UKMLA Geriatrics & Frailty: High-Yield Revision Guide

Geriatrics is the sleeper specialty of UKMLA. Students assume the AKT will test cardiology, respiratory, and emergency medicine — and then one in six questions is about an 82-year-old with polypharmacy, a fall, an acute confusional state, or a complex capacity decision. The GMC content map lists frailty, delirium, falls, continence, end-of-life care, and comprehensive geriatric assessment (CGA) as discrete conditions, and the CPSA reliably tests ReSPECT conversations and Mental Capacity Act applications. Ignore this specialty and you will leave 10% of your exam on the table.

This guide is the UKMLA pillar for geriatrics and frailty. We cover CGA, the Rockwood Clinical Frailty Scale, falls assessment, delirium recognition with 4AT and CAM, reversible cognitive impairment, STOPP/START polypharmacy review, osteoporosis with FRAX-aligned pharmacological thresholds, infection patterns in the frail, end-of-life planning (advance decisions, ReSPECT, ceiling of care), Mental Capacity Act and DoLS intersection, iatrogenic harm, and continence — closing with the exam-technique principle that geriatric stems reward the conservative NICE-aligned answer almost every time.

Use this alongside our psychiatry high-yield guide for delirium–dementia differentiation, the prescribing safety guide for polypharmacy and anticholinergic burden, the consent, capacity and Mental Capacity Act guide for the legal framework, and NICE guidelines high-yield for the NG97 (dementia), NG249 (falls), CG103 (delirium) alignment the AKT expects.

1. Why Geriatrics Is a Sleeper Specialty in UKMLA

The GMC's 212 presentations and 430 conditions are explicitly age-broad, and frail elderly patients are over-represented in the vignettes for a reason: they test whether you can integrate rather than recall. A classic geriatrics SBA gives you a patient with atrial fibrillation (prescribe anticoagulation), mild cognitive impairment (consider capacity), osteoporotic fracture risk (bone protection), and a recent fall (STOPP-STOPP the bendroflumethiazide and oxybutynin) — four sub-questions disguised as one stem.

The test the examiner is really running is: can you de-prescribe as confidently as you prescribe? Can you recognise that a delirious 88-year-old who "suddenly developed dementia overnight" has a UTI and needs screening for constipation and medication review before a formal dementia diagnosis? Can you spot that the CT head for a fall might not be in this patient's best interests? Can you hold a ReSPECT conversation without defaulting to futile full CPR?

Three habits raise a candidate's geriatrics score quickly: (1) always screen for the iatrogenic cause first — falls, confusion, and constipation are usually drug-related until proven otherwise; (2) assess capacity on the specific decision in front of you, not globally; (3) default to NICE-aligned conservative management — exercise, reassessment, deprescription, family meeting — because the SBA "next best action" is usually a non-pharmacological intervention.

2. Comprehensive Geriatric Assessment (CGA)

CGA is the gold-standard multidisciplinary evaluation of older people with frailty. It improves outcomes (reduced mortality, improved function, increased likelihood of living at home 6 months on — NNT around 13 in systematic reviews).

The five domains (the UKMLA will ask you to name them):

1. Medical — diagnoses, medication review, nutrition, continence, pain, skin integrity.
2. Functional — ADLs (Barthel index: feeding, bathing, toileting, transfers, mobility, dressing, continence, grooming, stairs, bowels/bladder) and IADLs (shopping, cooking, managing finances, medications).
3. Cognitive and mental health — cognitive screen (4AT, 6-CIT, Mini-ACE), mood (PHQ-9, Geriatric Depression Scale), capacity where relevant.
4. Social — living situation, informal carers, social network, housing adequacy, financial security.
5. Environmental — home hazards, equipment, access, safety adaptations.

Who delivers it: consultant geriatrician, nurse specialist, OT, physiotherapist, social worker, pharmacist, SLT/dietician as needed. Often led by the OT in the community or geriatrician in secondary care.

When it is indicated: Clinical Frailty Scale ≥5, recurrent falls, post-discharge at home, post-hip-fracture, anyone facing a major medical/surgical decision where frailty changes the balance.

SBA trap: "Which intervention has the strongest evidence base for improving outcomes in frail inpatients?" — answer is comprehensive geriatric assessment, not a specific drug or test.

3. Frailty — Rockwood Clinical Frailty Scale

The Clinical Frailty Scale (CFS) is the NHS-standard tool. It is a clinical judgement rating after at least two weeks of stable observation (not measured acutely during delirium).

Why it matters in UKMLA:

• CFS ≥5 triggers comprehensive geriatric assessment (NHS England).
• CFS ≥6 is often the threshold for discussions about ceilings of care, ReSPECT, and avoiding potentially inappropriate ICU admission.
• CFS 7–9 means palliative-first approach; most acute hospitalisation or invasive intervention becomes less beneficial.

SBA trap: admitting a CFS 7 patient with pneumonia — choose oral antibiotics + symptom control + family meeting about ceiling of care, rather than escalation to HDU and NIV. The examiner wants to see proportionality.

Other tools: Fried phenotype (5 criteria — weight loss, exhaustion, low activity, slowness, weakness), PRISMA-7, electronic Frailty Index (primary care).

4. Falls — Multifactorial Assessment + NICE Guidance

Falls are the commonest cause of A&E attendance in the over-75s and a leading cause of NOF fractures. NICE NG249 (2025) is the current standard.

Multifactorial risk assessment (one fall in the past year in the community, or any fall in an inpatient, triggers assessment):

• Gait and balance (Timed Up and Go >15 seconds, 180° turn >4 steps)
• Cardiovascular (lying-standing BP — 20 mmHg systolic drop or 10 mmHg diastolic drop = postural hypotension)
• Vision
• Cognition (delirium, dementia)
• Continence (urge to void, rushing to toilet)
• Medications (STOPP-STOPP the culprits — see below)
• Home hazards (rugs, lighting, stairs, bathroom grab rails)
• Feet and footwear
• Bone health (FRAX + DEXA if at risk)

Medications that cause falls (classic SBA content):

• Antihypertensives (especially diuretics, α-blockers, combinations)
• Sedatives and hypnotics (benzodiazepines, Z-drugs — 5x fall risk)
• Antidepressants (tricyclics, SSRIs)
• Antipsychotics
• Opioids
• Anticholinergics (oxybutynin, amitriptyline)
• Hypoglycaemics (especially long-acting insulins, sulfonylureas)
• Antiarrhythmics (especially digoxin, β-blockers)

Interventions that work (evidence-based):

• Strength and balance exercise programmes (OTAGO, Falls Management Exercise) — reduce falls by ~20%.
• Home-hazard assessment and modification — especially for recurrent fallers.
• Medication review (STOPP/START) and deprescription.
• Vitamin D supplementation if deficient (not blanket — NICE is conservative).
• Cataract surgery — reduces falls by 30–40%.
• Pacemaker for cardioinhibitory carotid sinus syndrome.

UKMLA trap: the stem will list medications; scan for anticholinergic or sedating drugs and the right answer is usually "medication review" or "stop oxybutynin."

5. Delirium — 4AT, CAM, Management

Delirium is an acute disturbance of consciousness, attention, cognition, and perception. It is common (up to 50% of hospitalised over-65s), under-diagnosed, and associated with increased mortality, longer length of stay, and higher institutionalisation rates.

Subtypes:

• Hyperactive — agitation, wandering, hallucinations. Most recognised.
• Hypoactive — withdrawal, drowsiness, quiet. Most under-diagnosed; worse prognosis.
• Mixed — fluctuates between the two.

Diagnosis (NICE CG103):

• 4AT (preferred screening tool, <2 minutes):
  • Alertness (0 normal / 4 abnormal)
  • AMT4 (age, DOB, place, year — 0–2)
  • Attention (months backwards — 0–2)
  • Acute change or fluctuating course (0 or 4)
  • Total ≥4 = possible delirium.
• CAM (Confusion Assessment Method): acute onset + inattention plus either disorganised thinking OR altered consciousness.

Causes — "PINCH ME":

• Pain
• Infection (UTI, pneumonia, cellulitis, intracranial)
• Nutrition and hydration (constipation, dehydration)
• Constipation
• Hydration (overlapping)
• Medication (new, changed dose, withdrawal)
• Environment (ICU, moves, sensory deprivation)

Investigations: bloods (FBC, U&E, LFT, bone profile, glucose, TFTs, B12/folate, CRP), urinalysis, CXR, ECG, review medication list. CT head if trauma, focal neurology, or unexplained after initial workup.

Management:

• Treat the cause.
• Non-pharmacological first: orient the patient (clock, calendar, glasses, hearing aids), minimise moves, consistent staffing, mobilise, maintain sleep-wake cycle.
• Pharmacological only if severe agitation risking self/others and non-pharmacological has failed: haloperidol 0.5 mg oral or IM (NICE CG103). Avoid in Parkinson's/Lewy body (use lorazepam 0.5–1 mg). Review within 24 hours; do not continue routinely.
• Avoid: benzodiazepines in non-alcohol-related delirium (they can worsen), physical restraint, excessive sedation.

Prevention: target multicomponent interventions — orientation, hydration, mobility, sensory aids, sleep, pain control. Halves incidence in at-risk hospital patients.

UKMLA trap: a patient on long-term PD meds who becomes confused in hospital — the right antipsychotic is quetiapine or clozapine, never haloperidol (exacerbates parkinsonism). If urgent parenteral sedation is unavoidable, lorazepam.

6. Reversible Causes of Cognitive Impairment

Before any dementia diagnosis, exclude reversibles. The UKMLA will test this.

SBA trap: 78-year-old with cognitive decline, magnetic gait, and urinary incontinence → NPH → CT head → shunt. Don't diagnose "dementia."

7. Polypharmacy — STOPP/START Criteria

Polypharmacy (≥5 regular medicines) doubles the risk of adverse drug reactions. STOPP/START (Screening Tool of Older People's Prescriptions / Screening Tool to Alert to Right Treatment) is the UK-standard framework.

STOPP (stop these):

• Long-term benzodiazepines / Z-drugs (falls, delirium, dependence)
• Anticholinergics (oxybutynin, amitriptyline, promethazine) in cognitive impairment or constipation
• Duplicate drug classes (two β-blockers, two ACEi)
• NSAIDs in CKD stage ≥4, HF, or with anticoagulants
• Long-term PPI at full dose without clear ongoing indication
• Warfarin + aspirin without compelling indication
• Digoxin >125 micrograms daily in CKD (toxicity)
• Tricyclics in dementia, prostatism, glaucoma, arrhythmia
• First-generation antihistamines
• α-blockers in men with frequent postural hypotension

START (start these):

• Vitamin K antagonist or DOAC in AF (see cardiology guide)
• Statin in established atherosclerotic disease (CHD, stroke, PAD) if life expectancy >5 years
• Antiplatelet in symptomatic atherosclerotic disease
• ACE inhibitor in HF with reduced EF, post-MI
• β-blocker in stable HF
• Bisphosphonate + calcium/D in osteoporosis or after a fragility fracture
• Laxative in chronic opioid use
• L-dopa in established Parkinson's disease

Anticholinergic burden: Anticholinergic Cognitive Burden (ACB) scale — score ≥3 doubles risk of cognitive decline and falls. Top offenders: oxybutynin, solifenacin, amitriptyline, paroxetine, promethazine, cyclizine.

Medication review process:

1. List all drugs (prescribed, OTC, herbal).
2. Check indication, benefit vs risk, duplication.
3. Apply STOPP/START.
4. Involve pharmacist (community medication review or CPA).
5. Discuss with patient (shared decision-making, capacity).
6. Stop one drug at a time, monitor.

UKMLA trap: 84-year-old with recurrent falls on bendroflumethiazide (postural hypotension), oxybutynin (anticholinergic, confusion), diazepam (falls), simvastatin and aspirin — the NICE-aligned first action is medication review, not a head CT.

8. Osteoporosis — FRAX, Bisphosphonates, DEXA

Osteoporosis is reduced bone mass + microarchitectural deterioration → fragility fracture risk.

Definitions (WHO, DEXA-based):

• T-score ≥ −1: normal
• T-score −1 to −2.5: osteopenia
• T-score ≤ −2.5: osteoporosis
• T-score ≤ −2.5 + fragility fracture: severe osteoporosis

Risk assessment:

• FRAX — 10-year probability of hip/major osteoporotic fracture. Use in anyone age ≥65 (women) or ≥75 (men), or younger with risk factors (previous fragility fracture, parental hip fracture, long-term steroids, alcohol, smoking, BMI <19).
• QFracture — alternative UK tool (validated for ages 30–99, integrates more comorbidities).

Thresholds (NICE TA464 / NOGG 2021):

• FRAX 10-year major osteoporotic fracture risk ≥10% or hip fracture ≥3% → treat.
• Any fragility fracture in age ≥75 → treat without DEXA (start bisphosphonate).
• Age <75 with fragility fracture or high FRAX → DEXA then treat if T ≤ −2.5.

Management (NICE NG226):

• Lifestyle: weight-bearing exercise, balance training, smoking cessation, alcohol <14 units/week, vitamin D (calcium/D combined if dietary intake low).
• First-line pharmacological: oral alendronic acid 70 mg weekly (or risedronate 35 mg weekly). Once weekly on empty stomach, full glass of water, remain upright 30 minutes. Rare but examined ADRs: oesophagitis, atypical femoral fracture (subtrochanteric, thigh pain — stop drug), osteonecrosis of the jaw (dental assessment before; avoid extractions during).
• IV bisphosphonates: zoledronic acid 5 mg IV yearly (if oral intolerance, poor adherence).
• Denosumab 60 mg SC 6-monthly (second-line; rebound fracture risk on discontinuation — must continue or switch to bisphosphonate).
• Teriparatide / romosozumab for severe osteoporosis.
• HRT only if menopausal symptoms as primary indication (not first-line for osteoporosis).
• Review at 5 years (oral) or 3 years (IV) — consider drug holiday in low risk.

Post-NOF-fracture bundle: every hip fracture patient should leave hospital on vitamin D + calcium + bisphosphonate unless contraindicated.

9. UTIs and Pneumonia in the Frail

Both present atypically in the frail — missing the "classic" features and presenting instead as delirium, falls, or functional decline.

UTI:

• Diagnose UTI in the elderly only with new lower urinary symptoms (dysuria, frequency, urgency, suprapubic pain, haematuria, acute change in continence) + positive urinalysis.
• Do not diagnose UTI on dipstick alone without symptoms — asymptomatic bacteriuria is common in the elderly and catheterised and should not be treated.
• First-line: nitrofurantoin (avoid if eGFR <45) or trimethoprim (avoid in first trimester pregnancy, caution with renal impairment). Duration 3 days in women, 7 days in men and complicated UTI.
• Catheter-associated UTI: change catheter at diagnosis.

Pneumonia:

• See infectious diseases guide for CURB-65 and empirical antibiotics.
• In the frail: aspiration is a major differential (post-stroke, swallow impairment, reduced consciousness). SLT assessment, NBM if unsafe swallow, modified-consistency diet.
• Ceiling of care: choose oral over IV, ward-based rather than HDU, symptom-focused palliative care in CFS 7–9.

Classic trap — "asymptomatic bacteriuria":

• A nursing home resident is "sent in with a UTI" because the urine dipstick is positive and nitrite positive. They are not systemically unwell and have no new urinary symptoms — do not treat as UTI. Look for another cause of the presentation (drugs, dehydration, constipation, pain).

10. End-of-Life Care — Advance Decisions, ReSPECT

End-of-life planning is explicitly examined in the CPSA. Four UK-relevant concepts:

Advance Decision to Refuse Treatment (ADRT):

• Legally binding refusal of specific treatments in specified circumstances, if made while the patient had capacity.
• Must be in writing, signed, witnessed, and state that it applies "even if life is at risk" to refuse life-sustaining treatment.
• Cannot demand treatment; can only refuse.

Advance Statement:

• A statement of preferences (cultural, religious, personal care, preferred place of death). Not legally binding but guides clinicians and LPAs.

Lasting Power of Attorney (LPA):

• Two types: Property & Financial Affairs; Health & Welfare.
• Health & Welfare LPA can only consent or refuse treatment after the patient has lost capacity.
• An LPA for Health & Welfare cannot override an ADRT.

ReSPECT (Recommended Summary Plan for Emergency Care and Treatment):

• A UK-wide clinical record of shared decisions about emergency treatment preferences — not a legal document, but a communication tool between patient, family, and clinicians.
• Includes CPR preferences (DNACPR replaces), ceiling of care (ward vs HDU vs ITU), preferences for hospitalisation, and reasons.
• Revisited at each clinical contact and as the patient deteriorates.

CPR discussions:

• CPR is an active treatment with risks. It is not offered when it cannot work (clear clinical futility — advanced frailty, multi-organ failure, metastatic cancer in terminal phase).
• Under Tracey judgment: patients have a right to know if a DNACPR decision has been made; it should be discussed unless that would cause physical or psychological harm.
• A DNACPR does not mean "do not treat" — active management of reversible disease continues.
• ReSPECT conversations are a CPSA station — empathetic framing, exploring patient values, shared decision-making.

Symptom management in the last days of life (from NICE NG31 Care of dying adults):

• Pain: opioids (morphine/oxycodone SC infusion via syringe driver).
• Agitation: midazolam 2.5–5 mg SC PRN.
• Secretions: hyoscine butylbromide 20 mg SC PRN or glycopyrronium 200 micrograms SC PRN.
• Nausea: haloperidol 500 micrograms – 1.5 mg SC PRN.
• Dyspnoea: low-dose morphine + fan therapy.

SBA trap: a dying patient with an ADRT refusing CPR and invasive ventilation — the LPA cannot override that. Palliate symptoms.

11. Mental Capacity Act Intersection

Full treatment in the consent, capacity and Mental Capacity Act guide. Geriatric-specific reminders:

• Capacity is decision-specific and time-specific (understand, retain, weigh, communicate). Reassess every significant decision.
• Adults are presumed to have capacity unless proven otherwise.
• Incapacity requires: an impairment of/disturbance in the mind/brain (may be temporary — delirium counts) AND inability on one of the four limbs.
• If incapacitous: decide in best interests (MCA s.4). Consider past preferences, values, views of family/IMCA/LPA.
• Best-interest meetings for major decisions (starting/withdrawing life-sustaining treatment, major surgery, care home placement).
• Delirium does not automatically mean incapacitous for all decisions; reassess when the delirium clears.

12. DoLS Overview

Deprivation of Liberty Safeguards (DoLS) protect people who lack capacity and are deprived of their liberty in a hospital or care home.

When DoLS applies:

• Patient lacks capacity to consent to arrangements for care/treatment.
• The arrangements amount to a deprivation of liberty — the "acid test" (Cheshire West judgment): (1) under continuous supervision and control, AND (2) not free to leave.
• In a hospital or care home. (In other settings, an order from the Court of Protection is needed — "Liberty Protection Safeguards" expected to replace DoLS but not yet enacted as of 2026.)

Process:

• Best-interests assessor completes assessment.
• Standard authorisation valid up to 12 months.
• Urgent authorisation for up to 7 days while standard is being arranged.
• Representative appointed; right of review.

When DoLS is NOT needed:

• Patient has capacity to consent (even if distressed).
• Not deprived of liberty (e.g. can leave if they want to).
• Covered by Mental Health Act section.

UKMLA trap: a delirious patient trying to leave hospital who is being given sedation and kept in a side room is being deprived of liberty — they need a DoLS authorisation (or, if appropriate, Mental Health Act assessment).

13. Iatrogenic Harm — Prescribing Pitfalls

The geriatric de-prescribing list (complement to STOPP/START):

• Falls cocktail: diuretics + α-blockers + anticholinergics + hypnotics.
• Delirium cocktail: opioids + anticholinergics + benzodiazepines + steroids + new antibiotic.
• GI bleed cocktail: NSAID + aspirin + warfarin + SSRI (each doubles risk; combinations multiplicative).
• AKI cocktail: ACEi/ARB + NSAID + diuretic ("triple whammy") — stop NSAID and hold ACEi/diuretic in intercurrent illness ("sick day rules").
• Hyponatraemia cocktail: thiazide + SSRI + PPI + NSAID.
• Constipation cocktail: opioids + anticholinergics + iron + calcium without laxative cover.

Sick day rules (for the patient to know):

• Omit ACEi/ARB, diuretics, metformin, SGLT2i on days of D&V, dehydration, fever.
• Continue β-blockers, statins, insulin (with dose adjustment and monitoring).

14. Continence Assessment

Urinary incontinence is commonly under-assessed. Four types — mapped to management:

Stress: leak on cough, laugh, exertion. Management: pelvic floor exercises (first-line, 3 months), duloxetine if refractory, surgery (colposuspension, mid-urethral sling).

Urge (overactive bladder): sudden urgency, leak. Management: bladder training (first-line, 6 weeks), antimuscarinics (oxybutynin, tolterodine — but avoid oxybutynin in elderly due to anticholinergic burden; prefer solifenacin or trospium), mirabegron (β3 agonist, avoid in uncontrolled HTN), botulinum toxin A, sacral nerve stimulation.

Mixed: treat the predominant type first.

Overflow: neurological disease, BPH, diabetes. Investigate with bladder scan post-void, urodynamics. Management: catheterise, treat BPH with α-blocker + 5-ARI.

Functional: cognitive/mobility-related (can't get to toilet). Scheduled toileting, environment modifications, continence pads.

Faecal incontinence: assess for overflow from impaction (rectal exam, AXR), neurological disease, obstetric/surgical sphincter damage. First-line: bowel habit management, anti-diarrhoeals or laxatives as needed.

UKMLA trap: an elderly woman with new urge incontinence on oxybutynin and confusion → stop oxybutynin, reassess continence, consider solifenacin or mirabegron.

15. Exam Technique: Geriatric SBAs Reward Conservative Answers

The most reliable heuristic in geriatrics SBAs: prefer the conservative, NICE-aligned, non-pharmacological answer.

• Falls → medication review + exercise programme (not "CT head").
• Delirium → non-pharmacological measures + identify cause (not "start haloperidol").
• BPH in CFS 7 → symptom management (not "radical prostatectomy").
• CFS 8 with pneumonia → oral antibiotics + symptom control + ReSPECT review (not "HDU admission").
• New incontinence on oxybutynin → stop the drug (not "urodynamics").
• Asymptomatic bacteriuria in catheterised patient → do not treat (not "nitrofurantoin").
• End-of-life pain → SC opioid via syringe driver (not "IV paracetamol QDS in a cannulated dying patient").

Other rules of thumb:

• De-prescribe more than prescribe.
• Capacity is specific to the decision — don't generalise.
• Advance decisions bind; LPAs cannot override them.
• CFS guides ceilings of care and escalation decisions.

The UKMLA Geriatrics Pattern Library

Twelve stems worth owning:

1. 84 y/o, recurrent falls, on bendroflumethiazide and diazepam → medication review + strength & balance exercise.
2. 82 y/o post-op day 2 hip fracture, acutely confused → delirium → 4AT, treat cause (pain, constipation, hypoxia, UTI), non-pharm first.
3. CFS 7 with pneumonia → oral antibiotics + symptom control; ReSPECT review.
4. 78 y/o with magnetic gait + cognitive decline + incontinence → NPH → CT head → shunt.
5. Nursing home resident sent in "with UTI," dipstick +ve but no new symptoms → do not treat → look for another cause.
6. Post-NOF fracture in 80 y/o → discharge on vitamin D + calcium + alendronic acid.
7. 88 y/o with capacity, refusing amputation for ischaemic foot → document capacity assessment, support their decision.
8. Delirious patient trying to leave hospital; restrained chemically and physically → DoLS application.
9. PD patient with hospital delirium → lorazepam or quetiapine (NOT haloperidol).
10. End-of-life patient with an ADRT refusing CPR → respect; family cannot override.
11. New urge incontinence on oxybutynin + confusion → stop oxybutynin; switch to solifenacin or mirabegron.
12. FRAX hip 4% in 72 y/o with previous Colles' fracture → bone protection → oral alendronic acid + calcium/D.

Putting It All Together

Geriatrics rewards integration. The strongest geriatric answers are almost always the ones that (1) consider frailty before committing to invasive investigation or treatment, (2) screen for iatrogenic causes first, (3) use the Mental Capacity Act correctly on the specific decision, and (4) choose non-pharmacological management wherever it exists.

Pair this pillar with the psychiatry high-yield guide for delirium–dementia–depression differentiation, the prescribing safety guide for anticholinergic burden and STOPP/START in practice, the consent, capacity and Mental Capacity Act guide for the legal framework that underpins best-interest decisions and DoLS, and NICE guidelines high-yield for the NG97, NG249, NG226 alignment the AKT expects. The infectious diseases guide overlaps on atypical infection presentations in the frail.

If a geriatrics SBA is unclear, apply the two-question test: "what drug could be causing this?" and "would a non-pharmacological intervention fix it first?" In almost every UKMLA geriatrics stem, one of those two routes is the right answer. Ready to test yourself? Start with an MLA Prep geriatrics mini-mock and see which of the twelve patterns you close on first read.