FMGE 2023 - Psychiatry PYQs Practice Questions

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]

Question 1

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

Accepted Answer

Concentration

Answer

Judgment

Answer

Language

Answer

Orientation

Question 2

What is the most common symptom of cannabis intake?

Accepted Answer

Dream-like state

Answer

Anxiety

Answer

Depressed mood

Answer

Decreased appetite

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?

Accepted Answer

Schizophrenia

Answer

Mania

Answer

Delusional disorder

Answer

Brief psychotic disorder

Question 4

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

Accepted Answer

Dilated pupils, rapid pulse and sweating.

Answer

Black tongue and teeth.

Answer

Hallucination of insects crawling on the skin (formication).

Answer

Nasal/palatal perforation.

Question 5

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

Accepted Answer

Auditory hallucination

Answer

Acute onset

Answer

Elderly age

Answer

Loss of consciousness

FMGE 2023 — Psychiatry