Geriatrics Practice Questions

Q: Which of the following is the most common cause of reversible dementia in the geriatric population?

Depression. The correct answer is **Depression**. In the geriatric population, depression often presents with cognitive impairment, memory loss, and poor concentration, a clinical entity known as **Pseudodementia**. It is the most common cause of reversible cognitive decline [1]. Unlike true dementia (e.g., Alzheimer’s), patients with pseudodementia typically provide "I don't know" answers during testing, appear distressed by their deficits, and show significant improvement with antidepressant therapy or ECT. Analysis of Incorrect Options: **Normal Pressure Hydrocephalus (NPH):** Characterized by the triad of gait ataxia, urinary incontinence, and dementia ("Wet, Wobbly, and Wacky"). While reversible via a ventriculoperitoneal shunt, it is statistically less common than depression [1]. **Hypothyroidism:** Can cause cognitive slowing and "myxedema madness." While a standard part of the dementia workup (checking TSH), it is a less frequent cause of isolated reversible dementia compared to psychiatric illness. **Vitamin B12 Deficiency:** Leads to Subacute Combined Degeneration of the spinal cord and cognitive changes. While common in the elderly due to atrophic gastritis, it ranks below depression in prevalence as a primary cause of reversible cognitive impairment [1].

Q: An elderly male patient has presented with recurrent falls. Which of the following medicines is most likely responsible?

Prazosin. **Explanation:** Recurrent falls in the elderly are a major cause of morbidity and are often multifactorial [1]. However, medication-induced **orthostatic (postural) hypotension** is a leading preventable cause [2]. **1. Why Prazosin is correct:** Prazosin is a selective **alpha-1 adrenergic blocker**. It causes potent peripheral vasodilation, which significantly impairs the body’s ability to maintain blood pressure upon standing. This leads to a sudden drop in cerebral perfusion, causing dizziness, syncope, and falls—a phenomenon known as the **"first-dose effect"** or chronic postural hypotension. In the elderly, baroreceptor sensitivity is already diminished, making them hypersensitive to the hypotensive effects of alpha-blockers [2]. **2. Why the other options are incorrect:** * **Metformin & Acarbose:** These are oral hypoglycemic agents with a very low risk of causing hypoglycemia. Since they do not typically cause sudden neuroglycopenia or hemodynamic instability, they are not primary triggers for falls. * **Thiazides:** While diuretics can cause volume depletion and electrolyte imbalances (like hyponatremia) which may contribute to falls, they are generally considered safer than alpha-blockers regarding immediate postural instability. Prazosin has a much stronger and more direct association with orthostatic syncope. **Clinical Pearls for NEET-PG:** * **Beers Criteria:** Prazosin and other alpha-1 blockers (for HTN) are listed in the Beers Criteria as potentially inappropriate medications for the elderly due to the high risk of orthostatic hypotension. * **Drugs increasing fall risk:** Benzodiazepines (sedation), TCAs (orthostasis + sedation), Antipsychotics (extrapyramidal symptoms), and Antihypertensives [2]. * **Prescribing Tip:** If an alpha-blocker must be used (e.g., for BPH), it should be administered at bedtime to minimize the impact of orthostatic changes.

Question 1

Which of the following is the most common cause of reversible dementia in the geriatric population?

Accepted Answer

Depression

Answer

Normal Pressure Hydrocephalus

Answer

Hypothyroidism

Answer

Vitamin B12 deficiency

Question 2

An 80-year-old female presented with diffuse muscle pain in the back, buttocks, and right thigh. On examination, the patient was obtunded, responsive only to simple commands, and had paralysis of the left half of her body. Neighbors found her after she did not respond to multiple calls. CT brain was performed. Lab findings revealed increased serum creatinine out of proportion to BUN. Which of the following ECG findings corresponds with the most common electrolyte abnormality found in this condition?

Accepted Answer

All of the above

Answer

ECG showing peaked T waves

Answer

ECG showing flattened T waves

Answer

ECG showing prolonged QT interval

Question 3

Reversible dementia is a feature of which of the following conditions?

Accepted Answer

Hypothyroidism

Answer

Alzheimer's disease

Answer

Pick's disease

Answer

Multi-infarct dementia

Question 4

What is a key consideration for hypertensive treatment in the elderly?

Accepted Answer

Elderly patients may exhibit lower compliance compared to younger patients.

Answer

Elderly patients generally have less tolerance to antihypertensive medications compared to younger patients.

Answer

The principles of hypertensive treatment are the same for both elderly and younger patients.

Answer

ACE inhibitors are particularly useful in hypertensive elderly patients.

Question 5

An elderly male patient has presented with recurrent falls. Which of the following medicines is most likely responsible?

Accepted Answer

Prazosin

Answer

Metformin

Answer

Acarbose

Answer

Thiazides

Geriatrics — MCQs

Geriatrics — MCQs

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