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