Geriatric Medicine 🧓

A 78 year old man presents for a follow-up having had a urinary catheter inserted 2 weeks ago as a part of his long term management of urinary retention. He has no complaints and mentions that the flow of urine via the catheter is unimpeded. His vitals and systemic examination are within normal limits. A urine culture and sensitivity was done on the side of caution by a junior doctor at the end of the first week as he had mild pelvic discomfort which resolved a few hours later. The report indicates the growth of E.coli of >10 cfu/ml and demonstrates sensitivity to trimethoprim. Which of the following is the SINGLE best option to manage this patient?

A 77 year old woman has been discharged from the hospital following an episode of taking an overdose of her lithium tablets. Her daughter suspects that she took an overdose because she cannot remember when she last took her lithium tablet. She has a background of bipolar disorder and dementia. She lives alone and can manage her day to day task which includes cooking and cleaning. Her daughter stays down the road from where she lives and visits daily. Her daughter is afraid that she may take extra tablets as she often forgets if she had already taken her medications. What is the SINGLE most appropriate management?

A 65 year old woman presents to the GP clinic with her son. She has been confused since yesterday, and her son noticed that her disorientation fluctuates. Today, she was found talking to her friend who was not present and was referring to things in the room which did not exist. She has been feeling unwell for the past 2 days with a fever and productive cough. Her blood pressure is 110/76mmHg; heart rate is 120 beats/minute, and body temperature is 38.1°C. On assessment, she is disoriented to time and place and complained of feeling tired. Which of the following is the SINGLE most likely cause of her symptoms?

A 65 year old man is visited in the care home by the geriatric team. He takes tramadol for his knee pain. Over the past few weeks, he has been suffering from difficulty defecating. He defecates 2 to 3 times a day but with only small amounts of stool. His stool consistency is soft. He eats a healthy, balanced diet and drinks plenty of fluid. What is the most appropriate laxative to prescribe?

A 69 year old woman has had terrible experiences in the hospital. She has end-stage renal failure and her preferred place of death is at home. She lives with her husband. She has stated multiple times to health care professionals that she wishes to be at home during the last days of life and does not want to go to the hospital should she become ill. What legal document would be helpful to ensure her wishes are followed?

An 88 year old man in a nursing home becomes confused over the past two days. His confusion fluctuates during the day. He is disoriented and was found to be using another patient’s toilet the night before. He has no history of dementia. He has a background of prostate cancer which he does not receive any more active treatment. He is having to urinate more frequently for the past few days and at times he is incontinent. His last blood test which included HbA1c, renal profile, full blood count and liver function test was done a year ago which was unremarkable. What is the SINGLE most appropriate investigation?

A 92 year old woman was admitted and treated for a lower respiratory tract infection in the hospital for the past 5 days. She has recovered and is now medically fit for discharge. She normally lives with her son but he is opposed to the discharge decision because he does not think it is safe for her to return home as she is frail and not very mobile. She would like to go home as soon as possible. What is the SINGLE most appropriate action?

A 65 year old woman has been recently diagnosed with glioblastoma multiforme. She is compos mentis. She would like to appoint her niece as a person that can make decisions on her behalf should she become non-compos mentis. What legal document needs to be filled?