Samir Shah MBBS MRCPsych MSc Chapter 3: Questions and Answers Consultant psychiatrist in general adult psychiatry. Ankush Singhal MBBS MD MRCPsych Chapter 2: Questions and Answers Consultant Liaison Psychiatrist Pennine Care NHS Foundation Trust The Royal Oldham Hospital Oldham, UK.
Test questions: 1
Questions: MCQs
HISTORY AND MENTAL STATE EXAMINATION
COGNITIVE ASSESSMENT
A 21-year-old man takes a large number of paracetamol tablets with alcohol after an argument with his girlfriend. In which of the following conditions are the NINDS-AIREN criteria useful in their diagnosis?
NEUROLOGICAL EXAMINATION
A The California Verbal Learning Test B The Cambridge Contextual Reading Test C The National Adult Reading Test D Raven's Progressive Matrices. A 29-year-old African man came to the emergency department confused and irritable with headache and high temperature.
ASSESSMENT
You are asked to evaluate an 80-year-old widow whose family tells you they cannot manage her at home because she has been verbally abusive and threatening. You are asked to evaluate an 80-year-old widow whose family tells you they cannot manage her at home because she has been aggressive and threatening to them.
AETIOLOGY
D Make sure you collect all the necessary clinical information before you leave. E Ignore the patient's behavior and continue with the assessment. B. He was repeatedly placed in a "double bind" situation during his childhood C. He experiences strongly expressed emotions in the family home. D. Maternal alcohol consumption during pregnancy.
DIAGNOSIS
CLASSIFICATION
BASIC PSYCHOPHARMACOLOGY
Which of the following statements about the physiological effects of benzodiazepines in therapeutic doses is correct? Which of the following statements about monoamine interactions in the central nervous system is correct?
BASIC PSYCHOLOGICAL PROCESSES
At which stage of Kohlberg's model of development is the boy most likely. A 13-year-old boy always does the right thing because he wants people to like him.
HUMAN PSYCHOLOGICAL DEVELOPMENT
A boy goes through the life phase of initiative versus guilt and has a fear of punishment. A Each stage is a prerequisite for the next stage of development B Cognitive development is described by Jean Piaget in six stages C It is described in four stages by Mary Ainsworth.
SOCIAL PSYCHOLOGY
Which of the following theories suggests that when two beliefs are mutually inconsistent, the less strongly held one will change. Which of the following theories suggests that people prefer conditions that appear to provide an optimal cost-benefit ratio.
DESCRIPTION AND MEASUREMENT
BASIC PSYCHOLOGICAL TREATMENTS
PREVENTION OF PSYCHIATRIC DISORDER
DESCRIPTIVE PSYCHOPATHOLOGY
A 40-year-old alcoholic man saw his wife talking to her boss at work. A 36-year-old man diagnosed with schizophrenia sees different colors in the sky every time he hears the sound of water running from a faucet.
DYNAMIC PSYCHOPATHOLOGY
HISTORY OF PSYCHIATRY
BASIC ETHICS AND PHILOSOPHY OF PSYCHIATRY
A 26-year-old male school teacher presents with anhedonia, which is a lack of pleasure in activities that were previously enjoyable.
STIGMA AND CULTURE
A It is classified as a culture-bound psychotic syndrome in the DSM-IV B It is the compulsive desire to become a cannibal. C It is found in South America D It is treated by an antipsychotic drug E It mainly occurs with anxiety symptoms.
Answers: MCQs
- E Three-word recall
- E Perseveration is a sign of a frontal lobe lesion
- A Attention
- D The muscle tone is preserved
- B Amnesia of the episode
- D Delirium
- D Non-fluent expressive dysphasia
- E Vascular dementia
- D The trail-making test
- D Matrix reasoning
- D Remote
- D Raven’s progressive matrices
- E Vascular dementia
- D Matrix reasoning
- D When light shone back to the left eye from the right, the pupil dilates
- D Pure word deafness
- B Optic chiasma
- D Toxoplasma encephalitis
- A Abnormal synacthen test
- D Increased free serum copper
- E Raised urinary catecholamine
- A General health questionnaire
- E Mini-mental state examination
- E Wisconsin card sorting test (WCST)
- D Ophthalmoplegia
- B Anterograde amnesia
- B Calmly leave the interview room
- E Overdose when alone in a hotel room
- E Transketolase
- E Poor parental supervision
- C Functional abnormalities in the prefrontal area
- E Ventral tegmental area dopamine and enkephalin
- B Antisocial behaviour
- A Being born in an urban area
- A Charles Bonnet syndrome
- B Delirium
- A Acute stress reaction
- E Post-traumatic stress disorder
- D Other neurotic disorders
- D More user friendly than the DSM-IV
- C Personality disorder is classified on a separate axis in the DSM-IV
- D The ICD-10 was developed by the World Health Organization whereas the DSM-IV was developed
- B Global assessment of functioning
- D There is 95% protein binding
- C The dexamethasone suppression test is mostly unaffected
- B The concentration of an intravenously administered drug declines exponentially
- D Naproxen
- D Neuroleptic malignant syndrome
- C Nausea
- D 5-HT₂ A receptors increase glutamate release
- D Stimulation of α 1 - receptors leads to serotonin release
- D α 2 -Receptor antagonism
- D Serotonin, noradrenaline and dopamine
- B Buspirone
- D Haloperidol
- D Figure–ground differentiation
- D Preoperational stage
- B Formal operational stage
- B Circular reaction
- D Preconventional morality
- A Conventional morality
- C 12 months
- A 3 years
- E 9 months
- C 3–5 years
- B Anxious avoidant
- B Oral phase
- D Temperament
- C Egocentric thinking
- A Each stage is a prerequisite for the next stage of development
- D Social learning incorporates both classic and operant models
- B Classic conditioning is the association of a neutral stimulus with a conditioned stimulus which brings a
- B Changing cognitions involved in the dissonant relationship
- D It leads to the same mean score in different response patterns
- C Osgood and Tannenbaum’s congruity theory
- E Social exchange theory
- D Is useful in detecting frontal lobe lesions
- B Death of a spouse/partner
- A Non-target stimuli are represented among a series of random stimuli on a computer screen
- B The test correlates well with other established tests of cognitive function
- A Consists of 21 items
- D Events
- C Dichotomous reasoning
- E It was influenced by the work of Albert Ellis
- B Crowds
- D Preparedness
- B The benefits of reducing the DUP appear to be long-lasting
- D Onset of a first episode of psychosis is delayed
- D Sodium valproate
- B She has a five-fold risk of relapse
- B Emotional incontinence
- D Nihilistic delusions
- A Ambitendence
- D Selective mutism
- D Incongruent affect
- B Tangentiality
- A Compulsions
Schizotypal disorder is classified with schizophrenia in the ICD-10, while it is classified with a personality disorder in the DSM-IV. Of the options given, sodium valproate is effective in the prophylaxis of bipolar affective disorder.
100. E Somatic hallucinations
101. C Thought broadcasting
103. A Delusional memory
104. B Delusional mood
105. E Othello’s syndrome
106. E Ekbom’s syndrome
107. B Completion illusion
108. A Affect illusion
109. E Pareidolic illusion
110. C Functional hallucination
111. D Reflex hallucination
112. B Extracampine hallucination
113. A Displacement
114. D Regression
115. C Sublimation
116. C Passive aggression
118. C Czech Republic
119. B Investigation of a serious crime
121. D Kurt Schneider
122. C Ewald Hecker
123. D Théodule-Armand Ribot
124. E Peter Sifneos
128. D Susto
Test questions: 2
C Insensitivity to the subtleties of social intercourse
Blunting of affect refers to an inadequacy or a complete loss of all emotional life, so that patients are indifferent to their own well-being and that of others. Reinforcement of affect refers to an initial congruent emotional response, but it does not change as the situation changes.
B The symptoms must occur within 1 month of an identifiable psychosocial stressor
C Constructional praxis
A Address test
D Most patients take <2 minutes to complete their opening statement
D Huntington’s disease
E How have you been feeling in your spirits recently?
A Concentration
B An average patient with untreated Alzheimer’s disease will lose 3–4 points per year
C Impaired consciousness
A Cognitive estimates test
C Speed of processing information
A Frontal lobes
C Low IQ at young age is a risk factor for schizophrenia
D Intact immediate memory
D Paired associative learning test
E Right temporal lobe
E Right internuclear ophthalmoplegia
C Hyperacusis
E Dysarthria
E Urinary incontinence
A Electroencephalogram
C Full blood count
Agranulocytosis with clozapine is also reversible after its early detection and discontinuation of the drug, but can be fatal if allowed to persist.
E Wechsler Adult Intelligence Scale–revised
B Halstead–Reitan battery
C Rorschach’s inkblot technique
A Childhood obesity
A Agoraphobia
D Between 18 and 19
C Delayed insulin release
A Cannabis use can precipitate schizophrenia in people who are vulnerable because of a family
A Duration of post-traumatic amnesia
B Four times more likely
A Dorsolateral prefrontal cortex
A Delirium tremens
D Frontotemporal dementia
D Transient stress-related paranoid ideation
C High functioning autistic spectrum disorder
D Hyperkinetic disorder
A Bizarre encapsulated delusions and systematised delusions
E Schizophrenia and affective disorders are at the same level
D Pattern of course of schizophrenia
A Dissociative disorder
A Disorders of sexual preferences
E Schizophrenia and related disorders
B Postschizophrenic depression
Schizotypal disorder is a separate category in the ICD-10 and it is included under personality disorders in the DSM-IV classification system.
B 2 weeks
C 6 months
B DSM-IV only
E 2 years
C 3 months
A Clonidine withdrawal
D Noradrenaline reuptake inhibitor
E Trazodone
A Amitriptyline
E Sigma receptors
C Exceeding the rate of recommended dose escalation
D Topiramate
E Vigabatrin
E Tachycardia
D 6–9 months of age
E Secure
B Dismissing
Adults, who had a dismissive type of attachment, often minimized their experience, were unable to elaborate and were found to give 'I don't know' type responses. Adults who had a disorganized type of attachment broke and interrupted logical flow of thought.
D Preoccupied
E Slow to warm up
Easy temperament: this is characterised by the regular rhythmic pattern of needs where a child adopts well, is active and shows a low intensity of emotions
Difficult temperament: this is characterised by a child presenting with an irregular biorhythm, negative mood and being uncomfortable with new experiences
Slow to warm up temperament: this is characterised by a child who adapts poorly to change, and has slow changes in mood, somewhat regular habits and mild intensity of emotions
D Short-term memory uses visual coding
A Episodic memory
E It has a short capacity
D Reduction
B Formal operational stage
E Object permanence is completed at 18 months
C Stage 4
C Temperament
B Long-term memory is also known as secondary or remote memory
D It implies incongruity in a person’s beliefs, knowledge and behaviour
A Authority
Reward: this is the power derived from the ability to allocate resources. Your employer or educational supervisor can reward you in different ways
Referent: this power is derived from another person liking you or wanting to be like you, e.g
D Referent
Reward: power derived from the ability to allocate resources. Your employer or educational supervisor can reward you in different ways
This is the power that compels someone to do something against their will. This power is derived from another person you like or want to be like you, eg. A union can amplify this kind of knowledge and power skills that someone else is looking for.
E Self-image
C Thurstone’s scale
C Premorbid intelligence
D PSE provides an operational definition of symptoms to be rated
D Present state examination
The General Health Questionnaire is suitable for screening psychiatric morbidity in the general population.
A A smooth pattern of behaviour is found with a variable–ratio schedule
D Patient’s interpretation of life events is responsible for anxiety
C Hormone replacement therapy
C Prolonged education
C Higher number of previous depressive episodes
C Preventive measures targeted at high-risk individuals produces the best pay-off for those
B Automatic obedience
C Recognition
A Delusion of control
100. B Clock drawing
101. A Cotard’s syndrome
Confabulation is the falsification of memory that occurs in a clear awareness of an organically derived amnesia.
104. A Decoding
105. A Mannerisms
106. D Perception
107. B Thought broadcasting
109. C Haptic hallucination
110. A Affect illusion
111. A Capgras’ syndrome
112. B Ineffective decoding
113. B Concrete thinking
114. B Projection
115. E Social anxiety disorder
116. E Unconscious
117. D Projection
119. C Kahlbaum
120. C Deniker
The first symptoms are thought insertion, thought withdrawal, thought emission, delusions, passivity, third-party auditory hallucinations, and running commentary.
122. C Hecker
123. D Ribot
124. A Carl Schneider
126. D Modecate (fluphenazine decanoate)
127. A Bradford Hill
128. C Imipramine
129. D Kasanin
130. B Cade
131. C Need to hide the condition from others
Test questions: 3
Which of the following is the most appropriate and fastest assessment test for performance IQ? Which of the following is present in Brown-Séquard syndrome with a right-sided lesion? Which of the following signs is the first indication of increased intracranial pressure causing compression of cranial nerve III.
A Ability to oppose the thumb B Loss of pronation of the forearm C No sensory loss over the palm D Loss of sensory over the little finger E Loss of thenar muscles. You have been called to assess an 83-year-old man who was found wandering by the police. A 23-year-old schizophrenic man had problems with visual hallucinations, restlessness, and marked thirst.
Which of the following single-photon emission computed tomography (SPECT) scan reports is characteristic of Alzheimer's disease.
ETIOLOGY
Which of the following parts of the brain is probably involved in the difference between homosexual and heterosexual men. According to the International Classification of Diseases, 10th revision (ICD-10), which of the following is a diagnostic criterion of paranoid personality disorder. Which of the following statements about assimilation in Piaget's theory of cognitive development is correct.
Which of the following occurs in the sensorimotor stage of Piaget's theory of cognitive development. Which of the following statements about the treatment of depressive illness without psychotic symptoms is correct. Which of the following statements about the sedative properties of tricyclic and tetracyclic antidepressants is correct.
When treating post-stroke depression in a patient also taking warfarin, which of the following is the most appropriate antidepressant?
PREVENTION OF PSYCHIATRIC DISORDERS
B Circular question
B Hypothetical question
D Functional hallucination
E Reflex hallucination
C Lilliputian hallucinations
A Have you been sleeping well?’
D Language understanding
D Facial hypomimia
C Raven’s progressive matrices
C Scores of < 82 predict dementia with 100% sensitivity
B Comprehension
B Phonemic paraphasia
B Cactus and camel test
C Priming
A Frontal lobe
D Loss of pain and temperature sensation on the left side
E Ipsilateral slowness of the pupillary response
E Wasting of the thenar muscles
B Facial weakness
E Working memory
C Procedural memory
C Retrograde memory
A Antimuscarinic intoxication
E Reduced perfusion in the posterior temporal lobes
C Hayling’s sentence completion test
A Cognitive estimates test
E Serotonin transporter
E Polymorphism in the dopamine D 4 transporter gene
E Impaired hearing
D Narcolepsy
B Hypothalamus
D Neurological dysfunction
B Autism
D Narcissistic personality disorder
E Obsessive–compulsive disorder
A Dual-role transvestism
B Hebephrenic (disorganised) schizophrenia
A Being excessively sensitive to setbacks and rebuffs
D Axis I and Axis III
C Functional impairment
D 6 months
C ICD-6
B Furosemide
A Amisulpride
E Serum lithium levels increase in the immediate postpartum period
D Lithium
D Grapefruit juice irreversibly blocks intestinal cytochrome P450
B Convert sensitisation
Habituation: through graded exposure from the least uncomfortable to the worst situation, for a period long enough for the unwanted reaction to subside. Implosion: similar to flood, but the exposure to the unwanted situation is imagined (in vivo).
E Reciprocal inhibition and systemic desensitisation
C 18–24 months
A Conservation
E Transductive reasoning
D Non-logical thought is a feature of ages 7–11 years
E Skinner
D Oral phase
D Oedipus complex
B 3 years
D Preoccupied/entangled
There is an 80% agreement between a mother's attachment category on AAI and her infant's attachment pattern on strange situation behavior, developed by Mary Ainsworth.
C Assimilation
E Symbiosis
E Moral reasoning in adults
D It leads to more aggression in patients undergoing catharsis
D Preoperational
C Self-esteem
Integration of the self: this is concerned with the consistency of the different elements of the self
D He passed the examination due to my hard work and academic prowess
E Reward
E Stereotyping of the victim of prejudice
B Awareness of the role of the interviewer
A It forms the basis of a therapy that aims to help people construct more effective interpretations and
D Ready for action
D Refer to social services
B Fallacy of fairness
D Catastrophisation is a major mechanism
D Pre-evaluation
C These receptors are linked to sodium channels
D Serum lithium concentrations should be measured with changing renal function
B Diuretics alter the availability of lithium
C Failure of adequate trial occurs in 25% of patients
D Trazodone is a highly sedative tetracyclic antidepressant
C Quetiapine
E An antipsychotic has not been prescribed
A Citalopram
A Age of onset of psychosis is 2.7 years earlier in cannabis users
A Boys experience more physical abuse than girls
D Seeing vivid pictures in clouds
A Dysmegalopsia
E Pareidolia is vivid illusions without any extra effort
E Normal people can be persuaded to hallucinate
D Reflex hallucination
C Characterised by akinetic mutism
C Hysterical dissociation is present with apparent disorientation
A Memory of actual events is displaced in space and time
E Perseveration
100. B Cataplexy
101. C Primary delusion
Delusion is a type of primary delusion in which a normal perception is interpreted with a delusional meaning.
102. E Pressure
103. D Logoclonia
104. C Perseveration
106. B Concentration
107. D Parapraxis
108. E Telegraphic speech
110. A Déjà-vu
112. A Anger
113. D Overvalued idea
114. C Mastery and control
115. A Countertransference
116. B Eugen Bleuler
117. D Kraepelin
118. E Morel
119. C Cultural bias in testing of IQ
120. A Emotions
121. E Winnicott
If a mother is attentive to her baby's needs, the baby can become more in tune with its bodily functions and instincts; this forms the basis for a gradually developing sense of self.
126. D Infant is exposed to escalating amounts of stress
Test questions: 4
Which of the following statements about Brewin's dual representation model of post-traumatic stress disorder is correct. Which of the following is the most appropriate assessment tool to measure the severity and change in psychotic symptoms. Which of the following brain imaging scans would best help distinguish Alzheimer's disease from dementia with Lewy bodies.
Which of the following is included under schizophrenia in the International Classification of Disease, 10th revision (ICD-10). Which of the following statements is not part of the diagnostic criteria for emotionally unstable personality disorder in the ICD-10. Which of the following is the most appropriate antipsychotic drug supported by available data regarding its effectiveness in treating the negative symptoms of schizophrenia.
Which of the following is a correct match for the approximate prevalence of this side effect with an antidepressant medication.
BASIC PSYCHOLOGY
E Recapitulation of information is encouraged
During a psychiatric interview, both verbal and non-verbal communication is important, and not just the actual information we get from the patient. Open-ended questions are good conversation starters as they allow information to flow, while closed-ended questions help elicit factual information and specific details. The interviewer should have a balance between open questions (usually at the beginning) and closed questions (usually come later in the interview).
E Vascular dementia
A Circumstantiality
D Russell’s sign
Callus on the back of the hand caused by self-induced vomiting or purging in a patient with an eating disorder Xanthelasma Hyperlipidemia.
E Open question
B Compound question
B Clang association
A It does not assess frontal lobe functioning
E Wisconsin card sorting test
D Rivermead behavioural memory test
A Considerable amount of traumatic experience- related information is stored as situationally
A Capgras’ syndrome
B Wechsler test of adult reading
E Wisconsin card scoring test
B Raven’s progressive matrices
B Diencephalic amnesia
E Wrist drop
A Calf pain
B Bitemporal hemianopia
B Contralateral homonymous hemianopia
E Right middle cerebral artery occlusion
C Dementia of Lewy bodies
E Somatisation disorder
D Opioids
D Practice effect
A Brief psychiatric rating scale
B DAT scan
D Stage 2 of grief reaction
D Migrated from other country
C Cocaine use in pregnancy
B 2–4 times higher
D Vitamin D
A Decreases
High genetic risk of major depression – it was noted that patients with a high genetic risk of depression had spontaneous onset of the depressive episode with little to no association with
C Environmental cause
B January, February, March
E Schizophrenia
E Schizotypal personality disorder
E Schizophrenia
D Prodromal symptoms of psychotic disorder
E Social phobia
B Postschizophrenic depression
A Axis I
E Narcissistic personality disorder
C 3 months
C Other neurotic disorder
C Mixed and other personality disorder
D Transient stress-related paranoid ideation
E 24 months
C Olanzapine
D 60–70% with selective serotonin reuptake inhibitors
E Ziprasidone
E Naltrexone
B Naltrexone acts on all three types of opioid receptors
E N-Methyl- d -aspartate receptor antagonism
A Clozapine
A Antabuse irreversibly blocks aldehyde dehydrogenase
E Wilson’s disease
B Chemical antagonism
C 15 hours
C Lithium
E Tremor
E Reciprocal inhibition
A Aversive conditioning
B Classic conditioning
B Extinction
C Catastrophic thinking
D Overgeneralisation
E Personalisation
A Arbitrary inference
C 4 months
C Initiative versus guilt
A Conventional: 13–16 years
Preconventional: 7–12 years to middle childhood; stage1: obedience and punishment orientation; stage 2: reward orientation
B Attachment is increased if the mother is hostile towards her child
D Lorenz described newly hatched goslings programmed to follow a movable object
D It increases when the onset of the mental disorder is acute
B BF Skinner
A Antilocution
C Instrumental function
Defensive Ego: Certain attitudes protect us from acknowledging the basic truth about ourselves and the harsh reality of life.
A California Personality Inventory
E Understanding of the origin and adoption of unhelpful ‘modes’
D Radical acceptance
D Rolling with resistance
E Systemic family therapy
C Cognitive–analytic therapy
E Random screening of drivers for breath alcohol levels is a form of primary prevention
E Topiramate
B Fostering moderate informal drinking and promoting awareness of hazards
D Lithium
B It has been demonstrated in animal experiments
C Occur in Ganser’s syndrome
E Severe interference with social functioning
100. D Running commentary
When the patient hears his or her thoughts spoken just before or at the same time as they occur, it is called gedankenlautwerden.
102. E Delusion of reference
103. E Delusional perception
104. B Automatic obedience
105. E Nihilistic delusion
106. D Illogicality
107. B Neologism
Gedankenlautwerden describes hearing one's thoughts spoken just before or at the same time as they occur. Écho de la pensée is the phenomenon of hearing one's own thoughts after they have already occurred.
109. A Extracampine hallucination
110. A Normal phenomenon
111. E Syllogomania
112. A Condensation
113. D Isolation
114. A Altruism
116. A Cade
117. A Cerletti
118. E Zimelidine
119. A Carlsson and Linquist
Electroconvulsive therapy was invented in Italy and was first used in Britain in 1939. Before 1939, seizures were artificially induced by cardiazole, also known as metrazole, in mental hospitals in Britain.
121. E Thorndike
122. B Bini
123. C Normal autism
124. E Schizophrenia
Pathofacilitating culture contributes to the frequency of psychopathology. Pathogenic effect Culture causes the mental illness. Pathoplastic effect Culture contributes to the manifestation of psychopathology. Pathoreactive culture responses to mental illness.
127. E Zar
Mock examination
A 45-year-old man drank almost 35 units of alcohol per week for the past seven years. Which of the following tests uses ambiguous stimuli to evaluate a person's thought patterns, attitudes, observational skills, and emotional responses? A 29-year-old man was found on the street with some memory loss after his 5-year-old son died suddenly.
Which of the following is a diagnostic criterion for borderline personality disorder in DSM-IV but not in ICD-10. A 45-year-old man with stroke presented with an inability to name the right or left side of his body. A 55-year-old man presented with foot drop after recently having a cast removed from the same lower extremity.
Which of the following bedside tests would best assess a patient's short-term verbal memory?
