NEET-PG 2013 — Psychiatry
87 Previous Year Questions with Answers & Explanations
A person presents to the outpatient department with tremors and visual hallucinations after a 2-day history of alcohol cessation. What is the diagnosis?
Among which of the following conditions is suicide risk highest?
What is the total score in the Mini Mental Status Examination (MMSE)?
Doppelganger is a term used to describe which medical phenomenon?
What deficiency may contribute to relapse in a patient who has experienced remission with selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants (TCAs)?
Muttering delirium is seen with: NEET 13
What is the term for the salivation of a dog in response to a bell after it has been conditioned with food?
Which of the following develop first during dependence of a substance ?
In psychiatric assessment, which term refers to a temporary and subjective judgment or viewpoint expressed by a patient regarding their condition or treatment?
Which of the following is an antipsychotic drug?
NEET-PG 2013 - Psychiatry NEET-PG Practice Questions and MCQs
Question 1: A person presents to the outpatient department with tremors and visual hallucinations after a 2-day history of alcohol cessation. What is the diagnosis?
- A. Korsakoff’s psychosis
- B. Delirium tremens (Correct Answer)
- C. Wernicke encephalopathy
- D. Alcoholic hallucinosis
Explanation: ***Delirium tremens*** - Delirium tremens is a severe form of **alcohol withdrawal** characterized by **tremors**, disorientation, and **visual hallucinations**, typically appearing **48 to 96 hours** (2-4 days) after the last drink. - This is a medical emergency with potential for **seizures**, **hyperthermia**, and **cardiovascular collapse** due to dysregulation of neurotransmitters (decreased **GABA** activity and increased **glutamate** activity). - Autonomic hyperactivity (tachycardia, hypertension, diaphoresis) is a key feature distinguishing it from other alcohol-related conditions. *Korsakoff's psychosis* - This is a chronic **neuropsychiatric syndrome** typically occurring after an episode of **Wernicke encephalopathy**, characterized by severe **memory impairment** (anterograde and retrograde amnesia) and **confabulation**. - It develops over weeks to months in the course of chronic alcoholism and is **not an acute withdrawal syndrome**, unlike the symptoms described in this 2-day presentation. *Wernicke encephalopathy* - This is an acute neurological condition caused by **thiamine (vitamin B1) deficiency**, commonly seen in chronic alcoholics, characterized by the classic triad of **ophthalmoplegia** (especially nystagmus), **ataxia**, and **confusion**. - While it can precede Korsakoff's psychosis and involves confusion, it does not typically present with the prominent **tremors** and **visual hallucinations** characteristic of alcohol withdrawal, and the timing (2 days post-cessation) points more toward withdrawal rather than nutritional deficiency. *Alcoholic hallucinosis* - Alcoholic hallucinosis involves primarily **auditory hallucinations** (often threatening voices) that occur without significant clouding of consciousness, typically within **12-24 hours** of alcohol cessation. - Unlike delirium tremens, it **lacks autonomic instability**, severe tremors, and global disorientation, and the hallucinations are predominantly auditory rather than visual.
Question 2: Among which of the following conditions is suicide risk highest?
- A. Depression (Correct Answer)
- B. Alcohol dependence
- C. Dementia
- D. Schizophrenia
Explanation: ***Depression*** - **Major depressive disorder** is the psychiatric condition most frequently associated with **suicide**, accounting for a large percentage of completed suicides. - The presence of severe depression, especially with features like **hopelessness**, **agitation**, and **prior suicide attempts**, significantly elevate the risk. *Alcohol dependence* - While **alcohol dependence** is a significant risk factor for suicide, it often co-occurs with mood disorders like depression; alcohol can exacerbate suicidal ideation and impulsivity. - It is an important comorbidity, but **major depression** alone has a higher prevalence in suicide statistics than alcohol dependence as a primary factor. *Dementia* - **Dementia** generally poses a lower risk of completed suicide compared to mood disorders, as cognitive decline can impair the ability to plan and execute such acts. - Early stages of dementia, particularly when insight into cognitive decline is preserved, may carry some risk, but it is not the highest risk condition overall. *Schizophrenia* - Individuals with **schizophrenia** have a significantly elevated risk of suicide compared to the general population, often due to factors like **command hallucinations**, hopelessness, and adverse effects of medication. - However, **depression** remains the leading psychiatric diagnosis associated with suicide completions.
Question 3: What is the total score in the Mini Mental Status Examination (MMSE)?
- A. 25
- B. 32
- C. 30 (Correct Answer)
- D. 35
Explanation: ***Correct: 30*** - The **Mini Mental State Examination (MMSE)** is a 30-point questionnaire used to screen for **cognitive impairment** and monitor changes in cognitive function over time. - The score is calculated by summing points for correct responses across various cognitive domains such as **orientation**, **attention**, **memory**, **language**, and **visuospatial skills**. - This is the **maximum total score** achievable on the MMSE. *Incorrect: 25* - A score of 25 in the MMSE is significantly below the maximum, and depending on age and education, it often suggests **mild cognitive impairment** or early **dementia**. - While 25 is a possible score a patient can achieve, it is not the **maximum total score** for the examination itself. *Incorrect: 32* - The MMSE is standardized to have a maximum score of **30**, so 32 is higher than the possible range for this particular cognitive assessment tool. - No domain in the MMSE allows for a score that would lead to a total of 32 points. *Incorrect: 35* - Like 32, a score of 35 is beyond the **maximum achievable score** on the MMSE. - This indicates a misunderstanding of the MMSE's scoring rubric, as the highest possible score is **30 points**.
Question 4: Doppelganger is a term used to describe which medical phenomenon?
- A. Shadow following person
- B. Feeling of double of oneself (Correct Answer)
- C. Identification of stranger as familiar
- D. None of the options
Explanation: ***Feeling of double of oneself*** - **Doppelganger** (also called **autoscopy** or **heautoscopy**) refers to the experience of seeing or sensing one's own double or duplicate - This is the **correct definition** of the term doppelganger in medical terminology - Associated with **neurological conditions** (temporal lobe epilepsy, brain lesions, migraine) and **psychiatric conditions** (schizophrenia, dissociative states) - The person perceives their duplicate as a separate entity, which may appear visually or be sensed as a presence *Shadow following person* - This is not a recognized medical or psychiatric phenomenon - Does not describe the autoscopic experience of seeing one's own double - Not related to the definition of doppelganger *Identification of stranger as familiar* - This more closely describes **Fregoli delusion**, where a person believes that different people are actually a single person in disguise - Could also relate to other delusional misidentification syndromes - **Not doppelganger**, which specifically involves seeing one's own double, not misidentifying others - Note: **Capgras syndrome** is the opposite—believing a familiar person has been replaced by an imposter *None of the options* - Incorrect because "Feeling of double of oneself" accurately describes the doppelganger phenomenon
Question 5: What deficiency may contribute to relapse in a patient who has experienced remission with selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants (TCAs)?
- A. Pyridoxine
- B. Cobalamin
- C. Ascorbate
- D. Folate (Correct Answer)
Explanation: ***Folate*** - **Folate (vitamin B9) deficiency** is strongly linked to depression and is a well-established cause of relapse in patients treated with antidepressants. - Folate plays a crucial role in the **one-carbon metabolism pathway**, which is essential for the synthesis of monoamine neurotransmitters including **serotonin, norepinephrine, and dopamine**. - Studies show that **low folate levels** are associated with poor response to SSRIs and TCAs, and folate supplementation can improve antidepressant efficacy. - Approximately **30% of depressed patients** have folate deficiency, making it a clinically significant factor in treatment resistance and relapse. *Cobalamin* - **Cobalamin (vitamin B12)** deficiency can cause neuropsychiatric symptoms including depression and cognitive impairment. - While B12 is important for myelin formation and neurotransmitter synthesis, it is less specifically implicated in antidepressant relapse compared to folate. - B12 deficiency more commonly presents with **cognitive and neurological symptoms** rather than pure mood symptoms. *Pyridoxine* - **Pyridoxine (vitamin B6)** is a cofactor in neurotransmitter synthesis, including serotonin and dopamine. - While B6 deficiency can contribute to mood disturbances, it is not commonly implicated as a primary cause of relapse in antidepressant-treated depression. *Ascorbate* - **Ascorbate (vitamin C)** is an antioxidant with some role in neurotransmitter metabolism. - Severe vitamin C deficiency (scurvy) can have psychiatric manifestations, but it is not typically associated with relapse in patients treated with SSRIs or TCAs.
Question 6: Muttering delirium is seen with: NEET 13
- A. Datura (Correct Answer)
- B. Castor oil plant
- C. Cocaine (stimulant)
- D. Monkshood (Aconitum)
Explanation: ***Datura*** - **Datura poisoning** is characterized by an **anticholinergic toxidrome**, which includes central nervous system effects like **muttering delirium, hallucinations**, and disorientation. - The patient exhibits features like **dilated pupils, dry mouth, flushed skin**, and **tachycardia** due to the blockage of muscarinic acetylcholine receptors. *Castor oil plant* - The **castor oil plant** contains **ricin**, a potent toxin that causes **gastrointestinal symptoms** (nausea, vomiting, abdominal pain, bloody diarrhea) and eventually multi-organ failure. - It does not typically cause the central nervous system effects like **muttering delirium** seen with Datura poisoning. *Cocaine (stimulant)* - **Cocaine** is a central nervous system stimulant that causes **euphoria, agitation, paranoia, dilated pupils**, and **tachycardia**. - While it can cause psychosis, the specific **muttering delirium** is not its hallmark presentation; instead, it is associated with a hyperadrenergic state. *Monkshood (Aconitum)* - **Monkshood** contains **aconitine**, a neurotoxin that primarily affects cardiac and neurological function, causing **paresthesias, muscle weakness, bradycardia**, and potentially fatal arrhythmias. - It does not typically cause the **muttering delirium** with features of an anticholinergic syndrome.
Question 7: What is the term for the salivation of a dog in response to a bell after it has been conditioned with food?
- A. Conditioned reflex (Correct Answer)
- B. Reinforcement
- C. Habituation
- D. Innate reflex
Explanation: ***Conditioned reflex (Conditioned Response)*** - A **conditioned reflex** is a learned response developed through **classical conditioning**, where a previously neutral stimulus becomes associated with an unconditioned stimulus. - In Pavlov's experiment: The **bell (Conditioned Stimulus)** is paired with **food (Unconditioned Stimulus)**, leading the dog to eventually salivate to the bell alone. - The **salivation to the bell** is the **Conditioned Response (CR)** - a learned behavior, not an innate one. *Reinforcement* - **Reinforcement** is a concept from **operant conditioning** (Skinner), not classical conditioning. - It involves strengthening a behavior by providing a consequence (reward or punishment) after the behavior occurs. - This describes a process that increases behavior frequency, not the learned response itself. *Habituation* - **Habituation** is a decrease in response to a repeatedly presented stimulus that proves to be irrelevant. - The organism learns to **ignore** the stimulus over time (e.g., getting used to background noise). - This is the opposite of developing a new learned response. *Innate reflex* - An **innate reflex** is an **unlearned, inborn** automatic response (e.g., salivation directly to food, pupillary reflex, sucking reflex). - The dog's salivation **to food** is innate, but salivation **to the bell** is learned through conditioning.
Question 8: Which of the following develop first during dependence of a substance ?
- A. Tolerance
- B. Physical dependence
- C. Psychological dependence (Correct Answer)
- D. Withdrawal symptoms
Explanation: ***Psychological dependence*** - **Psychological dependence** often develops first, characterized by an emotional need for the substance to experience pleasure or avoid discomfort. - This involves a strong **craving** and compulsive drug-seeking behavior despite negative consequences, driven by the substance's effect on brain reward pathways. *Tolerance* - **Tolerance** means that increasing doses of the substance are required to achieve the same effect previously achieved with lower doses. - While it often develops early in substance use, the initial "need" to use the substance is often psychological before physiological adaptations occur. *Physical dependence* - **Physical dependence** describes the body's physiological adaptation to the substance, leading to withdrawal symptoms if use is stopped or reduced. - It typically develops after consistent, prolonged use and is usually preceded by psychological dependence and often tolerance. *Withdrawal symptoms* - **Withdrawal symptoms** are the physiological and psychological signs that occur when a dependent person stops or drastically reduces their substance intake. - These are a direct manifestation of physical dependence and thus develop once physical dependence has been established.
Question 9: In psychiatric assessment, which term refers to a temporary and subjective judgment or viewpoint expressed by a patient regarding their condition or treatment?
- A. Opinion (Correct Answer)
- B. Belief
- C. Practice
- D. Attitude
Explanation: ***Opinion*** - An **opinion** is a transient, personal judgment or viewpoint that a patient expresses, often based on their current understanding or feelings. - It does not necessarily reflect deep-seated convictions but rather a momentary take on their condition or treatment. *Belief* - A **belief** is a more deeply held and enduring conviction that a patient holds, often influencing their perspective and decision-making over time. - Unlike an opinion, a belief is less likely to change quickly and can be foundational to a patient's understanding of their health or illness. *Practice* - **Practice** refers to the regular implementation of specific behaviors, routines, or strategies, especially those related to treatment or self-care. - It describes actions rather than a patient's thoughts, judgments, or viewpoints. *Attitude* - An **attitude** is a more stable predisposition or mental stance towards an object, person, or situation, encompassing thoughts, feelings, and behavioral intentions. - While it can influence opinions, an attitude is a broader and more consistent concept than a temporary judgment.
Question 10: Which of the following is an antipsychotic drug?
- A. Flupenthixol (Correct Answer)
- B. Rasagiline
- C. Clobazam
- D. Divalproex
Explanation: ***Flupenthixol*** - **Flupenthixol** is a **first-generation (typical) antipsychotic** used primarily for managing **schizophrenia** and other psychotic disorders. - It acts by blocking **dopamine D2 receptors** in the brain, reducing positive symptoms like **hallucinations and delusions**. *Rasagiline* - **Rasagiline** is a **monoamine oxidase-B (MAO-B) inhibitor** used in the treatment of **Parkinson's disease**. - It works by preventing the breakdown of **dopamine** in the brain, thereby improving motor symptoms, and is not an antipsychotic. *Clobazam* - **Clobazam** is a **benzodiazepine** primarily indicated for the treatment of **epilepsy** (specifically Lennox-Gastaut syndrome) and **anxiety**. - Its mechanism involves enhancing the effect of **GABA** in the brain, producing sedative and anticonvulsant effects, distinct from antipsychotic action. *Divalproex* - **Divalproex** is a combination product of **valproic acid** and **sodium valproate**, typically used as a **mood stabilizer** for **bipolar disorder**, an **antiepileptic**, and for **migraine prophylaxis**. - It modulates **GABAergic** transmission and sodium channels, but it is not classified as an antipsychotic drug.