Geriatrics

1)why do we use ace inhibitors after mi>>>to decrease blood pressure/preload (not sure which is
correct)

2) Which patient is exhibiting an early warning sign of Alzheimer's disease?

A- A 65 year old Male doesn't recognize his family members and close friends B-

A 59 year old female misplaces her purse and jokes about having memory loss

C- ‫كان عيان كبير راجل عنده‬incontinence ‫ومش بيعمل‬hygene ‫كويس‬

D- A 72 year old female unable to locate the address where she has lived for 10 year

3)it was a case describing murmur of aortic stenosis and aortic regurgitation and what do we expect
in this case? pulsus bisferiens

4) A 78 years old lady was having her first screening assessment for fall risk. By history she fell once
during the last year but didn't get injured. She performed timed get up and go test in 13 seconds
and her gait was balanced. What should we do next for her fall risk assessment ??

a- Re asses after 6 months B-

Re asses after one year

C- Re asses after two years

D- Refer her for specialist comprehensive assessment

5) Elderly patients recently discharged from hospital have a fourfold increased risk of falling
especially within

A- First 5 weeks after discharge from hospital B-

First 4 weeks after discharge from hospital

C- First 3 weeks after discharge from hospital

D- First 2 weeks after discharge from hospital

6)a female patient suffering from dementia ,she has been taking paracetamol for a short time
,suddenly she became confused and had delirium what is the cause? Medication related (correct)

Progression of dementia (no)

7)male patient had diabetes, peripheral neuropathy and pvr about 550ml ,what is the cause of
inconvenience? Detrusor under activity

8) female patient has been suffering from burning micturition and incontinence
Cause is >>transient cause

9)female patient had urine dribbling few seconds after cough cause>> urethral obstruction
10)patient had delirium after admitting to hospital we can tell this is delirium by >>asking doctor
and said patient was oriented when he admitted

___________________________________________________________
Round 2
MCQ

1) 78 year old patient reported mild cognitive impairment and memory impaired, he asked the
doctor to prescribe a drug prevent progression to Alzheimer's disease, which can be used :
i. Memantine
ii. Donepezil
iii. Haloperidol
iv. No treatment

2) Patient with delirium, What is the initial investigation be used :

i. Serum Vitamin B12
ii. plasma glucose
iii. Electrolyte panel
iv. Serum ammonia

3) what is the initial assessment in a patient for urge incontinence after prostatectomy:
i. Urodynamics
ii. Bladder diary
iii. Urethroscopy
iv. Ultrasonography

4) which can be cause of overflow incontinence :

i. Pelvic muscle weakness
ii. Post urologic surgery
iii. Diabetes mellitus
iv. Urethral sphincter weakness

5) The most common complication of falls in the elderly:

i. fracture of neck of femur.
ii. recurrent fall
iii. Colle's neck fracture.

6) 78-year-old ma is evaluated for the onset of dyspnea on exertion. He has a long history of
tobacco abuse, obesity, and diabetes mellitus. His current medications include metformin,
aspirin, and occasional ibuprofen. On physical examination his peripheral pulses show a
delayed peak and he has a prominent left ventricular heave. He is in a regular rhythm with a
 IV/VI mid-systolic murmur that is loudest at the base of the heart and radiates to the carotid
arteries. A fourth heart sound is present. Does the patient have
i. Calcific aortic stenosis
ii. Calcific mitral stenosis
.‫ بس كان موجود فيه الكالم الل تحته خط‬،‫*مش دي صيغة السؤال بالضبط‬

7) A 68-year-old male with a history of myocardial infarction and congestive heart failure is
comfortable at rest. However, he develops dyspnea, fatigue, and sometimes palpitations,
when he walk to his car(less than the ordinary physical activity). He must rest for several
minutes before these symptoms resolve. Which of the following is his New York Heart
Association classification?
i. Class I
ii. Class II
iii. Class III
iv. Class IV

8) What is the criteria that makes you diagnose patient with dementia not delirium
i. Chronic onset and progressive course.
ii. Rapid onset
iii. Fluctuating

9) Old healthy patient came to you complaining from recurrent falls, what should you do?
i. Restrict the patient movement
ii. Give the patient vitamin D supplementation
iii. Check the environmental hazards
iv. Advise him to walk with caregiver

10) Old female fell two weeks ago, since that she isn't able to walk without the assistance of her
daughter despite she doesn't have any physical trauma. Does the patient have
i. Depression
ii. Fear of falling

OSCE
1. Osteoarthritis
2. Ankle reflex
3. Palpate the apex of the heart
4. Auscultate the apex.