NEET-PG 2024 - Psychiatry PYQs Practice Questions

Q: A 45-year-old female presents to the OPD with complaints of "feeling tense" and experiencing stomach upset with heartburn and diarrhea. She reports having these symptoms for many years and mentions that her family members also usually feel tense and nervous. Which of the following symptoms is most likely to be seen in this patient?

Tingling of extremities. ***Tingling of extremities*** - The patient's presentation of "feeling tense," **stomach upset, heartburn, and diarrhea** for many years, alongside a family history of similar issues, suggests significant **anxiety**. - **Peripheral neurological symptoms** such as **tingling of extremities (paresthesia)** are common manifestations of anxiety and panic attacks due to **hyperventilation** (causing respiratory alkalosis and decreased ionized calcium) and **physiological arousal**. *Ideas of reference* - **Ideas of reference** are typically seen in **psychotic disorders** (e.g., schizophrenia) where a person believes that unrelated, external events have a special, personal meaning. - While anxiety can sometimes lead to misinterpretations, **ideas of reference** at a delusional level are not characteristic of generalized anxiety. *Hallucination* - **Hallucinations** are perceptual disturbances where an individual experiences sensory perceptions (e.g., hearing voices, seeing things) in the absence of an external stimulus. - These are core symptoms of **psychotic disorders** and are not typical findings in anxiety disorders without comorbid conditions. *Neologism* - A **neologism** is the coining of new words or phrases, often without clear meaning, which is a hallmark feature of disorganized thought in **psychotic disorders** (e.g., schizophrenia). - This symptom is related to severe thought disorganization and is not associated with anxiety disorders. [Practice more Psychiatry PYQs on OnCourse]

Q: A 30-year-old male needs to be dressed in female lingerie and high heels to feel aroused and have intercourse with a female. He denies any attraction towards males. What is the most likely diagnosis?

Transvestic Disorder. ***Transvestic Disorder*** - This condition involves **recurrent, intense sexual arousal from cross-dressing** in clothes typically associated with the opposite sex. The man experiences this specifically for sexual arousal and activity with a female partner, rather than for gender identity reasons. - The patient's denial of attraction to males and the context of heterosexual intercourse confirm that this is a paraphilic disorder related to specific sexual arousal patterns. - This diagnosis (formerly called "Transvestic fetishism" in DSM-IV) is the appropriate term in DSM-5-TR. *Gender dysphoria* - This involves a **marked incongruence between one's experienced/expressed gender and one's assigned gender**, often accompanied by distress or impairment. The patient's desire to dress in female clothing is for sexual arousal, not because he identifies as female. - Individuals with gender dysphoria typically experience a persistent and profound discomfort with their birth-assigned gender and a strong desire to be of the other gender, which is not described in this case. *Homosexuality* - This refers to **sexual attraction to individuals of the same sex**. The patient explicitly denies any attraction towards males, indicating that his sexual orientation is not homosexual. - His arousal is tied to a specific activity, cross-dressing, in the context of heterosexual intercourse, not the gender of his partner. *Testicular feminization* - This is an older term for **Androgen Insensitivity Syndrome (AIS)**, a genetic condition where an individual who is genetically male (XY) is resistant to male hormones (androgens). This results in female external sexual characteristics or ambiguous genitalia. - This is a biological developmental disorder, not a psychological or sexual preference, and is unrelated to the behavioral description of sexual arousal from cross-dressing. [Practice more Psychiatry PYQs on OnCourse]

Q: A 24-year-old male presents for evaluation. He appears very calm and charming in front of the psychiatrist but often gets into fights with friends, skips classes, breaks traffic rules, and is involved in multiple police cases. What is the most likely diagnosis?

Antisocial personality disorder. ***Antisocial personality disorder*** - The patient's **charming demeanor** while frequently engaging in **fights, rule-breaking**, and **legal issues** is characteristic of antisocial personality disorder. - Individuals with this disorder often display **disregard for social norms**, lack **empathy**, and have a history of **irresponsibility** and **deceitfulness**. *Narcissistic personality disorder* - This disorder is marked by a pervasive pattern of **grandiosity**, a need for **admiration**, and a lack of **empathy**, but it does not typically involve a pattern of recurrent **antisocial behavior** or **criminality** like that described. - While they might be perceived as charming, their primary motivation is self-enhancement and they are less likely to repeatedly engage in behaviors that actively violate the rights of others or societal rules for personal gain or impulsivity. *Paranoid personality disorder* - Characterized by pervasive **distrust and suspiciousness** of others' motives, interpreting them as malevolent, which is not depicted in this patient's presentation. - Individuals with this disorder tend to be **guarded, hold grudges**, and may be **secretive**, rather than openly engaging in antisocial acts and charming manipulation. *Schizotypal personality disorder* - Involves patterns of **eccentric behavior**, peculiar thinking, and extreme discomfort in close relationships, often due to **perceptual distortions** or **magical beliefs**. - This patient's presentation of social charm and calculated antisocial acts is not consistent with the **social isolation** and **oddities** typical of schizotypal personality disorder. [Practice more Psychiatry PYQs on OnCourse]

Q: A 40-year-old female has visited multiple plastic surgeons requesting correction of a perceived facial deformity. She was referred to a psychiatrist because she repeatedly checks her face, insists that it is deformed and needs surgery despite no evidence on examination. She persists with her demand despite reassurances by family members and doctors. What is the most appropriate management?

Behavior therapy. ***Behavior therapy*** - This patient presents with **body dysmorphic disorder (BDD)**, characterized by preoccupation with a perceived defect in appearance that is not observable to others, leading to significant distress and impairment. - **Cognitive behavioral therapy (CBT)**, specifically **CBT-BDD with exposure and response prevention (ERP)**, is the **first-line treatment** with the strongest evidence base for BDD. - CBT-BDD addresses the core cognitive distortions, reduces checking behaviors, and provides sustained long-term improvement without medication side effects. - **Most appropriate management** involves CBT as primary treatment, often combined with pharmacotherapy for optimal outcomes. *SSRI* - **Selective serotonin reuptake inhibitors (SSRIs)** are the first-line **pharmacotherapy** for BDD, often requiring higher doses than those used for major depressive disorder. - SSRIs are highly effective and can be used as monotherapy or preferably in combination with CBT. - While SSRIs are appropriate, CBT has superior evidence as the primary intervention for BDD. *Atypical antipsychotics* - **Atypical antipsychotics** may be considered as an augmentation strategy for BDD in cases that do not respond to SSRI monotherapy, especially with significant delusional features or severe functional impairment. - They are not first-line pharmacological treatment. *Allow her to have surgery* - Allowing plastic surgery is **contraindicated** in patients with BDD because it rarely alleviates distress and often leads to dissatisfaction with surgical outcomes, potentially worsening symptoms or causing further unnecessary procedures. - The core problem is distorted perception of self, not an actual physical defect that can be remedied surgically. [Practice more Psychiatry PYQs on OnCourse]

Q: Untreated ADHD persisting from childhood increases the risk of developing which of the following in adolescence?

Conduct disorder. ***Conduct disorder*** - **Untreated ADHD**, marked by impulsivity and difficulty with emotional regulation, significantly increases the risk of developing **conduct disorder** in adolescence. - Adolescents with untreated ADHD may struggle with following rules, exhibiting aggressive behaviors, and engaging in antisocial acts, which are hallmarks of conduct disorder. *Selective mutism* - This is an **anxiety disorder** characterized by a child's consistent failure to speak in specific social situations where there is an expectation for speaking despite speaking in other situations. - While it can co-occur with ADHD, it is not a direct consequence of untreated ADHD and involves distinct psychological mechanisms. *Binge eating disorder* - This disorder is characterized by recurrent episodes of **eating unusually large amounts of food** in a short period, often accompanied by a sense of loss of control. - While there is a higher prevalence of eating disorders in individuals with ADHD, it is not a primary or direct developmental risk from untreated ADHD in adolescence. *Separation anxiety disorder* - This disorder involves **excessive fear or anxiety** concerning separation from home or from attachment figures, beyond what is expected for the individual's developmental level. - While it can co-occur with ADHD, it is not a direct developmental risk that emerges from untreated ADHD in adolescence. [Practice more Psychiatry PYQs on OnCourse]

Question 1

A 45-year-old female presents to the OPD with complaints of "feeling tense" and experiencing stomach upset with heartburn and diarrhea. She reports having these symptoms for many years and mentions that her family members also usually feel tense and nervous. Which of the following symptoms is most likely to be seen in this patient?

Accepted Answer

Tingling of extremities

Answer

Ideas of reference

Answer

Hallucination

Answer

Neologism

Question 2

A 30-year-old male needs to be dressed in female lingerie and high heels to feel aroused and have intercourse with a female. He denies any attraction towards males. What is the most likely diagnosis?

Accepted Answer

Transvestic Disorder

Answer

Gender dysphoria

Answer

Homosexuality

Answer

Testicular feminization

Question 3

A 24-year-old male presents for evaluation. He appears very calm and charming in front of the psychiatrist but often gets into fights with friends, skips classes, breaks traffic rules, and is involved in multiple police cases. What is the most likely diagnosis?

Accepted Answer

Antisocial personality disorder

Answer

Narcissistic personality disorder

Answer

Paranoid personality disorder

Answer

Schizotypal personality disorder

Question 4

A 40-year-old female has visited multiple plastic surgeons requesting correction of a perceived facial deformity. She was referred to a psychiatrist because she repeatedly checks her face, insists that it is deformed and needs surgery despite no evidence on examination. She persists with her demand despite reassurances by family members and doctors. What is the most appropriate management?

Accepted Answer

Behavior therapy

Answer

SSRI

Answer

Atypical antipsychotics

Answer

Allow her to have surgery

Question 5

Untreated ADHD persisting from childhood increases the risk of developing which of the following in adolescence?

Accepted Answer

Conduct disorder

Answer

Selective mutism

Answer

Binge eating disorder

Answer

Separation anxiety disorder

Question 6

A young girl presents with a history of multiple episodes of loss of consciousness lasting for 20 minutes. These episodes occur only in front of family members and only during the daytime. There is no history of tongue biting or incontinence, and EEG and MRI studies are normal. What is the most appropriate management?

Accepted Answer

Insight-oriented psychotherapy

Answer

Treat with aversive therapy

Answer

Valproate

Answer

Ketogenic diet

NEET-PG 2024 — Psychiatry