Geriatric Assessment Flashcards

A 72-year-old woman is diagnosed with osteoporosis (T-score -2.8) following a fragility wrist fracture. According to Australian osteoporosis guidelines, which is the recommended first-line pharmacological treatment?

Answer: Oral bisphosphonates such as alendronate

Oral bisphosphonates such as alendronate are the recommended first-line pharmacological treatment for osteoporosis in postmenopausal women with fragility fractures in Australia, with calcium and vitamin D used as adjuncts.

Which type of dementia is most prevalent in Australia and is characterised by insidious onset, progressive episodic memory loss, and hippocampal atrophy on neuroimaging?

Answer: Alzheimer's disease

Alzheimer's disease accounts for approximately 60–70% of all dementia cases in Australia and is characterised by insidious onset, progressive episodic memory impairment, and cortical atrophy predominantly affecting the hippocampus.

A 77-year-old man with Parkinson's disease develops recurrent detailed visual hallucinations and marked fluctuations in alertness. Which dementia diagnosis should be prioritised?

Answer: Dementia with Lewy bodies

Dementia with Lewy bodies is characterised by the clinical triad of fluctuating cognition, recurrent vivid visual hallucinations, and Parkinsonism, and should be distinguished from Parkinson's disease dementia based on the onset timing of motor versus cognitive symptoms.

Which medication is CONTRAINDICATED in patients with confirmed dementia with Lewy bodies due to risk of severe neuroleptic sensitivity reactions?

Answer: Haloperidol

Typical antipsychotics such as haloperidol are contraindicated in Lewy body dementia because they can precipitate severe neuroleptic sensitivity reactions including profound Parkinsonism, reduced consciousness, and potentially fatal outcomes.

When reviewing medications in a falls-prone elderly patient, which class should be prioritised for deprescribing due to the strongest association with fall risk?

Answer: Psychotropic medications including benzodiazepines and antipsychotics

Psychotropic medications including benzodiazepines, antipsychotics, antidepressants, and sedating agents have the strongest evidence of association with falls risk and should be prioritised for review and cautious deprescribing in elderly patients.

An 84-year-old woman is brought to the emergency department with sudden-onset confusion, dyspnoea, and diaphoresis but denies chest pain. Which diagnosis must be actively excluded?

Answer: Acute myocardial infarction presenting atypically

Elderly patients, particularly women and those with diabetes, frequently present with atypical AMI symptoms such as confusion, dyspnoea, diaphoresis, or epigastric pain without classic chest pain, making early ECG and troponin testing essential.

A 91-year-old man with end-stage heart failure, advanced dementia, and a recent hip fracture is consistently refusing all interventions and appears to be in his final days. His family requests aggressive treatment. Which approach best reflects best practice in Australian geriatric and palliative care?

Answer: Prioritise comfort-focused care aligned with the patient's expressed wishes and explain this sensitively to the family

Person-centred geriatric and palliative care prioritises the patient's expressed goals and values; where a patient is refusing intervention and approaching end of life, comfort-focused care is appropriate, with compassionate family communication and support.