Organic mental disorders: apathetic hyperthyroidism: 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.

Try it

Psychiatry · Organic mental disorders: apathetic hyperthyroidism

Sample item

A 75-year-old woman has lost weight, is withdrawn and apathetic, and has mild confusion and new atrial fibrillation. She has no tremor, heat intolerance or goitre. Which test is the most useful next step?

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

The answer and the reasoning

D. TSH and free thyroxine

Hyperthyroidism in older people can be apathetic, with weight loss, atrial fibrillation, depression-like withdrawal and confusion, and without the classic adrenergic features. A thyroid function test is therefore needed in late-life depression and delirium with weight loss.

Option by option

  • A. Serum cortisol

    Cortisol would assess adrenal disease, which does not fit with atrial fibrillation and weight loss.

  • B. Serum vitamin B12

    B12 deficiency causes cognitive and neurological change but not weight loss with atrial fibrillation.

  • C. CSF analysis

    CSF analysis is not the first step in this presentation.

  • D. TSH and free thyroxine (correct)

    Correct. Thyroid function testing identifies apathetic hyperthyroidism.

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.

More Psychiatry questions

Questions about this Psychiatry question

What is the answer to this Psychiatry question?

The best answer is D, TSH and free thyroxine. Hyperthyroidism in older people can be apathetic, with weight loss, atrial fibrillation, depression-like withdrawal and confusion, and without the classic adrenergic features.

Why is "Serum cortisol" not the answer?

Cortisol would assess adrenal disease, which does not fit with atrial fibrillation and weight loss.

Why is "Serum vitamin B12" not the answer?

B12 deficiency causes cognitive and neurological change but not weight loss with atrial fibrillation.

Why is "CSF analysis" not the answer?

CSF analysis is not the first step in this presentation.

What concept does this question test?

It tests Organic mental disorders: apathetic hyperthyroidism in Psychiatry. A thyroid function test is therefore needed in late-life depression and delirium with weight loss.

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 mental disorders: apathetic hyperthyroidism?

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.