NEET-PG 2015 Practice Questions

Q: What is the primary cause of death in Neuroleptic Malignant Syndrome?

None of the options. ***None of the options*** - The **primary cause of death** in Neuroleptic Malignant Syndrome is **renal failure secondary to rhabdomyolysis**, which is not listed among the options. - **Severe muscle rigidity** in NMS leads to massive muscle breakdown (rhabdomyolysis) → release of myoglobin → myoglobinuria → acute tubular necrosis → acute renal failure. - Mortality in NMS ranges from **10-20%**, with renal complications being the leading cause of death. - Other significant causes include **cardiovascular collapse, arrhythmias, DIC**, and **respiratory complications**, but renal failure remains the most common fatal outcome. *Respiratory failure* - While respiratory complications occur in NMS (aspiration pneumonia, respiratory muscle rigidity), this is **not the primary cause of death**. - Respiratory failure can contribute to mortality but is typically **secondary** to other complications or occurs less frequently than renal failure as the direct cause. - It is a serious complication but not the most common fatal outcome. *Liver failure* - **Hepatotoxicity** is not a characteristic feature or primary cause of death in NMS. - Though elevated liver enzymes may occur, liver failure is **not a typical cause of mortality** in NMS. - The pathophysiology centers on **dopamine blockade**, autonomic instability, and muscle breakdown, not hepatic dysfunction. *Drug toxicity* - NMS is an **idiosyncratic reaction** to dopamine antagonists (typical and atypical antipsychotics), not a dose-dependent toxic effect. - Death results from the **physiological complications of the syndrome** (renal failure, cardiovascular collapse, hyperthermia), not from direct drug toxicity or overdose. - The mechanism is related to dopamine receptor blockade and subsequent dysregulation, not toxic poisoning.

Q: The site of lesion in Korsakoff's psychosis is

Mammillary body. ***Mammillary body*** - **Korsakoff's psychosis** is a neurocognitive disorder characterized by severe **memory impairment**, confabulation, and apathy, primarily due to **thiamine deficiency**. - The disease involves damage to several brain areas, most notably the **mammillary bodies** and the dorsal medial nucleus of the thalamus, which are critical for memory formation. *Frontal lobe* - While frontal lobe dysfunction can lead to cognitive deficits, the **primary lesion** in Korsakoff's psychosis is not typically located here. - Damage to the frontal lobe is more commonly associated with executive dysfunction, personality changes, and disinhibition, rather than the profound amnesia seen in Korsakoff's. *Cingulate gyrus* - The cingulate gyrus plays a role in emotion, learning, and memory, but it is **not considered the primary site of lesion** in Korsakoff's psychosis. - Although it can be affected, lesions in the mammillary bodies are more directly linked to the characteristic memory deficits. *Corpus striatum* - The corpus striatum is involved in motor control and habit formation, and its damage is associated with movement disorders like **Parkinson's or Huntington's disease**. - This area is **not the primary site of pathology** in Korsakoff's psychosis, which is fundamentally a memory disorder.

Q: In which condition is sex reassignment surgery typically performed?

Gender dysphoria. ***Gender dysphoria*** - **Sex reassignment surgery** is primarily performed as part of the treatment for **gender dysphoria**, a condition where there is a marked incongruence between an individual's experienced/expressed gender and their assigned sex. - The surgery aims to align the individual's physical appearance with their **gender identity**, alleviating distress and improving quality of life. *Premature ejaculation* - This condition involves consistent or recurrent ejaculation with minimal sexual stimulation before, during, or shortly after penetration and before the person wishes it. - Treatment typically includes behavioral therapies, medication (e.g., SSRIs), and psychological counseling, not surgical intervention. *Erectile dysfunction* - **Erectile dysfunction** is the inability to achieve or maintain an erection firm enough for satisfactory sexual intercourse. - Treatments range from lifestyle changes and oral medications (e.g., PDE5 inhibitors) to vacuum devices, penile injections, and in some cases, penile implants, but not sex reassignment surgery. *Orgasmic dysfunction* - This condition refers to persistent or recurrent delay in, or absence of, orgasm following a normal phase of sexual excitement. - Management often involves psychological counseling, addressing underlying medical conditions, or adjusting medications; it does not involve sex reassignment surgery.

Q: Which of the following is not typically associated with dementia?

Alteration of consciousness. ***Alteration of consciousness*** - An **alteration of consciousness** is a hallmark feature of **delirium**, which is an acute confusional state, usually fluctuating. - **Dementia** is primarily characterized by a chronic, progressive decline in cognitive function with **clear consciousness**. *Forgetfulness* - **Forgetfulness**, particularly memory loss impacting daily life, is one of the **earliest and most common symptoms** of dementia. - This symptom progressively worsens, affecting short-term and eventually long-term memory. *Reduced personal care* - As dementia progresses, individuals often experience a decline in their ability to perform **activities of daily living (ADLs)**, including personal care. - This can manifest as forgetting to bathe, difficulty dressing, or neglecting personal hygiene due to cognitive impairment. *Loss of neurons in brain* - **Neurodegeneration**, characterized by the **loss of neurons** and synapses in the brain, is the underlying pathological basis of most types of dementia, such as Alzheimer's disease. - This neuronal loss leads to brain atrophy and the cognitive deficits seen in dementia.

Q: A girl exhibits aggressive behavior such as smashing and throwing objects and verbally abusing hospital staff. However, she shows a different demeanor towards a particular resident doctor. What could be the most likely diagnosis?

Borderline personality disorder. ***Borderline personality disorder*** - Patients with **borderline personality disorder** often exhibit **impulsivity**, intense mood swings, and a pattern of unstable interpersonal relationships, leading to aggressive outbursts. - Their unpredictable behavior and tendency to form intense, unstable attachments or a "favorite person" dynamic are characteristic, as seen in her differing demeanor towards a particular resident doctor. *Bipolar disorder* - While bipolar disorder involves **mood swings**, the behavioral patterns are typically characterized by distinct episodes of **mania** or hypomania and depression, with less emphasis on chronic interpersonal instability and aggression. - The aggression in bipolar disorder is often associated with the manic phase but lacks the consistent pattern of relationship instability and "favorite person" dynamic described. *Schizoaffective disorder* - This disorder involves a combination of **psychotic symptoms** (like delusions or hallucinations) and **mood symptoms** (like depression or mania), which are not explicitly described here as the primary issue. - The aggressive behavior is not primarily driven by psychosis, and the specific interpersonal dynamic with staff is more suggestive of a personality disorder. *Antisocial personality* - **Antisocial personality disorder** is characterized by a pervasive pattern of disregard for and violation of the **rights of others** and may include aggression, but it often involves a lack of empathy and manipulativeness rather than the intense emotional dysregulation and unstable interpersonal patterns seen in borderline personality. - While aggressive behavior is present, the specific description of verbally abusing staff while showing a "different demeanor" towards a particular doctor points away from the typical presentation of antisocial disregard for others.

Q: What is the most common cause of delirium?

Infection. ***Infection*** - **Infections**, particularly urinary tract infections (UTIs) or pneumonia, are a very common and often reversible cause of **delirium**, especially in elderly or immunocompromised patients [1]. - The systemic inflammatory response to infection can lead to neuroinflammation and direct effects on brain function, manifesting as acute changes in attention and cognition. *Liver failure* - While **liver failure** can cause **hepatic encephalopathy**, which presents with altered mental status, it typically has a more gradual onset and a different neurochemical profile than acute delirium caused by infection. - Hepatic encephalopathy is characterized by abnormal ammonia metabolism and often includes motor signs like **asterixis**, which are not universally present in delirium from infection. *Belladonna poisoning* - **Belladonna poisoning** (due to **anticholinergic toxicity**) can cause **delirium**, along with a constellation of symptoms like dilated pupils, dry mouth, and tachycardia. - However, it is a specific toxicological cause and not as broad or commonly encountered as infection as a general cause of new-onset delirium in hospitalized or elderly populations. *None of the options* - This option is incorrect because **infection** is indeed a very common and recognized cause of delirium [1].

Q: What does the term 'jamais vu' refer to?

The feeling of strangeness in a familiar situation. ***The feeling of strangeness in a familiar situation*** - **Jamais vu** describes the opposite of déjà vu; it is the experience of encountering something familiar—a person, place, or word—but feeling that it is **unfamiliar or strange**. - This phenomenon can sometimes be a symptom associated with certain neurological conditions like **temporal lobe epilepsy**. *A thought that feels familiar but is actually new* - This describes a sensation closer to **cryptomnesia** or a "false familiarity," where a new idea is mistakenly believed to be an original thought. - Jamais vu specifically relates to the **perception of external reality** or recognition of known entities, not the familiarity of internal thoughts. *A situation that feels familiar but is actually new* - This is the definition of **déjà vu**, not jamais vu. Déjà vu involves experiencing a new event or situation as if it has happened before. - **Déjà vu** translates to "already seen," directly contrasting with the "never seen" sensation of jamais vu. *An illusion where one feels they have heard something before* - This is a specific type of **déjà vu** known as **déjà entendu** ("already heard"). - Jamais vu involves the *loss of familiarity* with something known, rather than the *false familiarity* with something new.

Q: Which of the following conditions is most commonly associated with self-mutilation?

Borderline personality disorder. **_Borderline personality disorder_** - **Self-mutilation** (e.g., cutting, burning) is a common coping mechanism in **borderline personality disorder (BPD)**, used to relieve intense emotional pain or a sense of emptiness. - This behavior is often associated with the characteristic **emotional dysregulation**, **impulsivity**, and unstable interpersonal relationships seen in BPD. - Self-mutilation is included as a diagnostic criterion in DSM-5 for BPD. *Catatonic schizophrenia* - This subtype of schizophrenia is characterized by profound disturbances in psychomotor behavior, such as **immobility**, **mutism**, **posturing**, or **excessive, purposeless motor activity**. - While individuals with catatonia may injure themselves during periods of extreme agitation or impulsivity, **self-mutilation** is not a primary or defining feature of catatonic schizophrenia. *Paranoid schizophrenia* - This type of schizophrenia is dominated by **delusions** (often persecutory or grandiose) and **auditory hallucinations**. - While individuals with paranoid schizophrenia may engage in self-harm if driven by delusional beliefs or command hallucinations, **self-mutilation** as a primary coping mechanism is not a hallmark characteristic of this disorder. *None of the options* - This option is incorrect because **borderline personality disorder** is strongly and specifically associated with self-mutilation.

Q: A patient inventing new words is a feature of?

Schizophrenia. ***Schizophrenia*** - The invention of new words, known as **neologisms**, is a characteristic symptom of **thought disorder** in schizophrenia. - These words often have personal meaning to the patient but are unintelligible to others, reflecting disturbed communication. *Neurotic disorders* - These disorders, such as anxiety and phobias, primarily involve **distress and maladaptive coping mechanisms** but do not typically feature neologisms. - **Thought content** may be ruminative or anxious, but not disorganized to the extent of inventing new words. *Aphasia* - Aphasia is a **language disorder caused by brain damage** (e.g., stroke), resulting in difficulty with language production or comprehension. - While it can involve word-finding difficulties or paraphasias (word substitutions), it is distinctly different from the deliberate invention of new, non-existent words seen in psychosis. *Obsessive-Compulsive Disorder (OCD)* - OCD is characterized by **recurrent, intrusive thoughts (obsessions)** and repetitive behaviors (compulsions). - It does not involve thought disorganization or the creation of neologisms; language remains structured, though often focused on obsessive themes.

Q: Increased dopamine levels are associated with which of the following conditions?

Schizophrenia. ***Schizophrenia*** - The **dopamine hypothesis of schizophrenia** is the most well-established association with increased dopamine levels, particularly in the **mesolimbic pathway**, which contributes to positive symptoms such as **hallucinations** and **delusions**. - Antipsychotic medications, which are **dopamine D2 receptor antagonists**, effectively reduce these positive symptoms by blocking dopamine activity. - This is the **classic and primary answer** when considering increased dopamine levels in psychiatry. *Depression* - Depression is primarily associated with **decreased levels of monoamines**, including **serotonin**, **norepinephrine**, and **dopamine**. - Treatments for depression often aim to increase these neurotransmitter levels, not related to dopamine excess. *Mania* - Mania, a hallmark of **bipolar disorder**, is associated with **increased dopamine activity** along with elevated **norepinephrine** and **serotonin** levels. - While mania does involve dopamine elevation, **schizophrenia** remains the **primary and most established** condition associated with the dopamine hypothesis in psychiatric literature. - The distinction is that schizophrenia's pathophysiology is more centrally and specifically linked to dopamine dysregulation. *Delirium* - Delirium is a state of **acute brain failure** characterized by a fluctuating course and disturbances in attention and cognition. - While neurotransmitter imbalances, including dopamine, **acetylcholine deficiency**, and GABA alterations, can contribute to delirium, it is not primarily defined by increased dopamine as the main pathophysiological mechanism.

Question 1

What is the primary cause of death in Neuroleptic Malignant Syndrome?

Accepted Answer

None of the options

Answer

Respiratory failure

Answer

Liver failure

Answer

Drug toxicity

Question 2

The site of lesion in Korsakoff's psychosis is

Accepted Answer

Mammillary body

Answer

Frontal lobe

Answer

Cingulate gyrus

Answer

Corpus striatum

Question 3

In which condition is sex reassignment surgery typically performed?

Accepted Answer

Gender dysphoria

Answer

Premature ejaculation

Answer

Erectile dysfunction

Answer

Orgasmic dysfunction

Question 4

Which of the following is not typically associated with dementia?

Accepted Answer

Alteration of consciousness

Answer

Reduced personal care

Answer

Loss of neurons in brain

Answer

Forgetfulness

Question 5

A girl exhibits aggressive behavior such as smashing and throwing objects and verbally abusing hospital staff. However, she shows a different demeanor towards a particular resident doctor. What could be the most likely diagnosis?

Accepted Answer

Borderline personality disorder

Answer

Bipolar disorder

Answer

Schizoaffective disorder

Answer

Antisocial personality

Question 6

What is the most common cause of delirium?

Accepted Answer

Infection

Answer

Liver failure

Answer

Belladonna poisoning

Answer

None of the options

Question 7

What does the term 'jamais vu' refer to?

Accepted Answer

The feeling of strangeness in a familiar situation

Answer

A thought that feels familiar but is actually new

Answer

A situation that feels familiar but is actually new

Answer

An illusion where one feels they have heard something before

Question 8

Which of the following conditions is most commonly associated with self-mutilation?

Accepted Answer

Borderline personality disorder

Answer

Catatonic schizophrenia

Answer

Paranoid schizophrenia

Answer

None of the options

Question 9

A patient inventing new words is a feature of?

Accepted Answer

Schizophrenia

Answer

Aphasia

Answer

Neurotic disorders

Answer

Obsessive-Compulsive Disorder (OCD)

Question 10

Increased dopamine levels are associated with which of the following conditions?

Accepted Answer

Schizophrenia

Answer

Depression

Answer

Mania

Answer

Delirium

NEET-PG 2015

Psychiatry