Geriatric Psychiatry Practice Questions

Q: Which condition is characterized by illusions with an altered sensorium?

Delirium. **Explanation:** The hallmark of **Delirium** (Acute Confusional State) is an **altered sensorium** (clouding of consciousness) with a fluctuating course. In this state, the patient’s ability to receive, process, and recall information is impaired. **Illusions** (misinterpretations of real external stimuli) and visual hallucinations are very common in delirium because the clouded consciousness prevents the brain from accurately perceiving the environment. **Analysis of Options:** * **Delirium (Correct):** It is an organic brain syndrome characterized by a global cognitive impairment, reduced awareness of the environment, and perceptual disturbances (like illusions) specifically occurring in the presence of a disturbed consciousness. * **Schizophrenia:** This is a functional psychosis where the sensorium remains **clear**. While hallucinations (mostly auditory) are common, the patient is usually oriented and conscious. * **Hysteria (Dissociative/Conversion Disorder):** These are psychogenic disorders. While patients may show "pseudo-hallucinations" or "la belle indifference," they do not have a medically altered sensorium or organic perceptual distortions. * **Manic Depressive Psychosis (MDP/Bipolar Disorder):** This is a mood disorder. During manic or depressive episodes, the sensorium remains **clear** unless the condition is severe enough to reach a state of "delirious mania," which is rare. **High-Yield Clinical Pearls for NEET-PG:** * **Visual hallucinations** are more common in organic brain syndromes (Delirium), whereas **Auditory hallucinations** are more common in functional psychoses (Schizophrenia). * The most common cause of delirium in the elderly is **UTI**, and in general practice, it is often **metabolic** or **drug-induced**. * **EEG finding in Delirium:** Generalized slowing of background activity (except in Delirium Tremens, where there is low-voltage fast activity).

Q: Which of the following features are characteristic of dementia: impaired judgment, impaired memory, alteration of mood, clouding of consciousness?

Impaired judgment, impaired memory, and alteration of mood. **Explanation:** Dementia is a chronic, progressive syndrome characterized by a decline in multiple cognitive domains without the impairment of consciousness. The core diagnostic feature is **impaired memory** (especially short-term memory), but it must be accompanied by at least one other cognitive deficit, such as **impaired judgment**, aphasia, apraxia, or executive dysfunction. Additionally, **alteration of mood** (e.g., depression, irritability, or apathy) and personality changes are frequently observed as secondary features due to the degeneration of frontal and temporal lobes. **Why the other options are incorrect:** * **Option A:** While memory and judgment are central, this option is incomplete as it ignores the significant mood alterations that characterize the clinical picture of dementia. * **Options C & D:** These are incorrect because they include **"clouding of consciousness."** This is the hallmark feature of **Delirium**, not Dementia. In dementia, the level of consciousness remains clear until the very terminal stages of the disease. **High-Yield Clinical Pearls for NEET-PG:** * **Dementia vs. Delirium:** The most critical differentiator is that consciousness is **preserved** in dementia and **impaired/fluctuating** in delirium. * **Reversible Dementias:** Always rule out Vitamin B12 deficiency, Hypothyroidism, and Normal Pressure Hydrocephalus (NPH). * **Pseudodementia:** This refers to severe depression in the elderly that mimics dementia. A key differentiator is that patients with pseudodementia often complain of memory loss ("I don't know"), whereas true dementia patients often try to hide or minimize their deficits (confabulation). * **Alzheimer’s Disease:** The most common cause of dementia; characterized by amyloid plaques and neurofibrillary tangles (Tau protein).

Q: Which of the following is NOT true regarding delirium?

Normal consciousness. **Explanation:** Delirium (Acute Confusional State) is an etiologically non-specific organic cerebral syndrome characterized by concurrent disturbances of consciousness, attention, perception, and cognition. **Why "Normal Consciousness" is the correct answer:** The hallmark of delirium is a **clouding of consciousness** (decreased awareness of the environment) and a reduced ability to focus, sustain, or shift attention. Therefore, consciousness is never "normal" in a delirious patient; it typically fluctuates throughout the day. **Analysis of Incorrect Options:** * **A. Acute onset:** Delirium typically develops over a short period (hours to a few days) and represents an acute change from baseline. This is a key feature distinguishing it from dementia. * **B. Sleep disturbance:** Disturbance of the sleep-wake cycle is a core diagnostic criterion. Patients often experience daytime drowsiness and nighttime agitation ("sundowning"), or complete reversal of the sleep-wake cycle. * **C. Myoclonus:** Delirium is often associated with motor abnormalities. Myoclonus, asterixis (flapping tremors), and coarse tremors are common physical signs, especially in metabolic or toxic encephalopathies. **NEET-PG High-Yield Pearls:** * **EEG Finding:** Characterized by **generalized slowing** of background activity (except in Delirium Tremens, where EEG shows low-voltage fast activity). * **Visual Hallucinations:** These are the most common type of hallucinations in delirium (unlike Schizophrenia, where auditory hallucinations predominate). * **Reversibility:** Unlike dementia, delirium is usually reversible once the underlying medical cause (infection, electrolyte imbalance, drug toxicity) is treated. * **Drug of Choice:** Low-dose **Haloperidol** is the preferred antipsychotic for agitation in delirium (avoid benzodiazepines unless it is alcohol withdrawal delirium).

Q: Which of the following features is not common between delirium and dementia?

Fluctuating course. ### Explanation The key to distinguishing between Delirium and Dementia lies in their **temporal profile** and **level of consciousness**. **Why "Fluctuating Course" is the correct answer:** While both conditions can show variations, a **fluctuating course** (specifically "sundowning" or rapid shifts in arousal and attention within hours) is a **hallmark characteristic of Delirium**. In contrast, Dementia typically presents with a **progressive, stable decline** over months to years. While dementia patients may worsen at night, the acute, hour-to-hour waxing and waning of consciousness is unique to delirium. Therefore, it is not a "common" feature shared by both. **Analysis of Incorrect Options:** * **Disturbance of Memory:** This is a core feature of both. Dementia involves chronic memory loss (usually short-term first), while Delirium involves impaired registration and recall due to inattention. * **Hallucinations:** Both can present with psychotic symptoms. In delirium, visual hallucinations are very common; in dementia (especially Lewy Body Dementia), they are also a frequent feature. * **Delusions:** Both conditions can manifest with delusions. In delirium, they are usually fragmented and persecutory; in dementia, they are often related to theft or infidelity (e.g., "Othello syndrome"). **NEET-PG High-Yield Pearls:** * **Delirium:** Acute onset, **impaired attention** (cardinal sign), reversible, and usually due to an underlying medical cause (metabolic, infectious, or drug-induced). * **Dementia:** Insidious onset, **clear consciousness** (until late stages), irreversible, and primarily a structural brain pathology. * **EEG Finding:** Delirium typically shows **generalized slowing** (except in alcohol withdrawal/DTs), whereas the EEG in early dementia is often normal.

Question 1

A 60-year-old man is found roaming aimlessly and brought to the hospital. He is unable to tell his address. Blood investigations reveal: Na+ 115 mEq/L, K+ 3.2 mEq/L. Which of the following is the most likely diagnosis?

Accepted Answer

Delirium

Answer

Multi-infarct dementia

Answer

Alzheimer's disease

Answer

Dissociative fugue

Question 2

All of the following are true about dementia except:

Accepted Answer

Loss of long-term memory

Answer

Loss of short-term memory

Answer

Deterioration of personality

Answer

Impaired learning

Question 3

Which condition is characterized by illusions with an altered sensorium?

Accepted Answer

Delirium

Answer

Schizophrenia

Answer

Hysteria

Answer

Manic Depressive Psychosis (MDP)

Question 4

What differentiates delirium from dementia?

Accepted Answer

Sudden change in mental status

Answer

Confusion

Answer

Difficulty in communicating

Answer

Hallucination

Question 5

Which of the following are considered cognitive disorders?

Accepted Answer

Delirium

Answer

Depersonalization

Answer

Dementia

Answer

Secondary gain

Question 6

Which of the following features are characteristic of dementia: impaired judgment, impaired memory, alteration of mood, clouding of consciousness?

Accepted Answer

Impaired judgment, impaired memory, and alteration of mood

Answer

Impaired judgment and impaired memory

Answer

Alteration of mood and clouding of consciousness

Answer

Impaired judgment, impaired memory, alteration of mood, and clouding of consciousness

Question 7

In a 75-year-old male patient, which diagnostic technique is most appropriate to differentiate delirium from dementia?

Accepted Answer

EEG

Answer

Evoked EEG

Answer

CT scan

Answer

PET scan

Question 8

All of the following are features of delirium except?

Accepted Answer

Most common organic mental disorder with an acute onset

Answer

Clouding of consciousness is pathognomic

Answer

After cataract surgery it is known as black patch delirium

Answer

Floccillations are seen

Question 9

Which of the following is NOT true regarding delirium?

Accepted Answer

Normal consciousness

Answer

Acute onset

Answer

Sleep disturbance

Answer

Myoclonus

Question 10

Which of the following features is not common between delirium and dementia?

Accepted Answer

Fluctuating course

Answer

Disturbance of memory

Answer

Hallucinations

Answer

Delusions

Geriatric Psychiatry — MCQs

Geriatric Psychiatry — MCQs

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