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

Calcium and vitamin D supplementation alone

Answer

Hormone replacement therapy

Answer

Denosumab

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

Vascular dementia

Answer

Lewy body dementia

Answer

Frontotemporal dementia

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

Alzheimer's disease

Answer

Frontotemporal dementia

Answer

Vascular dementia

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

Rivastigmine

Answer

Quetiapine

Answer

Memantine

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

Antihypertensives

Answer

Statins

Answer

Proton pump inhibitors

Question 6

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?

Accepted Answer

Acute myocardial infarction presenting atypically

Answer

Urinary tract infection

Answer

Hypertensive urgency

Answer

Pulmonary embolism

Question 7

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?

Accepted Answer

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

Answer

Initiate full resuscitation as the family are the legal decision-makers

Answer

Transfer to ICU for medical optimisation before transitioning to palliation

Answer

Discharge to a residential aged care facility without further family discussion