ABIM Geriatric Medicine — Questions and Answers
Question 1: Which feature best distinguishes delirium from dementia?
- Acute onset with fluctuating inattention (Correct answer)
- Memory impairment
- Older age
- Gradual progression over years
Correct answer: Acute onset with fluctuating inattention
Delirium has an acute onset and a fluctuating course, and inattention is its core feature (as in the Confusion Assessment Method). Dementia is usually gradual and progressive, with attention relatively preserved early on.
Question 2: Per the AGS Beers Criteria, which medication is potentially inappropriate for insomnia in a 78-year-old?
- Cognitive behavioral therapy for insomnia
- Melatonin
- Diphenhydramine (Correct answer)
- Sleep hygiene education
Correct answer: Diphenhydramine
First-generation antihistamines such as diphenhydramine are strongly anticholinergic and raise the risk of confusion, constipation, urinary retention, and falls in older adults. The Beers Criteria list them to avoid.
Question 3: Which intervention does the USPSTF recommend to prevent falls in community-dwelling adults 65 and older at increased fall risk?
- Vitamin D supplementation
- Exercise interventions (Correct answer)
- Routine hip protectors
- Benzodiazepine taper only
Correct answer: Exercise interventions
The USPSTF gives a B recommendation to exercise interventions, such as gait, balance, and strength training, for fall prevention. It recommends against vitamin D supplementation to prevent falls in community-dwelling older adults.
Question 4: An 82-year-old hospitalized patient develops hyperactive delirium but is not a danger to self or others. What is the first-line management?
- Lorazepam at night
- Physical restraints
- Scheduled haloperidol
- Non-pharmacologic measures: reorientation, sleep hygiene, mobilization, hearing and vision aids (Correct answer)
Correct answer: Non-pharmacologic measures: reorientation, sleep hygiene, mobilization, hearing and vision aids
Non-pharmacologic, multicomponent interventions are first-line for both preventing and managing delirium, along with treating the underlying cause. Benzodiazepines can worsen delirium (except in alcohol withdrawal). Restraints and routine antipsychotics should be avoided.
Question 5: A sacral wound shows partial-thickness skin loss with exposed pink dermis, and no slough or fat is visible. What is the pressure injury stage?
- Stage 1
- Stage 2 (Correct answer)
- Stage 3
- Unstageable
Correct answer: Stage 2
Stage 2 is partial-thickness skin loss with exposed dermis. Stage 1 is intact skin with non-blanchable erythema. Stage 3 is full-thickness loss with visible fat. Unstageable means slough or eschar hides the base.
Question 6: A 76-year-old woman has urgency and leaks urine before reaching the toilet. What is the most appropriate initial treatment?
- Bladder training (behavioral therapy) (Correct answer)
- Oxybutynin
- Indwelling catheter
- Surgical sling
Correct answer: Bladder training (behavioral therapy)
Behavioral therapy, such as bladder training and timed voiding, is first-line for urge incontinence. Anticholinergics like oxybutynin are on the Beers list because of cognitive effects. Slings treat stress incontinence, and catheters are not appropriate for this.
