Medicine
Geriatrics & Psychiatry
Which complication or major adverse outcome is particularly associated with Acute mania in bipolar disorder?
A. Self-harm, neglect or functional deterioration
B. Functional impairment and comorbid depression
C. Severe financial, social or safety-related harm
D. Withdrawal seizures or delirium tremens
Correct Answer: C
Impaired judgment and risk-taking during mania can produce major psychosocial and physical consequences.
Medicine
Geriatrics & Psychiatry
A patient is diagnosed with Acute mania in bipolar disorder. Which is the most appropriate management principle?
A. Use evidence-based psychotherapy and/or antidepressant treatment according to severity and patient factors
B. Use an appropriate mood stabilizer and/or antipsychotic; hospitalize when severe risk or inability to care for self is present
C. Use antipsychotic therapy together with psychosocial interventions and adherence support
D. Use cognitive behavioral therapy and/or an appropriate first-line antidepressant when symptoms are persistent
Correct Answer: B
Acute mania often needs rapid pharmacologic stabilization and sometimes inpatient care.
Medicine
Geriatrics & Psychiatry
In a patient with suspected Acute mania in bipolar disorder, which investigation or diagnostic approach is most appropriate at this stage?
A. Clinical assessment including substance or medication causes and immediate risk
B. Cognitive assessment, functional history and evaluation for reversible contributors
C. Clinical psychiatric assessment including direct suicide-risk evaluation
D. Clinical psychiatric assessment with screening for medical, neurologic and substance-induced causes
Correct Answer: A
Mania is diagnosed clinically; medical and substance-related mimics must be excluded.
Medicine
Geriatrics & Psychiatry
A patient has decreased need for sleep, pressured speech, grandiosity, increased goal-directed activity and risky behavior. What is the most likely diagnosis?
A. Delirium
B. Alzheimer-type major neurocognitive disorder
C. Major depressive disorder
D. Acute mania in bipolar disorder
Correct Answer: D
A sustained period of elevated or irritable mood with increased energy and functional disturbance is characteristic of mania.
Medicine
Geriatrics & Psychiatry
What is the most appropriate way to assess possible suicidal ideation?
A. Avoid asking because it may create suicidal thoughts
B. Ask only family members
C. Ask directly about thoughts, intent, plan, means and protective factors
D. Wait until the patient volunteers the information
Correct Answer: C
Direct, structured questioning is appropriate and does not cause suicidality.
Medicine
Geriatrics & Psychiatry
Which complication or major adverse outcome is particularly associated with Major depressive disorder?
A. Withdrawal seizures or delirium tremens
B. Suicide
C. Hip fracture with loss of independence
D. Functional decline and increased mortality
Correct Answer: B
Major depression is strongly associated with suicidal ideation and behavior.
Medicine
Geriatrics & Psychiatry
A patient is diagnosed with Major depressive disorder. Which is the most appropriate management principle?
A. Use evidence-based psychotherapy and/or antidepressant treatment according to severity and patient factors
B. Use cognitive behavioral therapy and/or an appropriate first-line antidepressant when symptoms are persistent
C. Use symptom-guided benzodiazepine therapy and give thiamine with supportive monitoring
D. Deprescribe high-risk medicines where possible and implement individualized strength, balance and environmental interventions
Correct Answer: A
Treatment should be individualized; urgent safety intervention is required when suicide risk is high.
Medicine
Geriatrics & Psychiatry
In a patient with suspected Major depressive disorder, which investigation or diagnostic approach is most appropriate at this stage?
A. Clinical psychiatric assessment with screening for medical, neurologic and substance-induced causes
B. Clinical assessment while excluding substance effects, thyroid disease and other medical mimics
C. Clinical severity assessment with evaluation for electrolyte abnormalities, liver disease and coexisting illness
D. Clinical psychiatric assessment including direct suicide-risk evaluation
Correct Answer: D
Diagnosis is clinical and every assessment should consider suicidality, bipolar history, substance use and medical mimics.
Medicine
Geriatrics & Psychiatry
A patient has persistent depressed mood, loss of interest, impaired sleep and concentration with significant functional impairment. What is the most likely diagnosis?
A. Acute mania in bipolar disorder
B. Schizophrenia-spectrum psychosis
C. Major depressive disorder
D. Generalized anxiety disorder
Correct Answer: C
Persistent mood and anhedonia symptoms with associated neurovegetative and cognitive features support major depression.
Medicine
Geriatrics & Psychiatry
Which feature is more typical of dementia than delirium?
A. Abrupt onset over hours
B. Gradual progressive decline over months to years
C. Marked fluctuation during the same day
D. Prominent acute inattention after infection
Correct Answer: B
Dementia generally evolves gradually, while delirium is acute and fluctuating.
Medicine
Geriatrics & Psychiatry
Which complication or major adverse outcome is particularly associated with Alzheimer-type major neurocognitive disorder?
A. Loss of independent activities of daily living
B. Functional decline and increased mortality
C. Suicide
D. Severe financial, social or safety-related harm
Correct Answer: A
Progressive cognitive decline eventually impairs medication management, finances, driving and self-care.
Medicine
Geriatrics & Psychiatry
A patient is diagnosed with Alzheimer-type major neurocognitive disorder. Which is the most appropriate management principle?
A. Deprescribe high-risk medicines where possible and implement individualized strength, balance and environmental interventions
B. Treat the cause and use nonpharmacologic orientation, sleep, mobility and sensory-support measures
C. Use evidence-based psychotherapy and/or antidepressant treatment according to severity and patient factors
D. Use supportive care, safety planning, caregiver support and appropriate cognitive-symptom therapy when indicated
Correct Answer: D
Management is multidisciplinary and focuses on cognition, function, behavior, safety and caregiver needs.
Medicine
Geriatrics & Psychiatry
In a patient with suspected Alzheimer-type major neurocognitive disorder, which investigation or diagnostic approach is most appropriate at this stage?
A. Clinical severity assessment with evaluation for electrolyte abnormalities, liver disease and coexisting illness
B. Multifactorial falls assessment including medicines, orthostatic vitals, gait, vision and home hazards
C. Cognitive assessment, functional history and evaluation for reversible contributors
D. Focused clinical assessment plus evaluation for reversible precipitants
Correct Answer: C
Diagnosis combines objective cognitive testing with functional assessment and exclusion of potentially reversible causes.
Medicine
Geriatrics & Psychiatry
A patient has insidious progressive impairment of episodic memory and other cognitive domains that interferes with independent function. What is the most likely diagnosis?
A. Generalized anxiety disorder
B. Alzheimer-type major neurocognitive disorder
C. Alcohol withdrawal
D. Falls related to polypharmacy and frailty
Correct Answer: B
Progressive multidomain cognitive decline affecting daily function is typical of major neurocognitive disorder such as Alzheimer disease.
Medicine
Geriatrics & Psychiatry
Which feature best distinguishes delirium from uncomplicated dementia?
A. Acute fluctuating impairment of attention
B. Slow progression over years
C. Stable cognition throughout the day
D. Isolated long-term memory loss only
Correct Answer: A
Delirium is acute and fluctuating with prominent inattention, whereas most dementias have a chronic progressive course.
Medicine
Geriatrics & Psychiatry
Which complication or major adverse outcome is particularly associated with Delirium?
A. Severe financial, social or safety-related harm
B. Self-harm, neglect or functional deterioration
C. Functional impairment and comorbid depression
D. Functional decline and increased mortality
Correct Answer: D
Delirium is associated with falls, prolonged admission, functional loss and worse survival.
Medicine
Geriatrics & Psychiatry
A patient is diagnosed with Delirium. Which is the most appropriate management principle?
A. Use evidence-based psychotherapy and/or antidepressant treatment according to severity and patient factors
B. Use an appropriate mood stabilizer and/or antipsychotic; hospitalize when severe risk or inability to care for self is present
C. Treat the cause and use nonpharmacologic orientation, sleep, mobility and sensory-support measures
D. Use antipsychotic therapy together with psychosocial interventions and adherence support
Correct Answer: C
Correction of the trigger and supportive non-drug strategies are first-line; sedating medication is reserved for specific safety situations.
Medicine
Geriatrics & Psychiatry
In a patient with suspected Delirium, which investigation or diagnostic approach is most appropriate at this stage?
A. Cognitive assessment, functional history and evaluation for reversible contributors
B. Focused clinical assessment plus evaluation for reversible precipitants
C. Clinical psychiatric assessment including direct suicide-risk evaluation
D. Clinical assessment including substance or medication causes and immediate risk
Correct Answer: B
Delirium is diagnosed clinically; infection, medications, pain, retention, metabolic problems and other triggers should be sought.
Medicine
Geriatrics & Psychiatry
A patient is an older hospitalized patient with acute fluctuating inattention, disorganized thinking and altered level of consciousness. What is the most likely diagnosis?
A. Delirium
B. Falls related to polypharmacy and frailty
C. Alzheimer-type major neurocognitive disorder
D. Major depressive disorder
Correct Answer: A
Acute onset, fluctuation and impaired attention are core features of delirium.
Medicine
Gastroenterology & Hepatology
Which combination is most concerning for acute liver failure?
A. Isolated mild ALT elevation with normal INR
B. Chronic stable splenomegaly only
C. Uncomplicated dyspepsia
D. Coagulopathy with hepatic encephalopathy in a patient without pre-existing cirrhosis
Correct Answer: D
Acute liver failure is characterized by rapid severe hepatic dysfunction with coagulopathy and encephalopathy in the absence of established cirrhosis.