FMGE 2025 — Psychiatry
13 Previous Year Questions with Answers & Explanations
A 28-year-old woman diagnosed with schizophrenia had been compliant with her prescribed olanzapine for several months. However, she discontinued the treatment. Which of the following is the most likely reason for her discontinuation?
A patient shows flat affect. What does it indicate?
A young man with a psychiatric disorder has become very aggressive. He speaks very rapidly and sleeps very little. He exhibits hyperactive behavior after discontinuing his prescribed medication. What is the most likely diagnosis?
A doctor asked the patient what her age is and she told him that she is married to an older man, and she has 2 kids of 15 and 18 years, and she is 39 years old. What is the disorder present?
A patient was asked a direct question about her age. Instead, she provided excessive and unnecessary details about her marriage and children before eventually answering the question. This is characteristic of which speech pattern?
A lady presents to the hospital after having a fight with her husband. She reports that she is unable to speak. However, all neurological and physical examinations are normal, and she does not seem concerned about her health status. What is the most likely diagnosis?
A 55-year-old man presents to the hospital with auditory hallucinations and inability to recognize his own family members. He reports his last alcohol intake was 48 hours ago. What is the most likely diagnosis?
A man presents to the hospital with a bizarre behavior. He is unable to recall his personal identity and has no memory of how he traveled 100 km to reach the hospital. A collateral history reveals he experienced a traumatic earthquake a few months ago. Which of the following is the most likely diagnosis?
A 28-year-old software engineer presents with sleep disturbances, low mood, and stress for the past 3 months. He attributes his symptoms to ongoing problems at work. He has no prior psychiatric history. Which of the following is the most likely diagnosis?
A female presents with symptoms of being excessively talkative, hyperactive, sleeping very little, and spending large amounts of money on shopping sprees. When confronted, she becomes irritable. What is the most likely diagnosis?
FMGE 2025 - Psychiatry FMGE Practice Questions and MCQs
Question 1: A 28-year-old woman diagnosed with schizophrenia had been compliant with her prescribed olanzapine for several months. However, she discontinued the treatment. Which of the following is the most likely reason for her discontinuation?
- A. Weight gain (Correct Answer)
- B. Tardive dyskinesia
- C. Acute dystonia
- D. Akathisia
Explanation: ***Weight gain*** - **Olanzapine** is associated with one of the highest propensities among all antipsychotics for causing significant **weight gain** and metabolic syndrome (dyslipidemia, hyperglycemia). - For young women, this effect is often highly stigmatizing and is the leading cause for non-adherence and treatment discontinuation after several months of successful compliance. *Acute dystonia* - This is an acute **Extrapyramidal Symptom (EPS)** characterized by sudden, sustained muscle contractions, typically appearing within the first few days or weeks of starting treatment. - Olanzapine has a low rate of acute dystonia, and it would likely have caused discontinuation much earlier than several months into therapy. *Akathisia* - **Akathisia** is characterized by distressing subjective restlessness and motor agitation; although possible, it usually manifests early in the treatment course or after dose increases. - While bothersome, weight gain accumulated over several months is a statistically more frequent reason for patient-led drug discontinuation in this population than chronic akathisia. *Tardive dyskinesia* - **Tardive dyskinesia (TD)** is an involuntary movement disorder that is a late-onset side effect, typically developing after years of cumulative antipsychotic exposure. - Given that she was compliant for only several months, the development of severe TD causing discontinuation is highly improbable compared to chronic, rapidly accumulating metabolic side effects like weight gain.
Question 2: A patient shows flat affect. What does it indicate?
- A. Affect symptom
- B. Negative symptom (Correct Answer)
- C. Cognitive symptom
- D. Positive symptom
Explanation: ***Correct: Negative symptom*** Flat affect refers to the **reduction** or **absence** of emotional expression, which is defined as a deficit in normal function or experience. Along with **alogia** (poverty of speech), **avolition** (lack of motivation), and **anhedonia** (inability to feel pleasure), flat affect is a core component of the **negative symptom** cluster, particularly in **schizophrenia**. Negative symptoms represent deficits or diminutions in normal emotional, motivational, and social functioning. *Incorrect: Positive symptom* Positive symptoms involve the **presence** or **addition** of abnormal mental phenomena, such as **hallucinations** (perceptual disturbances), **delusions** (fixed false beliefs), or **disorganized behavior**. Flat affect represents a **diminution** of normal emotional expression and is therefore categorized as a negative symptom, opposite to the addition of phenomena seen in positive symptoms. *Incorrect: Affect symptom* While flat affect is fundamentally related to the expression of **affect** (emotion), "affect symptom" is not a standard clinical classification used in psychiatric diagnostic systems. Psychiatric symptoms are primarily categorized into **positive**, **negative**, and **cognitive** domains for diagnostic and treatment purposes, particularly in disorders like schizophrenia. *Incorrect: Cognitive symptom* Cognitive symptoms relate to deficits in **executive function**, **attention**, **working memory**, and **processing speed**. These involve difficulties with thinking, concentration, and mental organization. Flat affect is categorized as an **emotional expression deficit** (negative symptom), which is distinct from the primary cognitive processing difficulties related to thought and memory.
Question 3: A young man with a psychiatric disorder has become very aggressive. He speaks very rapidly and sleeps very little. He exhibits hyperactive behavior after discontinuing his prescribed medication. What is the most likely diagnosis?
- A. Schizophrenia
- B. Bipolar disorder - manic episode (Correct Answer)
- C. Substance-induced mood disorder
- D. Depression
Explanation: ***Bipolar disorder - manic episode*** - The constellation of extremely elevated mood features, including **rapid speech** (or pressured speech), severely **decreased need for sleep**, highly aggressive and **hyperactive behavior** (psychomotor agitation), defines a **manic episode**.- Discontinuation of established mood-stabilizing medication is a very strong predictor for relapse into a full-blown manic state in individuals with **bipolar disorder (Type I)**.*Depression* - Depression typically manifests with symptoms opposite to those observed, such as **low energy**, pervasive sadness, **anhedonia**, and often psychomotor **retardation**.- The patient's **aggression**, **hyperactivity**, and **pressured speech** are inconsistent with the core diagnostic features of a depressive episode.*Schizophrenia* - Schizophrenia is characterized fundamentally by prominent **psychotic symptoms** (hallucinations, delusions) and profound **disorganization** in speech and thought.- While agitation can occur, the cyclical mood features, specifically the dramatic decrease in the **need for sleep** and **pressured speech**, are hallmarks of mania, not schizophrenia.*Substance- induced mood disorder* - This diagnosis requires symptoms to be directly attributable to the physiological effects of **substance intoxication** or withdrawal.- Although substance use can mimic mania, the presence of a known **psychiatric disorder** and the exacerbation following cessation of **prescribed medication** make primary Bipolar I disorder relapse the most likely explanation.
Question 4: A doctor asked the patient what her age is and she told him that she is married to an older man, and she has 2 kids of 15 and 18 years, and she is 39 years old. What is the disorder present?
- A. Flight of ideas
- B. Tangentiality
- C. Derailment
- D. Circumstantial speech (Correct Answer)
Explanation: ***Circumstantial speech***- This thought process is characterized by including **excessive, irrelevant details** in the conversation before finally reaching the point or answering the question.- The patient eventually answered the question (age 39) but only after providing unnecessary associated details (married to an older man, kids' ages).*Derailment*- Also known as **loose associations**, this involves a continuous shifting from one subject to another in a way that is illogical or completely unrelated.- In derailment, the main point or question is usually completely lost as the flow moves to an entirely new, unlinked topic.*Flight of ideas*- This involves a rapid, continuous succession of thoughts where the shift between topics is based on **distractibility or recognizable associations** (like rhyming or wordplay).- It is typically characterized by **pressured speech** and is often seen in the manic phase of **Bipolar Disorder**.*Tangentiality*- This speech pattern occurs when the patient responds to a question in an obliquely relevant way but **never provides the actual answer** or reaches the main point.- The thread of conversation moves away from the initial topic (takes a tangent) and does not return, unlike **circumstantial speech**.
Question 5: A patient was asked a direct question about her age. Instead, she provided excessive and unnecessary details about her marriage and children before eventually answering the question. This is characteristic of which speech pattern?
- A. Circumstantial speech (Correct Answer)
- B. Derailment
- C. Flight of ideas
- D. Tangentiality
Explanation: **_Circumstantial speech_** - This pattern is characterized by the inclusion of **excessive, unnecessary details** and parenthetical remarks that delay the completion of a thought or the answer to a question. The speaker eventually returns to the original point or answers the question after a circuitous route, meaning the **goal of the thought is eventually reached**. *Derailment* - Also known as **loose associations**, this refers to a pattern where the speaker shifts topics that are unrelated or connected only remotely and illogically. It represents a significant form of **formal thought disorder**, where the train of thought breaks down, often observed in schizophrenia. *Flight of ideas* - This involves an extremely rapid, pressured speech pattern where the thoughts accelerate and quickly shift from one topic to the next, often connected by **punning, rhyming, or environmental stimuli**. It is a prominent feature of the **manic phase** of bipolar disorder, reflecting accelerated cognitive processing. *Tangentiality* - The speaker moves from the initial thought to another thought that is related but fails to return to the original point or answer the question (**Goal of the thought is never reached**). This differs from circumstantiality because the subject deviates and **never actually answers the direct question** posed by the interviewer.
Question 6: A lady presents to the hospital after having a fight with her husband. She reports that she is unable to speak. However, all neurological and physical examinations are normal, and she does not seem concerned about her health status. What is the most likely diagnosis?
- A. Conversion Disorder (Correct Answer)
- B. Somatic Symptom Disorder
- C. Adjustment Disorder
- D. Malingering
Explanation: ***Correct: Conversion Disorder*** - Patient presents with **acute loss of function (mutism)** following a psychological stressor (marital conflict) - **Neurological examination is normal**, ruling out organic causes - Most characteristic feature: **La belle indifférence** - lack of appropriate concern about the disability - Conversion disorder involves neurological symptoms (paralysis, blindness, mutism, seizures) that cannot be explained by medical conditions - Symptoms are **unconscious** (not intentionally produced) and follow psychological stress *Incorrect: Somatic Symptom Disorder* - Involves **excessive thoughts, feelings, or behaviors** related to somatic symptoms - Patients show **high anxiety** and preoccupation with their symptoms (opposite of la belle indifférence) - Symptoms are persistent (>6 months), not acute - Does not typically present with complete loss of function like mutism *Incorrect: Adjustment Disorder* - Involves emotional/behavioral symptoms in response to stressor - Does NOT present with **neurological deficits** like mutism - Symptoms are mood-related (depression, anxiety) rather than functional neurological symptoms - Would not explain the dramatic presentation of complete speech loss *Incorrect: Malingering* - **Conscious, intentional** production of symptoms for secondary gain (financial, avoiding work/legal issues) - No clear secondary gain mentioned in this scenario - Malingerers typically show concern and emphasize their symptoms (not la belle indifférence) - Would be suspected if obvious external incentive present
Question 7: A 55-year-old man presents to the hospital with auditory hallucinations and inability to recognize his own family members. He reports his last alcohol intake was 48 hours ago. What is the most likely diagnosis?
- A. Schizophrenia
- B. Delirium tremens (Correct Answer)
- C. Alcoholic hallucinosis
- D. Alcohol-induced psychosis
Explanation: ***Delirium tremens***- This severe form of alcohol withdrawal typically manifests 48 to 96 hours after the last drink, aligning perfectly with the patient's 48-hour abstinence period.- The presence of **auditory hallucinations** combined with **inability to recognize family members** (indicating **delirium** or **global disorientation**) confirms the diagnosis of Delirium Tremens (DT), which also includes autonomic hyperactivity.*Alcoholic hallucinosis*- This condition is characterized primarily by **auditory hallucinations** but generally occurs earlier, typically 12 to 24 hours after cessation.- Crucially, alcoholic hallucinosis occurs with a **clear sensorium** (clear consciousness), meaning there is no significant **delirium** or global confusion, unlike the presentation described.*Alcohol-induced psychosis*- While this broad category encompasses alcohol-related psychotic symptoms, **Delirium Tremens** is the specific and most appropriate diagnosis for the severe, time-locked withdrawal syndrome involving **delirium**, hallucinations, and autonomic instability 48 hours post-cessation.- This term is less specific and fails to capture the emergent nature and associated **autonomic hyperactivity** seen in DT.*Schizophrenia*- Schizophrenia is a **primary psychotic disorder** with a typical onset in early adulthood and a chronic course; the acute onset of psychosis temporally linked to **alcohol cessation** suggests an organic etiology.- The presence of **global confusion/disorientation** (inability to recognize family) is highly indicative of **delirium** and rules out schizophrenia, which does not involve a clouding of consciousness.
Question 8: A man presents to the hospital with a bizarre behavior. He is unable to recall his personal identity and has no memory of how he traveled 100 km to reach the hospital. A collateral history reveals he experienced a traumatic earthquake a few months ago. Which of the following is the most likely diagnosis?
- A. Dissociative identity disorder
- B. Schizophrenia
- C. Dissociative amnesia (Correct Answer)
- D. Global amnesia
Explanation: ***Dissociative amnesia*** - The presentation of sudden, unplanned travel away from home (called **dissociative fugue**) combined with an inability to recall important **autobiographical information** (personal identity) is the classic manifestation of severe dissociative amnesia. - This disorder is overwhelmingly triggered by psychological stress or **trauma**, such as the patient's recent experience of a traumatic earthquake. *Dissociative identity disorder* - This disorder requires the presence of two or more distinct personality states (or **alters**) that recurrently take control of the person's behavior, which is not described here. - While amnesia is a feature, the primary pathology is the fragmentation of identity, not just the loss of personal autobiographical memory without distinct alters. *Schizophrenia* - Schizophrenia is characterized by **psychotic features** such as delusions, hallucinations, and grossly disorganized thinking and behavior, which are absent in this presentation. - The core deficit here is memory and identity retrieval linked to trauma, not a primary thought disorder or persistent **psychosis**. *Global amnesia* - **Transient Global Amnesia (TGA)** involves anterograde amnesia (inability to form new memories) and retrograde amnesia (loss of recent past memories). - Crucially, in contrast to dissociative amnesia, severe impairment of **personal identity** and highly selective memory loss linked to trauma are typically absent in TGA.
Question 9: A 28-year-old software engineer presents with sleep disturbances, low mood, and stress for the past 3 months. He attributes his symptoms to ongoing problems at work. He has no prior psychiatric history. Which of the following is the most likely diagnosis?
- A. Generalized anxiety disorder
- B. Adjustment disorder (Correct Answer)
- C. Post-traumatic stress disorder (PTSD)
- D. Acute stress disorder
Explanation: ***Adjustment disorder*** - This diagnosis is characterized by the development of emotional or behavioral symptoms in response to an identifiable **psychosocial stressor** (ongoing work problems) occurring within **3 months** of the onset of the stressor. - The patient's symptoms (low mood, stress, sleep disturbances) are clinically significant but do not meet the full diagnostic criteria for a more severe disorder like **Major Depressive Disorder** or **Generalized Anxiety Disorder**. *Generalized anxiety disorder* - This disorder primarily involves **excessive anxiety and worry** about numerous events or activities, occurring more days than not for at least **6 months**. - The patient's symptoms are directly tied to a specifiable stressor, making adjustment disorder a better fit than the broader, persistent worry characteristic of GAD. *Acute stress disorder* - This diagnosis requires exposure to a **traumatic stressor** (e.g., threat to life or serious injury), which is not the etiology described here (work problems). - Furthermore, symptoms must resolve within **one month** of the traumatic event; this patient's symptoms have persisted for 3 months. *Post-traumatic stress disorder (PTSD)* - Similar to acute stress disorder, PTSD requires exposure to an actual or threatened **death, serious injury, or sexual violence**, which is not indicated by the vignette. - Core features of PTSD include **intrusive memories** (flashbacks), avoidance of stimuli, and hyperarousal, none of which are reported by the patient.
Question 10: A female presents with symptoms of being excessively talkative, hyperactive, sleeping very little, and spending large amounts of money on shopping sprees. When confronted, she becomes irritable. What is the most likely diagnosis?
- A. Schizophrenia
- B. Obsessive-compulsive disorder
- C. Bipolar II + Hypomania
- D. Bipolar I + Mania (Correct Answer)
Explanation: ***Bipolar I + Mania***- The presentation of *pressured speech* (excessively talkative), *decreased need for sleep*, *hyperactivity*, and severe *impulsivity* (large spending) meets the criteria for a **full manic episode**.- A manic episode is defined by lasting at least one week, causing severe functional impairment, and is necessary for the diagnosis of **Bipolar I Disorder**.*Bipolar II + Hypomania*- Symptoms of a **hypomanic episode** are similar but are less severe, last a minimum of 4 consecutive days, and *do not cause marked functional impairment* or require hospitalization.- The patient’s severe symptoms (reckless spending, irritability upon confrontation) leading to major social/occupational problems indicate **mania**, not hypomania.*Obsessive-compulsive disorder*- This disorder is characterized by intrusive, recurrent **obsessions** (thoughts) and repetitive **compulsions** (behaviors) performed to relieve anxiety, which are not the primary symptoms here.- While spending could be impulsive, it is part of a cluster of mood and activity disturbances, not an ego-dystonic ritualistic compulsion.*Schizophrenia*- The primary features of **Schizophrenia** involve psychosis, such as **hallucinations**, **delusions**, and **disorganized thinking**, which are not described in this presentation.- Although irritability and hyperactivity may overlap, the core presentation is dominated by symptoms of a disruptive mood state, making a primary mood disorder more likely.