Geriatrics Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Geriatrics. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Geriatrics Indian Medical PG Question 1: Neurocardiagenic syncope, the least useful investigation is -
- A. Carotid sinus massage
- B. Echocardiography
- C. Orthostatic blood pressure recording
- D. Carotid duplex scan (Correct Answer)
Geriatrics Explanation: ***Carotid duplex scan***
- This investigation evaluates for **carotid artery stenosis** and **atherosclerotic disease**, which is not relevant to neurocardiogenic syncope pathophysiology.
- Neurocardiogenic syncope is a **reflex-mediated condition** involving inappropriate vasodilation and/or bradycardia, not mechanical vascular obstruction [2].
*Carotid sinus massage*
- Relevant as a **provocative test** that can help identify reflex-mediated syncope by assessing **baroreflex sensitivity** [2].
- Can induce **bradycardia** or **hypotension** similar to neurocardiogenic syncope, making it diagnostically useful.
*Echocardiography*
- Essential for ruling out **structural heart disease** such as **valvular abnormalities**, **hypertrophic cardiomyopathy**, or **impaired ventricular function**.
- Crucial in the **differential diagnosis** of syncope to distinguish cardiac causes from neurocardiogenic syncope [1].
*Orthostatic blood pressure recording*
- While it may be normal in neurocardiogenic syncope, it remains a **fundamental, first-line investigation** in all syncope evaluations [3].
- Important to rule out **orthostatic hypotension** and should always be performed as part of basic syncope workup [1].
Geriatrics Indian Medical PG Question 2: Which of the following is the most appropriate initial antihypertensive treatment for an elderly patient with isolated systolic hypertension?
- A. Amlodipine (Correct Answer)
- B. Lisinopril
- C. Atenolol
- D. Losartan
Geriatrics Explanation: Amlodipine
- **Calcium channel blockers (CCBs)**, especially dihydropyridines like amlodipine, are recommended as initial therapy for isolated systolic hypertension in the elderly due to their effectiveness in reducing elevated systolic pressure [2].
- They are well-tolerated and can reduce the risk of cardiovascular events in this population.
*Lisinopril*
- **ACE inhibitors** like lisinopril are effective antihypertensives but are generally not the first-line choice for isolated systolic hypertension, particularly in elderly patients where a decrease in diastolic pressure might be detrimental [1].
- They are associated with side effects such as **cough** and can cause **acute kidney injury**, which can be a concern in older adults [1].
Atenolol
- **Beta-blockers** like atenolol are generally not recommended as first-line therapy for isolated systolic hypertension due to their limited efficacy in lowering systolic blood pressure compared to other drug classes.
- They may also worsen certain conditions common in the elderly, such as **peripheral vascular disease** and **bronchospastic lung disease**.
*Losartan*
- **Angiotensin receptor blockers (ARBs)** like losartan are effective for hypertension but are not typically favored over CCBs or thiazide diuretics as initial monotherapy for isolated systolic hypertension in the elderly [1].
- They share similar side effects and contraindications with ACE inhibitors, including the risk of **renal dysfunction** [1].
Geriatrics Indian Medical PG Question 3: Which of the following features helps in distinguishing seizures from syncope?
- A. Urinary incontinence
- B. Injury due to fall
- C. Physical weakness with clear sensorium (Correct Answer)
- D. Loss of consciousness
Geriatrics Explanation: ***Physical weakness with clear sensorium***
- This describes the **post-syncopal state**, where a patient typically feels weak but is fully aware and oriented immediately upon regaining consciousness, unlike the **post-ictal confusion** seen after a seizure [1].
- The rapid return to a clear sensorium is a key differentiating feature as syncope is a transient global cerebral hypoperfusion event without the sustained neuronal discharge of a seizure [1], [2].
*Urinary incontinence*
- **Urinary incontinence** can occur in both severe syncopal episodes and seizures, making it a non-specific differentiator [1], [2].
- While more common and often tonic in seizures, brief bladder control loss can happen with significant hypotension in syncope.
*Injury due to fall*
- **Injury due to fall** can occur in both seizures and syncope, as both conditions involve a sudden loss of postural control [2].
- The nature of the injury might differ (e.g., specific injuries like posterior shoulder dislocation in seizures), but the fall itself is not distinctive.
*Loss of consciousness*
- Both **seizures** and **syncope** are characterized by a transient **loss of consciousness** [3].
- This symptom defines the core presentation of both conditions and therefore does not help in distinguishing between them.
Geriatrics Indian Medical PG Question 4: 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?
- A. Rhinoscleroma (Correct Answer)
- B. Nasal polyposis
- C. Atrophic rhinitis
- D. Chronic sinusitis
Geriatrics Explanation: ***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
Geriatrics Indian Medical PG Question 5: If the contractility of the heart is decreased, which of the following is seen ?
- A. Increased ejection fraction
- B. Increased stroke work
- C. Decreased stroke volume (Correct Answer)
- D. Increased cardiac output
Geriatrics Explanation: ***Decreased stroke volume***
- A decrease in the **contractility** of the heart directly reduces the force of myocardial contraction.
- This weaker contraction results in less blood being ejected from the ventricle per beat, leading to a **decreased stroke volume**.
*Increased ejection fraction*
- **Ejection fraction** is the percentage of blood ejected from the ventricle with each beat, calculated as (stroke volume / end-diastolic volume) x 100.
- When contractility decreases, **stroke volume** decreases, which would typically lead to a *decreased* ejection fraction, not an increased one.
*Increased stroke work*
- **Stroke work** is a measure of the work done by the ventricle to eject blood, and it depends on both stroke volume and aortic pressure.
- With decreased contractility, **stroke volume** falls, which would *decrease* the stroke work, assuming afterload remains constant.
*Increased cardiac output*
- **Cardiac output** is the product of stroke volume and heart rate (CO = SV x HR).
- Since decreased contractility leads to a **decreased stroke volume**, without a compensatory increase in heart rate, cardiac output would *decrease*, not increase.
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