Free Geriatric Psychiatry Practice Questions

Question 1

A 77-year-old man has gradually lost the ability to manage his medications and finances. His wife describes striking swings between lucid conversation and prolonged inattentiveness, and he repeatedly sees unfamiliar children in their living room. Cognitive decline began interfering with independent daily activities nine months before spontaneous bradykinesia and rigidity. A previous clinician obtained an amyloid PET scan, which was positive, and diagnosed Alzheimer disease. How should the PET result be integrated with the clinical history?

Accepted Answer

Probable dementia with Lewy bodies remains supported; amyloid pathology can coexist

Answer

Alzheimer dementia with late psychosis best accounts for the presentation

Answer

Parkinson disease dementia is favored because the motor syndrome is now established

Answer

Possible dementia with Lewy bodies requires an abnormal dopamine-transporter scan for probable status

Question 2

“I have ruined everyone's lives; food would be wasted on me,” says a 77-year-old man hospitalized with severe psychotic depression. He has lost 9 kg and required intravenous fluids twice because he barely drinks. Sertraline and quetiapine were started ten days ago. Volume and electrolyte deficits have been corrected, but intake remains negligible despite nutritional support. Which treatment should be offered now?

Accepted Answer

Begin an acute course of electroconvulsive therapy during this admission

Answer

Continue medication alone until a six-week antidepressant trial is complete

Answer

Choose repetitive transcranial magnetic stimulation to avoid general anesthesia

Answer

Replace quetiapine with lithium augmentation and reassess after several weeks

Question 3

Ten days after completing alcohol withdrawal treatment, a 74-year-old man wants medication to help him remain abstinent. He takes oxycodone daily for cancer pain, and his oncology team expects opioid treatment to continue. Creatinine clearance is stable at 42 mL/min; hepatic testing is unremarkable. He is attending counseling and can manage a three-times-daily regimen. Select the medication plan that fits his recovery goal and medical treatment.

Accepted Answer

Start acamprosate 333 mg orally three times daily

Answer

Start acamprosate 666 mg orally three times daily

Answer

Start naltrexone 50 mg orally once daily

Answer

Defer medication until creatinine clearance exceeds 50 mL/min

Question 4

An 81-year-old retired attorney scores 28/30 on the Montreal Cognitive Assessment (MoCA). Over 14 months, he has repeatedly double-paid bills and taken duplicate medication doses. Written reminders no longer compensate, so his daughter has taken over both tasks. Neuropsychological testing documents substantial decline in learning and executive function compared with prior testing. He still bathes and dresses himself; there is no delirium or major mood syndrome. Which classification fits his cognitive and functional status?

Accepted Answer

Major neurocognitive disorder despite a high screening score

Answer

Mild neurocognitive disorder; independence in basic personal care is preserved

Answer

Subjective cognitive decline; the screening score remains in the unimpaired range

Answer

Unclassified cognitive symptoms pending etiologic biomarker confirmation

Question 5

Six days after moving into a smoke-free residence, a 74-year-old man with schizophrenia develops daytime sedation and increased drooling. His clozapine trough concentration has nearly doubled despite unchanged dosing and observed adherence. He previously smoked 20 cigarettes daily and now uses a nicotine patch. There is no infection, new interacting medication, or organ-function change. Which prescribing response addresses the interaction?

Accepted Answer

Reduce clozapine and recheck its concentration; nicotine replacement can continue

Answer

Stop nicotine replacement; maintain the current clozapine dose

Answer

Continue both unchanged because nicotine replacement preserves the smoking interaction

Answer

Switch to olanzapine because its clearance is unaffected by smoking status

Question 6

For nine months, a 73-year-old woman has avoided buses, supermarkets, and crowded church services unless her daughter accompanies her. She fears becoming dizzy where escape or help would be difficult, but remains comfortable entertaining friends at home. She has never had an unexpected panic attack. Medical assessment finds no active cause of dizziness or mobility limitation. Her daughter now does most of her shopping, although she would prefer to go herself. Which diagnosis best explains her avoidance?

Accepted Answer

Agoraphobia

Answer

Social anxiety disorder

Answer

Specific phobia

Answer

Panic disorder

Question 7

“Her urine culture is positive; should we start ceftriaxone?” asks a nurse about an 86-year-old resident with stable dementia who became inattentive and intermittently drowsy yesterday. Oxybutynin was started four days ago for longstanding urge incontinence. She is afebrile and hemodynamically stable, with no new urinary symptoms, suprapubic tenderness, or flank pain. The culture grows more than 100,000 CFU/mL of E. coli with pyuria. Which recommendation is most appropriate?

Accepted Answer

Stop oxybutynin, assess other delirium precipitants, and observe closely without antibiotics

Answer

Start oral nitrofurantoin because pyuria makes the positive culture clinically significant

Answer

Give intravenous ceftriaxone until attention improves, then narrow treatment to culture susceptibilities

Answer

Obtain a catheterized culture before evaluating other causes of the mental-status change

Question 8

A laboratory flags a lithium concentration of 0.5 mmol/L as low against its printed range of 0.6-1.2 mmol/L. The sample was drawn 12 hours after the evening dose in an 83-year-old woman with bipolar I disorder. She has remained well on the same dose for three years, with unchanged renal and thyroid results, no adverse effects, and no new interacting medication. How should the flagged result affect prescribing?

Accepted Answer

Continue the effective dose, with periodic lithium levels and renal and thyroid monitoring

Answer

Increase the dose to reach the laboratory's printed range

Answer

Begin a gradual taper because remission has lasted three years

Answer

Replace lithium with valproate to reduce age-related toxicity risk

Question 9

For two years, a 74-year-old woman's restless legs symptoms began around bedtime and improved with pramipexole. Over the past six months, symptoms have shifted to early afternoon, appear within minutes of sitting, and sometimes involve her arms. Increasing pramipexole briefly helped, followed by further worsening. Ferritin is 145 ng/mL and transferrin saturation is 28%; renal function is normal, and she takes no other sedating drugs. What change in treatment best addresses this pattern?

Accepted Answer

Introduce pregabalin and gradually taper pramipexole, monitoring rebound symptoms and adverse effects

Answer

Move pramipexole to noon and add a second dose for evening breakthrough symptoms

Answer

Discontinue pramipexole immediately; introduce a replacement after symptoms settle

Answer

Replace pramipexole with levodopa taken before the daily symptoms begin

Question 10

A daughter asks that donepezil be prescribed over her 82-year-old mother's objection, citing a health-care proxy that becomes active if her mother cannot make the decision. The patient has early Alzheimer dementia and an MMSE of 22/30. She explains the drug's limited symptomatic benefit, recognizes how her illness affects her, compares treatment with no treatment, and consistently prefers avoiding the nausea she experienced on an earlier trial. There is no delirium. How should the refusal be handled?

Accepted Answer

Respect her refusal and document capacity for this particular treatment decision

Answer

Use the daughter's consent because the Alzheimer diagnosis activates the proxy

Answer

Defer the decision until neuropsychological testing establishes her general competence

Answer

Seek a court-appointed guardian before accepting refusal of dementia treatment

Free Geriatric Psychiatry Practice Questions

Domain 3: Substance-related and addictive disorders (7-9%)

Question 1

Domain 5: Depressive disorders (8-12%)

Question 2

Domain 6: Bipolar and related disorders (5-7%)

Question 3

Domain 7: Anxiety disorders (7-9%)

Question 4

Domain 13: Sleep-wake disorders (2-4%)

Question 5

Domain 20: Neurocognitive disorders (13-17%)

Question 6

Question 7

Domain 27: Diagnostic procedures (10-14%)

Question 8

Domain 28: Treatment (31-35%)

Question 9

Domain 30: Professionalism, ethics, and the law (2-4%)

Question 10

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