Geriatrics – KFP public report review 2016-2024 topics in exam

Geriatrics – Diabetes and Cognitive Impairment

1. Aged Care with Hypoglycaemia and Long-Term Cognitive Impairment

• Key Areas:
  • Identifying hypoglycaemia secondary to sulfonylurea use and urgent management
  • Appropriate initial investigation of long-term cognitive impairment
• Common Errors:
  • Not recognizing hypoglycaemia as the most likely diagnosis
  • Providing vague answers without effective medical management
  • Recommending investigations that had already been performed or were not indicated by current guidelines

2. Cognitive Decline in Elderly

• Key Topics:
  • Identification and management of cognitive decline in elderly patients
• Candidate Performance:
  • Misdiagnosis and inappropriate management plans
• Improvement Areas:
  • Accurate diagnosis of cognitive disorders and development of comprehensive management plans

3. Dementia Management

• Insight:
  • Differential diagnosis of memory difficulties is essential, with a focus on dementia and mood disorders
  • Non-pharmacological management in dementia care is pivotal
• Strengths:
  • Accurate identification of differential diagnoses and initial investigations
• Improvements:
  • Avoid over-reliance on pharmacological interventions for behavioral and psychological symptoms in dementia

Geriatrics – Falls and Mobility

1. Falls and Gait Disorders

• Key Topics:
  • Identifying the underlying cause for changes in gait and increasing falls
  • Investigating appropriate further investigations based on the patient’s medical and medication history
  • Pharmacological Management: Optimizing medication management to address falls and gait issues
  • Non-Pharmacological Interventions: Providing specific and detailed non-pharmacological interventions
  • Making appropriate referrals with clear details relevant to the patient’s presenting problem
• Common Errors in Responses:
  • Failing to optimize or correctly adjust medications
  • Providing treatment contraindicated by the scenario
  • Giving non-specific answers regarding referrals
  • Not addressing the presenting problem adequately with non-pharmacological interventions

2. Management of an Elderly Patient Following a Fall

• Key Topics:
  • Wound Care: Initial management of a large skin tear
  • Appropriate subsequent dressings for an elderly patient
  • Ongoing wound care advice for the patient
• Common Errors in Responses:
  • Failure to identify the correct subsequent dressing for the skin tear
  • Not providing appropriate advice for ongoing wound care
  • Providing only the initial wound management but neglecting the follow-up care instructions

3. Delirium and Falls

• Medical Heading: Geriatrics, focusing on the management of delirium and fall prevention
• Candidates Did Well On:
  • Identifying possible causes for acute confusion and behavior change
• Improvement Areas:
  • Demonstrating a holistic approach to falls risk management, avoiding overemphasis on single aspects like fracture minimization

Geriatrics – Polypharmacy and Medication Management

1. Polypharmacy

• Key Topics:
  • Reviewing and optimizing the patient’s medication regimen
  • Identifying and adjusting relevant medications for better health outcomes
• Improvement Areas:
  • Rationalizing drug therapy in the elderly and addressing patient concerns regarding medication changes

2. Pain Management and Polypharmacy

• Medical Heading: Geriatrics, addressing pain management and polypharmacy in an elderly nursing home resident
• Candidates Did Well On:
  • Applying knowledge to the case specifics and comorbidities
• Improvement Areas:
  • Focusing on reducing polypharmacy according to evidence-based guidelines and specific analgesia options for palliative care

Geriatrics – Acute and Chronic Conditions

1. Pre-Colonoscopy Management

• Key Topics:
  • Adjusting medications prior to the colonoscopy procedure
  • Ensuring safe medication management around the time of the colonoscopy

2. Behavioral Change in an Elderly Man

• Key Topics Discussed:
  • Differential diagnoses
  • Initial investigations
  • Pharmacological management
• Candidate Performance:
  • Non-specific diagnoses and irrelevant management actions
• Improvement Areas:
  • Specific and relevant management actions based on a comprehensive understanding of geriatric psychiatry

3. Annual Health Assessment in an Elderly Female

• Key Topics Discussed:
  • Causes of abnormal results
  • Further investigations
  • Immediate management
• Candidate Performance:
  • Non-specific responses to abnormal results
• Improvement Areas:
  • Directly address abnormal findings with appropriate investigations and management, tailored to the elderly patient’s context

4. Tiredness and Back Pain in an Elderly Male

• Key Topics Discussed:
  • Diagnosis
  • Appropriate investigations
  • Handling inquiries from family
• Candidate Performance:
  • Lack of holistic approach and patient confidentiality considerations
• Improvement Areas:
  • Comprehensive diagnostic approach, respecting patient confidentiality while engaging with family

5. Cognitive Decline and Stiffness

• Key Topics Discussed:
  • Differential diagnosis for cognitive changes
  • Initial investigations
  • Non-pharmacological management for behavior changes
• Candidate Performance:
  • Inadequate specificity in pharmacological management not tailored to the case
• Improvement Areas:
  • Focus on specific non-pharmacological interventions for cognitive and behavioral symptoms, guided by differential diagnosis

6. Proactive Health Care in an Older Man

• Key Topics Discussed:
  • Pharmacological management based on past medical history and blood investigations
  • Handling request for a medical certificate
• Candidate Performance:
  • Reiteration of previous pharmacological options and misalignment with key case features
• Improvement Areas:
  • Tailor pharmacological management to patient’s history and current clinical presentation

7. Delirium and Scabies in Elderly

• Key Topics:
  • Management of delirium
  • Outbreak control of scabies in residential facilities
• Candidate Performance:
  • Challenges in pharmacological management of scabies and delirium
• Improvement Areas:
  • Comprehensive approach to delirium management
  • Pharmacological treatment of scabies
  • Implementation of public health measures in care facilities

Geriatrics – Legal and Ethical Considerations

1. Driving Licence Medical for an Elderly Man

• Medical Heading: Legal Medicine
• Key Topics:
  • Fitness to drive assessments
  • Understanding of legal and occupational requirements
  • Management following fitness to drive assessment
• Candidate Performance:
  • Generic examination responses and lack of specificity in managing fitness to drive outcomes
• Improvement Areas:
  • Familiarize with ‘fitness to drive’ criteria
  • Develop comprehensive management plans that include legal and ethical considerations post-assessment

Geriatrics – Comprehensive Care

1. Management of a Patient Reporting Sexual Assault

• Key Topics Discussed:
  • History taking for diagnosis determination
  • Immediate holistic management considering the assault
• Candidate Performance:
  • Overlooking provided case information
  • Failing to consider the patient holistically
• Improvement Areas:
  • Sensitive, comprehensive approach to history taking and immediate management in cases of sexual assault
  • Considering both physical and psychological aspects