Adult & Geriatric Medicine
Adult & Geriatric Medicine
This domain tests your ability to recognise and manage common adult medical conditions and age-related syndromes in West African practice, where multi-morbidity and late presentation are common. Expect questions on hypertension, diabetes, tuberculosis, HIV, and the geriatric giants.
Core rules and concepts
- Hypertension: Confirm with repeated readings; look for target-organ damage (LVH, retinopathy, proteinuria). First-line options include a thiazide-like diuretic, ACE inhibitor/ARB, or calcium-channel blocker. Avoid ACE inhibitors in bilateral renal artery stenosis and pregnancy.
- Diabetes: Diagnosis is fasting plasma glucose ≥7.0 mmol/L, 2-hour OGTT ≥11.1 mmol/L, or HbA1c ≥6.5%. HbA1c is unreliable in sickle cell disease/trait, pregnancy, and haemoglobinopathies-common in West Africa.
- Tuberculosis: Chronic cough >2 weeks, weight loss, night sweats. Sputum GeneXpert is preferred. Test all TB patients for HIV and vice versa.
- Geriatric syndromes: Falls, delirium, incontinence, and polypharmacy. Comprehensive geriatric assessment (CGA) is multidisciplinary and improves outcomes.
- Delirium vs dementia: Delirium is acute, fluctuating, with altered consciousness; dementia is chronic and progressive with preserved consciousness until late. Always look for reversible causes of delirium: infection, drugs, dehydration, constipation, urinary retention.
Worked example
A 72-year-old man with hypertension and type 2 diabetes becomes confused over 2 days after starting oxybutynin for urinary frequency. He is drowsy and disoriented. Reasoning: acute onset and fluctuating course suggest delirium, not dementia. Anticholinergic drugs are a common precipitant. Check capillary glucose, electrolytes, urinalysis, and review all medications. Treat the underlying cause; avoid antipsychotics unless agitation threatens safety.
Traps
- Labelling confusion as dementia without excluding delirium.
- Missing TB in older adults because fever may be absent.
- Using HbA1c to diagnose diabetes in sickle cell disease.
- Prescribing renally cleared drugs without dose adjustment.