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MRCP PART 1 · GERIATRIC MEDICINE

Geriatric medicine questions
for MRCP Part 1.

Clinora has 192 geriatric medicine single best answer questions covering 191 topics. Every question explains all five options, separates the key clue from what it means and what to do next, and links to its source. Try the 5 sample questions below, then practise more for free.

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FREE SAMPLE QUESTIONS

Try 5 geriatric medicine questions

Choose your answer, then open the explanation.

Question 1Recurrent fallsMedium

A 79-year-old reports two falls in the past year. On one occasion she could not get up without help. She has no acute injury. What is the most appropriate next step?

  1. AOffer a comprehensive falls assessment and management
  2. BUse a numerical falls-risk score only
  3. CProvide general exercise advice without assessment
  4. DArrange brain MRI
  5. EReassure because neither fall caused injury
Show answer and explanation

Answer: A Offer a comprehensive falls assessment and management

Two falls in a year and a 'long lie' (being unable to get up without help) mark her as high risk. These features should trigger a multifactorial falls assessment and individual plan rather than generic advice. NICE NG249 also advises against using falls-risk prediction tools to decide who gets assessed, because their predictive accuracy is poor. The assessment typically covers falls history and circumstances, gait, balance and muscle strength, medication review (especially sedatives, antihypertensives and anticholinergics), postural blood pressure, vision, cognition, continence, foot problems, fear of falling, and home hazards. It also includes osteoporosis risk, because fracture is the main harm from falling. Interventions follow from what is found: strength and balance training, medication changes, home hazard modification and treatment of specific causes. A long lie also signals the need to teach her how to get up from the floor and to consider a personal alarm.

Key clue
Two falls and inability to rise
What it means
High-risk falls history
What to do
Comprehensive falls assessment and management

Why the other options are less appropriate

  • B NICE advises against using falls-risk scores to predict falls or decide management; their accuracy is too poor to rely on.
  • C Generic exercise advice skips the assessment that finds her own modifiable causes, such as medicines, postural hypotension or vision.
  • D Brain imaging is for focal neurological signs or a head injury with specific indications. It is not a routine part of falls assessment.
  • E The absence of injury so far does not lower her risk. A long lie is itself a marker of high risk and possible harm.

Source: NICE NG249 Falls: assessment and prevention

Question 2Postural hypotensionMedium

An 81-year-old becomes light-headed after standing. Blood pressure is 148/76 mmHg supine and 116/64 mmHg after standing for 3 minutes. Which finding most directly explains the symptom?

  1. AIsolated systolic hypertension
  2. BWhite-coat hypertension
  3. COrthostatic hypotension
  4. DNormal age-related variation
  5. EHypertensive emergency
Show answer and explanation

Answer: C Orthostatic hypotension

Light-headedness on standing, with systolic pressure falling from 148 to 116 mmHg (32 mmHg) and diastolic from 76 to 64 mmHg (12 mmHg), is orthostatic hypotension. The usual definition is a sustained fall of at least 20 mmHg systolic or 10 mmHg diastolic within 3 minutes of standing. Both thresholds are met here. On standing, blood pools in the legs and the baroreflex should raise heart rate and vascular tone. In older people this reflex is blunted, and drugs, dehydration and autonomic failure make it worse. Common causes are antihypertensives, diuretics, alpha-blockers, nitrates, levodopa and antidepressants, plus volume depletion and autonomic neuropathy from diabetes or Parkinson's disease. NICE NG249 includes measuring lying and standing blood pressure as part of the multifactorial falls assessment. Supine hypertension often coexists and makes treatment harder. Management starts with a medication review, adequate fluid intake, rising slowly and compression stockings. Midodrine or fludrocortisone may be considered by a specialist if symptoms persist.

Key clue
Symptoms on standing with marked BP fall
What it means
Postural cerebral hypoperfusion
What to do
Orthostatic hypotension

Why the other options are less appropriate

  • A The supine pressure is mildly raised, but supine hypertension does not cause dizziness on standing. The postural fall does.
  • B White-coat hypertension is a raised clinic reading. It does not cause a reproducible fall on standing or postural symptoms.
  • D A fall of this size with symptoms is not normal ageing. It is a treatable cause of falls.
  • E There is no severe hypertension or acute organ damage. The problem is low pressure on standing.

Source: NICE NG249 Falls: assessment and prevention

Question 3Syncope after a fallMedium

A 77-year-old is found on the floor and recalls sudden loss of consciousness while standing, without tripping. Examination is now normal. What is the best interpretation?

  1. AProbable syncope requiring blackout assessment
  2. BA mechanical fall requiring no further assessment
  3. COrthostatic hypotension, needing only lying and standing blood pressure
  4. DDefinite epilepsy
  5. EVasovagal syncope, so no ECG is needed
Show answer and explanation

Answer: A Probable syncope requiring blackout assessment

The key clue is that the patient lost consciousness suddenly while standing, without tripping. That makes this a blackout that ended in a fall, not a mechanical fall. NICE NG249 says that when a fall involved, or may have involved, loss of consciousness, the person should be assessed under the transient loss of consciousness guidance (NICE CG109). That assessment starts with a detailed account from the patient and any witness, a full examination, lying and standing blood pressure, and a 12-lead ECG. Orthostatic hypotension is a fall in systolic pressure of at least 20 mmHg, or in diastolic pressure of at least 10 mmHg, within 3 minutes of standing. CG109 lists features that need specialist cardiovascular assessment within 24 hours. These include an abnormal ECG, heart failure, a blackout during exertion, a family history of sudden cardiac death under 40, new breathlessness, a heart murmur, and a blackout without warning symptoms in someone over 65. A sudden blackout at 77 meets that last criterion, so arrhythmia must be excluded. Remember the DVLA driving rules.

Key clue
Sudden loss of consciousness without trip
What it means
Possible syncope
What to do
Initiate blackout/syncope assessment

Why the other options are less appropriate

  • B Nothing in the history suggests a trip or slip. Calling this a mechanical fall would miss a possible cardiac cause.
  • C Orthostatic hypotension is possible, but a sudden blackout without warning at 77 also needs an ECG and cardiac assessment.
  • D There are no features of a seizure, such as a prolonged post-ictal state or tongue biting. Epilepsy cannot be diagnosed from this history.
  • E Nothing suggests a vasovagal trigger or warning symptoms, and every blackout needs a 12-lead ECG.

Source: NICE NG249 Falls: assessment and prevention

Question 4Delirium assessmentEasy

A ward clinician notices new fluctuating confusion in a non-ICU inpatient. Which tool does NICE recommend for assessment?

  1. AMMSE
  2. BMoCA only
  3. CCAM-ICU
  4. DGCS alone
  5. E4AT
Show answer and explanation

Answer: E 4AT

New, fluctuating confusion in a hospital inpatient should be assessed for delirium. NICE CG103, updated in 2023, recommends the 4AT for assessing suspected delirium outside critical care and recovery settings. In critical care or the recovery room, it recommends CAM-ICU. The 4AT takes about 2 minutes, needs no special training, and can be used in people who are drowsy or cannot complete full testing. It has four items: alertness; the AMT4 (age, date of birth, place and current year); attention, tested by saying the months of the year backwards; and acute change or a fluctuating course. A score of 4 or more suggests possible delirium. A score of 1–3 suggests possible cognitive impairment, which needs further assessment. Diagnosis should then be confirmed by a healthcare professional trained and competent in diagnosing delirium. Look for and treat causes such as infection, drugs (especially anticholinergics, opioids and sedatives), dehydration, pain, urinary retention, constipation, hypoxia and metabolic upset. Use antipsychotics only for distress or risk when other measures fail.

Key clue
New fluctuating confusion on a ward
What it means
Delirium indicators present
What to do
Assess using 4AT

Why the other options are less appropriate

  • A The MMSE tests cognition over a longer period. It is not designed for acute delirium and is not the NICE-recommended tool.
  • B MoCA screens for cognitive impairment. It does not capture acute onset or fluctuation and is not recommended for delirium.
  • C CAM-ICU is for critical care and recovery settings, including people who cannot speak. NICE recommends the 4AT on general wards.
  • D GCS measures conscious level only. It does not test attention or acute change, which are key to delirium.

Source: NICE CG103 Delirium: prevention, diagnosis and management

Question 5Vascular dementia pharmacotherapyHard

A 79-year-old has vascular dementia after several strokes. Specialist assessment finds no evidence of comorbid Alzheimer's disease, Parkinson's disease dementia or dementia with Lewy bodies. Which statement about cognitive-enhancing medicines is most accurate?

  1. AOffer donepezil routinely to every person with vascular dementia
  2. BDo not offer an acetylcholinesterase inhibitor or memantine solely for vascular dementia
  3. COffer memantine routinely because stroke history predicts response
  4. DCombine rivastigmine and memantine from diagnosis
  5. EUse galantamine only when vascular risk is uncontrolled
Show answer and explanation

Answer: B Do not offer an acetylcholinesterase inhibitor or memantine solely for vascular dementia

Pure vascular dementia, without features of Alzheimer's disease, Parkinson's disease dementia or dementia with Lewy bodies, is not an indication for cognitive-enhancing drugs. Trials of acetylcholinesterase inhibitors and memantine in vascular dementia showed only small effects on cognition, of uncertain clinical value, with adverse effects. NICE NG97 therefore advises considering donepezil, galantamine, rivastigmine or memantine in vascular dementia only if comorbid Alzheimer's disease, Parkinson's disease dementia or dementia with Lewy bodies is suspected. Mixed dementia is common in older people, so specialist assessment of features and imaging matters. Management centres on secondary prevention of stroke and vascular disease: antiplatelet or anticoagulant therapy as indicated, blood pressure control, statins, diabetes care and stopping smoking. Offer group cognitive stimulation therapy for mild to moderate dementia. Review medicines that worsen cognition, especially those with a high anticholinergic burden. Support carers and plan future care early.

Key clue
Vascular dementia without comorbid neurodegenerative dementia
What it means
The NICE exception for cognitive enhancers is absent
What to do
Do not offer them solely for vascular dementia

Why the other options are less appropriate

  • A Donepezil is not recommended for vascular dementia alone. NICE advises considering it only with suspected comorbid Alzheimer's, Parkinson's or Lewy body dementia.
  • C A history of stroke does not predict response to memantine. Memantine is not recommended for pure vascular dementia.
  • D Combination treatment from diagnosis is not supported, and neither drug is indicated for pure vascular dementia.
  • E Galantamine is not chosen according to vascular risk control. Vascular risk factors should be treated directly.

Source: NICE NG97 Dementia: assessment, management and support

That is 5 of 192. Carry on with geriatric medicine in the practice bank, with progress tracking, flashcards and timed sessions.

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Topics covered

Show all 191 geriatric medicine topics
  • A normal brief memory score
  • Acute change on chronic decline
  • Acute dysphagic stroke
  • Acute stroke swallowing
  • Advance care planning capacity
  • Age-related hearing loss
  • Agitation in dementia
  • Alzheimer treatment continuation
  • Anticholinergic burden
  • Anticholinergic confusion and retention
  • Antipsychotic sensitivity
  • Antipsychotics in dementia
  • Asymmetric sensorineural hearing loss
  • Asymptomatic bacteriuria
  • Atrial fibrillation and recurrent falls
  • Atypical infection presentation
  • Best-interests decisions
  • Bladder-scan preference
  • Bone health
  • Borderline fracture risk
  • Capacity
  • Capacity assessment
  • Capacity principles
  • Care coordination
  • Carer breakdown
  • Carotid sinus syncope
  • Carotid sinus syndrome
  • Cataract-related falls risk
  • Category 1 pressure ulcer
  • Choosing among AChE inhibitors
  • Chronic subdural haematoma
  • Clinical Frailty Scale timing
  • Cognition
  • Cognition medicines in multiple sclerosis
  • Cognitive assessment with sensory and language barriers
  • Cognitive stimulation
  • Combination treatment
  • Comprehensive assessment
  • Comprehensive geriatric assessment
  • Constipation delirium trigger
  • Continence
  • Covert medication in a care home
  • Critical-care assessment
  • De-intensification after severe hypoglycaemia
  • Delirium
  • Delirium assessment
  • Delirium prevention
  • Delirium screening attention
  • Delirium treatment
  • Delirium versus dementia
  • Dementia and driving
  • Dementia assessment
  • Dementia with Lewy bodies
  • Dementia with Lewy bodies and antipsychotics
  • Deprescribing
  • Digoxin toxicity
  • Discharge safety
  • Distress in dementia
  • Donepezil-associated conduction disease
  • Dopamine agonist adverse effects
  • Driving and dementia
  • DXA sequencing
  • Dysphagia and medicines
  • Elder abuse response
  • Enteral feeding in severe dementia
  • Environmental prevention
  • Equivalent care for comorbidity in dementia
  • Falls
  • Falls are not just a gait problem
  • Falls intervention
  • Falls medication review
  • Falls risk tools
  • Financial abuse
  • Five-chair-stand assessment
  • Fracture risk over age 80
  • Fracture-risk assessment by age
  • Fracture-risk tools
  • Frailty
  • Frailty identification in outpatients
  • Frailty phenotype
  • Frontotemporal dementia pharmacotherapy
  • Functional decline
  • Functional incontinence
  • Gait apraxia localisation
  • Goal-directed functional rehabilitation in dementia
  • Haloperidol safety
  • Hearing impairment
  • Hidden medication contribution
  • High treatment burden
  • Hip fracture rehabilitation
  • Hip-fracture analgesia
  • Hip-fracture nerve block
  • Hip-fracture surgery timing
  • Home hazard intervention
  • Hospital admission in severe dementia
  • Hypernatraemia
  • Hypertension with postural symptoms
  • Hypoactive delirium
  • Hypodermoclysis
  • Incontinence-associated dermatitis
  • Independence and home care
  • Individualised goals
  • Levothyroxine overtreatment
  • Lewy body dementia treatment
  • Lewy-body dementia and acute behavioural disturbance
  • Male lower urinary tract symptoms
  • Malnutrition screening
  • Medication safety
  • Medication-related falls
  • Mild cognitive impairment
  • Mixed motor subtype
  • Motoric cognitive risk syndrome
  • Multidisciplinary geriatric assessment
  • Nocturnal polyuria
  • Normal-pressure hydrocephalus
  • Normal-pressure hydrocephalus triad
  • NSAID-related harm
  • Nutrition
  • Occult hip fracture imaging
  • Oral nutrition support
  • Oral-health assessment on admission
  • Oropharyngeal dysphagia
  • Orthostatic hypotension definition
  • Osteoporotic hip fracture
  • Overflow diarrhoea from faecal impaction
  • Overflow incontinence
  • Oxybutynin safety
  • Pain assessment in advanced dementia
  • Paratonia
  • Parkinson disease hallucinations
  • Parkinson first-line therapy
  • Parkinson hallucinations
  • Parkinson medicine timing
  • Parkinson's disease dementia
  • Pneumococcal vaccination
  • Polypharmacy
  • Polypharmacy and competing goals
  • Polypharmacy review
  • Possible elder abuse
  • Possible vascular dementia
  • Post-void residual assessment
  • Postoperative weight bearing
  • Postprandial hypotension
  • Postural hypotension
  • Prescribing cascade
  • Pressure injury staging safety
  • Pressure-ulcer nutrition
  • Pressure-ulcer prevention
  • Pressure-ulcer risk
  • Probable sarcopenia
  • Rapid cognitive deterioration
  • Reablement after acute functional decline
  • Recurrent falls
  • Refeeding management
  • Refeeding risk
  • Rehabilitation goals
  • Renal function and dosing
  • Retropulsion on the pull test
  • RSV vaccination
  • Safeguarding
  • Sarcopenia intervention
  • Sarcopenia management
  • Sarcopenic obesity
  • Self-neglect
  • Severe Alzheimer disease
  • Shingles vaccination in severe immunosuppression
  • Sleep disturbance in Alzheimer disease
  • Stopping an ineffective dementia antipsychotic
  • Stress incontinence
  • Structured medication review
  • Supporting capacity
  • Suspected abuse in a care home
  • Syncope after a fall
  • Therapeutic exercise after falls
  • Thiazide-associated hyponatraemia
  • Transdermal patch duplication
  • Transitions of care
  • Unexplained syncope after initial assessment
  • Unintentional weight-loss nutritional risk
  • Unstageable pressure ulcer
  • Urgency incontinence
  • Urinary retention
  • Urinary retention delirium trigger
  • Valproate for agitation in dementia
  • Vascular dementia pharmacotherapy
  • Vertigo within a falls review
  • Visual assessment after a dementia diagnosis
  • Vitamin B12 deficiency
  • Vitamin D and falls
  • When the cognitive diagnosis is uncertain
  • Withdrawal delirium

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