Geriatrics Module 1

What biomarkers are now required for the diagnosis of Alzheimer’s disease according to the revised criteria published in 2024?

APOE genotype, amyloid-beta and tau PET imaging

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Blood test for amyloid-beta and tau levels

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Neurofilament light chain in cerebrospinal fluid

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Brain MRI for hippocampal atrophy

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Cognitive assessment score and clinical history

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What is the primary objective of the Functional Reach Test?

To assess dynamic balance and functional mobility

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To measure an individual's maximum height reach

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To evaluate lower body strength

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To determine cognitive function

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To quantify lung capacity

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A 45-year-old male presents with a one-year history of progressive memory loss, impaired judgment, and changes in mood and behavior. His family history is significant for early-onset dementia in his father. On examination, there is notable difficulty in planning, organizing, and following instructions.

Which of the following is the most likely risk factor for his early-onset dementia?

Genetic predisposition

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Long-standing hypertension

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Late-life depression

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Chronic alcohol use

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Occupational solvent exposure

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Which of the following intervention is most effective in reducing the risk of falls and hip fractures in elderly population?

Exercise program

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Vitamin D supplementation

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Hip protectors

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Proper footwear

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Walking aids

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Which of the following is NOT part of the Confusion Assessment Method (CAM) criteria for the diagnosis of delirium?

impaired memory

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acute onset

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inattention

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disorganized thinking

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altered level of consciousness

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The FINGER study recently demonstrated that a multi-domain intervention could improve or maintain cognitive functioning in at-risk elderly people.

Which of the following intervention was NOT actually included in this study?

Vitamin D supplementation

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Nutritional advice

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Exercise

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Cognitive training

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Vascular risk reduction

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An 80 year old man with dementia who lives at home with his wife is becoming increasingly difficult to manage. He is frequently aggressive and has recently been prescribed low dose antipsychotic medication.

He has been refusing to take his medication so his wife has been crushing the tablets and mixing them into his food.

Which ethical principle has been breached?

Autonomy

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Beneficence

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Non-maleficence

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Equity

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Competency

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The most common cause of chronic incontinence in the elderly is:

urge incontinence

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stress incontinence

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urinary overflow

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urinary infection

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dementia

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An 82-year-old female complains of a decline in short-term memory, specifically difficulty remembering the names of her friends and also some telephone numbers. She lives alone in her own home and remains independent in all of her activities of daily living.

Her husband had passed away 2 years ago.

Her mini-mental state examination (MMSE) score is 27 out of 30, with short-term recall of only one out of three items.

What is the most likely diagnosis?

mild cognitive impairment

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early vascular dementia

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early Alzheimer's dementia

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grief reaction

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normal aging

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Donepezil, a cholinesterase inhibitor that is used to improve cognitive function in Alzheimers disease is least likely to cause the following side effect:

weight gain

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diarrhea

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nausea

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urinary frequency

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headache

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Frailty is considered highly prevalent in old age and confers to the high risk for falls, disability, hospitalization, and mortality.

In a recent study, frailty can phenotypically be characterized by the following features except?

memory loss

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unintentional weight loss

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self reported exhaustion

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weakness in grip strength

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slow walking speed

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Which of the following intervention is most likely to reduce frailty in old people?

Physical exercise

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Multivitamins

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Caloric restriction

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Micronutrients

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Home assessment

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With regards to treatment of hypertension in the elderly population over the age of 80, which anti-hypertensive medication significantly reduced the risk of stroke and all cause mortality?

Indapamide

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Felodipine

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Bendrofluazide

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Metoprolol

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Diltiazem

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When administered to a 70 year old man, which of the following drug is most likely to cause urinary retention?

Amitriptyline

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Inhaled ipratropium

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Sertraline

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Glibenclamide

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Propranolol

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If a healthy and independent 80 year old person performs daily moderate exercise for 3 months, which one of the following would likely to improve?

Performance on a six-minute walk test

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Improved balance

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Knee extension strength

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Tandem and one-leg stance time

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Ability to perform activities of daily living

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An elderly man comes to see you complaining of having poor sleep quality.

Which one of the following age related factors is least likely to contribute to this man’s problem?

A marked decrease in their need for sleep

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Increased incidence of chronic disease and medication use

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A greater susceptibility to external arousal

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Increased nocturnal arousals

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Increased incidence of periodic limb movement disorders

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The following features are highly suggestive of Dementia with Lewy Bodies except?

MRI showing hippocampal atrophy

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Early appearance of Parkinsonism features

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Visual hallucinations

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Delusional misidentification

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REM sleep disorder

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A 75-year-old man is seen in the Memory clinic. His daughter reports that for the past 12 months he has become increasingly forgetful and has now started to wander around at night. His MMSE is 18 out of 30. Neurological examination is unremarkable. A full blood screen is also requested, all of which comes back as normal.

What is the most appropriate next step?

Arrange a brain MRI

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Perform carotid Dopplers

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Give practical advice + advise family to contact Alzheimer's Society

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Prescribe aspirin

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Prescribe donepezil

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An 85 year old lady presents with mild memory impairment, difficulty in concentrating and apathy.

Which of the following would suggest depression is more likely rather than dementia?

psychomotor agitation that is often worse in the morning

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reduced activity

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gradual weight loss (over months to years)

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weight gain

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gradual disruption of sleep wake cycle.

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The following features are highly suggestive of Alzheimer’s disease except?

Rapid decline in memory

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Normal results on lab test

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MRI showing atrophy of hippocampus

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MRI showing diffisue cortical atrophy

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Slow progressive decline in orientation

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Which one of the following is the most common side effect of anti dementia drug donepezil?

Diarrhea

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Rash

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Urinary frequency

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Sedation

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Angioedema

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What is the mechanism of action of Memantine used in Alzheimer’s disease?

NMDA antagonist

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Calcium channel blocker

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Sodium channel blocker

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Cholinesterase inhibitor

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Dopamine agonist

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The following are benefits of using cholinesterase inhibitors and Memantine in Alzheimer’s except?

sustained effect in decreasing the rate of cognitive decline

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improved caregiver ratings of patients' functioning

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able to maintain MMSE score for close to a year

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slow cognitive deterioration in patients with moderate to severe AD

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improvement in apathy and psychosis.

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Which feature is least consistent with the diagnosis of vascular dementia?

Loss of episodic memory

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Personality change

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Gait disorders

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Emotional lability

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Depression

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What is the strongest risk factor for developing vascular dementia?

Previous stroke

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Old age

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Positive family history

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Female

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Diabetes

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Which of the following feature is not consistent with CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy)?

progressive dementia developing in the fifth to seventh decades in multiple family members.

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Skin biopsy shows characteristic dense bodies in the media of arterioles.

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caused by mutations in the notch 5 gene

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no known treatment is available.

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an inherited form of diffuse white matter disease

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The following are known genetic factors for early onset Alzheimer’s disease except?

ApoE 4

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Down's syndrome

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B-amyloid precursor gene

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Presenilin 1

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Presenilin 2

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A deficit in this compound is thought to be the basis of fluctuating cognition and visual hallucinations seen in patients with dementia with lewy bodies:

acetylcholine

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adrenaline

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dopamine

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histamine

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noradrenaline

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Which of the following feature is most suggestive of frontotemporal dementia?

Prominent behavioural change

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Visual hallucinations

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Delusional misorientation

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REM sleep disorder

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Impaired memory

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Which of the following medications have been shown to be the most efficacious in the treatment of psychotic symptom in Alzheimer’s disease and mixed dementia?

Risperidone

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Haloperidol

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Donepezil

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Sodium valproate

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Cipramil

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Which one of the following symptoms in a person with Alzheimer’s disease is most likely to respond to haloperidol?

Delusion

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Wandering

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Calling out

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Disorientation

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Apathy

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A 75-year-old woman presents with a twelve-month history of deteriorating behaviour and memory and increasing social withdrawal. She has been tearful and emotional with poor quality sleep. A diagnosis of depression has been made by her general practitioner, and she has been commenced on Sertraline 50mg / day with a limited response over the last eight weeks.

Neurological examination reveals normal tone and no pyramidal findings. She scores 21/30 on a minimental state examination.

Thyroid stimulating hormone, full blood count, urea and electrolytes, calcium and liver function tests are normal.

Cranial CT Scan shows age related involutional change. Her EEG demonstrates diffuse symmetrical slowing over both fronto- temporal head regions with an excess of delta activity.

The most likely diagnosis is:

Alzheimers type dementia with associated depression

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undertreated Major depression

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diffuse Lewy body disease with associated depression

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Creutzfeldt Jakob disease with associated depression

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depression with hysterical conversion disorder

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The following are proven strategies in reducing the risk of falls for elderly people living in the community except:

Encourage use of multifocal glasses while walking

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Regular exercise and physical activity

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Ensuring adequate lighting in living areas

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Installing grab bars in bathrooms

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Using non-slip mats in slippery areas

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Geriatrics Module 1

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