Medicine
Geriatrics & Psychiatry
Which nonpharmacologic intervention reduces delirium risk in hospitalized older adults?
A. Orientation, sleep promotion, mobility and sensory aids
B. Routine restraints
C. Nightly sedatives for all patients
D. Prolonged bed rest
Correct Answer: A
Multicomponent measures that support orientation, sleep, mobility, hydration and vision/hearing reduce delirium risk.
Medicine
Geriatrics & Psychiatry
A patient has recurrent unexpected panic attacks and persistent fear of another attack. What is the most likely diagnosis?
A. Panic disorder
B. Specific phobia only
C. Schizophrenia
D. Somatic symptom disorder
Correct Answer: A
Recurrent unexpected panic attacks followed by ongoing concern or behavioral change are characteristic of panic disorder.
Medicine
Geriatrics & Psychiatry
A patient with severe depression expresses a specific plan and intent to die. What is the immediate priority?
A. Ensure safety and urgent psychiatric assessment
B. Schedule routine follow-up in 6 months
C. Avoid asking about access to means
D. Provide sleeping pills only
Correct Answer: A
Specific suicidal intent and plan indicate high acute risk requiring immediate safety measures and urgent assessment.
Medicine
Geriatrics & Psychiatry
An older adult with recurrent falls, cognitive complaints and urinary incontinence has a broad-based magnetic gait. What condition should be considered?
A. Normal-pressure hydrocephalus
B. Parkinson disease only
C. Cerebellar tumor only
D. Peripheral neuropathy only
Correct Answer: A
The combination of gait impairment, cognitive decline and urinary symptoms suggests normal-pressure hydrocephalus.
Medicine
Geriatrics & Psychiatry
A patient with alcohol dependence develops tremor, agitation, hallucinations and autonomic hyperactivity 2 days after stopping alcohol. What is the treatment priority?
A. Benzodiazepines and supportive care
B. Antipsychotic monotherapy only
C. Opioids
D. Insulin infusion
Correct Answer: A
Alcohol withdrawal is treated primarily with benzodiazepines, together with thiamine, fluids and monitoring according to severity.
Medicine
Geriatrics & Psychiatry
A patient reports voices commenting on his actions and believes television messages are directed specifically to him. These symptoms are examples of:
A. Hallucinations and delusions of reference
B. Obsessions only
C. Derealization only
D. Negative symptoms only
Correct Answer: A
Hearing voices is an auditory hallucination; believing neutral broadcasts contain personal messages is a delusion of reference.
Medicine
Geriatrics & Psychiatry
A patient has elevated mood, decreased need for sleep, grandiosity and pressured speech for 8 days with marked functional impairment. What is the diagnosis?
A. Manic episode
B. Hypomanic episode
C. Generalized anxiety disorder
D. Dysthymia
Correct Answer: A
A manic episode involves at least one week of elevated or irritable mood with increased energy and marked impairment, hospitalization or psychosis.
Medicine
Geriatrics & Psychiatry
Which medication class is especially associated with falls and confusion in older adults and should be minimized when possible?
A. Benzodiazepines
B. Topical emollients
C. Simple antacids only
D. Topical antibiotics only
Correct Answer: A
Benzodiazepines can cause sedation, cognitive impairment, gait instability and falls, with greater sensitivity in older adults.
Medicine
Geriatrics & Psychiatry
An elderly patient repeatedly falls when standing. Which bedside measurement should be checked?
A. Orthostatic blood pressure and pulse
B. Visual acuity only
C. Peak expiratory flow only
D. Abdominal girth only
Correct Answer: A
Orthostatic vital signs help identify postural hypotension, a common reversible contributor to falls in older adults.
Medicine
Geriatrics & Psychiatry
A patient on an antipsychotic develops high fever, severe rigidity, autonomic instability and markedly elevated CK. What is the diagnosis?
A. Neuroleptic malignant syndrome
B. Serotonin syndrome
C. Panic attack
D. Alcohol withdrawal
Correct Answer: A
NMS is a life-threatening dopamine-antagonist reaction characterized by hyperthermia, lead-pipe rigidity, autonomic instability and elevated CK.
Medicine
Geriatrics & Psychiatry
A patient taking an SSRI plus a monoamine oxidase inhibitor develops agitation, fever, diaphoresis, hyperreflexia and clonus. What is the diagnosis?
A. Serotonin syndrome
B. Neuroleptic malignant syndrome
C. Anticholinergic toxicity
D. Opioid withdrawal
Correct Answer: A
Serotonergic excess causes autonomic instability, neuromuscular hyperactivity including clonus, and altered mental state.
Medicine
Geriatrics & Psychiatry
A patient has depressed mood, anhedonia, poor sleep, guilt and impaired concentration for 6 weeks. Which diagnosis is most likely?
A. Major depressive episode
B. Normal grief only
C. Generalized anxiety disorder
D. Delirium
Correct Answer: A
Persistent depressed mood or anhedonia with associated neurovegetative and cognitive symptoms for at least 2 weeks supports major depression.
Medicine
Geriatrics & Psychiatry
An older adult has progressive cognitive decline, visual hallucinations, fluctuating cognition and parkinsonism. What is the most likely diagnosis?
A. Dementia with Lewy bodies
B. Alzheimer disease only
C. Frontotemporal dementia
D. Normal aging
Correct Answer: A
Early visual hallucinations, fluctuating cognition and spontaneous parkinsonism strongly suggest dementia with Lewy bodies.
Medicine
Geriatrics & Psychiatry
What is the most important initial approach to delirium in an older adult?
A. Identify and treat the underlying cause while providing supportive care
B. Start long-term antipsychotics in every patient
C. Use physical restraints routinely
D. Assume irreversible dementia
Correct Answer: A
Delirium is usually secondary to acute illness, medication or physiologic disturbance; treatment focuses on the precipitant and nonpharmacologic support.
Medicine
Geriatrics & Psychiatry
An 82-year-old develops acute fluctuating confusion and inattention after surgery. What is the most likely diagnosis?
A. Delirium
B. Dementia
C. Major depression
D. Schizophrenia
Correct Answer: A
Acute onset, fluctuating course and impaired attention are core features of delirium.
Medicine
Geriatrics & Psychiatry
Which medication characteristic should particularly trigger a review in an older adult with recurrent falls?
A. Topical skin moisturizer use
B. Routine saline nasal spray
C. Occasional artificial tears
D. Sedating or blood-pressure-lowering effects
Correct Answer: D
Sedatives and medicines causing orthostatic hypotension are common modifiable contributors to falls.
Medicine
Geriatrics & Psychiatry
Which complication or major adverse outcome is particularly associated with Falls related to polypharmacy and frailty?
A. Suicide
B. Severe financial, social or safety-related harm
C. Hip fracture with loss of independence
D. Self-harm, neglect or functional deterioration
Correct Answer: C
Falls are a major cause of fragility fracture, hospitalization and disability in older adults.
Medicine
Geriatrics & Psychiatry
A patient is diagnosed with Falls related to polypharmacy and frailty. Which is the most appropriate management principle?
A. Use supportive care, safety planning, caregiver support and appropriate cognitive-symptom therapy when indicated
B. Deprescribe high-risk medicines where possible and implement individualized strength, balance and environmental interventions
C. Use evidence-based psychotherapy and/or antidepressant treatment according to severity and patient factors
D. Use an appropriate mood stabilizer and/or antipsychotic; hospitalize when severe risk or inability to care for self is present
Correct Answer: B
Medication optimization and targeted physical or environmental measures reduce recurrent falls.
Medicine
Geriatrics & Psychiatry
In a patient with suspected Falls related to polypharmacy and frailty, which investigation or diagnostic approach is most appropriate at this stage?
A. Multifactorial falls assessment including medicines, orthostatic vitals, gait, vision and home hazards
B. Focused clinical assessment plus evaluation for reversible precipitants
C. Cognitive assessment, functional history and evaluation for reversible contributors
D. Clinical psychiatric assessment including direct suicide-risk evaluation
Correct Answer: A
Falls prevention requires identification of modifiable intrinsic and environmental risk factors.
Medicine
Geriatrics & Psychiatry
A patient is an older adult with recurrent falls, multiple sedating and antihypertensive medicines, gait impairment and postural symptoms. What is the most likely diagnosis?
A. Alcohol withdrawal
B. Delirium
C. Alzheimer-type major neurocognitive disorder
D. Falls related to polypharmacy and frailty
Correct Answer: D
Falls in older adults are commonly multifactorial, with medication burden, orthostasis, frailty and gait problems contributing.