Geriatric Psychiatry Practice Questions

Q: In Alzheimer's disease (AD), which of the following is NOT commonly seen in early stages?

Acalculia. ***Acalculia*** - **Acalculia**, the inability to perform mathematical calculations, is a **late-stage feature** of Alzheimer's disease that requires extensive **parietal lobe atrophy**. - Among all the cognitive impairments listed, acalculia appears **latest in the disease progression**, making it the feature **NOT commonly seen in early stages**. *Apraxia* - **Apraxia** (inability to perform learned motor tasks) is a **middle-stage feature** that develops as **premotor and parietal cortices** become involved. - While not an early feature, it appears **earlier than acalculia** in the disease course, typically in moderate stages. *Aphasia* - **Mild anomia** (word-finding difficulty) and **naming problems** are **common early symptoms** of Alzheimer's disease. - This reflects early involvement of **temporal-parietal language areas** and is often one of the first cognitive domains affected after memory. *Agnosia* - **Agnosia** (inability to recognize objects, faces, or sounds) is a **middle-stage feature** that appears as **cortical atrophy progresses**. - While not truly early, it typically develops **before acalculia** as the disease advances from mild to moderate stages.

Q: An elderly patient with dementia is brought by family members who report concerns about self-neglect. On examination, you notice atrophic, dry nasal mucosa, extensive encrustations, and a woody, hard external nose. The family attributes these findings to poor hygiene due to cognitive decline. Which of the following is the most appropriate next step in management?

Rhinoscleroma. ***Rhinoscleroma*** - This is a chronic granulomatous disease caused by *Klebsiella rhinoscleromatis* characterized by progressive **fibrosis and sclerosis** of the respiratory tract - The description of a **"woody, hard external nose"** with extensive encrustations and atrophic changes is **pathognomonic for rhinoscleroma** - Often leads to significant nasal deformity and represents a serious chronic infection requiring systemic antibiotics - In elderly patients with cognitive decline, this condition may be misattributed to poor hygiene, delaying proper diagnosis *Nasal polyposis* - Presents with **boggy, edematous, grape-like masses** in the nasal cavity - The symptoms described (woody, hard external nose with atrophic mucosa) are **not typical for nasal polyposis** - Usually causes nasal obstruction and anosmia but does not cause hardening of the external nose *Atrophic rhinitis* - Involves progressive **atrophy of the nasal mucosa** and turbinates with **fetid odor (ozena)**, crusting, and nasal dryness - While this shares some features (atrophy, crusting), it does **not cause a woody, hard external nose** - The external nasal deformity is the key distinguishing feature pointing to rhinoscleroma *Chronic sinusitis* - Characterized by persistent inflammation of the paranasal sinuses with nasal discharge and congestion - Does **not cause atrophic, dry nasal mucosa** or a **woody, hard external nose** - Typically presents with facial pain, purulent discharge, and pressure symptoms

Q: Which of the following is not a common symptom of Alzheimer's disease?

Cerebral infarcts. ***Cerebral infarcts*** - While **cerebral infarcts** (strokes) can cause cognitive impairment (vascular dementia), they are not a defining or common symptom of Alzheimer's disease itself. - Alzheimer's is characterized by distinct **neurodegenerative changes** (amyloid plaques, neurofibrillary tangles), not typically acute vascular events. *Memory loss* - **Memory loss**, particularly of recent events, is often the earliest and most prominent symptom of Alzheimer's disease, significantly impacting daily life. - This progressive decline in episodic memory is a core diagnostic criterion. *Delusions* - **Delusions**, such as paranoid thoughts or beliefs that things are being stolen, can occur in the moderate to late stages of Alzheimer's disease. - These psychotic symptoms are often a source of distress for both the patient and caregivers. *Apraxia and aphasia* - **Apraxia** (difficulty with learned movements despite normal motor function) and **aphasia** (language difficulties, including word-finding problems) are common cognitive deficits in Alzheimer's. - These symptoms reflect diffuse cortical dysfunction as the disease progresses beyond memory centers.

Q: Which of the following non-memory cognitive symptoms can be associated with Alzheimer's disease (AD)?

All of the options. ***All of the options*** - Alzheimer's disease is characterized by a decline in various cognitive domains, extending beyond memory impairment to include **aphasia**, **apraxia**, and **agnosia**. - These non-memory symptoms become increasingly prominent as the disease progresses and are essential for a comprehensive diagnostic evaluation. *Aphasia* - **Aphasia**, or difficulty with language production or comprehension, is a common non-memory cognitive symptom in AD. - Patients may struggle to find words, understand spoken or written language, or produce coherent sentences. *Apraxia* - **Apraxia**, the inability to perform learned motor movements despite intact motor function and comprehension, is frequently observed in AD. - This can manifest as difficulty with activities of daily living, such as dressing, eating, or using tools. *Agnosia* - **Agnosia**, the inability to recognize objects, people, sounds, shapes, or smells despite intact sensory function, is another non-memory cognitive deficit seen in AD. - Patients may not recognize familiar faces or common household items.

Question 1

In Alzheimer's disease (AD), which of the following is NOT commonly seen in early stages?

Accepted Answer

Acalculia

Answer

Apraxia

Answer

Aphasia

Answer

Agnosia

Question 2

An elderly patient with dementia is brought by family members who report concerns about self-neglect. On examination, you notice atrophic, dry nasal mucosa, extensive encrustations, and a woody, hard external nose. The family attributes these findings to poor hygiene due to cognitive decline. Which of the following is the most appropriate next step in management?

Accepted Answer

Rhinoscleroma

Answer

Nasal polyposis

Answer

Atrophic rhinitis

Answer

Chronic sinusitis

Question 3

Which of the following is not a common symptom of Alzheimer's disease?

Accepted Answer

Cerebral infarcts

Answer

Memory loss

Answer

Delusions

Answer

Apraxia and aphasia

Question 4

Which of the following non-memory cognitive symptoms can be associated with Alzheimer's disease (AD)?

Accepted Answer

All of the options

Answer

Aphasia

Answer

Apraxia

Answer

Agnosia

Geriatric Psychiatry — MCQs

Geriatric Psychiatry — MCQs

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