ABIM Geriatric Medicine

Question 1

Which feature best distinguishes delirium from dementia?

Accepted Answer

Acute onset with fluctuating inattention

Answer

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?

Accepted Answer

Diphenhydramine

Answer

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?

Accepted Answer

Exercise interventions

Answer

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?

Accepted Answer

Non-pharmacologic measures: reorientation, sleep hygiene, mobilization, hearing and vision aids

Answer

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?

Accepted Answer

Stage 2

Answer

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.

ABIM - American Board of Internal Medicine Practice Test

ABIM - American Board of Internal Medicine Practice Test

ABIM Geriatric Medicine