Paper III — Geriatrics (Geriatric Medicine)

What is Comprehensive Geriatric Assessment?

Tools of functional assessment / functional assessment in the elderly.

Describe the pathogenesis, diagnosis, prevention and management of frailty; and its pathophysiology, evaluation and management.

Fried’s criteria.

Clinical frailty scales.

Sarcopenia in the elderly — etiology, pathogenesis and evaluation.

Write a brief note on deconditioning and its prevention.

Immobility.

Elaborate on the 5 Ms of Geriatrics.

Theories of ageing.

Discuss the approach to recurrent falls in the elderly, with emphasis on prevention and management.

A 60-year-old known diabetic and hypertensive with coronary artery disease and depression, on oral antidiabetics, diuretics, antihypertensives and antidepressants, presents with recurrent falls over the past week. How will you evaluate and manage the patient?

What are the intrinsic risk factors for falls?

Falls prevention strategy in the elderly.

Post-falls syndrome.

Long lie.

Gait and balance assessment.

What are the phases in human walking? Describe in detail with appropriate diagrams.

How will you approach a patient with dizziness?

How would you diagnose and manage a case suspected to have Benign Paroxysmal Positional Vertigo?

Vestibular rehabilitation.

Syncope.

Hypersensitive carotid sinus syndrome.

Discuss dementia in the elderly and its management.

Compare and contrast the clinical features and the areas of the brain involved in the four common dementias.

The neurodegenerative disorders associated with Tau, Progranulin or TDP-43 pathology — pathology, clinical presentation, course, prognosis and treatment modalities.

Write a note on Lewy body dementia; and counsel a daughter whose father has been newly diagnosed — etiology, clinical features, treatment, progression, her own risk and whether it can be prevented.

What is Pick’s disease? What is its pathology and treatment?

What are the reversible / treatable dementias? How would you investigate and manage them, and what investigations rule them out?

Mild cognitive impairment — diagnostic criteria, progression and treatment modalities.

Cognitive assessment tools / tests of cognition and rating scales.

Behavioural symptoms of dementia.

Discuss the aetiology, pathogenesis, differential diagnosis and management of acute confusional state in the elderly.

A 75-year-old diabetic and hypertensive smoker developed cough and fever for three days and became incoherent, abusive and drowsy on the third day with stable vitals. What are your differentials and the trigger factors? How would you evaluate and manage him on the ward?

Assessment of delirium.

Strategies for prevention of delirium in elderly inpatients.

Normal pressure hydrocephalus.

What are the pathology, pathogenesis and treatment of Parkinson’s disease — with emphasis on choice of drug, side effects, newer treatment modalities and the treatment of non-motor symptoms?

Parkinsonism.

Drug treatment for Parkinson’s disease.

Levodopa.

Motor fluctuations in Parkinson’s disease.

Non-motor symptoms of Parkinson’s disease.

Etiopathogenesis, clinical presentation and management of the Parkinson-plus syndromes in older adults.

Progressive supranuclear palsy — clinical features, management and prognosis.

Benign essential tremor — clinical presentation, differential diagnosis and treatment.

Discuss coma in the elderly.

Lacunar infarcts.

Management of extracranial carotid artery stenosis; and the pros and cons of carotid angioplasty versus carotid endarterectomy in a patient with 80% stenosis of the artery supplying the infarcted territory.

How would you assess swallow at the bedside in a patient with a recent stroke?

Brief note on subdural haematoma.

Definition, pathophysiology, clinical features, investigations and treatment of epilepsy in the elderly.

Motor neuron disease — presentation, evaluation and treatment modalities.

Subacute combined degeneration of the cord — presentation and treatment.

Neuritic pain.

Inflammatory myopathies.

Discuss the management of hypertension in the elderly.

Isolated systolic hypertension and its management.

Postural hypotension — evaluation and management.

What is the etiology, clinical features, diagnostic evaluation and management of a patient with congestive cardiac failure? What categories of drugs would you use, with their indications and side effect profile? What is your approach to refractory heart failure?

Congestive heart failure — diagnostic evaluation.

Refractory cardiac failure.

Diastolic dysfunction.

Cardiomyopathies — pathophysiology, etiology, clinical features, diagnosis and treatment; including dilated cardiomyopathy.

Infective endocarditis.

Atrial fibrillation and its management.

Cardiac pacemaker.

Write a note on sick sinus syndrome.

Explain, with an appropriate diagram, the rise and fall of cardiac enzymes following an acute coronary syndrome.

Calcium channel antagonists.

Use of statins in the elderly.

Causes, treatment and prevention of deep vein thrombosis.

The causes, diagnosis and management of pulmonary embolism.

Venous thromboembolism and post-operative management of anticoagulation.

Anticoagulants in geriatric practice — indications and agents.

Describe the risk factors, pathology and clinical features of Chronic Obstructive Pulmonary Disease. How will you differentiate it from bronchial asthma? Discuss the management and complications of COPD.

GOLD criteria for assessment of COPD and treatment options based on this assessment; the new GOLD criteria and the changes from the previous criteria, with a note on the ABCD criteria.

Metered dose inhalers.

Long term oxygen therapy.

Discuss the etiology, clinical features and management of community-acquired pneumonia in the elderly.

Interstitial lung disease.

Respiratory failure — types, causes and management.

Discuss the types, clinical features and management of bronchogenic carcinoma.

Sleep apnoea.

Polysomnography.

Extrapulmonary tuberculosis.

Classify urinary incontinence and discuss its evaluation and treatment; and discuss the types, diagnosis, management and reversible causes of incontinence in the elderly.

Urinary incontinence in males — types, epidemiology, pathogenesis, risk factors, screening, diagnostic evaluation and management.

A 65-year-old normotensive, non-diabetic lady presents with frequent urination, nocturia and intermittent involuntary leakage of urine for six months. What are the causes, and how will you evaluate and manage her?

Bladder retraining protocol.

Overactive bladder.

Chronic indwelling catheter usage in the elderly.

Catheter-associated urinary tract infections — prevention and management.

Recommendations regarding treatment of complicated urinary tract infection in males.

Algorithm to investigate and treat an elderly male with lower urinary tract symptoms; and the next steps in the investigative and management pathway for a man with LUTS whose PSA is 10 ng/ml.

Prostate specific antigen.

Uroflowmetry.

Medical management of benign prostatic hypertrophy.

Write a short note on the clinical features, investigation and treatment of obstructive uropathy.

What are the causes of erectile dysfunction and what treatment options are currently available?

Andropause.

Discuss fluid and electrolyte disturbances in the elderly and their management.

Approach to the evaluation and treatment of hyponatremia.

Hypocalcemia.

Metabolic acidosis.

Enumerate the causes and outline the treatment of acute kidney injury in an elderly male; and the differentials and investigations in a 65-year-old male with acute kidney injury.

Drug-induced renal impairment in the elderly.

Renal osteodystrophy — laboratory and radiological abnormalities, and treatment.

Anaemia of chronic kidney disease — type, investigation and treatment modalities.

What is osteoporosis? Describe in detail its risk factors, pathology, clinical features, investigations, management and complications.

Dual energy X-ray absorptiometry — DEXA scan and its clinical uses; and how the bone mineral density test is interpreted, with a note on the FRAX tool.

FRAX score.

A 68-year-old woman had surgery for fracture of the left neck of femur two months ago and asks whether treatment for osteoporosis will benefit her. What is her risk of another fragility fracture? What further tests would you do and what are her treatment options?

Atypical femur fractures due to drugs.

Selective estrogen receptor modulators.

Osteoarthritis management.

Late-onset rheumatoid arthritis.

Psoriatic arthropathy.

Polymyalgia rheumatica.

Discuss temporal arteritis.

Sjögren’s syndrome — definition, epidemiology, pathophysiology, presentation and management.

Paget’s disease.

Treatment of hypothyroidism.

Subclinical hypothyroidism.

Solitary thyroid nodule.

Evaluation and management of hypoglycaemia.

SGLT2 inhibitors in type 2 diabetes mellitus.

Discuss hormone replacement therapy / hormone replacement in geriatric patients.

Gynaecomastia.

Hirsutism and baldness in elderly women.

Approach to upper gastrointestinal bleed / haematemesis.

Gastro-oesophageal reflux disease.

Gastrointestinal motility disorders in the elderly.

Malabsorption / malabsorption syndrome in the elderly.

Management of chronic constipation, its pharmacological management, and the management of constipation in the elderly.

How would you assess a patient’s nutrition? Write a note on the various methods used and their advantages and disadvantages.

What is the Mini Nutritional Assessment score? What are its components, how will you score and interpret it, and what interventions can you suggest?

What are the tools used in screening for malnutrition? Enumerate at least three of them, and add a table on Body Mass Index and their cut-offs in Asians.

Total parenteral nutrition.

Vitamin deficiencies.

Anaemia of chronic disease.

Blood transfusion.

What are the mechanisms of drug-induced thrombocytopenia?

Myelodysplastic syndrome — classification, etiology, clinical features, differential diagnosis, investigations and treatment in the elderly.

What are the types of Non-Hodgkin’s lymphoma? What are their clinical presentations and prognosis, and what are the principles of therapy?

Tumour lysis syndrome — presentation, investigation and treatment.

Paraneoplastic syndrome.

Hormone therapy in malignancy.

Mammography.

A 62-year-old woman has a suspicious breast lump on her recent mammogram. What is the ideal approach to a suspicious breast lesion in an older woman?

Discuss currently accepted strategies for cancer screening in the elderly.

Atypical presentations of infections in the elderly.

A 65-year-old male, a known diabetic with chronic kidney disease, is admitted to the emergency ward with altered sensorium, fever, elevated total leucocyte count and hypotension. How will you evaluate and manage this patient?

Approach to pyrexia of unknown origin in older adults.

Herpes zoster infection in the elderly — etiology, clinical features and management.

Influenza vaccination.

Vaccines for the elderly.

Immunology and ageing — elaborate on the innate and adaptive immune systems and the impact of ageing, with a note on immunosenescence and cancer.

Clostridium difficile colitis.

What are the common sleep disorders in the elderly and what is their line of management?

Describe the pathophysiology of insomnia and its management.

Sleep hygiene.

Discuss the assessment and management of chronic pressure ulcers in the elderly, and the prevention of pressure sores.

How would you deal with constant itching in an elderly patient?

Visual impairment — enumerate the age-related causes and how you would approach them.

Macular degeneration — clinical presentation, etiology, diagnosis, treatment and prevention.

Heat stroke.

Heat exhaustion.

Describe the principles of drug therapy in the elderly.

Rational drug prescribing in older adults.

What do you mean by polypharmacy? How would you prevent it?

Drug holiday.

Perioperative assessment and management in older people; and a patient admitted with fracture neck of femur after a fall at home, who is diabetic, hypertensive and has COPD and is posted for surgery — what assessments should be done before surgery, and how should he be managed post-operatively and at follow-up?

Rehabilitation team.

Role of physiotherapy in the elderly.

What is the role of an occupational therapist in the life of an elderly person with mobility issues living with an ageing spouse?

You are the doctor in charge of a transitional care home accommodating 30 people. What would be your prerequisites for admitting and discharging a patient? Whom would you appoint to manage your patients and what would be their role?

Elder mistreatment / elder abuse.

Advanced care planning.

End of life care issues.

Enumerate and expand the principles of palliative care that one should use to treat a patient with end-stage cardiac failure. What are the social issues one should address in this condition?