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ABPN Geriatric Psychiatry study materials
ABPN Geriatric Psychiatry study resources

ABPN Geriatric Psychiatry practice questions

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Question 1Geriatric Psychiatry

Which medication is considered a first-line pharmacologic treatment for moderate to severe Alzheimer disease because it targets the cholinergic deficit?

  1. Lorazepam
  2. Propranolol
  3. Donepezil Correct answer.
  4. Quetiapine

Explanation

Cholinesterase inhibitors such as donepezil increase synaptic acetylcholine and are first-line for mild to moderate Alzheimer disease, with modest benefit on cognition and function. The other agents address behavioral symptoms or unrelated conditions rather than the core cholinergic deficit.

Question 2Geriatric Psychiatry

A 78-year-old with Alzheimer disease becomes agitated and sees people who are not there. Which agent class is most appropriate to treat these psychotic symptoms when nonpharmacologic measures fail?

  1. Atypical antipsychotic Correct answer.
  2. SSRI antidepressant
  3. Benzodiazepine
  4. Cholinesterase inhibitor

Explanation

When nonpharmacologic strategies fail and psychosis causes distress or danger, an atypical antipsychotic at the lowest effective dose and shortest duration is the standard approach, with monitoring for cerebrovascular and mortality risk. Cholinesterase inhibitors are for cognition, SSRIs target depression, and benzodiazepines can paradoxically worsen agitation and falls.

Question 3Geriatric Psychiatry

Which finding best distinguishes delirium from dementia at the bedside?

  1. Acute onset with fluctuating attention Correct answer.
  2. Preserved level of consciousness
  3. Stable cognitive deficits across days
  4. Gradual decline over years

Explanation

Delirium is characterized by acute onset, fluctuating course, and impaired attention and awareness, distinguishing it from the insidious, stable course of dementia. Dementia typically shows progressive decline with relatively preserved consciousness until late stages.

Question 4Geriatric Psychiatry

An older adult with baseline mild cognitive impairment develops sudden confusion and agitation two days after starting a new medication. What is the most likely diagnosis?

  1. Late-life depression
  2. Major neurocognitive disorder
  3. Delirium Correct answer.
  4. Normal aging

Explanation

Acute onset of confusion and agitation after a medication change in a vulnerable older adult is classic for delirium, which is often multifactorial and medication-triggered. Dementia and depression have more gradual courses, and normal aging does not cause acute confusion.

Question 5Geriatric Psychiatry

Which nonpharmacologic intervention has the strongest evidence for preventing delirium in hospitalized older adults?

  1. Physical restraints
  2. Multicomponent prevention programs Correct answer.
  3. Continuous bed rest
  4. Routine benzodiazepine prophylaxis

Explanation

Multicomponent programs addressing orientation, sleep, mobility, hydration, and sensory aids reduce delirium incidence. Benzodiazepines, restraints, and immobility increase delirium risk rather than prevent it.

Question 6Geriatric Psychiatry

Which feature is most characteristic of late-life depression compared with depression in younger adults?

  1. Higher rates of substance use
  2. More frequent bipolar conversion
  3. Predominance of atypical features
  4. Prominent somatic complaints Correct answer.

Explanation

Older adults with depression often present with somatic complaints, cognitive slowing, and apathy rather than reporting sadness directly. Substance use and atypical features are more common in younger populations.

Question 7Geriatric Psychiatry

Which screening instrument is most appropriate for detecting depression in an older adult with mild cognitive impairment?

  1. Mini-Mental State Examination
  2. Geriatric Depression Scale Correct answer.
  3. Clock drawing test
  4. Braden Scale

Explanation

The Geriatric Depression Scale is designed for older adults and relies less on somatic items that confound medical illness; a short form is often used. The MMSE and clock drawing assess cognition, and the Braden Scale assesses pressure ulcer risk.

Question 8Geriatric Psychiatry

An 82-year-old with depression has failed two adequate trials of SSRIs. Which treatment is a reasonable next step with good evidence in late-life depression?

  1. Electroconvulsive therapy Correct answer.
  2. Stopping all treatment
  3. Long-term benzodiazepine monotherapy
  4. Anticholinergic tricyclic at high dose

Explanation

Electroconvulsive therapy is highly effective for treatment-resistant and severe late-life depression and is often better tolerated than tricyclics in older adults. Benzodiazepines and anticholinergic tricyclics carry substantial risk in this population.

Question 9Geriatric Psychiatry

Which medication is the first-line treatment for generalized anxiety disorder in an older adult without complicating medical illness?

  1. Diphenhydramine
  2. Hydroxyzine
  3. Escitalopram Correct answer.
  4. Diazepam

Explanation

SSRIs such as escitalopram are first-line for late-life anxiety because of favorable tolerability and lower dependence risk. Benzodiazepines and antihistamines carry sedation, falls, and anticholinergic risks in older adults.

Question 10Geriatric Psychiatry

Which brain region shows the earliest and most severe atrophy in Alzheimer disease?

  1. Cerebellum
  2. Primary motor cortex
  3. Occipital cortex
  4. Medial temporal lobe Correct answer.

Explanation

Alzheimer disease begins in the medial temporal lobe, especially the hippocampus and entorhinal cortex, producing early memory impairment. Occipital, cerebellar, and motor cortices are relatively spared until late.

Question 11Geriatric Psychiatry

A patient with suspected dementia has a stepwise decline, focal neurologic signs, and a history of vascular risk factors. Which diagnosis is most likely?

  1. Vascular dementia Correct answer.
  2. Alzheimer disease
  3. Dementia with Lewy bodies
  4. Frontotemporal dementia

Explanation

Stepwise decline with focal neurologic findings and cerebrovascular risk factors suggests vascular dementia. Alzheimer disease is typically gradual, Lewy body dementia features fluctuations and visual hallucinations, and frontotemporal dementia presents with behavioral or language changes.

Question 12Geriatric Psychiatry

Which clinical triad is characteristic of dementia with Lewy bodies?

  1. Fluctuating cognition, visual hallucinations, parkinsonism Correct answer.
  2. Aphasia, apraxia, agnosia
  3. Stepwise decline, focal deficits, hypertension
  4. Personality change, disinhibition, language loss

Explanation

Dementia with Lewy bodies is defined by fluctuating cognition, recurrent visual hallucinations, and spontaneous parkinsonism, often with REM sleep behavior disorder. The other clusters describe Alzheimer disease, vascular dementia, and frontotemporal dementia.

Question 13Geriatric Psychiatry

Which medication class should be avoided in a patient with dementia with Lewy bodies because of severe neuroleptic sensitivity?

  1. SSRIs
  2. Cholinesterase inhibitors
  3. Typical antipsychotics Correct answer.
  4. Melatonin

Explanation

Patients with Lewy body dementia have marked sensitivity to typical antipsychotics, which can cause severe rigidity, immobility, and even fatal reactions. Cholinesterase inhibitors, SSRIs, and melatonin are relatively safer options.

Question 14Geriatric Psychiatry

Which behavioral variant of frontotemporal dementia is most likely in a 60-year-old with progressive disinhibition, apathy, and loss of empathy?

  1. Alzheimer disease
  2. Behavioral variant frontotemporal dementia Correct answer.
  3. Vascular dementia
  4. Normal pressure hydrocephalus

Explanation

Early personality change, disinhibition, apathy, and impaired empathy with relatively preserved memory suggest behavioral variant frontotemporal dementia. Alzheimer disease begins with memory loss, vascular dementia with stepwise decline, and normal pressure hydrocephalus with the gait-incontinence-cognitive triad.

Question 15Geriatric Psychiatry

Which feature best supports a diagnosis of normal pressure hydrocephalus?

  1. Visual hallucinations with parkinsonism
  2. Magnetic gait with urinary incontinence and cognitive decline Correct answer.
  3. Prominent language impairment with preserved memory
  4. Stepwise cognitive decline after strokes

Explanation

Normal pressure hydrocephalus classically presents with the triad of gait disturbance, urinary incontinence, and cognitive impairment, and may improve with shunt placement. The other options describe Lewy body dementia, vascular dementia, and primary progressive aphasia.

Question 16Geriatric Psychiatry

Which test is most useful to exclude reversible causes when evaluating a new dementia presentation?

  1. Lumbar puncture in all patients
  2. Thyroid-stimulating hormone and vitamin B12 Correct answer.
  3. Skin biopsy
  4. Routine electroencephalogram

Explanation

Guidelines recommend checking TSH and vitamin B12 to identify reversible contributors to cognitive impairment. Routine EEG, lumbar puncture, and skin biopsy are not indicated in uncomplicated presentations.

Question 17Geriatric Psychiatry

An older adult with dementia is prescribed an anticholinergic bladder medication. What is the main concern?

  1. Reduced fall risk
  2. Increased cholinergic transmission
  3. Improved memory
  4. Worsening cognition and confusion Correct answer.

Explanation

Anticholinergic burden can worsen cognition, cause confusion, and increase delirium risk in older adults with dementia. These drugs block rather than enhance cholinergic transmission and increase rather than reduce fall risk.

Question 18Geriatric Psychiatry

Which principle of the Beers criteria applies to prescribing in older adults?

  1. Use anticholinergics liberally for urinary symptoms
  2. Prescribe all medications at maximum dose
  3. Prefer long-acting benzodiazepines for insomnia
  4. Avoid potentially inappropriate medications when safer alternatives exist Correct answer.

Explanation

The Beers criteria identify potentially inappropriate medications to avoid or use cautiously in older adults when safer alternatives are available. Maximum dosing, long-acting benzodiazepines, and liberal anticholinergic use run counter to these recommendations.

Question 19Geriatric Psychiatry

An 80-year-old on warfarin for atrial fibrillation is at increased risk of which adverse outcome if prescribed an NSAID for arthritis?

  1. Reduced fall risk
  2. Improved anticoagulation
  3. Enhanced renal function
  4. Gastrointestinal bleeding Correct answer.

Explanation

Combining warfarin with NSAIDs markedly increases gastrointestinal bleeding risk through anticoagulant interaction and mucosal injury. NSAIDs do not improve anticoagulation, reduce falls, or enhance renal function; they can impair it.

Question 20Geriatric Psychiatry

Which factor most strongly predicts an increased risk of suicide in older adults?

  1. Female sex alone
  2. High social support
  3. Depression with recent loss and social isolation Correct answer.
  4. Younger age at onset

Explanation

Late-life suicide risk is strongly associated with depression, recent bereavement or loss, social isolation, and access to lethal means. Social support is protective, and older men have higher completed suicide rates than women.

Question 21Geriatric Psychiatry

Which assessment is essential before starting a cholinesterase inhibitor in an older adult?

  1. Baseline cardiac rhythm review Correct answer.
  2. Vision screening
  3. Routine liver biopsy
  4. Bone density scan

Explanation

Cholinesterase inhibitors can cause bradycardia and syncope, so reviewing baseline cardiac rhythm and conduction is important. Liver biopsy, bone density, and vision screening are unrelated to this medication's main risks.

Question 22Geriatric Psychiatry

Which intervention is recommended for an older adult with insomnia before pharmacologic treatment?

  1. Cognitive behavioral therapy for insomnia Correct answer.
  2. Diphenhydramine nightly
  3. Alcohol at bedtime
  4. Long-term zolpidem

Explanation

Cognitive behavioral therapy for insomnia is first-line and avoids the falls, confusion, and dependence associated with sedative-hypnotics. Zolpidem, diphenhydramine, and alcohol all carry risks of sedation, cognitive impairment, and falls.

Question 23Geriatric Psychiatry

A patient with advanced dementia stops eating and drinking. Which approach is best supported by current guidance?

  1. Careful hand feeding with comfort-focused care Correct answer.
  2. Aggressive intravenous hydration regardless of goals
  3. Routine percutaneous feeding tube placement
  4. Forced oral hydration

Explanation

In advanced dementia, careful hand feeding and comfort-focused care are preferred; feeding tubes do not improve survival or quality of life and may increase complications. Aggressive hydration may conflict with comfort goals.

Question 24Geriatric Psychiatry

Which medication should be used cautiously in older adults with chronic kidney disease because of accumulation risk?

  1. Gabapentin Correct answer.
  2. Levothyroxine
  3. Atorvastatin
  4. Furosemide

Explanation

Gabapentin is renally cleared and can accumulate in chronic kidney disease, causing sedation, confusion, and falls, so dosing must be adjusted. Atorvastatin, levothyroxine, and furosemide are managed differently and do not carry the same accumulation concern.

Question 25Geriatric Psychiatry

Which feature of grief most suggests it has become a major depressive episode rather than normal bereavement?

  1. Yearning for the deceased
  2. Temporary tearfulness during holidays
  3. Persistent anhedonia with worthlessness lasting months Correct answer.
  4. Waves of sadness triggered by reminders

Explanation

Prolonged pervasive anhedonia, worthlessness, and functional impairment beyond expected grieving suggest a major depressive episode. Waves of sadness, yearning, and temporary tearfulness are typical of normal grief.

Question 26Geriatric Psychiatry

Which finding on mental status examination most strongly suggests delirium rather than dementia in an older hospitalized patient?

  1. Preserved ability to sustain focus during conversation
  2. Impaired attention that fluctuates over the course of the day Correct answer.
  3. Stable cognitive performance across repeated assessments
  4. Gradual progression of memory loss over several years

Explanation

Delirium is defined by an acute disturbance of attention and awareness that tends to fluctuate, whereas dementia produces a stable, progressive cognitive decline with attention relatively preserved until late stages. Fluctuating inattention is therefore the most discriminating bedside feature.

Question 27Geriatric Psychiatry

Which medication is most appropriate as a first-line agent for acute agitation in an older adult with delirium who is a danger to staff?

  1. Haloperidol at a low dose Correct answer.
  2. Clozapine at a starting dose
  3. Lorazepam at a standard adult dose
  4. Diphenhydramine at bedtime

Explanation

When nonpharmacologic measures fail and a patient poses an immediate danger, a low dose of a high-potency antipsychotic such as haloperidol is preferred because it has limited anticholinergic and sedative burden. Benzodiazepines and anticholinergics can worsen confusion and are avoided except in specific withdrawal states.

Question 28Geriatric Psychiatry

An older adult reports falling asleep easily but waking at 3 a.m. and being unable to return to sleep. Which term best describes this pattern?

  1. Sleep-onset insomnia
  2. Advanced sleep phase syndrome
  3. Restless legs syndrome
  4. Sleep-maintenance insomnia Correct answer.

Explanation

Difficulty staying asleep after initial sleep onset defines sleep-maintenance insomnia. Sleep-onset insomnia refers to trouble falling asleep, and advanced sleep phase syndrome is a circadian shift with early evening sleepiness and early morning awakening at a consistent time.

Question 29Geriatric Psychiatry

Which neuroimaging finding is most consistent with a diagnosis of probable Alzheimer disease on structural MRI?

  1. Diffuse white matter hyperintensities without cortical volume loss
  2. Medial temporal lobe atrophy Correct answer.
  3. Multiple lacunar infarcts in the basal ganglia
  4. Frontal and anterior temporal atrophy with relative sparing of the parietal lobes

Explanation

Probable Alzheimer disease is supported by atrophy of the medial temporal structures, particularly the hippocampus and entorhinal cortex. Lacunar infarcts and prominent white matter disease instead point toward a vascular contribution.

Question 30Geriatric Psychiatry

Which feature on examination most strongly supports a diagnosis of Parkinson disease dementia rather than dementia with Lewy bodies?

  1. Visual hallucinations occurring early in the illness course
  2. Severe neuroleptic sensitivity to low-dose antipsychotics
  3. Dementia that begins more than one year after well-established parkinsonism Correct answer.
  4. Fluctuating cognition with marked daytime drowsiness

Explanation

The one-year rule separates the two disorders: in Parkinson disease dementia, motor symptoms precede cognitive decline by more than a year, whereas in dementia with Lewy bodies the dementia begins before or within one year of parkinsonism. Early hallucinations, fluctuation, and neuroleptic sensitivity are core features of dementia with Lewy bodies.

Question 31Geriatric Psychiatry

Which change in language is most typical of the logopenic variant of primary progressive aphasia?

  1. Profound loss of object knowledge with preserved repetition
  2. Nonfluent speech with distorted sounds and intact comprehension
  3. Impaired single-word retrieval with spared grammar and articulation Correct answer.
  4. Fluent speech with intact repetition and impaired word comprehension

Explanation

The logopenic variant is characterized by impaired word finding and impaired sentence repetition with relatively preserved grammar and motor speech. It is often associated with underlying Alzheimer pathology.

Question 32Geriatric Psychiatry

Which laboratory test is most important to obtain before starting donepezil in an older adult?

  1. Electrocardiogram to assess for bradycardia or conduction disease Correct answer.
  2. Serum ammonia level
  3. Antinuclear antibody panel
  4. Serum ceruloplasmin level

Explanation

Cholinesterase inhibitors can produce symptomatic bradycardia, syncope, and conduction block, so baseline cardiac rhythm assessment is prudent, especially in patients with known heart disease. The other tests are not routinely indicated for this purpose.

Question 33Geriatric Psychiatry

Which adverse effect is most characteristic of memantine?

  1. Agranulocytosis
  2. Hepatic failure
  3. Dizziness and somnolence Correct answer.
  4. Severe bradycardia

Explanation

Memantine is generally well tolerated; the most commonly reported adverse effects are dizziness, headache, confusion, and somnolence. Bradycardia is associated with cholinesterase inhibitors, and agranulocytosis is not a typical concern with memantine.

Question 34Geriatric Psychiatry

An older adult with mild cognitive impairment asks about preventing progression to dementia. Which intervention has the strongest evidence for reducing risk?

  1. Long-term use of ginkgo biloba
  2. Daily high-dose vitamin E supplementation
  3. Regular aerobic physical exercise Correct answer.
  4. Routine use of anti-amyloid monoclonal antibodies in mild cognitive impairment

Explanation

Physical activity is among the lifestyle factors with the most consistent observational and trial support for preserving cognition and reducing dementia risk. Vitamin E, ginkgo, and routine anti-amyloid therapy are not established preventive strategies for this population.

Question 35Geriatric Psychiatry

Which caregiver intervention has the strongest evidence for reducing caregiver burden in dementia?

  1. Placement of the patient in a nursing home as early as possible
  2. Structured multicomponent psychoeducation and skills training Correct answer.
  3. Scheduled respite limited to a single annual vacation
  4. Routine use of an SSRI for all caregivers

Explanation

Multicomponent programs combining education, problem-solving skills, and support have the best evidence for reducing caregiver burden and delaying institutionalization. Pharmacologic treatment of caregivers is reserved for those with a diagnosed disorder.

Question 36Geriatric Psychiatry

Which finding most strongly suggests that an older adult's cognitive complaints are due to depression rather than a neurodegenerative dementia?

  1. Progressive decline in instrumental activities over two years
  2. Consistent errors on delayed recall across visits
  3. Complaints of severe memory loss with normal performance on objective testing Correct answer.
  4. Preserved insight into cognitive deficits

Explanation

Marked subjective memory complaints with normal objective performance, sometimes termed pseudodementia, suggest a depressive contribution. True neurodegenerative decline produces measurable and progressive deficits on testing.

Question 37Geriatric Psychiatry

Which agent is most appropriate for treating alcohol withdrawal delirium in an older adult?

  1. Diphenhydramine
  2. Lorazepam with thiamine supplementation Correct answer.
  3. Haloperidol as monotherapy
  4. Propranolol as monotherapy

Explanation

Benzodiazepines are the mainstay of alcohol withdrawal treatment because they reduce autonomic hyperactivity and seizure risk, and thiamine is given to prevent Wernicke encephalopathy. Antipsychotics and beta-blockers do not treat the underlying withdrawal and may mask its severity.

Question 38Geriatric Psychiatry

Which statement about the epidemiology of late-life suicide is most accurate?

  1. Firearms are rarely used in late-life suicide
  2. Older men have the highest suicide rate of any age and sex group Correct answer.
  3. Suicide rates decline steadily after age 65 in both sexes
  4. Older women have the highest suicide rate of any group

Explanation

In the United States, older men, particularly those over 75, have the highest suicide rate of any demographic group. Older adults also tend to use more lethal methods, and rates do not decline with age in men.

Question 39Geriatric Psychiatry

Which feature most increases concern for imminent suicide risk in an older adult during evaluation?

  1. A history of dysthymia without current suicidal ideation
  2. Living with an adult child who provides daily supervision
  3. Passive thoughts of being better off dead without a plan
  4. Recent acquisition of a firearm and a specific plan Correct answer.

Explanation

Access to lethal means combined with a specific plan substantially raises imminent risk, and means restriction is a key intervention. Passive ideation without intent or plan is lower acuity, though it still warrants follow-up.

Question 40Geriatric Psychiatry

Which pharmacologic property makes a medication inappropriate for an older adult with constipation and urinary retention?

  1. Beta-adrenergic blockade
  2. Strong muscarinic antagonism Correct answer.
  3. Selective serotonin reuptake inhibition
  4. Proton pump inhibition

Explanation

Anticholinergic drugs block muscarinic receptors, worsening constipation and precipitating urinary retention, and they also contribute to cognitive impairment in older adults. Serotonergic, beta-blocking, and proton pump agents do not share this mechanism.

Question 41Geriatric Psychiatry

Which prescribing principle is central to the Beers criteria?

  1. Medications are flagged when they cost more than generic alternatives
  2. Medications are flagged only when the creatinine clearance falls below 30 mL/min
  3. Medications are flagged when their risks generally outweigh benefits in adults 65 and older Correct answer.
  4. Medications are flagged only when the patient has a documented allergy

Explanation

The Beers criteria identify potentially inappropriate medications whose risks generally outweigh benefits in older adults, independent of renal function or allergy status. They are intended to prompt individualized review rather than rigid prohibition.

Question 42Geriatric Psychiatry

An older adult with chronic kidney disease is to receive a medication cleared by the kidney. Which adjustment is most appropriate?

  1. Increase the dose to overcome reduced absorption
  2. Reduce the dose according to estimated creatinine clearance Correct answer.
  3. Double the dosing interval without checking renal function
  4. Maintain the usual dose because age does not affect clearance

Explanation

Many renally cleared drugs accumulate in chronic kidney disease, so dosing should be guided by estimated creatinine clearance. Age-related declines in glomerular filtration mean that a normal serum creatinine can mask substantial impairment.

Question 43Geriatric Psychiatry

Which drug interaction most increases bleeding risk in an older adult taking warfarin?

  1. Addition of trimethoprim-sulfamethoxazole Correct answer.
  2. Addition of a proton pump inhibitor
  3. Addition of an inhaled corticosteroid
  4. Addition of a thiazide diuretic

Explanation

Trimethoprim-sulfamethoxazole inhibits warfarin metabolism and displaces it from protein binding, raising the INR and bleeding risk. The other agents do not have a comparable clinically important interaction.

Question 44Geriatric Psychiatry

Which principle best guides the use of physical restraints in an agitated older adult with dementia in a nursing home?

  1. Restraints are appropriate as a first-line measure to prevent falls
  2. Restraints may be ordered verbally without documentation
  3. Restraints are a last resort after less restrictive measures have failed and require monitoring and limited duration Correct answer.
  4. Restraints may be used routinely at night to reduce staffing needs

Explanation

Regulations require that restraints be used only when less restrictive alternatives have failed, be time-limited, and be accompanied by monitoring and documentation. They are not a routine fall-prevention or staffing tool.

Question 45Geriatric Psychiatry

Which intervention is most appropriate first for an older adult with dementia who becomes agitated during bathing?

  1. Discontinue all bathing until the agitation resolves
  2. Add a standing order for an antipsychotic before each bath
  3. Apply wrist restraints during the bath
  4. Modify the bathing routine to reduce triggers and provide reassurance Correct answer.

Explanation

Behavioral symptoms in dementia are often triggered by care routines, so the first step is to identify and modify triggers, adjust the environment, and provide reassurance. Antipsychotics are reserved for severe symptoms after nonpharmacologic approaches fail.

Question 46Geriatric Psychiatry

Which statement best reflects current guidance on feeding in advanced dementia?

  1. Tube feeding reliably prevents aspiration pneumonia
  2. Intravenous hydration should be routine in the final weeks of life
  3. Percutaneous endoscopic gastrostomy is recommended for all patients with dysphagia
  4. Hand feeding with careful oral care is preferred over tube feeding Correct answer.

Explanation

Evidence does not show that tube feeding prolongs survival or prevents aspiration in advanced dementia, and hand feeding with oral care is the recommended approach. Artificial nutrition is generally avoided unless it clearly aligns with goals of care.

Question 47Geriatric Psychiatry

Which feature most suggests that a grief reaction has become a major depressive episode?

  1. Waves of sadness triggered by anniversaries
  2. Tearfulness when reminded of the deceased in the first two weeks
  3. Persistent worthlessness and functional impairment lasting more than two months after a loss Correct answer.
  4. Transient auditory hallucinations of the deceased's voice soon after death

Explanation

Uncomplicated grief typically comes in waves and may include transient hallucinations of the deceased, but persistent worthlessness, anhedonia, and functional impairment beyond the expected period suggest a major depressive episode. The distinction guides whether antidepressant or psychotherapeutic treatment is indicated.

Question 48Geriatric Psychiatry

Which factor most increases the risk of serotonin syndrome when an older adult is prescribed an SSRI?

  1. Concurrent use of a statin
  2. Concurrent use of a monoamine oxidase inhibitor Correct answer.
  3. Concurrent use of a thiazide diuretic
  4. Concurrent use of a proton pump inhibitor

Explanation

Serotonin syndrome results from excessive serotonergic activity, and combining an SSRI with a monoamine oxidase inhibitor is a classic and dangerous precipitant. Diuretics, statins, and proton pump inhibitors do not increase serotonergic tone.

Question 49Geriatric Psychiatry

An older adult with bipolar disorder has been stable on lithium for years. Which monitoring plan is most appropriate?

  1. Annual lithium level alone without renal or thyroid testing
  2. No monitoring once the patient has been stable for five years
  3. Periodic lithium levels, renal function, and thyroid function testing Correct answer.
  4. Monitoring only when the patient reports tremor

Explanation

Lithium has a narrow therapeutic index and is cleared renally, and long-term use can cause nephrogenic diabetes insipidus and hypothyroidism. Regular monitoring of levels, renal function, and thyroid function is required regardless of symptom stability.

Question 50Geriatric Psychiatry

Which electroconvulsive therapy consideration is most relevant in an older adult with severe depression and cardiac disease?

  1. Cardiovascular monitoring during the induced seizure because of hemodynamic stress Correct answer.
  2. Cognitive side effects do not occur in older adults
  3. Anesthesia is unnecessary for the procedure
  4. Electroconvulsive therapy is contraindicated in all patients over 75

Explanation

The seizure and anesthesia cause transient hypertension and tachycardia, so patients with cardiac disease need careful cardiovascular monitoring. ECT remains an effective option in late life, with transient memory effects that require discussion.