FMGE 2023 — Psychiatry

Q: The Mental State Examination (100-7) examines which of the following mental functions?

Concentration. ***Concentration***- The **'100 minus 7' serial subtraction task** is a core component of the Mental State Examination (MSE) specifically designed to test a patient's **concentration** and sustained attention. - Successful completion requires maintaining focus and managing working memory, making it an excellent measure of this cognitive function. *Judgment* - **Judgment** is typically evaluated by asking patients how they would respond to hypothetical situations (e.g., finding a lost wallet or envelope). - This component assesses the patient's ability to understand consequences, make reasoned decisions, and apply social norms. *Language* - **Language** assessment involves testing fluency, comprehension (ability to follow commands), repetition, and naming objects. - The 100-7 task is a test of attention and arithmetic, not of fundamental linguistic abilities. *Orientation* - **Orientation** assesses the patient's awareness of **person**, **place**, and **time** (P-P-T). - This function is tested by asking direct questions about identity, current location, and the date, distinct from computational tasks like 100-7. [Practice more Psychiatry PYQs on OnCourse]

Q: What is the most common symptom of cannabis intake?

Dream-like state. ***Dream-like state***- The most common and defining acute symptom of cannabis intoxication is the **psychoactive effect**, leading to altered sense of time, altered sensory perception, and a relaxed, sometimes euphoric, **dream-like state**.- This perceptual alteration is due to the agonist activity of **delta-9-tetrahydrocannabinol (THC)** primarily on central **CB1 receptors**. *Anxiety*- While **anxiety**, **paranoia**, and panic attacks are frequently reported adverse effects, particularly with high potency strains or accidental overdose, they are not the primary anticipated or most common effect.- The typical desired effect is generally **relaxation** and **euphoria**, which contrasts with the experience of acute anxiety.*Depressed mood*- Acute cannabis intoxication usually leads to a transient sense of **well-being** or **euphoria**, rather than an acutely depressed mood.- A primary depressive state or **amotivational syndrome** is more typically associated with chronic, heavy use or withdrawal states, not the initial acute intoxication.*Decreased appetite*- Cannabis is famously known for significantly **increasing appetite**, often termed **"the munchies,"** due to the stimulation of cannabinoid receptors in appetite centers.- The active component, THC, acts as an **orexigenic agent**, making decreased appetite an incorrect association. [Practice more Psychiatry PYQs on OnCourse]

Q: You see a middle-aged man presenting to the psychiatry OPD who reports aliens have been speaking to him and telling him to kill his relatives over the past 7 months. What is the likely diagnosis?

Schizophrenia. ***Schizophrenia***- The presence of prominent **auditory hallucinations** and **command hallucinations** lasting for 7 months fulfills the diagnostic criteria for Schizophrenia (continuous signs of disturbance for at least 6 months).- The symptoms described (hearing aliens commanding violence) represent **positive symptoms** of psychosis and are often associated with poor insight and significant functional decline characteristic of this disorder.*Mania*- Mania requires a sustained period of abnormally and persistently elevated, expansive, or irritable **mood**, and increased goal-directed activity or energy, which is not the primary complaint here.- Psychotic features in Mania are usually **mood-congruent** (e.g., grandiose delusions about immense power), whereas these command hallucinations are non-mood-congruent.*Delusional disorder*- This disorder is characterized by the presence of one or more **non-bizarre delusions** lasting >1 month, but prominent hallucinations are specifically excluded.- The patient is experiencing persistent and prominent **auditory hallucinations**, making schizophrenia a more appropriate diagnosis.*Brief psychotic disorder*- This diagnosis is reserved for psychotic symptoms (delusions, hallucinations, disorganized speech) that last for a period of **less than one month**.- Since the patient's symptoms have persisted for **7 months**, the duration clearly rules out brief psychotic disorder. [Practice more Psychiatry PYQs on OnCourse]

Q: Which of the following is NOT a symptom associated with chronic cocaine abuse?

Dilated pupils, rapid pulse and sweating.. ***Dilated pupils, rapid pulse and sweating.***- These manifestations (mydriasis, tachycardia, and diaphoresis) are classic signs of **acute cocaine intoxication** resulting from massive sympathetic nervous system overstimulation.- While they occur every time the drug is used, they reflect the transient state of acute drug action rather than structural, neurological, or hygienic **long-term complications** of chronic abuse.*Nasal/palatal perforation.*- Chronic intranasal cocaine abuse leads to severe **vasoconstriction** and subsequent **ischemic necrosis** of the cartilaginous and bony structures in the septum and palate.- This structural destruction is a definitive **long-term consequence** that may lead to chronic sinusitis, dysphonia, and septal perforation.*Black tongue and teeth.*- This presentation is a characteristic finding in individuals who chronically smoke **crack cocaine**, often referred to as "crack mouth."- It is caused by a combination of extreme heat exposure, chemical irritation from the smoke, and severe neglect of **oral hygiene** associated with addiction.*Hallucination of insects crawling on the skin (formication).*- This severe **tactile hallucination**, often colloquially termed "cocaine bugs," is a known psychiatric consequence of **chronic, high-dose stimulant abuse**.- It results from neurotoxicity and is a marker of severe dopaminergic system dysregulation due to long-term substance use. [Practice more Psychiatry PYQs on OnCourse]

Q: Which of the following does not suggest a medical cause of mental illness?

Auditory hallucination. ***Auditory hallucination***- **Auditory hallucinations** (especially voices commenting or conversing) are highly characteristic features of **primary psychiatric disorders** like schizophrenia.- In contrast, hallucinations associated with underlying medical conditions (organic causes or delirium) are typically **visual**, **tactile**, or **olfactory**.*Elderly age*- New onset of psychiatric symptoms (e.g., psychosis, acute confusion) in an **elderly patient** should raise suspicion for a **medical or neurological etiology** until proven otherwise.- The risk of conditions like **delirium**, **vascular dementia**, or adverse drug effects contributing to psychiatric symptoms is significantly higher in this age group.*Loss of consciousness*- **Loss of consciousness (LOC)** is a critical sign of a **neurological insult** or severe systemic medical illness (e.g., seizures, syncope, metabolic coma).- Primary psychiatric illnesses, by definition, do not cause true **unresponsiveness** or **altered sensorium** associated with genuine LOC.*Acute onset*- A syndrome that appears with **acute or sudden onset** (especially involving cognitive changes, confusion, or marked mood shifts) is often highly suggestive of **delirium** or an **acute medical/toxic etiology**.- Many classic primary psychiatric disorders, such as **Schizophrenia**, typically have a more **insidious** or gradual development, often over months or years. [Practice more Psychiatry PYQs on OnCourse]

5 Previous Year Questions with Answers & Explanations

Questions

The Mental State Examination (100-7) examines which of the following mental functions?

What is the most common symptom of cannabis intake?

You see a middle-aged man presenting to the psychiatry OPD who reports aliens have been speaking to him and telling him to kill his relatives over the past 7 months. What is the likely diagnosis?

Which of the following is NOT a symptom associated with chronic cocaine abuse?

Which of the following does not suggest a medical cause of mental illness?

FMGE 2023 - Psychiatry FMGE Practice Questions and MCQs

Question 1: The Mental State Examination (100-7) examines which of the following mental functions?

A. Judgment
B. Language
C. Concentration (Correct Answer)
D. Orientation

Explanation: ***Concentration***- The **'100 minus 7' serial subtraction task** is a core component of the Mental State Examination (MSE) specifically designed to test a patient's **concentration** and sustained attention. - Successful completion requires maintaining focus and managing working memory, making it an excellent measure of this cognitive function. *Judgment* - **Judgment** is typically evaluated by asking patients how they would respond to hypothetical situations (e.g., finding a lost wallet or envelope). - This component assesses the patient's ability to understand consequences, make reasoned decisions, and apply social norms. *Language* - **Language** assessment involves testing fluency, comprehension (ability to follow commands), repetition, and naming objects. - The 100-7 task is a test of attention and arithmetic, not of fundamental linguistic abilities. *Orientation* - **Orientation** assesses the patient's awareness of **person**, **place**, and **time** (P-P-T). - This function is tested by asking direct questions about identity, current location, and the date, distinct from computational tasks like 100-7.

Question 2: What is the most common symptom of cannabis intake?

A. Anxiety
B. Depressed mood
C. Dream-like state (Correct Answer)
D. Decreased appetite

Explanation: ***Dream-like state***- The most common and defining acute symptom of cannabis intoxication is the **psychoactive effect**, leading to altered sense of time, altered sensory perception, and a relaxed, sometimes euphoric, **dream-like state**.- This perceptual alteration is due to the agonist activity of **delta-9-tetrahydrocannabinol (THC)** primarily on central **CB1 receptors**. *Anxiety*- While **anxiety**, **paranoia**, and panic attacks are frequently reported adverse effects, particularly with high potency strains or accidental overdose, they are not the primary anticipated or most common effect.- The typical desired effect is generally **relaxation** and **euphoria**, which contrasts with the experience of acute anxiety.*Depressed mood*- Acute cannabis intoxication usually leads to a transient sense of **well-being** or **euphoria**, rather than an acutely depressed mood.- A primary depressive state or **amotivational syndrome** is more typically associated with chronic, heavy use or withdrawal states, not the initial acute intoxication.*Decreased appetite*- Cannabis is famously known for significantly **increasing appetite**, often termed **"the munchies,"** due to the stimulation of cannabinoid receptors in appetite centers.- The active component, THC, acts as an **orexigenic agent**, making decreased appetite an incorrect association.

Question 3: You see a middle-aged man presenting to the psychiatry OPD who reports aliens have been speaking to him and telling him to kill his relatives over the past 7 months. What is the likely diagnosis?

A. Mania
B. Delusional disorder
C. Schizophrenia (Correct Answer)
D. Brief psychotic disorder

Explanation: ***Schizophrenia***- The presence of prominent **auditory hallucinations** and **command hallucinations** lasting for 7 months fulfills the diagnostic criteria for Schizophrenia (continuous signs of disturbance for at least 6 months).- The symptoms described (hearing aliens commanding violence) represent **positive symptoms** of psychosis and are often associated with poor insight and significant functional decline characteristic of this disorder.*Mania*- Mania requires a sustained period of abnormally and persistently elevated, expansive, or irritable **mood**, and increased goal-directed activity or energy, which is not the primary complaint here.- Psychotic features in Mania are usually **mood-congruent** (e.g., grandiose delusions about immense power), whereas these command hallucinations are non-mood-congruent.*Delusional disorder*- This disorder is characterized by the presence of one or more **non-bizarre delusions** lasting >1 month, but prominent hallucinations are specifically excluded.- The patient is experiencing persistent and prominent **auditory hallucinations**, making schizophrenia a more appropriate diagnosis.*Brief psychotic disorder*- This diagnosis is reserved for psychotic symptoms (delusions, hallucinations, disorganized speech) that last for a period of **less than one month**.- Since the patient's symptoms have persisted for **7 months**, the duration clearly rules out brief psychotic disorder.

Question 4: Which of the following is NOT a symptom associated with chronic cocaine abuse?

A. Dilated pupils, rapid pulse and sweating. (Correct Answer)
B. Black tongue and teeth.
C. Hallucination of insects crawling on the skin (formication).
D. Nasal/palatal perforation.

Explanation: ***Dilated pupils, rapid pulse and sweating.***- These manifestations (mydriasis, tachycardia, and diaphoresis) are classic signs of **acute cocaine intoxication** resulting from massive sympathetic nervous system overstimulation.- While they occur every time the drug is used, they reflect the transient state of acute drug action rather than structural, neurological, or hygienic **long-term complications** of chronic abuse.*Nasal/palatal perforation.*- Chronic intranasal cocaine abuse leads to severe **vasoconstriction** and subsequent **ischemic necrosis** of the cartilaginous and bony structures in the septum and palate.- This structural destruction is a definitive **long-term consequence** that may lead to chronic sinusitis, dysphonia, and septal perforation.*Black tongue and teeth.*- This presentation is a characteristic finding in individuals who chronically smoke **crack cocaine**, often referred to as "crack mouth."- It is caused by a combination of extreme heat exposure, chemical irritation from the smoke, and severe neglect of **oral hygiene** associated with addiction.*Hallucination of insects crawling on the skin (formication).*- This severe **tactile hallucination**, often colloquially termed "cocaine bugs," is a known psychiatric consequence of **chronic, high-dose stimulant abuse**.- It results from neurotoxicity and is a marker of severe dopaminergic system dysregulation due to long-term substance use.

Question 5: Which of the following does not suggest a medical cause of mental illness?

A. Acute onset
B. Elderly age
C. Loss of consciousness
D. Auditory hallucination (Correct Answer)

Explanation: ***Auditory hallucination***- **Auditory hallucinations** (especially voices commenting or conversing) are highly characteristic features of **primary psychiatric disorders** like schizophrenia.- In contrast, hallucinations associated with underlying medical conditions (organic causes or delirium) are typically **visual**, **tactile**, or **olfactory**.*Elderly age*- New onset of psychiatric symptoms (e.g., psychosis, acute confusion) in an **elderly patient** should raise suspicion for a **medical or neurological etiology** until proven otherwise.- The risk of conditions like **delirium**, **vascular dementia**, or adverse drug effects contributing to psychiatric symptoms is significantly higher in this age group.*Loss of consciousness*- **Loss of consciousness (LOC)** is a critical sign of a **neurological insult** or severe systemic medical illness (e.g., seizures, syncope, metabolic coma).- Primary psychiatric illnesses, by definition, do not cause true **unresponsiveness** or **altered sensorium** associated with genuine LOC.*Acute onset*- A syndrome that appears with **acute or sudden onset** (especially involving cognitive changes, confusion, or marked mood shifts) is often highly suggestive of **delirium** or an **acute medical/toxic etiology**.- Many classic primary psychiatric disorders, such as **Schizophrenia**, typically have a more **insidious** or gradual development, often over months or years.