oxygen saturation is 94% on room air. He has not had a bowel movement in 3 days. Laboratory studies show a BUN of 45 mg/dL and creatinine of 1.8 mg/dL (baseline 1.1 mg/dL). He is receiving morphine for pain control.

Which of the following is the most likely contributing factor to this patient's current condition?

  1. Postoperative pain
  2. Acute kidney injury with uremia (correct answer)
  3. Surgical site infection
  4. Myocardial infarction
Explanation: This patient is experiencing postoperative delirium, which is multifactorial. The acute kidney injury evidenced by elevated BUN and creatinine from baseline represents uremia, a significant metabolic cause of delirium. While morphine, constipation, and the surgical stress all contribute, the acute kidney injury with uremia is the most significant metabolic derangement present. The other options are less supported by the clinical findings.