Organic brain syndromes: practice question

A Psychiatry question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Psychiatry · Organic brain syndromes

Sample item

A 74-year-old man has fluctuating cognition, well-formed visual hallucinations of children in the room and mild parkinsonism. After haloperidol is given for agitation he becomes rigid and severely confused. Which diagnosis best explains this?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Dementia with Lewy bodies

Dementia with Lewy bodies is defined by fluctuating cognition, recurrent visual hallucinations and parkinsonism. These patients show severe sensitivity to dopamine-blocking antipsychotics, with rigidity, sedation and sometimes neuroleptic malignant-like reactions. Cholinesterase inhibitors are useful, and low-dose quetiapine or clozapine is chosen if an antipsychotic is unavoidable.

Option by option

  • A. Dementia with Lewy bodies (correct)

    Correct. Fluctuations, visual hallucinations, parkinsonism and neuroleptic sensitivity are the core features.

  • B. Normal pressure hydrocephalus

    Normal pressure hydrocephalus presents with gait disturbance, urinary incontinence and dementia.

  • C. Alzheimer disease

    Alzheimer disease usually shows progressive memory loss and does not typically show early parkinsonism and prominent hallucinations.

  • D. Vascular dementia

    Vascular dementia shows stepwise decline with focal neurological signs.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Psychiatry question

What is the answer to this Psychiatry question?

The best answer is A, Dementia with Lewy bodies. Dementia with Lewy bodies is defined by fluctuating cognition, recurrent visual hallucinations and parkinsonism.

Why is "Normal pressure hydrocephalus" not the answer?

Normal pressure hydrocephalus presents with gait disturbance, urinary incontinence and dementia.

Why is "Alzheimer disease" not the answer?

Alzheimer disease usually shows progressive memory loss and does not typically show early parkinsonism and prominent hallucinations.

Why is "Vascular dementia" not the answer?

Vascular dementia shows stepwise decline with focal neurological signs.

What concept does this question test?

It tests Organic brain syndromes in Psychiatry. These patients show severe sensitivity to dopamine-blocking antipsychotics, with rigidity, sedation and sometimes neuroleptic malignant-like reactions. Cholinesterase inhibitors are useful, and low-dose quetiapine or clozapine is chosen if an antipsychotic is unavoidable.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Organic brain syndromes?

Learn each diagnosis by its core features and its first-line treatment. Then use the flashcards and the other Psychiatry questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.