Cognitive Impairment, Delirium, and Falls in the Elderly — WACS Viva & Clinical Scenarios (Geriatric Medicine and Palliative Care)

Exam-style cognitive impairment, delirium, and falls in the elderly viva scenarios with examiner probes and model answers for Internal Medicine candidates.

Scenarios covered

• SCENARIO 1: A 78-year-old male with mild baseline cognitive impairment is admitted with worsening confusion, visual hallucinations, and marked psychomotor agitation over 48 hours following a change in oral analgesics. Outline the diagnostic algorithm to confirm delirium, your bedside assessment utilizing a validated instrument, and your stepwise management protocol.
• SCENARIO 2: A 74-year-old female presents with progressive memory loss, spatial disorientation, and difficulty managing finances over 18 months. Detail the clinical evaluation required to differentiate Alzheimer disease, Vascular Cognitive Impairment, and Dementia with Lewy Bodies, including neuroimaging and biomarker evaluation.
• SCENARIO 3: An 82-year-old male presents following recurrent falls over the past four months, associated with postprandial dizziness and magnetic gait. Discuss your systematic diagnostic approach to recurrent falls in this patient, detailing clinical balance and gait tests, hemodynamic autonomic testing, and secondary fracture prevention.
• SCENARIO 4: A 79-year-old female with moderate vascular dementia develops severe agitation, nocturnal wandering, and verbal aggression that causes distress to family caregivers. Detail your approach to the evaluation and management of Behavioral and Psychological Symptoms of Dementia (BPSD), highlighting non-pharmacological strategies and the safety profile of psychotropic medications.
• SCENARIO 5: A 76-year-old male presents with urinary urgency, frequent incontinence episodes, progressive cognitive decline, and unsteady gait. Explain how you would systematically differentiate transient causes of urinary incontinence using the DIAPPERS framework from established structural or neurodegenerative conditions, focusing on Normal Pressure Hydrocephalus.