Geriatrics

Question 1

Routine geriatric screening tests?

Answer 1

FBG, lipids, colonoscopy (>10y life expectancy), FOBT, AAA U/S (<75).

Question 2

Vaccinations in elderly?

Answer 2

Pneumococcal, Td/Tdap (if >2y life expectancy), influenza yearly.

Question 3

Statins recommendation?

Answer 3

Yes, if cholesterol elevated.

Question 4

Screening methods for colon cancer?

Answer 4

FOBT ×3, colonoscopy, flexible sigmoidoscopy + FOBT.

Question 5

Proven preventive measures for colon cancer?

Answer 5

None (Vit E, fiber, aspirin not proven).

Question 6

Definition of insomnia?

Answer 6

Difficulty initiating/maintaining sleep, early waking, non-restorative sleep, daytime impairment.

Question 7

Important differential diagnoses for insomnia?

Answer 7

OSA, depression, GERD, nocturia, CHF, RLS, dementia, meds (stimulants, SSRIs, OCP, steroids, thyroid, β-blockers).

Question 8

First-line management for insomnia?

Answer 8

Sleep hygiene: no caffeine, fluids, or late meals; exercise in AM; no naps; bed for sleep/sex only.

Question 9

Medications for insomnia?

Answer 9

Short-term: temazepam, zopiclone, melatonin. Avoid long-term benzos in elderly.

Question 10

Major causes of falls?

Answer 10

Arrhythmia, postural hypotension, meds, anemia, arthritis, vision loss.

Question 11

Drugs that increase risk of falls?

Answer 11

Diuretics, sedatives, antihypertensives, antipsychotics, benzos, opioids.

Question 12

Signs of hip fracture?

Answer 12

Shortened leg, externally rotated.

Question 13

Prevention strategies for falls?

Answer 13

OT home safety, proper footwear, remove rugs/cords, handrails, lighting, bars in bathroom.

Question 14

Common presentation of hypercalcemia of malignancy?

Answer 14

Nausea, vomiting, confusion, dehydration.

Question 15

First-line treatment for hypercalcemia of malignancy?

Answer 15

Rehydration + calcitonin.

Question 16

Long-term prevention for hypercalcemia of malignancy?

Answer 16

Bisphosphonates (zoledronic acid, pamidronate) ± steroids.

Question 17

Alzheimer’s vs Delirium vs Depression (onset)?

Answer 17

Alzheimer’s = gradual; Delirium = abrupt, fluctuating; Depression = gradual with affective symptoms.

Question 18

Key investigations for cognitive decline?

Answer 18

CBC, electrolytes, TSH, B12, folate, calcium, glucose.

Question 19

First-line Rx for Alzheimer’s?

Answer 19

Cholinesterase inhibitors (donepezil, rivastigmine, galantamine); memantine (NMDA antagonist).

Question 20

When to order CT brain in dementia?

Answer 20

Age <60, rapid decline, short duration, neuro signs, cancer hx, anticoagulation, atypical features.

Question 21

Best management for delirium in elderly?

Answer 21

Identify underlying cause, supportive care, haloperidol if severe agitation.

Question 22

Opioid rotation example: morphine 5 mg q6h + 2.5 mg BT ×5 → new regimen?

Answer 22

Total daily dose 32.5 mg → switch to 15 mg morphine SR q12h + 2.5 mg BT.

Question 23

Most common opioid side effect?

Answer 23

Constipation (always prophylax with stimulant laxative).

Question 24

Neuropathic pain meds?

Answer 24

Amitriptyline, gabapentin, SNRIs.

Question 25

Constipation management in palliative care?

Answer 25

Hydration, fiber if possible, stimulant (senna), softener (colace), osmotic (lactulose), suppositories/enemas.

Question 26

Antiemetics in palliative care?

Answer 26

Metoclopramide, domperidone, ondansetron, stemetil.

Question 27

Ideal BMI?

Answer 27

18.5–25.

Question 28

Exercise recommendation?

Answer 28

30 min, 4–5×/week.

Question 29

Diet advice?

Answer 29

High fiber, fruits/vegetables, whole foods, limit alcohol.