GeriQBank · Paper II · Q29
Beers criteria, STOPP/START and anticholinergic burden
- Chapter
- Part VIII — Pressure Injury and Prescribing Safety
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Detailed answer
Pro · free in betaAttempt it firstOutline your answer as a 15-mark answer before revealing it — definition, causes, evaluation, management and the geriatric angle.Reveal answer
RECURRING
ANSWER
Textbook Core — 10 Points
The three forms of suboptimal prescribing. Overuse (drugs without a valid indication), misuse (potentially inappropriate medications, wrong dose or inadequate monitoring) and underuse (omission of indicated, beneficial drugs). Polypharmacy — conventionally five or more drugs — is the principal modifiable driver of adverse drug reactions, together with the number of comorbid conditions and the number of prescribers.
Scale of the problem. In the Three-City (3C) study, representative of community-dwelling French adults aged 65 and over, 21.7% were receiving an inappropriate medication — 6.4% an anticholinergic and 9.2% a long half-life benzodiazepine. European studies using Beers or McLeod lists report rates of 10–20%; a French geriatric short-stay unit found 66% had at least one inappropriate medication on admission. Rates in nursing homes are much higher and are linked to hospitalisation and death. Commonly implicated: cerebral vasodilators, long half-life benzodiazepines, anticholinergic antidepressants, and two or more psychotropics of the same class; also PPIs continued without indication and antipsychotics over-prescribed in nursing homes.
Beers criteria — what they are. An explicit list, first developed by Mark Beers in 1991 for institutionalised older people using a literature review and Delphi method, since adapted for ambulatory patients and updated regularly by the American Geriatrics Society. It applies to adults ≥65 years in ambulatory, acute and institutional settings — but not in hospice or end-of-life care.
Structure of the Beers criteria. Five core tables plus supporting tables: (i) potentially inappropriate medications to avoid in most older adults; (ii) PIMs to avoid because of drug–disease or drug–syndrome interactions; (iii) drugs to use with caution; (iv) clinically important drug–drug interactions to avoid; (v) drugs to avoid or dose-adjust for reduced kidney function; plus a table of drugs with strong anticholinergic properties. Classic examples: benzodiazepines and Z-drugs (falls, fractures, delirium), first-generation antihistamines, tricyclic antidepressants, antipsychotics for behavioural symptoms of dementia (increased stroke and mortality), NSAIDs, skeletal muscle relaxants, sliding-scale insulin, and PPIs beyond 8 weeks without indication.
Limitations of the Beers criteria. It was designed for collective (population and quality-indicator) evaluation, not for individual patients — a criticism Beers himself accepted. It does not cover underuse; it is US-specific, and in one European study about half the listed medications were unavailable in most European countries; and few studies have demonstrated a clinical benefit from applying the criteria. Some analyses found Beers-listed drugs account for only a small proportion of actual ADRs.
The drugs that actually cause harm. In Budnitz et al., only 3.6% of emergency admissions for adverse drug events involved drugs "always inappropriate" by Beers and 5.2% those inappropriate in certain conditions, whereas 33.3% followed just three drugs — warfarin (17.3%), insulin (13%) and digoxin (3.2%). Pirmohamed et al. similarly implicated low-dose aspirin, diuretics, warfarin and NSAIDs. The lesson: encourage good prescribing and monitoring rather than merely stigmatising "inappropriate" drugs — most avoidable errors occur at the monitoring stage (60–80%).
STOPP and START. Developed by Irish geriatricians using a Delphi method and organised by physiological system, which makes them more usable at the bedside. STOPP = Screening Tool of Older Persons' Prescriptions — detects potentially inappropriate prescriptions. START = Screening Tool to Alert to Right Treatment — detects prescribing omissions. In 715 older patients admitted acutely, an ADR was identified in 90 (12.5%), of which STOPP identified 91% versus 48% for Beers; STOPP-detectable prescriptions contributed to 11.5% of admissions versus 6% for Beers. STOPP is therefore especially useful when the presentation is non-specific, such as falls or delirium.
START and the problem of underuse. Applied to 600 acutely admitted patients over 65, at least one potentially useful medication had been omitted in 57.9%, rising to 72.2% in those over 85, with women at twice the risk of men. The omissions were mainly cardiovascular: statins in atherosclerotic disease (26%), anticoagulants in atrial fibrillation (9.5%), antiplatelets in arterial disease (7.3%), and calcium and vitamin D in osteoporosis with fracture (6%). START takes under 3 minutes to apply once the list of conditions and treatments is available.
Anticholinergic burden. The cumulative anticholinergic effect of multiple drugs, each individually regarded as only mildly anticholinergic. Peripheral effects: dry mouth, blurred vision, constipation, urinary retention, tachycardia, reduced sweating and heat intolerance. Central effects: sedation, confusion, delirium, falls and accelerated cognitive decline. Older adults are more susceptible because of reduced central cholinergic reserve, increased blood–brain barrier permeability, and reduced hepatic and renal clearance. Common culprits: amitriptyline, oxybutynin and tolterodine, chlorpheniramine, hydroxyzine, promethazine, olanzapine and clozapine, hyoscine, dicyclomine, trihexyphenidyl, prochlorperazine. Quantify with the Anticholinergic Cognitive Burden (ACB) scale, Anticholinergic Risk Scale or Anticholinergic Drug Scale — an ACB score ≥3 is associated with cognitive decline, falls and mortality. Prescribing an antimuscarinic bladder drug alongside a cholinesterase inhibitor is a classic prescribing cascade and a pharmacological contradiction.
Other tools and the practical approach. The Medication Appropriateness Index (MAI) is an implicit tool that evaluates ten criteria for each drug: indication, efficacy, dosage, correct directions, practical directions, drug–drug interactions, drug–disease interactions, duplication, duration and cost. A workable deprescribing sequence: (i) list every drug including OTC and herbal preparations, (ii) confirm a current indication for each, (iii) apply STOPP/START and Beers, (iv) calculate the anticholinergic burden, (v) rank by risk–benefit against the patient's goals and life expectancy, (vi) withdraw one drug at a time, tapering where withdrawal effects are expected, and (vii) monitor for withdrawal syndromes and disease recurrence.
Latest Updates (2023 – present)
2023 AGS Beers Criteria update (J Am Geriatr Soc 2023;71:2052–81) — key changes: avoid initiating aspirin for primary cardiovascular prevention, and consider deprescribing it in existing users; avoid warfarin as initial therapy for VTE or non-valvular atrial fibrillation (DOACs preferred; rivaroxaban avoided); avoid ALL sulfonylureas; use SGLT2 inhibitors with caution (euglycaemic ketoacidosis, urogenital infection); avoid initiating oral or transdermal oestrogen; anticholinergics reorganised into antihistamine, CNS/antiparkinson and gastrointestinal groups with explicit emphasis on cumulative anticholinergic burden; ticagrelor and skeletal muscle relaxants added; ~28–33 rarely used drugs removed; and a caution added against abruptly stopping digoxin in HFrEF. AGS also published an "Alternative Treatments" companion (JAGS 2025) giving safer pharmacological and non-pharmacological substitutes.
STOPP/START version 3 (2023, Age and Ageing) expanded the tool to 133 STOPP and 57 START criteria, with new sections covering antithrombotics, drugs that add to anticholinergic burden, drugs that predictably worsen frailty and falls, and drugs to avoid in limited life expectancy. Meanwhile the OPERAM and related multicentre trials show that structured medication review reduces drug-related hospital admissions only when the recommendations are actually implemented — implementation, not detection, is now the bottleneck.
Current Practice Update
Item Textbook Current recommendation Exam approach Aspirin Widely used; a common cause of 2023 Beers: avoid initiating for Quote it as a named 2023 ADR primary prevention; consider change deprescribing Anticoagulation Warfarin standard; a leading ADR Avoid warfarin as initial therapy; Pair with "warfarin caused cause DOAC preferred, rivaroxaban avoided 17.3% of ADR admissions"
Sulfonylureas Not specifically restricted Avoid all sulfonylureas; SGLT2 High-yield diabetes overlap inhibitors with caution STOPP/START 2008 version, 65 STOPP / 22 START Version 3 (2023): 133 STOPP / 57 Quote both versions and the START numbers Anticholinergics Considered drug by drug Cumulative burden quantified (ACB); Name the scale and the target a score below 3 threshold MNEMONIC ANCHOR "STOPP the wrong · START the missing · SCORE the anticholinergics." And for the deprescribing sequence: "LIST – INDICATION – SCREEN – SCORE – RANK – ONE AT A TIME – MONITOR."
NUMERICAL ANCHORS
Polypharmacy ≥5 drugs · Beers applies from age 65 · Three-City 21.7% inappropriate (6.4% anticholinergic, 9.2% long-acting benzodiazepine) · 66% of geriatric short-stay admissions had ≥1 PIM · STOPP detected 91% vs Beers 48% of ADRs · admissions attributable 11.5% vs 6% · omission in 57.9%, rising to 72.2% over 85 · MAI has 10 criteria · STOPP/START v3 = 133 + 57 · ACB threshold ≥3 · warfarin 17.3%, insulin 13%, digoxin 3.2% of ADR admissions.
NAMED EXAMINER TRAPS
(a) Beers is US-specific and excludes hospice and end-of-life care. (b) Remember that START is about underuse — candidates routinely forget it. (c) "Potentially inappropriate" is not "absolutely contraindicated" — it requires clinical judgement and shared decision-making. (d) Do not abruptly stop digoxin in a current user with HFrEF (2023 Beers caveat). (e) The drugs causing the most ADR admissions — warfarin, insulin, digoxin, antiplatelets — are largely NOT on the Beers list, so the criteria are a supplement to, not a substitute for, good monitoring. (f) Most avoidable errors occur at the monitoring stage, not the prescribing stage.
15-SECOND ANSWER SKELETON
Three types of suboptimal prescribing (overuse, misuse, underuse) → scale of the problem with figures → Beers: origin, Delphi, ≥65, five tables, examples → limitations of Beers → what actually causes ADRs (warfarin, insulin, digoxin) → STOPP/START: system-based, detects underuse, better ADR yield with figures → anticholinergic burden: mechanism, culprits, ACB ≥3, prescribing cascade → MAI and the seven-step deprescribing sequence → 2023 Beers changes and STOPP/START v3.
EXTRA RECALL BOX — INDIAN CONTEXT
Indian-specific prescribing hazards for the older adult: widespread over-the-counter availability of antibiotics, NSAIDs and benzodiazepines despite Schedule H1; heavy use of irrational fixed-dose combinations; concurrent AYUSH and allopathic prescribing with unrecognised interactions (for example ashwagandha with sedatives, or bhasma preparations with heavy-metal content); multiple prescribers with no shared record; and cost-driven non-adherence and self-tapering. Practical answer points: use a single reconciled medication list at every transition of care, engage the family caregiver, prefer once-daily and fixed-dose regimens for adherence in the frail, and note that no Indian consensus PIM list has been formally adopted nationally — Beers and STOPP/START are used with local adaptation, since many listed drugs differ in availability.
Exam One-Liners
Polypharmacy — ≥5 medications.
Beers — explicit list, AGS, age ≥65, not for hospice.
STOPP — inappropriate prescriptions; START — prescribing omissions.
STOPP versus Beers for detecting ADRs — 91% versus 48%.
MAI — implicit tool, 10 criteria per drug.
Anticholinergic scale and threshold — ACB ≥3.
2023 Beers headline change — avoid aspirin for primary prevention.
Latest tool version — STOPP/START v3 (133 + 57).
APPENDIX
Consolidated Night-Before Master Sheets
The three original rapid-recall grids, retained in full. Question numbers in these sheets refer to the original question sets; use the Table of Contents to map them to the numbering used in this volume.
Night-Before Master Sheet — Questions 63 to 75
A. The single highest-yield line for each topic
Q Topic The one sentence that earns the mark
63 Herpes zoster / PHN Antiviral within 72 hours for 7 days; PHN = pain beyond 3 months; prevention is the recombinant zoster vaccine from age 50.
64 CAUTI All chronic catheters are bacteriuric — treat the patient, not the culture; the best prevention is early removal.
65 Asymptomatic bacteriuria Do not screen and do not treat, except before urological procedures with mucosal bleeding.
66 IPC and AMS Hand hygiene is the most effective IPC measure; NAP-AMR 2.0 (2025–29) makes IPC mandatory in every Indian facility.
67 Leptospirosis and dengue In dengue the elderly die of fluid overload as often as of shock; in leptospirosis, doxycycline early, dialysis early.
68 COVID-19 Delirium and silent hypoxia are the presentations to know; antiviral within 5 days, steroids only if hypoxic.
69 PMR Girdle pain with a normal CK and a dramatic response to 12.5–25 mg prednisolone; watch for GCA.
70 Psoriatic arthropathy Seronegative arthritis with dactylitis, enthesitis, nail disease and pencil-in-cup; avoid JAK inhibitors over 65.
71 Systemic vasculitides GCA above 50, MPA at 65–75; start steroids before the biopsy; infection kills more older patients than the vasculitis.
72 Sjögren's syndrome Anti-Ro/La, Schirmer ≤5 mm, focus score ≥1; the commonest cause of dry mouth in an older person is a drug.
73 Osteoporosis / DEXA / FRAX T ≤ −2.5; FRAX gives 10-year probability; never stop denosumab without a follow-on bisphosphonate.
74 Pressure ulcers Four stages plus unstageable and DTPI; never reverse-stage; prevention beats dressings.
75 Beers / STOPP-START / ACB STOPP the wrong, START the missing, score the anticholinergics (ACB ≥3).
B. Steroid-sparing agents — the whole rheumatology block on one line each
Condition First line Steroid-sparing / advanced
Polymyalgia rheumatica Prednisolone 12.5–25 mg/day Sarilumab preferred (EULAR 2025); tocilizumab; methotrexate Giant cell arteritis Prednisolone 40–60 mg (IV if visual Tocilizumab or upadacitinib 15 mg (SELECT-GCA: 46% loss) vs 29%)
ANCA-associated vasculitis Steroids + rituximab (preferred in Avacopan; reduced-dose steroid regimen (PEXIVAS) elderly)
Psoriatic arthritis Methotrexate (peripheral only) IL-17 / IL-23 inhibitors; apremilast if frail; avoid JAKi over 65 Sjögren's syndrome Symptomatic + hydroxychloroquine Rituximab for systemic disease; ianalumab / nipocalimab emerging C. Numbers most likely to be asked Number What it belongs to 72 hours / 7 days / 3 months Zoster antiviral window, course, PHN definition 51% and 66% Zostavax reduction in herpes zoster and PHN ≥105 CFU/mL Significant bacteriuria (voided specimen)
45 minutes / >40 mm/h / >75 mm/h PMR morning stiffness; PMR ESR; ESR raising suspicion of GCA 12.5–25 mg vs 40–60 mg Prednisolone in PMR vs GCA 16–21% PMR patients who develop GCA 46% vs 29% SELECT-GCA sustained remission, upadacitinib vs placebo T ≤ −2.5 / −1 to −2.5 / ≤ −3.0 Osteoporosis / osteopenia / very high risk threshold 800–1200 mg and 800–1000 IU Daily calcium and vitamin D 5 years oral / 3 years IV Bisphosphonate review point before a drug holiday 30–35 kcal/kg, 1–1.5 g/kg protein, 1 mL/kcal Nutrition target in pressure injury >90% / >30 minutes / 2–4 hourly Lower-body ulcers, Stage 1 erythema, repositioning interval 91% vs 48% STOPP vs Beers detection of ADRs 57.9% and 72.2% Prescribing omission, all ages ≥65 and over 85 133 + 57 / ACB ≥3 STOPP/START v3 criteria; anticholinergic burden threshold D. Indian policy and programme hooks to drop into any answer Programme / instrument Where it fits NAP-AMR 2.0 (2025–2029), launched 18 CAUTI, asymptomatic bacteriuria, IPC and stewardship (Q64, 65, 66)
Nov 2025
ICMR AMRSN and ICMR AMSP guidelines Hospital antibiogram, stewardship programme structure (Q66) NCVBDC dengue and leptospirosis Dengue and leptospirosis (Q67)
programmes; TAK-003 approved 2026 for ages 4–60 NPHCE — geriatric clinics, district and Vaccination access, falls and osteoporosis services, chronic care (Q63, 68, 73) regional geriatric centres ISBMR position statements; Indian FRAX Osteoporosis (Q73)
model; ICMR-NIN calcium recommendation MWPSC Act 2007 and Elder Line 14567 Neglect presenting as a Stage 3–4 pressure injury (Q74) Schedule H1; AYUSH–allopathy co- Prescribing safety and stewardship (Q66, 75)
prescribing; irrational fixed-dose combinations AB-PMJAY, Rashtriya Vayoshri Yojana, Financing of fracture surgery, mobility and assistive devices (Q73, 74)
ADIP-ALIMCO
FIVE SENTENCES WORTH MEMORISING VERBATIM
"Bacteriuria in older persons is common and usually asymptomatic; in the absence of obstructive uropathy there is no evidence to support routine antimicrobial therapy."
"Advanced age has not been identified as an independent risk factor for pressure injury — it is the coexisting impairments in mobility, nutrition and skin health that create the risk."
"Polymyalgia rheumatica is a totally reversible cause of frailty that is often misdiagnosed; corticosteroids reverse the frailty it produces."
"Prevention and managing the underlying causes, rather than focusing on topical dressings, is most likely to be effective in pressure injury."
"It is more relevant to encourage good prescribing practices with the aim of reducing avoidable iatrogenic events than to stigmatise inappropriate treatments." Night-Before Master Sheet — Questions 168 and 169 A. The one sentence per topic Q Topic The sentence that earns the mark 168 Paget's disease Focal disorder of remodelling with high ALP but normal calcium, phosphate and PTH; X-ray confirms, bone scan maps; single 5 mg IV zoledronate; treat symptoms, not the alkaline phosphatase. 169 Late-onset RA SALADS — sex ratio 1:1, acute onset, large proximal joints, seronegative, higher disease activity, systemic features; under-treated, not treatment-resistant.
B. Numbers most likely to be asked
Number What it belongs to
1–2% over 55; rare below 40; M:F 3:2 Paget's disease epidemiology SQSTM1 in 40–50% familial, 5–10% sporadic Paget's genetics; P392L mutation 70–80% asymptomatic; osteosarcoma <1% Paget's presentation and worst complication >15–20% of skeleton Threshold for high-output cardiac failure Zoledronate 5 mg once; remission ~90%; retreat Paget's drug of choice ≥12 months Risedronate 30 mg × 2 months; alendronate 40 Oral alternatives in Paget's mg × 6 months Onset ≥60 (or 65); one-third of RA LORA definition and burden F:M 3:1 versus ~1:1 YORA versus LORA sex ratio PMR-like in ~25%; >20% of PMR reclassified LORA phenotypes and the PMR overlap ACR/EULAR 2010 score ≥6/10; eGFR <30 RA classification; methotrexate cut-off C. Two trials and two guidelines to name Trial / guideline What to say about it PRISM / PRISM-EZ Intensive bisphosphonate therapy to normalise turnover gave no reduction in fracture, orthopaedic surgery, deafness or quality of life, with a signal of harm — treat symptoms, not the number.
ZiPP Prophylactic zoledronic acid in SQSTM1 carriers modified new lesion development but did not change clinical outcomes — genetic screening with pre-emptive treatment is not routine. Endocrine Society / UK Paget's Both name single 5 mg IV zoledronate first-line; X-ray to confirm, bone scan to define extent.
Association
ORAL Surveillance JAK inhibitors not first-line over 65 — MACE, VTE, malignancy, herpes zoster.
THREE SENTENCES WORTH MEMORISING VERBATIM
"Paget's disease may lead to both conductive and sensorineural hearing loss and should be evaluated radiologically and by an alkaline phosphatase determination." (Kane's)
"In patients with established Paget's disease of bone, bisphosphonate therapy should focus on control of symptoms rather than suppression of bone turnover." (PRISM-EZ)
"Seronegative rheumatoid arthritis is not a mild form of the disease — it requires the same intensive treat-to-target therapy as seropositive disease."
THE LINK BETWEEN THE TWO QUESTIONS
Both are diseases of bone and joint in old age that are frequently missed because the presentation is constitutional rather than musculoskeletal. Paget's is usually found through an isolated raised alkaline phosphatase; LORA is usually found through weight loss, fatigue and a very high ESR. In each case the examiner is testing whether you will work systematically through the differential — the metabolic bone table for one, the OA-versus-inflammatory-arthritis table for the other — rather than jumping to the diagnosis in the question.
Night-Before Master Sheet — Questions 103 to 116 A. The single highest-yield line for each topic Q Topic The sentence that earns the mark 103 DOTS and DR-TB BPaLM for 6 months is the preferred MDR/RR-TB regimen; XDR (2021) = pre-XDR + resistance to bedaquiline or linezolid.
104 GeneXpert Cartridge PCR detecting MTB + rifampicin resistance in 2 hours via the rpoB hot-spot; never use for test of cure.
105 FUO In over-65s, GCA/PMR is the commonest identifiable cause; the highest-yield "tests" are the repeated examination and the drug chart.
106 Shock and septic shock Septic shock = vasopressor-dependent MAP <65 plus lactate >2; no antibiotic substitutes for source control.
107 Procalcitonin Suppressed by interferon-γ, so it stays low in viral infection; best proven role is shortening antibiotic duration.
108 Cerebral malaria IV artesunate 2.4 mg/kg at 0, 12, 24 h then daily; exclude and correct hypoglycaemia; no steroids.
109 Chikungunya Lymphopenia (not thrombocytopenia); no NSAIDs until dengue is excluded; chronic arthritis in 40–50%.
110 Scrub typhus Hunt for the eschar in hidden moist sites; doxycycline 100 mg BD with defervescence in 48 hours.
111 Ebola Death is from hypovolaemic shock, not haemorrhage; Ervebo ring vaccination and Inmazeb/Ebanga for Zaire only.
112 C. difficile Fidaxomicin first-line; soap and water, not alcohol gel; test only diarrhoeal stool, never a test of cure.
113 Influenza High-dose/adjuvanted/recombinant vaccine from 65; oseltamivir 30 mg BD if CrCl 30–60.
114 Vaccination Immunosenescence drives the schedule: influenza annually, PCV20/21 from 50, RZV ×2 from 50, RSV from 75.
115 Acute pyelonephritis Classic triad may be absent — delirium and falls may be the only features; white cell casts mean parenchymal disease.
116 Recurrent UTI Vaginal oestrogen first, methenamine second, antibiotics last; systemic HRT does not work.
B. The geriatric principles that run through the whole module (quote these anywhere)
"Febrile response may be blunted or absent in some older individuals with bacterial infections… A poor febrile response may also be a negative prognostic factor." (Kane's)
"The absence of leucocytosis in older patients should also not exclude consideration of a bacterial infection." (Kane's)
"Hypothermia in older patients should promptly be treated as sepsis unless proven otherwise." (Kane's)
"Acute unexplained functional deterioration should alert the physician to a potential acute infectious process." (Kane's)
"A useful rule in geriatric care is to suspect tuberculosis when a patient is inexplicably failing." (Kane's)
"The frequency of gram-negative bacilli increases in each category" of infection in older adults — so empirical cover must include them. (Kane's)
"Bacteriuria in older persons is common and usually asymptomatic… in the absence of obstructive uropathy, no evidence exists to support the routine use of antimicrobial therapy." (Kane's)
C. Numbers most likely to be asked
Number What it belongs to
BPaLM 6 months; bedaquiline 400 mg → 200 mg MDR/RR-TB regimen and dosing thrice weekly 81-bp rpoB; 2 hours; 16 CFU/mL (Ultra) GeneXpert target, turnaround, Ultra limit of detection >38.3 °C, >3 weeks; LTC fever >37.8 °C FUO definition and its geriatric modification SOFA ≥2; MAP <65; lactate >2; mortality >40% Sepsis-3 and septic shock 30 mL/kg in 3 h; antibiotics <1 h; MAP 60–65 if Septic shock bundle and SSC 2026 ≥65 y Rises 2–4 h, peaks 12–24 h; >0.5 ng/mL Procalcitonin kinetics and antibiotic threshold Artesunate 2.4 mg/kg at 0, 12, 24 h; GCS ≤11 Cerebral malaria Eschar in 20–50%; doxycycline 100 mg BD × 7 Scrub typhus d; response in 48 h Incubation 2–21 days; semen persistence ≥18 Ebola months WBC ≥15,000 or creatinine >1.5 mg/dL; C. difficile severity and recurrence recurrence 20–25% then 40–60% HR 0.75 hospitalisation, 0.52 death; oseltamivir Influenza vaccine benefit and antiviral dosing 30 mg BD if CrCl 30–60 PCV from 50; RZV ×2 from 50; RSV all ≥75 Current adult immunisation schedule 2 in 6 months or 3 in 12 months; methenamine 1 Recurrent UTI g BD; fluids 1.5 L D. Indian policy and programme hooks Programme / instrument Where it fits NTEP, Ni-kshay portal, Ni-kshay Poshan DOTS and drug-resistant TB (Q103)
Yojana ₹1000/month, Pradhan Mantri TB
Mukt Bharat Abhiyaan
Universal drug susceptibility testing; GeneXpert and TB diagnostics (Q103, 104)
CBNAAT; indigenous Truenat
NAP-AMR 2.0 (2025–2029); ICMR Sepsis, procalcitonin, C. difficile, pyelonephritis, recurrent UTI (Q106, 107, 112, 115, 116) treatment guidelines and AMRSN NCVBDC; National Framework for Malaria Cerebral malaria, chikungunya, scrub typhus (Q108–110)
Elimination; pre-referral rectal artesunate
NPHCE geriatric clinics; API / Geriatric Vaccination delivery — no adult UIP in India (Q113, 114)
Society of India adult immunisation guidance
AB-PMJAY and Ayushman Vay Vandana Financing of hospitalisation for sepsis, TB and severe infection Card THE THREAD THAT LINKS THIS WHOLE MODULE Every answer in this block turns on the same three geriatric facts: (i) the febrile and leucocyte responses are unreliable, so the presentation is delirium, falls and functional decline rather than fever; (ii) the pathogen spectrum shifts towards Gram-negative organisms, so empirical cover and local antibiograms matter more; and (iii) the greatest iatrogenic risks are over-treatment of colonisation, unadjusted drug doses, and fluid overload during resuscitation. If you open any answer in this module with those three points and close it with the relevant Indian programme, you will have framed it as a geriatrics answer rather than a general medicine one.
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References
- PAPERS-2-3-4_COMBINED.pdf — page 389
- GeriQBank source PDF — p. 389
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