Paper IV — Social and Preventive Geriatrics including Rehabilitation and Advances

Enumerate and explain in detail the theories of ageing.

Biomarkers of ageing.

Anti-ageing interventions.

Calorie restriction — role of caloric restriction in ageing.

Telomere.

Sirtuins in ageing and disease.

Interleukin-6.

Immunosenescence / immune senescence and its relevance to vaccination in the elderly.

Interventions for healthy ageing.

Describe active ageing and how will you achieve it?

Geriatric demography and its implications.

Geriatric syndromes.

Write in detail on Comprehensive Geriatric Assessment and its usefulness in geriatric practice.

Discuss the functional assessment in an 85-year-old lady.

Barthel's Index of Activities of Daily Living.

Physical Self-Maintenance Scale.

Integrated care of older people (ICOPE).

Discuss the causes of chronic disability in the elderly. Describe the methods of its prevention and management.

What is decisional capacity? What are the factors affecting it and how would one assess decisional capacity in an older person?

National Programme for Health Care of the Elderly (NPHCE) — background on which the programme was based, vision, objectives and expected outcomes; packages of services at different levels of care and the activities that centres must perform. As doctor in charge of a District Hospital, which components would you implement and how would you put theory into practice?

National Policy on Older Persons (NPOP) and the various existing beneficiary schemes for the elderly.

Role of Government in providing health care and economic security for older people.

Describe the social security system for older people in India.

Long term care.

Community based long term care services.

Home based care.

House call programme.

Need for day hospitals in geriatric practice.

The director of your hospital is keen on starting a day care centre for older adults and seeks your opinion. Discuss the role, benefits and logistics of running a day care centre facility for older adults.

Hospice and respite care.

Ethno-geriatrics.

Role of geriatric social workers.

Geriatric Nurse Practitioner — discuss their role in the health care team.

Enumerate and briefly explain the components of the Hospital Elder Life Program (HELP).

Write a short note on the history of the “Stroke Clinics”. Why were they set up and what issues do they address?

Elder abuse / mistreatment of the elderly — epidemiology, types and different forms, risk factors, identification, diagnosis and management. Discuss the role of the social worker in identifying elder mistreatment.

Advance directives — current status in India.

What is a living will? What is the procedure to write a living will in India and how is it executed?

Euthanasia and physician-assisted suicide.

Informed consent.

How will you communicate bad news? / Breaking bad news.

Recognition and management of the terminally ill patient — e.g. a patient diagnosed with end-stage lung cancer with brain and liver metastases. What are all the issues that need to be addressed in the care of the terminally ill?

What is palliative care? What are its principles? Name interventions in palliative care which would decrease the suffering of a person with painful bone metastasis, nausea, vomiting, constipation and breathlessness. How has this aspect of medical science evolved in India?

Classify the types of pain. Discuss the pathophysiology, clinical evaluation and management of chronic or persistent pain in the elderly, and the role of palliative care in geriatric practice.

End of life care issues.

Bereavement.

Caregiver burden / caregiver stress / apathy — what is it and how will you manage it?

Definition, evaluation and components of rehabilitation in the elderly.

Assessment of disability in older people and rehabilitation.

Community based rehabilitation.

You are chosen to head the interdisciplinary team on a rehabilitation ward with neurology rehabilitation patients, post-orthopaedic procedure patients and patients deconditioned by comorbidities. Whom would you choose to be part of your team? Enumerate their job responsibilities. How would you address conflict management and care planning?

Inputs from the occupational therapist on the team caring for the older person are not clearly understood. Highlight the role of the occupational therapist and how his or her presence can affect the care of the patient on the ward and at discharge.

Stroke rehabilitation.

Prior to initiating long term rehabilitation in a patient with stroke, what are the factors you would take into consideration before admitting such a patient into this facility?

Rehabilitation of a patient with osteoarthritis of the knee joints.

How will you rehabilitate an older adult with low vision?

Mobility aids / assistive devices for the elderly.

Artificial limb.

Gadgets which will improve the quality of life in the older person.

Exercise in the elderly — exercises in older adults: beneficial or harmful?

Assessment of swallow — when, how, by whom and with what.

Discuss the etiopathogenesis, risk factors, assessment, adverse consequences, prevention and management of falls in older adults.

Assessment of fall risk and prevention of falls in the elderly.

Fall risk assessment — tools for falls risk assessment.

How will you prevent falls in the elderly?

Role of sensor devices in the prevention of falls.

What are the causes of immobility in an elderly person? Write about the management and complications.

Pressure sores — enumerate the prevention of pressure sores in an elderly bedbound patient. What are the stages of a pressure sore and the common sites involved? How is it preventable and what is the appropriate treatment for each stage?

Osteoporosis — definition, predisposing and risk factors, pathogenesis, diagnosis, prevention and management including newer interventions. Also elaborate on male osteoporosis and premenopausal osteoporosis.

Antisclerostin antibodies in the treatment of osteoporosis.

Prevention of fractures.

DEXA scan.

Paget's disease.

Osteoarthritis — pathogenesis, diagnosis and treatment.

Temporal arteritis — diagnosis, clinical features, treatment and prognosis.

Diffuse idiopathic skeletal hyperostosis (DISH) — presentation, investigations and treatment options.

Dermatomyositis in the elderly — presentation, associated comorbidities, laboratory investigations, treatment options and prognosis.

Role of bisphosphonates in osseous metastases.

Discuss the various nutritional disorders / malnutrition in older adults — causes, approach to diagnosis, assessment and management.

Nutritional assessment in older persons.

Anorexia of ageing.

Discuss obesity in the elderly and its management.

Discuss sarcopenia in ageing. Briefly write about the diagnostic criteria, investigations and management.

Frailty is a common syndrome in older adults — discuss the etiopathogenesis, assessment, management and prevention of frailty.

Compare and contrast the tests used to identify / screen for frailty.

Alzheimer's dementia — pathogenesis, latest advances in pathogenesis at the molecular level, drugs used in dementia (mechanism of action, efficacy, indications for use and side effects) and newer treatment modalities being tried.

Advances in the diagnosis of early stages of Alzheimer's dementia and mild cognitive impairment.

Biomarkers for Alzheimer's dementia / emerging biomarkers in cognition.

Current drug therapy, newer therapy and newer drugs for Alzheimer's disease.

Discuss confusional states in the elderly. How will you do the investigations and plan the management?

Interventions to prevent delirium in post-operative older patients.

Discuss any three cognitive screening tests useful in the outpatient department.

Geriatric depression scales.

What are the newer antidepressants? What is the safety profile of these drugs in the older person?

Sleep protocol.

What are the causes, risk factors, clinical features, complications and treatment of REM (rapid eye movement) sleep behaviour disorder?

Impulse control disorders.

Nicotine dependence.

What are the effects and ill effects of alcohol in the geriatric population? How would you address the issue of alcoholism in an elderly patient? Write a note on alcohol de-addiction.

What is motor neuron disease? Discuss the etiopathogenesis, clinical presentation, symptoms, course, prognosis and the treatment modalities available.

Discuss the causes of coma in elderly people. (Asked together with: how will you investigate and manage diabetic ketoacidosis?)

Dizziness in the elderly.

Thrombolysis in stroke.

Discuss the recent advances in the management of parkinsonism.

Surgical management of parkinsonism.

Management of motor fluctuations in Parkinson's disease.

Parkinsonism-plus syndrome.

Pathognomonic MRI findings in progressive supranuclear palsy and multiple system atrophy.

Differential diagnosis of tremor in the older person. Discuss the treatment modalities for each of these conditions.

What are the risk factors and criteria to diagnose Restless Leg Syndrome? How will you manage a case of restless leg syndrome?

Causes, evaluation and management of a person presenting with features of peripheral neuropathy.

Myasthenia gravis — presentations, laboratory evaluation and treatment.

Ring-enhancing shadow on CT brain.

What are the types of acute coronary syndromes? How are they diagnosed, investigated and treated based on the latest recommendations published in literature — both acutely and on outpatient follow-up?

Discuss the management of ST elevation myocardial infarction. What are the recent advances in the approach to this entity?

Newer cardiac biomarkers in myocardial injury and their interpretation.

Drug eluting stents — pros and cons; advantages and disadvantages over bare metal stents.

Etiopathogenesis and management of in-stent stenosis.

Heart failure is commonly encountered on the geriatric wards. Describe the etiopathology, clinical presentation, stages and management of heart failure.

Management of systolic heart failure in an elderly patient with chronic kidney disease with a GFR of 40 ml/min.

Complete heart block.

AHA guidelines for stroke prevention in atrial fibrillation.

CHADS2-VASc score — what is it used in and what is its clinical significance?

Role of newer anticoagulants.

Low molecular weight heparins — types, indications for use, benefits and side effect profile.

The orthopaedic team wants you to draw up an evidence based protocol on venous thromboembolic prophylaxis following elective total hip and knee replacements. Draw up this protocol based on evidence in literature.

Enumerate the causes for secondary hypertension — how would you evaluate and treat this entity?

Lifestyle modification to reduce cardiovascular risk.

Primary prevention of cardiovascular disease.

Statins in the elderly.

Ezetimibe — indications, mode of action, metabolism, excretion, side effects and dosage.

Chronic obstructive pulmonary disease — management based on recent recommendations.

A known COPD patient on inhalers presents to the Emergency Department with severe breathlessness and an oxygen saturation of 60% after three days of cough with purulent sputum. How would you tailor oxygen requirements and oxygen delivery systems throughout his hospital stay and at discharge?

Role of CPAP in diseases of the elderly.

Describe the changes seen in the airways in emphysema and asthma.

Role of renal replacement therapy in the elderly.

Peritoneal dialysis.

Hyponatremia.

Hyperkalemia — how should you investigate hyperkalemia (including in a diabetic) and what is the line of management?

Urinary tract infection in the elderly.

Management of recurrent urinary tract infection in the elderly. A 65-year-old man has had three confirmed urinary tract infections, all needing hospitalisation and intravenous therapy in the last six months, and solicits your advice for this recurrent problem. What advice and therapies will you give him?

Asymptomatic bacteriuria — definition, treatment and prognosis.

Behavioural intervention in urinary incontinence.

Stress urinary incontinence in women. Add a note on Kegel's exercises.

Long term catheterization / continuous bladder drainage.

What is the preliminary assessment done in an older male with lower urinary tract symptoms? When would you refer to a urologist?

Testosterone replacement therapy in the elderly male / testosterone therapy in older men.

Prostate specific antigen — to screen or not to screen: what does the recent evidence show and why?

Alpha receptor antagonists.

How will you investigate and manage diabetic ketoacidosis? (Asked paired with: causes of coma in elderly people.)

Newer oral antidiabetic agents.

Newer insulin analogues — onset and duration of action, and their advantage over the older insulins.

Diabetic foot syndrome.

What are the clinical features of hyperthyroidism in the older person? What are the investigations to be sent and what should be the line of management?

Draw up an immunisation schedule for a fit elderly patient and give reasons for your choice of immunisation protocol based on evidence found in literature. Discuss the current guidelines for vaccination of older persons and the status of vaccination in the elderly with recent evidence.

Pneumococcal vaccination.

Travel recommendations for vaccinations in the elderly — CDC guidelines.

Define sepsis, septic shock, systemic inflammatory response syndrome and multiorgan dysfunction syndrome. Describe the epidemiology, etiopathogenesis, clinical presentation, diagnosis, investigations, management and prognosis of an older person with sepsis, and the recent advances in the management of sepsis.

How would you diagnose and manage multidrug-resistant tuberculosis based on the DOTS-Plus regime?

Malaria — treatment drugs: classes, uses, contraindications, side effect profile and efficacy. Also mention the drugs used in prophylaxis for malaria.

Recent trends in the treatment of Hepatitis C infection.

Treatment — older and newer modalities — of chronic Hepatitis B infection.

Cancer screening in the elderly.

Screening for colon cancer.

Tumour markers — role in detection and management of cancer.

Myelodysplastic syndrome — WHO classification and distinguishing features of each class; diagnostic criteria and the differentials one has to consider.

POEMS syndrome — clinical features, laboratory investigations and treatment.

Bone marrow transplant.

A 68-year-old man presents to the outpatient department with shortness of breath. On examination he was found to be pale and in failure. Elaborate on how one should investigate and manage him.

How do you prevent and manage chronic constipation in the elderly? Discuss the complications and management of constipation.

Liver transplantation.

Peri-operative care of the elderly / pre-operative assessment.

You are tasked with preparing a checklist for older adults undergoing diagnostic and therapeutic procedures in the ward. Discuss the common medical issues that need planning prior to these procedures and how they need to be addressed in the periprocedural period to avoid adverse patient outcomes — e.g. management of antiplatelet agents in the periprocedural period.

Eye donation.