Mock Geriatrics Module 1

An 82-year-old woman is admitted with community-acquired pneumonia. She weighs 48 kg. Her medications include perindopril and atorvastatin.

Investigations reveal:

Serum creatinine: 78 µmol/L (45–90)
Serum urea: 9.2 mmol/L (3.0–8.0)
eGFR (CKD-EPI): 62 mL/min/1.73m²
Sodium: 138 mmol/L (135–145)
Potassium: 4.4 mmol/L (3.5–5.2)

The trainee intern is preparing to prescribe gentamicin and asks about renal dosing.

Which of the following statements best explains why this patient’s true renal function may be worse than her serum creatinine suggests?

Reduced muscle mass leading to lower creatinine production

Correct Incorrect Correct answer

Increased tubular secretion of creatinine in ageing kidneys

Correct Incorrect Correct answer

Increased glomerular membrane permeability to creatinine

Correct Incorrect Correct answer

Enhanced renal blood flow preserving creatinine clearance

Correct Incorrect Correct answer

Elevated serum albumin increasing creatinine binding

Correct Incorrect Correct answer

A 79-year-old man presents for review of hypertension. His blood pressure is 168/72 mmHg. He is asymptomatic.

An ECG shows left ventricular hypertrophy.

An echocardiogram demonstrates a preserved ejection fraction of 60%, impaired relaxation with an E/A ratio reversal, and left atrial enlargement.

Which age-related physiological change is the primary contributor to this patient’s blood pressure profile?

Stiffening of large arteries with reduced elasticity

Correct Incorrect Correct answer

Reduced maximum heart rate

Correct Incorrect Correct answer

Reduced baroreceptor sensitivity

Correct Incorrect Correct answer

Reduced plasma renin activity

Correct Incorrect Correct answer

Decreased responsiveness to catecholamines

Correct Incorrect Correct answer

An 84-year-old woman is admitted following a fall. She is on hydrochlorothiazide for hypertension. She is clinically euvolaemic.

Investigations show:

Sodium: 124 mmol/L (135–145)
Potassium: 3.6 mmol/L (3.5–5.2)
Serum osmolality: 258 mmol/kg (275–295)
Urine osmolality: 420 mmol/kg
Urine sodium: 45 mmol/L
TSH: 2.1 mIU/L (0.4–4.0)
Cortisol (9am): 420 nmol/L

Which age-related physiological change predisposes this patient to this electrolyte abnormality?

Increased circulating antidiuretic hormone with impaired renal diluting capacity

Correct Incorrect Correct answer

Reduced antidiuretic hormone secretion

Correct Incorrect Correct answer

Increased aldosterone secretion

Correct Incorrect Correct answer

Increased plasma renin activity

Correct Incorrect Correct answer

Reduced atrial natriuretic peptide

Correct Incorrect Correct answer

A healthy, non-smoking 76-year-old man undergoes spirometry as part of a pre-operative assessment. He has no respiratory symptoms.

Which of the following pulmonary function findings is most consistent with normal ageing?

Preserved total lung capacity with increased residual volume

Correct Incorrect Correct answer

Reduced total lung capacity with reduced residual volume

Correct Incorrect Correct answer

Increased forced vital capacity

Correct Incorrect Correct answer

Increased elastic recoil of the lung

Correct Incorrect Correct answer

Reduced anatomic dead space

Correct Incorrect Correct answer

An 80-year-old man has routine bloods performed. He is asymptomatic and takes no medications. Results show:

Haemoglobin: 128 g/L (130–180)
MCV: 99 fL (80–98)
White cell count: 5.8 × 10⁹/L (4.0–11.0)
Lymphocytes: 1.0 × 10⁹/L (1.0–4.0)
Platelets: 240 × 10⁹/L (150–400)
Ferritin: 180 µg/L (30–300)
B12 and folate: normal

Which of the following statements about age-related haematological changes is most accurate?

There is a slight decrease in haemoglobin and slight increase in MCV with ageing

Correct Incorrect Correct answer

A significant fall in haemoglobin is a normal physiological consequence of ageing

Correct Incorrect Correct answer

Ageing causes a marked rise in the total white cell count

Correct Incorrect Correct answer

Bone marrow functional reserve increases with age

Correct Incorrect Correct answer

Platelet responsiveness to thrombotic stimuli decreases with age

Correct Incorrect Correct answer

A 78-year-old woman with atrial fibrillation is commenced on warfarin. She weighs 52 kg. She achieves a therapeutic INR at a substantially lower dose than expected. Baseline investigations show:

Bilirubin: 12 µmol/L (2–24)
ALT: 22 U/L (5–40)
ALP: 78 U/L (30–110)
Albumin: 32 g/L (35–50)
INR (baseline): 1.1

Which age-related physiological change best explains her heightened sensitivity to warfarin?

Reduced hepatic mass and blood flow with reduced synthesis of vitamin K-dependent clotting factors

Correct Incorrect Correct answer

Increased cytochrome P450 activity

Correct Incorrect Correct answer

Increased hepatic blood flow

Correct Incorrect Correct answer

Increased synthesis of clotting factors II, VII, IX and X

Correct Incorrect Correct answer

Increased serum albumin binding of warfarin

Correct Incorrect Correct answer

An 85-year-old nursing home resident is brought in with confusion and reduced oral intake over two days. She is normally cognitively intact. On examination her oral temperature is 37.3°C.

Investigations reveal:

White cell count: 14.2 × 10⁹/L (4.0–11.0)
CRP: 145 mg/L (<5)
Urinalysis: nitrites and leucocytes positive
Blood cultures: pending

Which factor best explains why this patient with a serious infection failed to mount a significant fever?

Reduced temperature response to pro-inflammatory cytokines IL-1, TNF and IL-6

Correct Incorrect Correct answer

Increased hepatic thermogenesis

Correct Incorrect Correct answer

Enhanced shivering threshold

Correct Incorrect Correct answer

Increased diurnal variation in body temperature

Correct Incorrect Correct answer

Increased diurnal variation in body temperature

Correct Incorrect Correct answer

A 77-year-old man reports difficulty rising from chairs and a slow walking speed. He has lost weight unintentionally. His grip strength is reduced and his gait speed is 0.7 m/s. A DEXA-derived appendicular skeletal muscle mass index is low.

His investigations show normal thyroid function, normal creatine kinase, and normal inflammatory markers.

Which of the following best describes the predominant age-related change underlying his condition?

The correct answer is preferential loss of type II (fast-twitch) muscle fibres.

Correct Incorrect Correct answer

Preferential loss of type I (slow-twitch) muscle fibres

Correct Incorrect Correct answer

Increased osteoblast number and activity

Correct Incorrect Correct answer

Increased water content of cartilage

Correct Incorrect Correct answer

Increased VO2 max due to muscle remodelling

Correct Incorrect Correct answer

A 81-year-old woman presents after a syncopal episode on standing. She takes amlodipine. She reports dizziness on standing.

Lying blood pressure is 148/82 mmHg with a heart rate of 72 bpm; after 3 minutes standing, blood pressure is 118/70 mmHg with a heart rate of 74 bpm.

Which factor best explains her failure to mount a compensatory tachycardia in response to the postural fall in blood pressure?

Reduced baroreceptor sensitivity and blunted response to β-adrenergic stimulation

Correct Incorrect Correct answer

Increased baroreceptor sensitivity

Correct Incorrect Correct answer

Increased parasympathetic outflow

Correct Incorrect Correct answer

Increased venous compliance

Correct Incorrect Correct answer

Enhanced response to catecholamines

Correct Incorrect Correct answer

A 79-year-old woman is investigated for fatigue and paraesthesiae in her feet. She has a history of long-term proton pump inhibitor use for reflux.

Investigations show:

Haemoglobin: 105 g/L (115–165)
MCV: 108 fL (80–98)
Serum B12: 118 pmol/L (145–600)
Folate: normal
Intrinsic factor antibodies: negative

Which age-related gastrointestinal change most likely contributes to her B12 deficiency?

Reduced gastric acid secretion with impaired B12 absorption

Correct Incorrect Correct answer

Increased secretion of hydrochloric acid and pepsin

Correct Incorrect Correct answer

Increased intrinsic factor production

Correct Incorrect Correct answer

Enhanced intestinal villous surface area

Correct Incorrect Correct answer

Reduced colonic sensitivity to opioids

Correct Incorrect Correct answer

A 78-year-old woman presents to the falls clinic after three falls in the past two months, typically occurring when she rises from bed in the morning. She describes lightheadedness and visual darkening on standing.

Her medications include amitriptyline, indapamide and amlodipine.

Her blood pressure measurements are:

Supine (after 5 minutes): 158/88 mmHg (SBP normal <140)
Immediately on standing: 132/78 mmHg
At 2 minutes standing: 128/72 mmHg

Heart rate rises from 72 to 78 bpm on standing.

Full blood count, electrolytes, and morning cortisol are normal. ECG shows sinus rhythm.

Which of the following is the most appropriate initial management step?

Review and rationalise her medications

Correct Incorrect Correct answer

Commence fludrocortisone

Correct Incorrect Correct answer

Commence midodrine

Correct Incorrect Correct answer

Refer for tilt-table testing

Correct Incorrect Correct answer

Commence droxidopa

Correct Incorrect Correct answer

An 82-year-old community-dwelling man has had two falls in the past six months. A comprehensive geriatric assessment identifies impaired balance, quadriceps weakness, and a Timed Up and Go time of 16 seconds (normal for elderly <12 seconds). His vision, medications, and postural blood pressure are unremarkable.

Which single intervention has the strongest evidence base for reducing his rate of falls?

Supervised balance and muscle-strengthening exercise

Correct Incorrect Correct answer

Provision of hip protectors

Correct Incorrect Correct answer

A general falls education pamphlet

Correct Incorrect Correct answer

Vitamin D supplementation

Correct Incorrect Correct answer

A non-specific home walking program

Correct Incorrect Correct answer

A 76-year-old woman living independently has had four falls in the last three months, all occurring at night when getting up to use the bathroom.

Her regular medications include temazepam 20 mg nocte (used for eight years), perindopril, and metformin.

Postural blood pressure, ECG, vision, and cognitive screening are normal. HbA1c is 52 mmol/mol (48–58 acceptable for elderly).

Which intervention is most likely to reduce her rate of falls?

Gradual withdrawal of temazepam

Correct Incorrect Correct answer

Switching temazepam to a shorter-acting benzodiazepine

Correct Incorrect Correct answer

Ceasing perindopril

Correct Incorrect Correct answer

Prescribing a nocturnal anticholinergic for urinary frequency

Correct Incorrect Correct answer

Adding melatonin and continuing temazepam

Correct Incorrect Correct answer

A 70-year-old man with type 2 diabetes reports recurrent falls, particularly when walking in poorly lit areas. He also reports burning neuropathic pain in his feet.

Examination reveals bilateral intrinsic foot muscle wasting, loss of vibration and proprioception to the ankles, and absent ankle reflexes. Romberg’s test is positive.

Investigations:

HbA1c 74 mmol/mol (target individualised)
Vitamin B12 210 pmol/L (>220 preferred)
TSH 2.1 mIU/L (0.4–4.0)

Which pharmacological agent for his neuropathic pain carries the greatest risk of increasing his falls?

Duloxetine

Correct Incorrect Correct answer

Topical capsaicin cream

Correct Incorrect Correct answer

Lidocaine patch

Correct Incorrect Correct answer

Paracetamol

Correct Incorrect Correct answer

Topical NSAID gel

Correct Incorrect Correct answer

An 84-year-old woman is admitted after a fall from standing height, sustaining a displaced intracapsular neck of femur fracture. She was independent with a four-wheel frame prior to admission.

Her admission bloods show haemoglobin 118 g/L (115–165), creatinine 90 µmol/L (45–90), and corrected calcium 2.30 mmol/L (2.10–2.60).

According to the Australian and New Zealand Hip Fracture Care guidelines, which of the following is most strongly associated with improved outcomes?

Surgery within 48 hours of admission

Correct Incorrect Correct answer

Delaying surgery until 72 hours to optimise comorbidities

Correct Incorrect Correct answer

Routine use of skin traction preoperatively

Correct Incorrect Correct answer

Prolonged bed rest postoperatively to allow bone healing

Correct Incorrect Correct answer

Non-operative management given her age

Correct Incorrect Correct answer

A 74-year-old man presents with recurrent falls. His wife reports his walking has become slow with small shuffling steps, and he has difficulty turning, pivoting “in one block.”. He also reports constipation and REM sleep behaviour disorder.

On examination there is a resting tremor of the right hand, cogwheel rigidity, reduced right arm swing, and a narrow-based gait with reduced stride length. Postural blood pressure shows a drop of 24 mmHg systolic.

Which is the most likely underlying diagnosis?

Idiopathic Parkinson's disease

Correct Incorrect Correct answer

Multiple system atrophy

Correct Incorrect Correct answer

Normal pressure hydrocephalus

Correct Incorrect Correct answer

Vitamin B12 deficiency

Correct Incorrect Correct answer

Hip osteoarthritis

Correct Incorrect Correct answer

A 79-year-old woman attending a falls clinic is assessed with the Timed Up and Go test.

She rises from a chair without using her arms, walks 3 metres, turns, and returns to sitting in 15 seconds.

Which of the following statements regarding this assessment is correct?

Her result indicates impaired functional mobility and increased falls risk

Correct Incorrect Correct answer

Her result is within normal limits for her age

Correct Incorrect Correct answer

The test requires specialised equipment and training to perform

Correct Incorrect Correct answer

The test cannot be used to monitor change over time

Correct Incorrect Correct answer

A result under 20 seconds excludes any falls risk

Correct Incorrect Correct answer

A 81-year-old man living alone has presented three times in the past year following falls. He has a history of type 2 diabetes, mild cognitive impairment, and cataracts.

His medications include glipizide, oxazepam, and an over-the-counter anticholinergic sleep aid.

Postural blood pressure shows a 22 mmHg systolic drop. Visual acuity is 20/80 (impaired). Timed Up and Go is 17 seconds.

Which management approach is most likely to reduce his risk of future falls?

A structured multifactorial intervention targeting his identified risk factors

Correct Incorrect Correct answer

A single home-hazard modification visit

Correct Incorrect Correct answer

Vitamin D supplementation alone

Correct Incorrect Correct answer

Provision of hip protectors

Correct Incorrect Correct answer

A falls education booklet mailed to his home

Correct Incorrect Correct answer

A 88-year-old woman residing in a residential aged care facility has fallen five times in three months. She has advanced dementia and requires assistance to mobilise. Her family asks whether hip protectors and physical restraints would prevent injury.

Investigations:

Haemoglobin 108 g/L (115–165)
Vitamin D 40 nmol/L (>50 preferred)
Corrected calcium 2.25 mmol/L (2.10–2.60)

Which statement regarding falls prevention in this setting is most accurate?

Multifactorial interventions in residential aged care have less robust evidence than in the community, and restraints are not recommended

Correct Incorrect Correct answer

Hip protectors are strongly evidence-based and should be provided

Correct Incorrect Correct answer

Physical restraints reduce falls and injuries and should be used

Correct Incorrect Correct answer

Bed rails eliminate the risk of falls from bed

Correct Incorrect Correct answer

Exercise programs are contraindicated in advanced dementia

Correct Incorrect Correct answer

A 77-year-old man is brought to the emergency department after an unwitnessed collapse. He reports no warning symptoms and has no recollection of the event, regaining awareness on the floor.

He has a history of aortic stenosis.

Examination reveals a slow-rising carotid pulse and an ejection systolic murmur radiating to the carotids.

Investigations:

ECG: sinus rhythm, left ventricular hypertrophy with strain
Postural blood pressure: no significant drop
Troponin: normal
Transthoracic echocardiogram: severe aortic stenosis (valve area 0.8 cm², mean gradient 45 mmHg)

Which of the following best explains his presentation and guides subsequent management?

Syncope due to severe aortic stenosis; refer for consideration of aortic valve replacement

Correct Incorrect Correct answer

This is a simple mechanical fall requiring only physiotherapy

Correct Incorrect Correct answer

Orthostatic hypotension requiring fludrocortisone

Correct Incorrect Correct answer

Vasovagal syncope requiring reassurance only

Correct Incorrect Correct answer

Peripheral neuropathy requiring nerve conduction studies

Correct Incorrect Correct answer

An 84-year-old man is referred for consideration of transcatheter aortic valve implantation (TAVI) for symptomatic severe aortic stenosis.

He requires assistance with instrumented activities of daily living (shopping, finances) but is independent for basic personal care.

He walks slowly with a stick and has reduced energy, limiting him to light housework. He has stable ischaemic heart disease and mild cognitive impairment.

Investigations:

Haemoglobin 116 g/L (130–180)
Albumin 34 g/L (35–50)
eGFR 48 mL/min/1.73m² (>60)
Echocardiogram: severe aortic stenosis, valve area 0.7 cm², mean gradient 48 mmHg, preserved ejection fraction

Using the Clinical Frailty Scale (Rockwood), how should it inform decision-making?

Frailty should be integrated into shared decision-making and procedural risk stratification

Correct Incorrect Correct answer

Proceed without frailty consideration

Correct Incorrect Correct answer

Palliative approach only

Correct Incorrect Correct answer

No additional assessment required

Correct Incorrect Correct answer

Active intervention contraindicated

Correct Incorrect Correct answer

A 79-year-old woman is admitted with reduced oral intake over three weeks following the death of her husband. She has lost 8 kg (approximately 12% of her body weight). Her BMI is 17.5 kg/m².She has eaten almost nothing for the past five days.

Investigations on admission:

Phosphate 0.72 mmol/L (0.75–1.50)
Magnesium 0.68 mmol/L (0.70–1.10)
Potassium 3.4 mmol/L (3.5–5.2)
Albumin 30 g/L (35–50)

Her Malnutrition Universal Screening Tool (MUST) score is calculated.

Which statement is most accurate regarding her assessment and management?

Her MUST score indicates high risk, and she is at high risk of refeeding syndrome requiring cautious calorie reintroduction with electrolyte replacement and thiamine

Correct Incorrect Correct answer

Her MUST score is low risk; no nutritional intervention is required

Correct Incorrect Correct answer

Nutrition should be commenced immediately at full caloric requirements

Correct Incorrect Correct answer

Low albumin confirms the diagnosis of malnutrition independently of MUST

Correct Incorrect Correct answer

MUST is a diagnostic rather than a screening tool

Correct Incorrect Correct answer

A 76-year-old man is brought by his daughter for progressive memory difficulties over 18 months.

He repeats questions and has become lost driving to familiar places. He remains independent for basic self-care but has stopped managing his own finances.

He has 12 years of formal education.

On the Montreal Cognitive Assessment (MoCA), he scores 19/30 (normal ≥26), with deficits in delayed recall, visuospatial/executive tasks and orientation.

Investigations:

TSH 2.0 mIU/L (0.4–4.0)
Vitamin B12 350 pmol/L (>220)
Sodium 139 mmol/L (135–145)
MRI brain: bilateral hippocampal and medial temporal lobe atrophy, no significant vascular burden

Which statement is most accurate regarding this presentation?

The pattern is consistent with major neurocognitive disorder, likely Alzheimer's disease, and cognitive screening alone cannot establish the diagnosis

Correct Incorrect Correct answer

The MoCA score is within normal limits given his education

Correct Incorrect Correct answer

A normal TSH and B12 exclude the need for further evaluation

Correct Incorrect Correct answer

The MoCA is diagnostic of Alzheimer's disease

Correct Incorrect Correct answer

A single low MoCA score confirms dementia without functional assessment

Correct Incorrect Correct answer

A 74-year-old man is admitted with a left middle cerebral artery ischaemic stroke, presenting with right hemiparesis and dysarthria.

On the ward he coughs when drinking water. A nurse-administered bedside swallow screen is failed.

Investigations:

CT brain: established left MCA territory infarct
Chest X-ray: patchy right lower zone consolidation
White cell count 13.5 x10⁹/L (4.0–11.0)
CRP 65 mg/L (<5)

Which of the following is the most appropriate next step in assessing his swallowing?

Keep nil by mouth pending formal assessment by a speech language therapist

Correct Incorrect Correct answer

Immediately commence a normal oral diet

Correct Incorrect Correct answer

Insert a percutaneous endoscopic gastrostomy (PEG) immediately

Correct Incorrect Correct answer

Rely on the bedside screen alone to guide diet upgrading

Correct Incorrect Correct answer

Provide thickened fluids without any further assessment

Correct Incorrect Correct answer

An 84-year-old man with moderate Alzheimer’s disease lives at home with his 80-year-old wife, who is his sole carer. She reports exhaustion, disturbed sleep due to his nocturnal wandering, and has stopped seeing friends.

She scores highly on the Caregiver Strain Index.

He has had two recent falls and is incontinent. He is independent for feeding but requires assistance with bathing and dressing.

Investigations:

MoCA 14/30 (normal ≥26)
Sodium 138 mmol/L (135–145)
TSH 1.8 mIU/L (0.4–4.0)
CT brain: generalised atrophy, no acute pathology

Which of the following is the most appropriate next step to support this patient and his carer?

Referral for an Aged Care Assessment Team (ACAT) assessment to determine eligibility for community supports, respite and appropriate levels of care

Correct Incorrect Correct answer

Immediate permanent residential aged care placement without further assessment

Correct Incorrect Correct answer

Prescribe an antipsychotic to manage the wandering

Correct Incorrect Correct answer

Advise the wife that carer strain is expected and requires no intervention

Correct Incorrect Correct answer

Cease all cognitive assessment as the diagnosis is established

Correct Incorrect Correct answer

An 82-year-old man is admitted with community-acquired pneumonia. On day two, nursing staff report he has become agitated overnight, is pulling at his cannula, and is drowsy and inattentive during the day.

His daughter states he was cognitively intact and independent at home one week ago. He is unable to recite the months of the year backwards and his attention fluctuates through the assessment.

Investigations:

White cell count 15.2 x10⁹/L (4.0–11.0)
CRP 120 mg/L (<5)
Sodium 130 mmol/L (135–145)
Urea 9.5 mmol/L (3.0–8.0)
CT brain: age-related atrophy, no acute intracranial pathology

Which of the following screening tools is most appropriate to confirm the suspected diagnosis?

The 4AT (or Confusion Assessment Method)

Correct Incorrect Correct answer

Montreal Cognitive Assessment (MoCA)

Correct Incorrect Correct answer

Addenbrooke's Cognitive Examination

Correct Incorrect Correct answer

Frontal Assessment Battery (FAB)

Correct Incorrect Correct answer

Mini-Mental State Examination (MMSE)

Correct Incorrect Correct answer

A 73-year-old woman from a non-English-speaking background, who completed only three years of formal schooling and is not literate in English, is referred for assessment of memory complaints reported by her family over the past two years.

She becomes distressed and performs poorly when asked to spell words backwards and to copy pentagons during initial testing.

Investigations:

TSH 2.2 mIU/L (0.4–4.0)
Vitamin B12 380 pmol/L (>220)
Sodium 140 mmol/L (135–145)
MRI brain: mild generalised atrophy

Which cognitive screening tool is most appropriate for this patient?

Rowland Universal Dementia Assessment Scale (RUDAS)

Correct Incorrect Correct answer

Mini-Mental State Examination (MMSE)

Correct Incorrect Correct answer

Montreal Cognitive Assessment (MoCA)

Correct Incorrect Correct answer

Addenbrooke's Cognitive Examination

Correct Incorrect Correct answer

Frontal Assessment Battery (FAB)

Correct Incorrect Correct answer

A 64-year-old man is brought by his wife with an 18-month history of progressive personality change.

He has become disinhibited, makes inappropriate comments in public, is apathetic at home, and has developed a preference for sweet foods.

His memory for recent events is relatively preserved.

On examination he demonstrates perseveration and a positive grasp reflex.

Investigations:

TSH 1.9 mIU/L (0.4–4.0)
Vitamin B12 410 pmol/L (>220)
Syphilis and HIV serology negative
MRI brain: asymmetric atrophy of the frontal and anterior temporal lobes

Which cognitive screening tool would be most sensitive to his specific deficits?

Frontal Assessment Battery (FAB)

Correct Incorrect Correct answer

Mini-Mental State Examination (MMSE)

Correct Incorrect Correct answer

Rowland Universal Dementia Assessment Scale (RUDAS)

Correct Incorrect Correct answer

The 4AT

Correct Incorrect Correct answer

Montreal Cognitive Assessment orientation subscale

Correct Incorrect Correct answer

A 68-year-old university-educated professional complains of subtle word-finding difficulty and occasionally misplacing items over the past year.

He remains fully independent in all activities of daily living and continues to work effectively. His wife is not concerned.

A Mini-Mental State Examination is performed and scores 29/30 (normal ≥24).

Investigations:

TSH 2.0 mIU/L (0.4–4.0)
Vitamin B12 400 pmol/L (>220)
Sodium 141 mmol/L (135–145)
MRI brain: no significant atrophy or vascular change

Which of the following is the most appropriate next step?

Perform a Montreal Cognitive Assessment (MoCA), which is more sensitive for mild cognitive impairment

Correct Incorrect Correct answer

Reassure him that his MMSE is normal and no further cognitive testing is needed

Correct Incorrect Correct answer

Diagnose Alzheimer's disease and commence a cholinesterase inhibitor

Correct Incorrect Correct answer

Perform a 4AT

Correct Incorrect Correct answer

Arrange immediate residential care planning

Correct Incorrect Correct answer

A 78-year-old woman with known Alzheimer’s disease (baseline MMSE 20/30 six months ago) is admitted following a fall.

Her son reports that over the last 48 hours she has become markedly more confused than usual, is drowsy, and has developed visual hallucinations.

She is inattentive and her conscious level fluctuates.

Investigations:

Urinalysis: nitrites and leucocytes positive
White cell count 14.0 x10⁹/L (4.0–11.0)
CRP 80 mg/L (<5)
Sodium 133 mmol/L (135–145)
CT brain: chronic small vessel ischaemic change, no acute pathology

Which of the following statements is most accurate regarding her assessment?

She has delirium superimposed on dementia; the 4AT is an appropriate screening tool, and formal cognitive testing should be deferred until the acute illness resolves

Correct Incorrect Correct answer

A MoCA should be performed now to quantify the deterioration

Correct Incorrect Correct answer

The change is due to progression of Alzheimer's disease and requires no acute intervention

Correct Incorrect Correct answer

An Addenbrooke's Cognitive Examination will distinguish delirium from dementia

Correct Incorrect Correct answer

The fluctuating course excludes delirium

Correct Incorrect Correct answer

Mock Geriatrics Module 1

Quiz Summary

Information

Results

Results

Categories

1. Question

2. Question

3. Question

4. Question

5. Question

6. Question

7. Question

8. Question

9. Question

10. Question

11. Question

12. Question

13. Question

14. Question

15. Question

16. Question

17. Question

18. Question

19. Question

20. Question

21. Question

22. Question

23. Question

24. Question

25. Question

26. Question

27. Question

28. Question

29. Question

30. Question

Average score
Your score