Free Specialty Certificate Examination in Geriatric Medicine Practice Questions

Sample Practice Questions

Try these 10 sample questions from the Specialty Certificate Examination in Geriatric Medicine practice bank. Each includes the answer and explanation. Continue with the interactive practice above to review the full question set.

1. 1A 78-year-old woman is starting injectable treatment for vitamin B12 deficiency unrelated to diet. Which cobalamin preparation is preferred for injections in UK practice because it remains in the body longer?

   1. A.Cyanocobalamin
   2. B.HydroxocobalaminCorrect answer: B
   3. C.Methylcobalamin
   4. D.Adenosylcobalamin

   Explanation: The NHS states, "For injections of vitamin B12 given in the UK, hydroxocobalamin is preferred to an alternative called cyanocobalamin." It explains, "This is because hydroxocobalamin stays in the body for longer." Hydroxocobalamin is therefore the appropriate injectable preparation; the other cobalamin forms are not the preferred UK injectable replacement specified here.

   Reference: NHS: Vitamin B12 or folate deficiency anaemia—treatment — Treating vitamin B12 deficiency anaemia, Not diet-related

2. 2Two older adults have similar illnesses and are the same age. One recovers promptly, whereas a minor infection causes disproportionate loss of function in the other because her physiological reserve is reduced. Which geriatric concept describes this vulnerability?

   1. A.Multimorbidity
   2. B.Disability
   3. C.FrailtyCorrect answer: C
   4. D.Chronological ageing

   Explanation: BGS defines frailty as "decreased physiological reserve, an increased vulnerability to stressors". This distinguishes frailty from simply having several diseases, an established functional limitation, or being a particular chronological age. Those features can overlap but are not the defining vulnerability described.

   Reference: BGS: Key messages—Frailty — 1. Frailty must be understood at every level of society

3. 3During rehabilitation planning, the team's disease-specific targets differ from an older patient's stated priorities for daily life. What should primarily determine the functional goals in the personalised care plan?

   1. A.The patient's meaningful daily-life prioritiesCorrect answer: A
   2. B.The service's standard discharge milestones
   3. C.The family's preferred level of performance
   4. D.The clinician's single-disease treatment targets

   Explanation: BGS states that effective plans require "goals that are based on the patient’s personal targets" linked to desired functional outcomes. Clinical targets, family views and service milestones inform discussion, but they do not replace the person’s own meaningful functional goals.

   Reference: BGS: Comprehensive Geriatric Assessment Toolkit — p. 22, Goal setting and action planning

4. 4An older adult in England no longer needs acute hospital care but requires a short period of help to recover daily-living skills and independence. Which service model best matches this need?

   1. A.Permanent residential care
   2. B.Intermediate care and reablementCorrect answer: B
   3. C.Long-term respite placement
   4. D.Specialist inpatient hospice care

   Explanation: The NHS states, "Intermediate care is short-term care that helps you recover and regain independence." The recovery-focused, time-limited need fits intermediate care. Permanent residential care, respite and hospice care have different purposes and are not selected solely because temporary functional support is required.

   Reference: NHS: Care to support recovery after leaving hospital — Introduction

5. 5An 86-year-old with previously stable memory develops inattention, disorientation and visual misperceptions over two days of acute illness. Alertness fluctuates markedly through the day. Which syndrome best explains this change?

   1. A.Alzheimer's dementia
   2. B.DeliriumCorrect answer: B
   3. C.Major depression
   4. D.Frontotemporal dementia

   Explanation: BGS describes delirium as "an acute confusional state, usually with a fluctuating course". The abrupt change and disturbed attention during acute illness distinguish delirium from a gradually progressive dementia or a depressive episode. Delirium can also occur on top of pre-existing dementia.

   Reference: BGS: Comprehensive Geriatric Assessment Toolkit — p. 37, Patients presenting with confusion and delirium

6. 6A 74-year-old woman leaks urine when coughing or lifting, without urgency. Which conservative treatment directly strengthens the muscular continence mechanism commonly weakened in stress incontinence?

   1. A.Timed bladder retraining
   2. B.Pelvic floor muscle trainingCorrect answer: B
   3. C.Intermittent catheterisation
   4. D.Urethral bulking injections

   Explanation: The NHS links stress incontinence to weakness of the pelvic floor and describes "pelvic floor exercises, where you strengthen your pelvic floor muscles by squeezing them". Training directly targets that weakness. Bladder retraining addresses storage habits, catheterisation empties the bladder, and bulking provides mechanical outlet support rather than muscle training.

   Reference: NHS: Urinary incontinence — Causes of urinary incontinence

7. 7A 78-year-old referred for elective colorectal surgery is undergoing preoperative frailty screening. The team is applying the CPOC/BGS perioperative frailty guideline. What is the minimum CFS score at which that guideline recommends comprehensive geriatric assessment and optimisation before surgery?

   1. A.CFS 3
   2. B.CFS 4
   3. C.CFS 5Correct answer: C
   4. D.CFS 7

   Explanation: The guideline states: "All patients living with frailty (CFS≥5) should undergo Comprehensive Geriatric Assessment and optimisation (CGA) prior to surgery, tailored to the time available." The threshold is therefore 5; higher scores also meet it, but are not the minimum.

   Reference: CPOC/BGS: Perioperative care for people living with frailty — Standards, standard 4, p. 9

8. 8A man with advanced lung cancer has persistent distressing breathlessness despite treatment of reversible causes and non-drug measures. Oxygen saturation is 97% on air. There is no bronchospasm, fluid overload, airway obstruction or prominent anxiety; renal function is preserved. Which medicine is appropriate for a carefully monitored low-dose therapeutic trial to relieve refractory breathlessness?

   1. A.Dexamethasone
   2. B.Furosemide
   3. C.MorphineCorrect answer: C
   4. D.Lorazepam

   Explanation: The Scottish guideline states that opioids "Can reduce breathlessness at rest, on exertion" and recommends: "Give as a therapeutic trial; monitor patient response and side effects." Low-dose morphine can therefore be trialled. The clinical findings do not support treatment for fluid overload, tumour-associated obstruction or prominent anxiety. Normal oxygen saturation does not create an indication for oxygen.

   Reference: Scottish Palliative Care Guidelines: Breathlessness — Pharmacological management — Opioids

9. 9An immobile older woman with light skin has persistent non-blanchable redness over the sacrum. The skin is intact, without blistering, tissue loss or purple discoloration. How should this pressure ulcer be categorised?

   1. A.Category 2
   2. B.Category 3
   3. C.Category 4
   4. D.Category 1Correct answer: D

   Explanation: The pressure-ulcer guideline describes Category/Stage I as: "Intact skin - In lighter skin tones, this presents as non-blanchable redness of a localised area usually over a bony prominence." Intact non-blanchable erythema fits Category 1. Categories 2–4 involve tissue loss of increasing depth.

   Reference: CPFT NHS: Prevention and management of pressure ulcers — Section 5, Category/Stage I, p. 7

10. 10A 76-year-old develops sudden unilateral weakness and dysphasia that resolve completely after 20 minutes. A TIA is suspected. She takes no antithrombotic medicine and has no bleeding disorder or aspirin contraindication. While arranging urgent specialist assessment, what aspirin dose should be given immediately?

    1. A.75 mg
    2. B.150 mg
    3. C.300 mgCorrect answer: C
    4. D.600 mg

    Explanation: The stroke guideline states that patients with suspected TIA "should be given aspirin 300 mg immediately unless contraindicated". Her fully resolved focal symptoms and absence of contraindications fit this recommendation. Assessment should also occur urgently within 24 hours; a lower maintenance dose is not the immediate loading dose asked for.

    Reference: National Clinical Guideline for Stroke for the UK and Ireland (2023) — Section 3.2, Recommendation A