Comprehensive Geriatric Assessment and Frailty Syndromes — WACS Viva & Clinical Scenarios (Geriatric Medicine and Palliative Care)

Exam-style comprehensive geriatric assessment and frailty syndromes viva scenarios with examiner probes and model answers for Internal Medicine candidates.

Scenarios covered

• SCENARIO 1: A 78-year-old male with a history of hypertension, osteoarthritis, and mild chronic kidney disease attends the medical outpatient clinic. Outline the key pharmacokinetic and pharmacodynamic changes associated with normal physiological ageing that alter drug distribution, metabolism, and excretion. Explain why normal serum creatinine levels may mask clinically significant renal impairment in this patient.
• SCENARIO 2: An 82-year-old female living alone is admitted to the medical ward following a mild urinary tract infection and is found to have rapid functional decline, poor oral intake, and reduced mobility. Detail the core clinical domains, specific validated assessment instruments, and interdisciplinary steps required to conduct a Comprehensive Geriatric Assessment (CGA) in this patient.
• SCENARIO 3: Differentiate between the Phenotypic Frailty Model (Fried criteria) and the Cumulative Deficit Model (Rockwood Clinical Frailty Scale). State the diagnostic criteria and algorithmic workflow for sarcopenia according to the European Working Group on Sarcopenia in Older People (EWGSOP2) consensus, including objective measurement tools and threshold cut-offs for physical performance and muscle strength.
• SCENARIO 4: An 80-year-old male presents with recurrent falls, constipation, and cognitive fluctuation. His current prescription list comprises diazepam 5 mg at night, amitriptyline 25 mg at night, digoxin 0.25 mg daily, glibenclamide 5 mg daily, and indomethacin 50 mg three times daily. Apply the STOPP/START and Beers criteria to identify potentially inappropriate medications, explain the pharmacological hazards of each drug in this patient, and formulate a structured deprescribing plan.
• SCENARIO 5: An 86-year-old bedbound woman in a residential care facility develops an ulcerated skin lesion over her sacrum. Describe the clinical staging classification of pressure ulcers, the clinical utility and parameter scoring of the Braden Risk Assessment Scale, and the systematic bedside management plan based on the TIME wound-bed preparation principles.