Which of the following is/are true about the relationship between health expectancy and life expectancy?

• a)
  

  In the 19th century, health expectancy and life expectancy were similar.

  
  
• b)
  

  In the 20th century, life but not health expectancy increased.

  
  
• c)
  

  Changes in life expectancy in the 20th century were mainly due to non-communicable diseases.

  
  
• d)
  

  In the 21st century, health expectancy is increased over life expectancy.

  
  
• e)
  

  In the 21st century, life expectancy is increased significantly more than health expectancy.

Which of the following is/are true about primary and secondary preventive health strategies?

• a)
  

  Vaccination is a secondary prevention strategy.

  
  
• b)
  

  Colonoscopy is a primary prevention strategy.

  
  
• c)
  

  Mammography is a secondary prevention strategy.

  
  
• d)
  

  Hormone replacement therapy is a primary prevention strategy for osteoporosis.

  
  
• e)
  

  Smoking cessation is a primary prevention strategy for lung cancer

Which of the following has/have taken place since the publication of the results from the Women’s Health Initiative?

• a)
  

  Reduction in the use of hormone replacement therapy.

  
  
• b)
  

  Increase in osteoporosis.

  
  
• c)
  

  Decrease in cardiovascular disease in elderly women.

  
  
• d)
  

  Increase in breast cancer.

  
  
• e)
  

  Decrease in cerebro-vascular accidents.

Which of the following statements is/are true regarding loss of muscle mass with ageing?

• a)
  

  Loss of muscle mass progresses at 1% per year until the age of 60 years, at which point it increases to 2%.

  
  
• b)
  

  Loss of muscle mass progresses at around 1% from the age of 25 years and until death.

  
  
• c)
  

  Loss of muscle mass progresses at 0.5% per year from the ages of 30 to 80 years.

  
  
• d)
  

  Loss of muscle mass progresses at around 0.5% per year from the age of 30 years until the age of 50 years, at which point it accelerates to 1.0 to 1.4% per year.

  
  
• e)
  

  Loss of muscle mass progresses at 1.5% per year from the age of 30 years.

Which of the following statements is/are true about non-steroidal anti-inflammtory drugs (NSAIDs)?

• a)
  

  NSAIDs reinforce myo-anabolic responses in young and adolescent people.

  
  
• b)
  

  NSAIDs inhibit myo-anabolic responses in young and adolescent people.

  
  
• c)
  

  NSAIDs reinforce myo-anabolic responses in elderly people.

  
  
• d)
  

  NSAIDs inhibit myo-anabolic responses in elderly people.

  
  
• e)
  

  NSAIDs do not influence skeletal muscle anabolism in any age group.

Which of the following statements is/are true regarding steroid therapy?

• a)
  

  Oestrogen therapy is indicated for the prevention of sarcopaenia in men.

  
  
• b)
  

  Oestrogen therapy is indicated for the prevention of sarcopaenia in women.

  
  
• c)
  

  Androgen therapy is indicated for the prevention of sarcopaenia in men.

  
  
• d)
  

  Androgen therapy is indicated for the prevention of sarcopaenia in women.

  
  
• e)
  

  No drugs are indicated for prevention of sarcopaenia for men or women.

Which of the following is/are true about the initial presentation of women with ischaemic heart disease (IHD)?

• a)
  

  Women generally present about 10 years later than men.

  
  
• b)
  

  Women diagnosed with IHD carry a significantly smaller risk factor burden compared with men.

  
  
• c)
  

  Women are more likely than men to present with typical angina.

  
  
• d)
  

  Women with IHD are more likely to present with a clearly defined cardiac event, such as myocardial infarction.

  
  
• e)
  

  Diabetes has the strongest association as a risk factor with significant coronary artery disease (CAD) in women.

The following statement(s) is/are true about the process of diagnosing IHD in women?

• a)
  

  The exercise tolerance test (ETT) is contraindicated in the diagnosis of IHD in women.

  
  
• b)
  

  Stress echocardiography offers better diagnostic accuracy than the conventional electrocardiogram (ECG) ETT.

  
  
• c)
  

  Normal coronaries or non-significant coronary artery disease are as common in women as in men across all age groups of patients undergoing first-time elective angiography for investigation of chest pain.

  
  
• d)
  

  Symptomatic women with chest pain and normal coronary arteries on angiogram should be reassured of their benign nature of their symptoms by their clinician and do not require further diagnostic investigations or treatment.

  
  
• e)
  

  The current European Society of Cardiology and American Heart Association guidelines suggest coronary artery calcium (CAC) testing in women with an intermediate risk of IHD.

Which of the following question(s) is/are true about IHD and the menopause?

• a)
  

  Administration of hormone replacement therapy (HRT) to postmenopausal women that are more than 10 years into the menopause may prevent or slow down progression of CAD.

  
  
• b)
  

  Administration of HRT for even less than 6 months slows down progression of disease in women with established CAD.

  
  
• c)
  

  Oral HRT has an deleterious effect on both the coagulation and fibrinolytic system which may affect the development of IHD.

  
  
• d)
  

  The beneficial effects of oestrogen on lipid metabolism may have a positive effect in the pathogenesis and progression of atherosclerosis.

  
  
• e)
  

  It is recommended that all postmenopausal women should receive HRT to prevent development of CAD, irrespective of age at the menopause.

Which of the following is/are true about treatments for pelvic organ prolapse (POP) in elderly women:

• a)
  

  Pessaries should be used for treating severe prolapse in elderly women only.

  
  
• b)
  

  Pessaries are suitable for elderly women, as compliance with follow up is not a prerequisite for their use.

  
  
• c)
  

  Preoperative counselling is of paramount importance before colpocleisis.

  
  
• d)
  

  Colpocleisis is suitable for frail individuals.

  
  
• e)
  

  The use of surgical mesh for transvaginal repair of POP is safe with low complication rates.

People with a chronic indwelling catheter who have urinary tract infections (UTIs):

• a)
  

  May present with fever.

  
  
• b)
  

  May be associated with increased mortality in elderly people.

  
  
• c)
  

  May not always have a bacteriuric infection.

  
  
• d)
  

  May not always require their catheters to be replaced before starting treatment for UTI.

  
  
• e)
  

  Can use indwelling catheters for treatment of urinary incontinence if resident in nursing homes.

Which of the following is/are true about chronic constipation in elderly people?

• a)
  

  It is caused by faecal retention.

  
  
• b)
  

  Bowel function is affected by degenerative disease.

  
  
• c)
  

  Stimulant laxatives help in alleviating symptoms.

  
  
• d)
  

  High doses of polyethylene glycol can be used with no significant side-effects.

  
  
• e)
  

  Stool softeners are first-line treatment with high efficacy.

Which of the following is/are true about urinary incontinence in elderly people?

• a)
  

  Impaired mobility is a contributing factor.

  
  
• b)
  

  Hormone replacement therapy is associated with an increased incidence of incontinence.

  
  
• c)
  

  Urethral bulking injections have very limited indications for the treatment of stress incontinence.

  
  
• d)
  

  Mid-urethral slings (MUS) may be used to treat stress urinary incontinence (SUI) but can cause de-novo urgency.

  
  
• e)
  

  Mid-urethral slings (MUS) used to treat stress urinary incontinence (SUI) in the elderly have lower success rates compared to younger women.

Which of the following is/are true about the regulation of the blood glucose level in the human body?

• a)
  

  It is a hormonally regulated homeostatic mechanism.

  
  
• b)
  

  It is a negative feedback loop.

  
  
• c)
  

  The endocrine system controls digestive functions.

  
  
• d)
  

  Incretins stimulate insulin from the pancreas only when nutrients enter the intestines.

  
  
• e)
  

  Growth hormone has the effect of increasing serum glucose.

Glucose is the only form of fuel used by which of the following:

• a)
  

  The central nervous system.

  
  
• b)
  

  The skeletal muscle.

  
  
• c)
  

  Adipose tissue.

  
  
• d)
  

  The heart.

  
  
• e)
  

  Smooth muscle.

The following is/are true regarding incretins?

• a)
  

  They are produced from pancreatic beta cells.

  
  
• b)
  

  They are produced from intestinal mucosa.

  
  
• c)
  

  They result in insulin secretion only when nutrients are in the intestine.

  
  
• d)
  

  They stimulate insulin secretion in a fasting state.

  
  
• e)
  

  They can slow gastric emptying time.

Type 2 diabetes is associated with which of the following?

• a)
  

  Beta cell damage.

  
  
• b)
  

  Insulin resistance.

  
  
• c)
  

  Obesity.

  
  
• d)
  

  Hypertension.

  
  
• e)
  

  Metabolic syndrome.

In the menopause, which of the following structure(s) is/are negatively affected?

• a)
  

  Skin epidermis.

  
  
• b)
  

  Intervertebral discs.

  
  
• c)
  

  Arteries.

  
  
• d)
  

  Bone matrix.

  
  
• e)
  

  Urogenital organs.

Which of the following is/are true about the molecular biology of the skin?

• a)
  

  Activator Protein-1 (AP-1) triggers the expression of matrix metalloprotein (MMP) genes.

  
  
• b)
  

  The levels of MMP-1 and MMP-9 are higher in older skin compared with levels in young skin.

  
  
• c)
  

  MMPs increase the synthesis of collagenases and gelatinases.

  
  
• d)
  

  Gelatinases breakdown collagen.

  
  
• e)
  

  MMPs help disintegrate elastin fibres.

Which of the following is/are true about the micro-inflammatory model of ageing skin?

• a)
  

  Neuropeptides in the skin increase the synthesis of adhesion molecules.

  
  
• b)
  

  Adhesion molecules enable circulating monocytes and granulocytes to migrate into the dermis.

  
  
• c)
  

  Damaged skin cells are stimulated to release leukotrienes and prostaglandins.

  
  
• d)
  

  Mast cells induce the secretion of histamine and tumour necrosis factor alpha.

  
  
• e)
  

  Tumour necrosis factor alpha stimulates endothelial cells to produce intra-cellular adhesion molecule-1.

Which of the following about body-weight changes during a life time is/are true?

• a)
  

  Mean body weight and body-mass index (BMI) gradually increase and reach peak values around 50–59 years of age in men and women.

  
  
• b)
  

  Body-mass indexes (BMI) gradually increase and reach peak values around 50–59 years of age in men and women.

  
  
• c)
  

  The maximal fat-free mass is usually reached at around 40 years of age in men and women.

  
  
• d)
  

  BMI shows the strongest correlation to visceral adipose tissue irrespective of age, sex, and the degree of obesity.

  
  
• e)
  

  Being overweight and obese accounts for about two-thirds of cases of type 2 diabetes.

Further regarding obesity, which of the following is/are true?

• a)
  

  The total body fat-mass confers the greatest risk of developing diabetes type 2.

  
  
• b)
  

  Waist circumference is the most commonly used measure of abdominal obesity.

  
  
• c)
  

  Obesity has not been shown to affect the risk of cancer disease.

  
  
• d)
  

  In menopausal women, obesity confers a lower risk of osteoporosis.

  
  
• e)
  

  Sarcopenia is a state when increasing fat-mass causes a functional impairment of multiple organs.

Regarding physical fitness and physical activity and healthy ageing, which of the following is/are true?

• a)
  

  Although regular physical activity contributes to well-being and physical fitness, it does not affect mortality rates in the ageing population.

  
  
• b)
  

  Significant decreases in blood pressure, body fat and triglycerides have been shown in both groups of normotensive and pre-hypertensive adults.

  
  
• c)
  

  Pedometers are simple and inexpensive sensors to assess physical activity.

  
  
• d)
  

  Pedometer-determined physical activity for adults can be classified in four groups: <5000 steps/day (‘sedentary’); 5000–7499 steps/day (‘low active’); 7500–9999 steps/day (‘somewhat active’); and ≥10 000 steps/day (‘active’).

  
  
• e)
  

  Regular physical activity has also been shown to affect the mechanisms behind rheumatoid arthritis and multiple sclerosis and thereby reduce the effects of these diseases.

An 89-year-old woman is seen in the gynaecology clinic with a vaginal prolapse. She was last seen aged 64 years with urinary incontinence. She is otherwise well, has no co-morbid disease and does not take any medication. Which of the following physiological changes are likely to have occurred between consultations?

• a)
  

  10% increase in body water.

  
  
• b)
  

  15% reduction in liver mass.

  
  
• c)
  

  30% increase in body fat.

  
  
• d)
  

  Reduction of eGFR from 90 to 45 ml/min/1.73 m ² .

  
  
• e)
  

  Increased sensitivity of adrenergic receptors.

An 85-year-old woman is started on oxybutynin for urinary incontinence. Her co-morbidities include atrial fibrillation, type 2 diabetes mellitus, and mild vascular dementia. She is currently taking digoxin, warfarin, furosemide, metformin, ramipril and simvastatin. She has an eGFR of 62 ml/min/1.73 m ² . Which of the following statement(s) about commencing oxybutynin in this patient is/are true?

• a)
  

  The starting dose should be halved because of her eGFR.

  
  
• b)
  

  Oxybutynin is likely to exacerbate her cognitive dysfunction.

  
  
• c)
  

  Warfarin metabolism increases the risk of bleeding.

  
  
• d)
  

  She will be at increased risk of tachycardia and worsening arrhythmia.

  
  
• e)
  

  Side-effects of dry mouth and constipation are less common in elderly people.

A 94-year old woman has undergone a total abdominal hysterectomy and is being prescribed morphine as post-operative analgesia. Which of the following statements about prescribing morphine for this patient is/are true?

• a)
  

  Morphine is contraindicated in people aged over 85 years.

  
  
• b)
  

  Elderly people should not receive patient-controlled analgesia.

  
  
• c)
  

  Morphine dosing should ‘start low, go slow’.

  
  
• d)
  

  Hepatic but not renal impairment will necessitate dose reduction.

  
  
• e)
  

  Morphine increases the risk of post-operative delirium.

An 87-year-old woman is being considered for chemotherapy for ovarian cancer. She has hypertension, osteoarthritis and diabetes mellitus. She lives alone, does her own shopping and housework but her exercise tolerance is limited by knee pain. Her medications are ramipril, bendroflumethiazide, amlodipine, ibuprofen, codeine phosphate, lansoprazole, lactulose, senna, metformin, gliclazide, ferrous sulphate, simvastatin. On examination, her pulse is 64 beats/min, blood pressure 96/54 mmHg, and body mass index 28 kg/m ² . Her abbreviated mental test score is 29 out of 30. Full blood count and biochemical profile are normal. Which of the following statements about her treatment are true?

• a)
  

  The evidence base for treating ovarian cancer is less robust in people aged 80–95 years than in people aged 50–70 years.

  
  
• b)
  

  She is likely to experience more side-effects from anticancer treatment than younger people.

  
  
• c)
  

  None of her current medications can be stopped.

  
  
• d)
  

  Chemotherapy is contraindicated because of her multiple co-morbidities.

  
  
• e)
  

  Her frailty is likely to interfere with her ability to adhere to treatment.

The menopause is a normal physiological process occurring in ageing women. The decline of sex steroids, particularly oestrogen, during this period may be accompanied by changes in behaviour, mood, sexuality, memory, and cognitive function. Which of the following is/are true regarding steroidogenesis after the menopause?

• a)
  

  Androgens produced by the ovary and the adrenal gland make extra-gonadal oestrogen.

  
  
• b)
  

  The adrenal and thyroid glands make extra hormones.

  
  
• c)
  

  The ovary continues secreting some oestrogen.

  
  
• d)
  

  The ovary continues secreting some progesterone.

  
  
• e)
  

  Adipose tissue produces more androgen after the menopause.

Oestrogen is directly associated with Alzheimer’s disease. Which of the following is/are true in relation to this and the brain?

• a)
  

  Oestrogen is associated with regulation of the presence of insoluble amyloid beta.

  
  
• b)
  

  Oestrogen has shown to increase tau protein.

  
  
• c)
  

  Oestrogen induces inflammation in the brain.

  
  
• d)
  

  Oestrogen induces neuronal damage.

  
  
• e)
  

  Oestrogen has been shown to cause neurotransmitter imbalance.