University papers · Sub. code 2056 / 4042
Paper II — General Medicine including Psycho-Geriatrics
Every question set between March 2009 and October 2025, de-duplicated and grouped by theme. Where a topic was set more than once, the fullest wording is shown with its repeat count.
- Sessions
- 20
- Questions set
- 240
- Unique questions
- 184
- With an answer
- 178
Most repeated
Set three or more times — prepare these thoroughly.
- ×4Depression in the elderly — treatment and management in older adults.
- ×4DOTS and the treatment, dose and regime of multidrug-resistant and XDR tuberculosis; drug resistance tuberculosis.
- ×4Hypercalcaemia — causes, evaluation and management, including PTH-independent hypercalcaemia and the flow chart to counteract it.
- ×3What are the behavioural and psychological symptoms of dementia? Describe their types, etiology, investigations and line of management, including the modes of action, indications and side effect profile of the drugs used.
- ×3Non-pharmacological management of behavioural disturbances in dementia.
- ×3What are the reversible dementias? How would you investigate and treat them?
- ×3Aortic stenosis and valvular aortic stenosis — clinical presentation, diagnosis and management.
- ×3Describe the types, clinical features, diagnosis and management of diffuse parenchymal lung disease in older adults, including its epidemiology, pathogenesis, classification, prognosis and natural history.
- ×3Hyponatremia.
- ×3Discuss the causes of jaundice in an older person and their management.
- ×3Management of gastro-oesophageal reflux disease.
- ×3Discuss giddiness in elderly people and its management; and the evaluation of dizziness in a 68-year-old.
1. Mood, Anxiety & Suicide
10 questions
- 1.
Describe the prevalence, clinical presentation and management of depression in the elderly. What is the role of ECT in an elderly patient with depression?
15-mark essayAnswer → - 2.
Depression in the elderly — treatment and management in older adults.
- 3.
Antidepressant medication in late-life depression.
7-mark noteAnswer → - 4.
A 65-year-old woman presents with loss of appetite, lack of interest in daily work, considerable weight loss and insomnia. She is teary and upset during the consultation, has thoughts of worthlessness and has contemplated killing herself. What would be your approach? What classes of drugs can be given safely in this age group, what is their side effect profile, and what would be your follow-up?
7-mark noteAnswer → - 5.
Suicide in elders and suicide risk assessment.
- 6.
Give an account of anxiety disorders and their management.
15-mark essayAnswer → - 7.
Anxiety in the elderly; generalised anxiety disorder.
- 8.
Phobias in old age.
7-mark noteAnswer → - 9.
Obsessive compulsive disorder.
7-mark noteAnswer → - 10.
Mood disorders in late life.
15-mark essayAnswer →
2. Psychosis, Psychotropics & Psychological Therapies
10 questions
- 11.
Late-life psychotic disorders.
7-mark noteAnswer → - 12.
Late-onset schizophrenia.
7-mark noteAnswer → - 13.
Atypical antipsychotics — their uses and side effects in the elderly.
- 14.
Electroconvulsive therapy in older adults.
- 15.
Cognitive behavioural therapy.
7-mark noteAnswer → - 16.
Non-pharmacological management of the agitated older individual.
7-mark noteAnswer → - 17.
Age-associated personality changes.
7-mark noteAnswer → - 18.
Diogenes syndrome.
7-mark noteAnswer → - 19.
Alcoholism in the elderly.
7-mark noteAnswer → - 20.
A 60-year-old man was found unconscious in the fields with profuse frothing at the mouth. He was well the previous night and had his usual dose of alcohol with his meal. He had incurred heavy debts after marrying off his daughter and had appeared depressed of late. How would you assess, investigate, diagnose and treat him based on evidence in literature?
15-mark essayAnswer →
3. Dementia, Cognition & Behavioural Symptoms
8 questions
- 21.
What are the behavioural and psychological symptoms of dementia? Describe their types, etiology, investigations and line of management, including the modes of action, indications and side effect profile of the drugs used.
- 22.
Non-pharmacological management of behavioural disturbances in dementia.
- 23.
How will you address caregiver stress in dementia?
7-mark noteAnswer → - 24.
What are the innovations you would suggest to ease caregiver burden?
7-mark noteAnswer → - 25.
What are the reversible dementias? How would you investigate and treat them?
- 26.
Mild cognitive impairment — evaluation, treatment and outcome.
- 27.
Vascular dementia.
7-mark noteAnswer → - 28.
Differentiating features of delirium, depression and dementia.
7-mark noteAnswer →
4. Delirium & Acute Confusional States
5 questions
- 29.
Acute confusional state.
- 30.
Delirium.
Asked ×27-mark note6-mark noteAnswer: Acute confusional state (Paper II)Answer: Delirium (Paper II)Answer: Delirium (Paper II) - 31.
Rating scales in delirium.
7-mark noteAnswer → - 32.
Confusion Assessment Method for the diagnosis of delirium.
7-mark noteAnswer → - 33.
A 78-year-old man with type 2 diabetes mellitus presents to the emergency outpatient department in acute confusion, with fever, headache, neck stiffness, vomiting and photophobia. What is your diagnosis and how will you manage this patient?
15-mark essayAnswer →
5. Neurology — Stroke, Seizures, Headache & Neuromuscular
19 questions
- 34.
Discuss epilepsy in elderly people and its management.
20-mark essayAnswer → - 35.
Complex partial seizure.
7-mark noteAnswer → - 36.
Newer anticonvulsants.
7-mark noteAnswer → - 37.
An 80-year-old hypertensive, diabetic woman with coronary artery disease and atrial fibrillation on medications was admitted to the medical ICU with altered sensorium following generalised tonic-clonic seizures. How will you evaluate and manage this patient?
15-mark essayAnswer → - 38.
Transient ischaemic attack.
- 39.
Lacunar stroke.
7-mark noteAnswer → - 40.
Subarachnoid haemorrhage.
7-mark noteAnswer → - 41.
What is the treatment of symptomatic and asymptomatic carotid disease in the elderly?
7-mark noteAnswer → - 42.
Wallenberg syndrome — cause, clinical features and treatment.
7-mark noteAnswer → - 43.
Discuss in detail the causes, clinical manifestations, diagnosis and management of hypoxic-ischaemic encephalopathy.
15-mark essayAnswer → - 44.
Post-acute management of traumatic brain injury.
7-mark noteAnswer → - 45.
Wernicke encephalopathy.
7-mark noteAnswer → - 46.
Cluster headache.
- 47.
Tension headache.
6-mark noteAnswer → - 48.
Etiology, clinical features, investigations and management of peripheral neuropathy in older adults. What are the common causes and what would be your approach?
- 49.
Cerebrospinal fluid findings in pyogenic, tuberculous, fungal and carcinomatous meningitis — use tables to illustrate your answer.
7-mark noteAnswer → - 50.
Serotonin syndrome.
7-mark noteAnswer → - 51.
Neuroleptic malignant syndrome.
7-mark noteAnswer → - 52.
Rhabdomyolysis.
7-mark noteAnswer →
6. Movement Disorders & Parkinsonism
8 questions
- 53.
Enumerate the motor and non-motor symptoms of Parkinson's disease. What treatment modalities are available and what is the side effect profile of the drugs used, with special reference to the geriatric population?
15-mark essayAnswer → - 54.
What are the principles of therapy and treatment in a 65-year-old patient recently diagnosed with Parkinson's disease who has predominant rigidity and minimal tremor?
7-mark noteAnswer → - 55.
Levodopa.
7-mark noteAnswer → - 56.
Drug-induced parkinsonism.
7-mark noteAnswer → - 57.
Multiple system atrophy — clinical features, types, diagnosis, prognosis and treatment.
15-mark essayAnswer → - 58.
Essential tremor.
7-mark noteAnswer → - 59.
Movement disorders in the elderly.
7-mark noteAnswer → - 60.
Describe the ageing changes in the central nervous system including the brain, and the degenerative diseases of the brain.
15-mark essayAnswer →
7. Cardiovascular Medicine
25 questions
- 61.
Discuss in detail the etiology, clinical features and management of chronic and congestive cardiac failure, including in a 85-year-old lady.
- 62.
Management of refractory heart failure.
7-mark noteAnswer → - 63.
Role of beta blockers in heart failure.
7-mark noteAnswer → - 64.
Diastolic dysfunction — clinical presentation, diagnosis and treatment options.
- 65.
A 70-year-old man presents to the Emergency Department in cardiac failure with hypotension and tachypnoea. What is the underlying pathophysiology? What differentials should be considered, what investigations rule them out, and what steps stabilise and manage him in the emergency department, ward and following discharge?
15-mark essayAnswer → - 66.
Clinical features, evaluation and management of unstable angina.
- 67.
Uses and limitations of the electrocardiogram in acute coronary syndromes.
7-mark noteAnswer → - 68.
What is your advice to a 65-year-old man with diabetes, hypertension, dyslipidaemia and a BMI of 35 who has just had two stents placed in his coronaries and comes for an outpatient consultation following discharge?
7-mark noteAnswer → - 69.
Discuss how you will manage hypertension in a 65-year-old with dyslipidaemia and coronary artery disease.
15-mark essayAnswer → - 70.
What are the stages of hypertension according to JNC 8, and what is the JNC 8 recommendation for target blood pressure in people over 60 years?
7-mark noteAnswer → - 71.
Accelerated hypertension.
7-mark noteAnswer → - 72.
Isolated systolic hypertension — cut-off value, treatment and prognosis.
7-mark noteAnswer → - 73.
Postural hypotension in the elderly — its evaluation and management.
7-mark noteAnswer → - 74.
Aortic stenosis and valvular aortic stenosis — clinical presentation, diagnosis and management.
- 75.
Aortic sclerosis.
7-mark noteAnswer → - 76.
Mitral regurgitation in the elderly.
6-mark noteAnswer → - 77.
Atherosclerosis and the biomarkers associated with it.
- 78.
Ankle brachial index and toe pressures — indications, assessment and interpretation.
7-mark noteAnswer → - 79.
Atrial fibrillation.
7-mark noteAnswer → - 80.
Tachyarrhythmias.
7-mark noteAnswer → - 81.
Head-up tilt test — its indication, procedure and interpretation.
7-mark noteAnswer → - 82.
Describe the aetiology, pathogenesis, differential diagnosis and management of syncope.
15-mark essayAnswer → - 83.
Drop attacks.
6-mark noteAnswer → - 84.
Polypill.
6-mark noteAnswer → - 85.
Cardiorenal syndrome.
7-mark noteAnswer →
8. Respiratory Medicine
17 questions
- 86.
What is community-acquired pneumonia? What is the etiopathogenesis of this entity and how will you diagnose and manage it?
15-mark essayAnswer → - 87.
Pneumonia in the elderly.
6-mark noteAnswer → - 88.
Hospital-acquired pneumonia.
7-mark noteAnswer → - 89.
A 67-year-old man presented to casualty with cough with purulent expectoration and fever for three days. On admission he was tachypnoeic, tachycardic and hypotensive. How will you investigate and treat this patient?
7-mark noteAnswer → - 90.
Describe the types, clinical features, diagnosis and management of diffuse parenchymal lung disease in older adults, including its epidemiology, pathogenesis, classification, prognosis and natural history.
- 91.
Etiopathogenesis, clinical features, differential diagnosis and management of pleural effusion in a 70-year-old — how will you approach and evaluate a case of pleural effusion in an older person?
- 92.
Management of chronic obstructive airway disease.
7-mark noteAnswer → - 93.
Asthma management based on GINA (Global Initiative for Asthma) guidelines.
7-mark noteAnswer → - 94.
Senile emphysema.
- 95.
Respiratory failure, including acute type 2 respiratory failure.
- 96.
Management of ARDS.
7-mark noteAnswer → - 97.
Pulmonary embolism.
7-mark noteAnswer → - 98.
Chronic pulmonary thromboembolism.
7-mark noteAnswer → - 99.
Obstructive sleep apnoea — clinical features, associated comorbidities, laboratory tests, management and prognosis.
7-mark noteAnswer → - 100.
Sleep problems in the elderly, and the ideal approach to insomnia in a 65-year-old who has recently retired from a busy professional career.
- 101.
Rapid Eye Movement (REM) sleep behavioural disorder.
7-mark noteAnswer → - 102.
A chronic smoker with 30 pack years presented with cough and a routine chest X-ray revealed a solitary pulmonary nodule. What is your next investigative procedure and how would you proceed to manage the patient?
7-mark noteAnswer →
9. Infectious Disease
14 questions
- 103.
DOTS and the treatment, dose and regime of multidrug-resistant and XDR tuberculosis; drug resistance tuberculosis.
- 104.
GeneXpert test.
7-mark noteAnswer → - 105.
Define fever of unknown origin. How will you evaluate and manage prolonged fever in the elderly?
15-mark essayAnswer → - 106.
Mention the types of shock. Describe the aetiopathogenesis, diagnosis and treatment of septic shock.
- 107.
Procalcitonin.
7-mark noteAnswer → - 108.
Cerebral malaria.
6-mark noteAnswer → - 109.
Chikungunya — clinical presentation, differential diagnosis, laboratory tests and management.
7-mark noteAnswer → - 110.
Scrub typhus.
7-mark noteAnswer → - 111.
Ebola virus — its clinical features, spread, treatment and prevention.
7-mark noteAnswer → - 112.
Diagnosis and management of Clostridium difficile.
7-mark noteAnswer → - 113.
Prevention and management of influenza.
7-mark noteAnswer → - 114.
Vaccinations in elderly patients.
7-mark noteAnswer → - 115.
What are the clinical presentations and diagnosis of acute pyelonephritis?
7-mark noteAnswer → - 116.
What is the appropriate line of management in an older female with recurrent urinary tract infection?
7-mark noteAnswer →
10. Renal, Fluid & Electrolytes
11 questions
- 117.
Discuss fluid and electrolyte disturbances in older patients and their management.
20-mark essayAnswer → - 118.
Etiopathogenesis, diagnosis and management of chronic kidney disease; and the conservative management of chronic kidney disease in the elderly.
- 119.
Management of acute kidney injury.
- 120.
What are the criteria for initiating renal replacement therapy in a patient, with special emphasis on the elderly in our country?
- 121.
Acute glomerulonephritis.
7-mark noteAnswer → - 122.
Interstitial nephritis.
7-mark noteAnswer → - 123.
Hyponatremia.
- 124.
SIADH.
20-mark essayAnswer → - 125.
A known diabetic on oral hypoglycaemic agents came for a regular outpatient check-up and his potassium was found to be 5.7 mEq/L. How would you investigate and treat this patient with regard to his potassium value?
7-mark noteAnswer → - 126.
Hypercalcaemia — causes, evaluation and management, including PTH-independent hypercalcaemia and the flow chart to counteract it.
- 127.
Glomerular filtration rate.
6-mark noteAnswer →
11. Gastroenterology & Hepatology
15 questions
- 128.
Discuss the causes of jaundice in an older person and their management.
- 129.
Drug-induced jaundice.
7-mark noteAnswer → - 130.
Chronic active hepatitis.
6-mark noteAnswer → - 131.
Alcoholic hepatitis.
7-mark noteAnswer → - 132.
What is the appropriate management of an elderly patient recently diagnosed with hepatitis B infection?
7-mark noteAnswer → - 133.
Etiology, pathogenesis, management and complications of decompensated chronic liver disease in the elderly; and the approach to a patient attending the outpatient department with chronic liver disease.
- 134.
Management of hepatic encephalopathy.
7-mark noteAnswer → - 135.
Hepato-renal syndrome.
7-mark noteAnswer → - 136.
Ascites and refractory ascites.
- 137.
Management of gastro-oesophageal reflux disease.
- 138.
The etiopathogenesis, clinical manifestations, diagnostic algorithm and management of a patient with malabsorption.
15-mark essayAnswer → - 139.
Draw and label the Bristol Stool chart. What are the different classes of laxatives available and what are their modes of action?
7-mark noteAnswer → - 140.
Parenteral nutrition.
7-mark noteAnswer → - 141.
Refeeding syndrome.
7-mark noteAnswer → - 142.
Inanition.
7-mark noteAnswer →
12. Endocrine, Metabolic & Diabetes
11 questions
- 143.
Subclinical hypothyroidism in the elderly.
- 144.
A 70-year-old on treatment for cardiac failure had a TSH of 50 micro IU/ml with suppressed T3 and T4, constipation, cold intolerance and considerable weight gain. How would you treat him, how would you follow him up and what would you specifically instruct him?
7-mark noteAnswer → - 145.
Hyperthyroidism in the elderly — presentation, investigation and treatment.
7-mark noteAnswer → - 146.
Hashimoto's thyroiditis.
7-mark noteAnswer → - 147.
A 65-year-old newly diagnosed diabetic with HbA1c of 10%, hypertension, dyslipidaemia, osteoarthritis and a BMI of 35 refuses to adhere to diet and exercise. What antidiabetic should be started and added on if needed, with special emphasis on his age and comorbidity profile?
7-mark noteAnswer → - 148.
Alpha glucosidase inhibitors.
6-mark noteAnswer → - 149.
A 65-year-old man presented with acute onset of severe pain in the right big toe for two days following a binge of alcohol. What is the most probable diagnosis and discuss the management of this condition.
7-mark noteAnswer → - 150.
Management of gout.
7-mark noteAnswer → - 151.
Pseudogout.
7-mark noteAnswer → - 152.
Discuss the clinical features, diagnostic criteria, differential diagnosis and treatment of heat stroke.
7-mark noteAnswer → - 153.
Chronic fatigue syndrome — diagnostic criteria, clinical manifestations, predisposing factors, course, prognosis and treatment modalities.
15-mark essayAnswer →
13. Haematology & Oncology
14 questions
- 154.
Anaemia in the elderly and the evaluation of anaemia.
- 155.
Anaemia of chronic disease.
- 156.
Thrombocytopenia.
7-mark noteAnswer → - 157.
Disseminated intravascular coagulation.
7-mark noteAnswer → - 158.
Name the various plasma cell dyscrasias. What are their clinical presentations, diagnostic criteria, course and progression, and their various treatment options?
- 159.
Etiology, diagnosis and management of multiple myeloma.
- 160.
Myelodysplasia.
7-mark noteAnswer → - 161.
Chronic myeloid leukaemia — clinical features and management.
- 162.
Prostatic cancer.
7-mark noteAnswer → - 163.
How will you evaluate and treat an elderly patient with vertebral secondaries and unknown primary?
7-mark noteAnswer → - 164.
Tumour lysis syndrome.
7-mark noteAnswer → - 165.
Write a short note on the indications and rationale for cancer screening in the elderly.
- 166.
Screening for breast, colorectal and cervical cancers — what is the target population, the tests available, the sensitivity and specificity of each test, and the guidelines for screening?
7-mark noteAnswer → - 167.
Positron emission tomography.
6-mark noteAnswer →
14. Rheumatology & Bone Disease
4 questions
- 168.
Paget's disease — epidemiology, etiology, pathophysiology, clinical manifestations and management.
15-mark essayAnswer → - 169.
Late or elderly onset rheumatoid arthritis — how does it differ from early or young onset rheumatoid arthritis? What relevant investigations should be sent and what is the most appropriate line of management?
7-mark noteAnswer → - 170.
Extra-articular manifestations of rheumatoid arthritis.
7-mark noteNo answer written yet - 171.
Major side effects of low-dose methotrexate.
7-mark noteNo answer written yet
15. Geriatric Syndromes, Continence & Special Senses
13 questions
- 172.
Prevention of falls in elderly people; and how will you evaluate a 70-year-old diabetic living alone with recurrent falls and prevent him from falling?
Asked ×27-mark note6-mark noteAnswer: Approach to recurrent falls in the elderly, with emphasis on prevention and management (Paper III)Answer: A 60-year-old diabetic, hypertensive, with CAD and depression on multiple drugs, presents with recurrent falls over one week — evaluate and manage Key insight for the examiner: falls clustering over one week in a previously stable patient indicate an acute precipitant superimposed on chronic risk factors — this is a “premonitory fall” pattern (Kane) and demands a search for acute illness, delirium or a recent drug change, not merely a routine falls assessment. (Paper III)Answer: Assessment of Fall Risk and Prevention of Falls in the Elderly (Paper IV) - 173.
Post-fall syndrome.
7-mark noteAnswer → - 174.
Discuss giddiness in elderly people and its management; and the evaluation of dizziness in a 68-year-old.
Asked ×320-mark essay7-mark noteAnswer: Approach to a patient with dizziness (Paper III)Answer: Dizziness in the Elderly (Paper IV) - 175.
A patient presents to the Emergency Department with sudden onset vertigo and vomiting. What are the differentials to be considered? What is the symptomatic treatment of vertigo and how should one investigate and manage this patient?
7-mark noteAnswer → - 176.
What are the types of incontinence? How would you investigate and manage them?
- 177.
Assessment and management of urinary incontinence in a male.
7-mark noteAnswer → - 178.
A 72-year-old woman has had faecal incontinence for one year. How will you evaluate her?
7-mark noteNo answer written yet - 179.
Polypharmacy.
6-mark noteAnswer → - 180.
Age-associated changes in sexual activity.
7-mark noteNo answer written yet - 181.
Tinnitus.
7-mark noteNo answer written yet - 182.
Define the following: physical abuse; neglect; financial or material abuse; psychological or verbal abuse; and caregiver burden.
- 183.
Enumerate the pre-operative assessment of a 68-year-old going for surgical correction of fracture neck of femur, who is a diabetic on oral hypoglycaemic agents with an HbA1c of 6.
- 184.
Differential diagnosis and management of a 70-year-old hypertensive, diabetic non-smoker presenting with breathlessness, pedal oedema, pallor and declining functional status.
7-mark noteNo answer written yet