Geriatric Syndromes — MCQs

10 questions

Which of the following tests is used to test anterior instability of shoulder?

A Patient falls down often with behavioral change and enuresis. What is the condition associated with him?

Minimal brain dysfunction (a historical term from the 1960s-70s) is most commonly associated with which of the following conditions?

Radiotherapy has the most significant therapeutic role in:

Incontinence in elderly females is most commonly due to:

Alzheimer's disease is associated with:

Which of the following accurately describes management of Grade 3 pelvic organ prolapse in an elderly woman who is a poor surgical candidate?

All of the following are features of dementia, EXCEPT:

A 60-year-old man had undergone cardiac bypass surgery 2 days back. Now he started forgetting things and was not able to recall names and phone numbers of his relatives. What is the probable diagnosis?

Q10

What is Binswanger disease commonly known as?

Geriatric Syndromes Indian Medical PG Practice Questions and MCQs

Question 1: Which of the following tests is used to test anterior instability of shoulder?

A. Push-pull test
B. Apprehension Test (crank test) (Correct Answer)
C. Posterior drawer test
D. Jerk test

Explanation: ***Apprehension Test (crank test)*** - The **apprehension test** assesses for anterior shoulder instability by passively abducting and externally rotating the arm, which is the position of potential anterior dislocation. - A positive test is indicated by the patient's **apprehension** or fear of dislocation, often accompanied by muscle guarding, as the head of the humerus is forced anteriorly. *Push-pull test* - The push-pull test is used to assess for **posterior shoulder stability**, specifically for **posterior labral tears** or instability. - It involves applying axial compression while simultaneously pulling the humerus posteriorly, looking for pain or a clunk. *Posterior drawer test* - The posterior drawer test is primarily used to evaluate **posterior glenohumeral instability**. - It involves stabilizing the scapula and applying a posterior force to the humerus while the arm is flexed, abducted, and internally rotated. *Jerk test* - The jerk test is used to identify **posterior-inferior glenohumeral instability** or a **posterior labral tear**, particularly a reverse Bankart lesion. - It involves axially loading the arm while moving it from an abducted and externally rotated position to an adducted and internally rotated position, looking for a sudden "jerk" or clunk.

Question 2: A Patient falls down often with behavioral change and enuresis. What is the condition associated with him?

A. Normal pressure hydrocephalus (NPH) (Correct Answer)
B. Parkinson's disease (PD)
C. Alzheimer's disease (AD)
D. Frontotemporal dementia (FTD)

Explanation: ***Normal pressure hydrocephalus (NPH)*** - NPH is characterized by the classic triad of symptoms: **gait disturbance** (leading to falls), **dementia/behavioral changes**, and **urinary incontinence** (enuresis) [1]. - These symptoms arise from the accumulation of cerebrospinal fluid (CSF) in the brain's ventricles without a corresponding increase in intracranial pressure [2]. *Parkinson's disease (PD)* - While PD causes **gait instability** and falls, its primary symptoms include **bradykinesia**, **rigidity**, and **resting tremor**, which are not mentioned. - Behavioral changes can occur later in the disease, but **enuresis** is not a hallmark symptom. *Alzheimer's disease (AD)* - AD primarily presents with **progressive memory loss** and cognitive decline, not gait disturbances or enuresis as early or prominent features. - Falls usually occur much later due to advanced cognitive impairment and not as an initial triad component. *Frontotemporal dementia (FTD)* - FTD is characterized by early and prominent **behavioral and personality changes** or language difficulties. - While falls can occur due to executive dysfunction, **gait disturbance** and **enuresis** as part of a triad are not typical presenting features.

Question 3: Minimal brain dysfunction (a historical term from the 1960s-70s) is most commonly associated with which of the following conditions?

A. Down's syndrome
B. Attention Deficit Hyperactivity Disorder (ADHD) (Correct Answer)
C. Learning Disabilities
D. Autism Spectrum Disorder

Explanation: ***Attention Deficit Hyperactivity Disorder (ADHD)*** - **Minimal brain dysfunction (MBD)** was an older, broad diagnostic term for a constellation of neurological impairments, with attention and behavioral issues forming a significant part. - The symptoms described as MBD, particularly problems with **attention, impulsivity, and hyperactivity**, overlap significantly with the modern diagnostic criteria for ADHD. *Learning Disabilities* - While **learning disabilities** were sometimes considered under the umbrella of MBD, the term primarily focused on difficulties with attention and behavior, not exclusively on academic skill deficits. - Learning disabilities specifically describe difficulties in acquiring and using listening, speaking, reading, writing, reasoning, or mathematical abilities. *Down's syndrome* - **Down's syndrome** is a genetic disorder caused by an extra copy of chromosome 21, leading to distinct physical features and intellectual disability. - This condition has a clear genetic etiology and distinct clinical features that do not align with the historical concept of **minimal brain dysfunction**. *Autism Spectrum Disorder* - **Autism Spectrum Disorder (ASD)** is characterized by persistent deficits in social communication and interaction, and restricted, repetitive patterns of behavior, interests, or activities. - While MBD was a broad term, the core diagnostic features of ASD are distinct from the primary focus of hyperactivity and inattention that defined much of what was once called MBD.

Question 4: Radiotherapy has the most significant therapeutic role in:

A. Monoclonal gammopathy
B. Tuberculosis
C. Sarcomas (Correct Answer)
D. Sarcoidosis

Explanation: ***Sarcomas*** - **Radiotherapy** plays a crucial therapeutic role in **sarcomas**, though typically as **adjuvant therapy** combined with surgical resection - Used for **local control** in soft tissue sarcomas, particularly when wide margins cannot be achieved - **Primary radiotherapy** is the treatment of choice for certain radiation-sensitive sarcomas like **Ewing's sarcoma** and in cases of **inoperable tumors** - Essential for reducing **local recurrence rates** in high-grade soft tissue sarcomas - Among the options listed, sarcomas have the **strongest and most established indication** for radiotherapy *Monoclonal gammopathy* - Generally **observation only** for MGUS (Monoclonal Gammopathy of Undetermined Significance) - Radiotherapy used only for **solitary plasmacytoma**, which is a specific localized manifestation - Multiple myeloma (if it progresses) is treated with **chemotherapy** and targeted agents, not radiotherapy as primary treatment *Tuberculosis* - An **infectious disease** caused by *Mycobacterium tuberculosis* - Treated exclusively with **anti-tubercular drug regimens** (RIPE: Rifampicin, Isoniazid, Pyrazinamide, Ethambutol) - Radiotherapy has **no role** in treating infections *Sarcoidosis* - A **systemic inflammatory condition** with non-caseating granulomas - Primary treatment is **corticosteroids** for symptomatic cases - Immunosuppressants used for refractory cases - Radiotherapy has **no role** in inflammatory/granulomatous diseases

Question 5: Incontinence in elderly females is most commonly due to:

A. Outlet obstruction
B. Vesicovaginal fistula
C. True stress incontinence
D. Detrusor instability (Correct Answer)

Explanation: ***Detrusor instability*** - This condition is the most common cause of **urge incontinence** in elderly females, characterized by **involuntary contractions of the detrusor muscle** [1]. - It leads to a sudden, strong urge to urinate that is difficult to postpone, often resulting in **leaking of urine** [1]. *Vesicovaginal fistula* - A **vesicovaginal fistula** is an abnormal connection between the bladder and the vagina, usually caused by trauma or surgery, leading to continuous leakage. - While it causes incontinence, it is a relatively **rare cause** compared to detrusor instability in the general elderly female population. *Outlet obstruction* - **Outlet obstruction** in females is uncommon and typically presents with **overflow incontinence**, not urge incontinence, where the bladder cannot empty properly. - Causes can include severe prolapse or urethral strictures, which are not the most frequent cause of incontinence in this demographic. *True stress incontinence* - **Stress incontinence** occurs when there is leakage of urine due to increased **intra-abdominal pressure** (like coughing, sneezing, or laughing) in the absence of a detrusor contraction. - While common in older women, **detrusor instability (urge incontinence)** becomes more prevalent with advanced age as the primary cause of incontinence [1].

Question 6: Alzheimer's disease is associated with:

A. Delusion
B. Parkinsonism
C. Delirium
D. Dementia (Correct Answer)

Explanation: ***Dementia*** - **Alzheimer's disease** is the most common cause of **dementia**, a chronic and progressive neurodegenerative disorder characterized by a decline in cognitive function. - Key features include **memory loss**, particularly of recent events, along with impairments in language, problem-solving, and other cognitive abilities that interfere with daily life. *Delusion* - **Delusions** are fixed, false beliefs that are not amenable to change in light of conflicting evidence, more commonly associated with **psychotic disorders** like **schizophrenia**. - While individuals with advanced Alzheimer's disease can experience neuropsychiatric symptoms, including delusions, they are not the primary or defining feature of the disease itself. *Parkinsonism* - **Parkinsonism** refers to a group of neurological disorders characterized by motor symptoms such as **tremor**, **bradykinesia**, **rigidity**, and **postural instability**. - It is the hallmark of diseases like **Parkinson's disease** or **Lewy body dementia**, but not the primary feature of Alzheimer's disease, although some individuals with Alzheimer's may later develop parkinsonian features. *Delirium* - **Delirium** is an acute, fluctuating confusional state characterized by a disturbance in attention and awareness. - It is typically caused by an underlying medical condition, medication, or substance withdrawal, and is often reversible, unlike the chronic and progressive nature of Alzheimer's dementia.

Question 7: Which of the following accurately describes management of Grade 3 pelvic organ prolapse in an elderly woman who is a poor surgical candidate?

A. Bladder sling
B. Vaginal hysterectomy
C. Pessary placement (Correct Answer)
D. Kegel exercises

Explanation: ***Pessary placement*** - **Pessaries** are a less invasive, effective option for **pelvic organ prolapse** management in patients who are **poor surgical candidates**, helping to support prolapsed organs. - They also serve as a good temporary option to improve symptoms before surgical intervention. *Bladder sling* - A **bladder sling** is a surgical procedure used primarily to treat **stress urinary incontinence**, not pelvic organ prolapse. - This option is unsuitable for a patient who is a **poor surgical candidate**. *Vaginal hysterectomy* - A **vaginal hysterectomy** involves surgical removal of the uterus through the vagina, which is a definitive treatment for **uterine prolapse**. - However, surgical interventions are contraindicated for an **elderly woman** who is a **poor surgical candidate** due to potential risks. *Kegel exercises* - **Kegel exercises** are beneficial for strengthening the **pelvic floor muscles** and preventing the progression of early-stage prolapse or improving mild symptoms. - However, they are generally **insufficient** for managing **Grade 3 pelvic organ prolapse**, which requires more robust support.

Question 8: All of the following are features of dementia, EXCEPT:

A. Clouding of consciousness present (Correct Answer)
B. Insidious in onset
C. Visual hallucinations may occur
D. Usually irreversible

Explanation: ***Clouding of consciousness present*** - **Clouding of consciousness** is a hallmark feature of **delirium**, not dementia. Delirium is characterized by an acute, fluctuating disturbance of attention and cognition. - In dementia, consciousness typically remains clear until the very late stages of the disease, even as cognitive functions decline significantly. *Insidious in onset* - Dementia typically has an **insidious onset**, meaning symptoms develop gradually over months or years, often unnoticed initially by the patient or family. - This contrasts with the sudden or acute onset often seen in conditions like delirium or stroke. *Visual hallucinations may occur* - **Visual hallucinations** can occur in various forms of dementia, particularly in **dementia with Lewy bodies** and Parkinson's disease dementia. - While not universally present, their occurrence is a recognized potential feature of the disease. *Usually irreversible* - Most types of dementia, including **Alzheimer's disease**, **vascular dementia**, and **dementia with Lewy bodies**, are progressive and **irreversible**. - There are some treatable causes of cognitive impairment that can mimic dementia, but true dementia conditions generally do not resolve.

Question 9: A 60-year-old man had undergone cardiac bypass surgery 2 days back. Now he started forgetting things and was not able to recall names and phone numbers of his relatives. What is the probable diagnosis?

A. Alzheimer's disease
B. Delirium (Correct Answer)
C. Depression
D. Post-traumatic psychosis

Explanation: ***Delirium*** - The **acute onset** of memory loss and confusion **2 days after cardiac bypass surgery** is characteristic of **postoperative delirium**. - Delirium is a disturbance in **attention**, **awareness**, and **cognition** that develops over a short period (hours to days) and is directly related to a medical condition or procedure. - **Cardiac surgery** is a well-known risk factor, with delirium occurring in **10-50%** of cardiac bypass patients due to factors like anesthesia, hypoperfusion, inflammation, and physiological stress. - Key features here: **acute onset**, **temporal relationship to surgery**, and **memory/cognitive deficits** without psychotic symptoms. *Alzheimer's disease* - Alzheimer's is a **chronic, progressive neurodegenerative disorder** with **gradual onset** over months to years. - The **sudden appearance** of symptoms immediately after surgery cannot be explained by Alzheimer's disease. - While Alzheimer's causes memory impairment, it does not present acutely in the postoperative setting. *Depression* - Depression can cause **pseudodementia** with cognitive complaints, but the primary features would be **persistent low mood**, **anhedonia**, **sleep disturbance**, and **appetite changes**. - The **acute temporal link** to surgery and absence of mood symptoms make depression unlikely. - Cognitive symptoms in depression are typically subjective complaints rather than objective deficits. *Post-traumatic psychosis* - This would involve **psychotic symptoms** such as **hallucinations**, **delusions**, or **disorganized behavior**, which are not described in this case. - The presentation of simple **memory deficits** without psychotic features does not support this diagnosis. - Surgery itself is not typically considered a psychologically traumatic event that would trigger psychosis.

Question 10: What is Binswanger disease commonly known as?

A. Subcortical arteriosclerotic encephalopathy (Correct Answer)
B. Hippocampal atrophy
C. Multiple cortical infarcts
D. Extrapyramidal dementia

Explanation: ***Subcortical arteriosclerotic encephalopathy*** - This is the medical term for **Binswanger disease**, reflecting its underlying pathology of small vessel disease affecting the **subcortical white matter** due to arteriosclerosis. - The condition leads to demyelination and tissue loss, resulting in **cognitive decline** and neurological deficits. *Hippocampal atrophy* - While observed in various dementias, particularly **Alzheimer's disease**, it is not the primary defining characteristic or an alternative common name for Binswanger disease. [1] - Hippocampal atrophy primarily affects memory formation, whereas Binswanger disease involves broader subcortical dysfunction impacting executive function and gait. *Multiple cortical infarcts* - This describes **multi-infarct dementia**, which involves acute, often stepwise, cognitive decline due to multiple strokes impacting the **cerebral cortex**. - Binswanger disease, in contrast, involves chronic, diffuse damage to subcortical white matter rather than distinct cortical infarcts. *Extrapyramidal dementia* - This term refers to dementias associated with **extrapyramidal symptoms** (e.g., Parkinsonism), such as **Lewy body dementia** or Parkinson's disease dementia. - While gait disturbances can occur in Binswanger disease, it is not primarily classified as an extrapyramidal disorder.

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