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 malnourished man with chronic alcohol dependence is brought in confused, with an unsteady gait and nystagmus with ophthalmoplegia. He is hypoglycaemic. What is the most appropriate management?

AIntravenous glucose alone, then thiamine laterBOral folic acid aloneCHaloperidol for the confusionDParenteral thiamine, given before or together with glucose

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

The answer and the reasoning

D. Parenteral thiamine, given before or together with glucose

The triad of confusion, ataxia and ophthalmoplegia indicates Wernicke encephalopathy from thiamine deficiency. Glucose metabolism consumes thiamine, so glucose given alone may precipitate or worsen the encephalopathy. Parenteral thiamine must be given promptly, before or with glucose.

Option by option

A. Intravenous glucose alone, then thiamine later
Glucose alone can precipitate acute Wernicke encephalopathy in a thiamine-depleted patient.
B. Oral folic acid alone
Folic acid does not treat Wernicke encephalopathy.
C. Haloperidol for the confusion
Haloperidol treats agitation but does not treat the underlying deficiency and may lower the seizure threshold.
D. Parenteral thiamine, given before or together with glucose (correct)
Correct. Replacing thiamine first prevents glucose loading from worsening the deficiency.

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.

Questions about this Psychiatry question

What is the answer to this Psychiatry question?

The best answer is D, Parenteral thiamine, given before or together with glucose. The triad of confusion, ataxia and ophthalmoplegia indicates Wernicke encephalopathy from thiamine deficiency.

Why is "Intravenous glucose alone, then thiamine later" not the answer?

Glucose alone can precipitate acute Wernicke encephalopathy in a thiamine-depleted patient.

Why is "Oral folic acid alone" not the answer?

Folic acid does not treat Wernicke encephalopathy.

Why is "Haloperidol for the confusion" not the answer?

Haloperidol treats agitation but does not treat the underlying deficiency and may lower the seizure threshold.

What concept does this question test?

It tests Organic brain syndromes in Psychiatry. Glucose metabolism consumes thiamine, so glucose given alone may precipitate or worsen the encephalopathy. Parenteral thiamine must be given promptly, before or with glucose.

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.