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Sample DGM(SA) Practice Questions
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1According to the Fried Frailty Phenotype, how many of the 5 core physical criteria (unintentional weight loss, exhaustion, low physical activity, slowness, and weakness) must be present to establish a diagnosis of frailty?
A.All 5 criteria
B.At least 1 criterion
C.At least 3 criteria
D.At least 2 criteria
Explanation: The Fried Frailty Phenotype defines frailty as the presence of 3 or more of the 5 criteria: (1) unintentional weight loss (>4.5 kg or >5% of body weight in the past year), (2) self-reported exhaustion, (3) weakness (reduced grip strength), (4) slow walking speed, and (5) low physical activity. The presence of 1 or 2 criteria indicates a 'pre-frail' state.
2An 82-year-old patient admitted to an acute medical ward is evaluated using the Clinical Frailty Scale (CFS). She requires assistance with all outside activities, heavy housework, and bathing, but manages light housework and eating independently. Which CFS category best describes her condition?
A.CFS 5 (Mildly Frail)
B.CFS 6 (Moderately Frail)
C.CFS 4 (Vulnerable)
D.CFS 7 (Severely Frail)
Explanation: CFS Level 6 (Moderately Frail) describes older adults who need help with all outside activities and keeping house, and often need help with stairs and bathing. CFS 5 (Mildly Frail) involves assistance with higher-level IADLs (finance, transportation, heavy housework) but independence in basic ADLs. CFS 7 (Severely Frail) reflects complete dependence for personal care (bathing, dressing, eating).
3Which of the following activities is classified as a basic Activity of Daily Living (ADL) on the Katz Index, rather than an Instrumental Activity of Daily Living (IADL) on the Lawton Scale?
A.Using a telephone
B.Managing personal finances
C.Preparing a meal
D.Transferring from bed to chair
Explanation: The Katz Index measures basic self-care ADLs essential for fundamental survival: bathing, dressing, toileting, transferring, continence, and feeding. Managing finances, telephone use, meal preparation, shopping, laundry, and medication management are Lawton Instrumental ADLs (IADLs), which measure independent community living capability.
4During a mobility assessment, an 78-year-old man completes the Timed Up and Go (TUG) test in 16 seconds. How should this result be clinically interpreted?
A.Normal mobility with low fall risk
B.Mild impairment with normal age-matched speed
C.Severe immobility requiring urgent bed-rest
D.Increased risk of falls requiring multifactorial fall evaluation
Explanation: A TUG test time of ≥12 to 15 seconds (commonly cutoff at ≥12s or ≥13.5s in community-dwelling older adults) indicates an increased risk of falls and warrants a comprehensive multifactorial fall risk evaluation. Times under 10 seconds represent normal mobility.
5An 84-year-old woman in a step-down facility completes the full Mini Nutritional Assessment (MNA). Her total score is 14 points out of a maximum 30 points. What is the correct nutritional status classification?
A.At risk of malnutrition
B.Malnourished
C.Normal nutritional status
D.Severe refeeding syndrome
Explanation: On the full MNA (30-point scale), scores of 24–30 indicate normal nutritional status, 17–23.5 indicate at risk of malnutrition, and scores <17 indicate malnutrition. A score of 14 points places the patient in the malnourished category, requiring individualized nutritional intervention.
6What score on the SARC-F questionnaire (range 0 to 10) is recommended as the cutoff to screen positive for sarcopenia?
A.Score of ≥4
B.Score of 10
C.Score of ≥7
D.Score of ≥1
Explanation: The SARC-F is a 5-item self-reported questionnaire assessing Strength, Assistance in walking, Rise from a chair, Climb stairs, and Falls (each scored 0–2). A score of ≥4 out of 10 indicates a positive screen for sarcopenia, prompting formal muscle strength and mass testing.
7Under the EWGSOP2 (European Working Group on Sarcopenia in Older People 2) 2019 consensus, what clinical finding confirms the diagnosis of sarcopenia after low muscle strength has been identified?
A.Elevated serum creatine kinase
B.High SARC-F questionnaire score
C.Low gait speed <0.8 m/s
D.Low muscle quantity or quality (measured by DXA or BIA)
Explanation: EWGSOP2 defines probable sarcopenia by low muscle strength (grip strength <27 kg for men, <16 kg for women, or chair stand >15s). The diagnosis is confirmed by demonstrating low muscle quantity or quality via Dual-Energy X-ray Absorptiometry (DXA) or Bioelectrical Impedance Analysis (BIA). Low physical performance (gait speed <0.8 m/s) categorizes sarcopenia as severe.
8What is the recommended daily dietary protein intake for frail older adults without severe chronic kidney disease to maintain muscle mass and prevent sarcopenia?
A.1.2 – 1.5 g/kg/day
B.0.6 – 0.8 g/kg/day
C.0.8 – 1.0 g/kg/day
D.2.0 – 2.5 g/kg/day
Explanation: Geriatric nutrition guidelines (PROT-AGE study group / ESPEN) recommend a dietary protein intake of 1.2 to 1.5 g/kg/day for frail older adults and those with acute or chronic inflammatory illness to overcome age-related anabolic resistance. The standard adult RDA of 0.8 g/kg/day is insufficient in frail elderly.
9An 80-year-old man admitted for pneumonia experiences a decline in his ability to dress and bathe independently at discharge despite clinical cure of his infection. What term describes this phenomenon?
A.Sarcopenic crisis
B.Post-intensive care psychosis
C.Iatrogenic delirium
D.Hospital-Associated Disability (HAD)
Explanation: Hospital-Associated Disability (HAD) refers to the loss of independence in one or more basic ADLs during acute hospitalisation, occurring in approximately 30% of older medical inpatients. It results from enforced bed rest, deconditioning, malnutrition, and environmental factors, independent of the primary admitting medical illness.
10Which of the following best outlines the four core dimensions assessed during a Comprehensive Geriatric Assessment (CGA)?
A.Pharmacological, Surgical, Radiological, Laboratory
B.Nutritional, Genetic, Metabolic, Immunological
C.Medical, Functional, Cognitive/Psychological, Socio-environmental
D.Cardiovascular, Respiratory, Renal, Neurological
Explanation: A Comprehensive Geriatric Assessment (CGA) is a multidimensional, multidisciplinary diagnostic process that evaluates: (1) Medical/physical health, (2) Functional capacity (ADLs/IADLs), (3) Cognitive and psychological well-being, and (4) Socio-environmental support and living conditions.
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