A 77 years old woman presents with generalized muscle pain and stiffness for several

hours, worse in the morning. Recently she has right sided headache which worse in the
morning. On examination, her blood pressure is 14/80, pulse is 80/ min, temperature is
37.3*C. her neurologic examination is normal. Her blood counts, urea and electrolytes
are within normal range except ESR is 86 mm in first hour.
What is most likely diagnosis

Giantcell Arteritis
Polyarteritis nodosa
Polymyalgia rheumatica
Multiple myeloma

Key: C

a 70 years old man presents with lower back and buttock pain which is gradually
increasing over the last 7 months, it is burning in character and partially relieved with
analgesics. Pain is so severe that he has to sit down in between while walking downhill
but relative relief while walking uphill and at rest. He has no bladder or bowel
dysfunction.

What is appropriate investigation for diagnosis

CT scan of thoraco-lumber spine

MR scan of thoraco-lumbar spine
Myelography of thoraco-lumbar spine
X ray of thoraco-lumbar spine

Key B

An 80 year old man presents with severe weight loss and anemia for three months. He
has past history of diet controlled diabetes mellitus and hypothyroidism well controlled
with thyroxin. He is cachectic with body mass index of 18.5 Kg/ m2. his hemoglobin is
102g/, TLC is 10 X 10*9/L, bilirubin 34 umol/ L and ALT is 85 u/L. chest x ray has
bilateral opacities. CT chest has bilateral homogenous opacities consisting with
metastatic malignancy.

What is predictor of poor prognosis in this patient

Anemia
Body mass index
Type 2 diabetes
Unknown primary tumor

Key: D

A 90 year old man presents with his 87 year old wife who is the primary caregiver, with
complaints of falls at home and diminished appetite. The physician adjusts the
antihypertensive medicines and he is scheduled for follow up after three months. After
three months he returns for follow up with history of falls two times in three months
duration and failure to thrive.

Which of the following is not consistent with the general principles of geriatric medicine?

Addressing the falls to prevent from other falls

Always placing the physician in charge of the geriatric assessment team because he is the
most qualified person
Arranging for the patient to see a social worker, a physical therapist and a home nurse
Monitoring results of dietary recommendations to assess improvement in intake

Key B

A 76 years old woman who is recovering from hip fracture is hospitalized at regional
hospital, where she is to undergo geriatric assessment.

Which of the following regarding geriatric assessment units is true?

Although geriatric assessment units improve quality of life, they do not affect the risk of
nursing home placement
Geriatric assessment units are more likely to be found in private settings because of their
ability to generate revenue
Shortage of trained geriatricians nationwide may prevent formation of formal geriatric
assessment units
The costs associated with geriatric assessment units are universally offset by decreasing
the institutional charges in the coming years

Key C