AMC Clinical Geriatric Assessment 3

Question 1

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?

Accepted Answer

Oral bisphosphonates such as alendronate

Answer

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.

Question 2

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

Accepted Answer

Alzheimer's disease

Answer

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.

Question 3

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?

Accepted Answer

Dementia with Lewy bodies

Answer

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.

Question 4

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

Accepted Answer

Haloperidol

Answer

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.

Question 5

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

Accepted Answer

Psychotropic medications including benzodiazepines and antipsychotics

Answer

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.

AMC Clinical Practice Test

AMC Clinical Practice Test

AMC Clinical Geriatric Assessment 3