NEET-PG 2025 - Psychiatry PYQs Practice Questions

Q: A man is extremely particular about being on time and consistently shows a strong need for order, control, and perfectionism. Which personality disorder does this behavior most likely suggest?

Obsessive-Compulsive Personality Disorder. ***Obsessive-Compulsive Personality Disorder*** - Core features include a pervasive pattern of preoccupation with **orderliness**, **perfectionism**, and **mental and interpersonal control**. - The extreme need to be on time and the consistent focus on control and order align perfectly with the diagnostic criteria for **OCPD**. *Paranoid Personality Disorder* - Characterized by a pervasive distrust and **suspiciousness** of others, often interpreting their motives as malevolent. - The primary concern is not order or perfectionism, but rather the fear of being **deceived** or **exploited**. *Narcissistic Personality Disorder* - Defined by a pervasive pattern of **grandiosity**, a need for admiration, and a lack of empathy; they believe they are special or unique. - While they may demand perfection from others, their own behavior is motivated by maintaining high **self-esteem** and status, not inherent orderliness or control for its own sake. *Schizoid Personality Disorder* - Involves profound detachment from social relationships and a restricted range of emotional expression; they typically prefer **solitary activities**. - This disorder does not involve the characteristic preoccupation with rules, control, or **perfectionism** seen in the patient described. [Practice more Psychiatry PYQs on OnCourse]

Q: A patient on long-term antipsychotics develops involuntary mouth and lip movements (perioral dyskinesia). What is the best treatment?

Stop antipsychotic and give tetrabenazine. ***Stop antipsychotic and give tetrabenazine*** - Managing **Tardive Dyskinesia (TD)** involves either switching to a less potent antipsychotic (like clozapine) or, ideally, reducing or discontinuing the offending antipsychotic if clinically feasible. - **Tetrabenazine** (or its analogues valbenazine/deutetrabenazine) are **VMAT2 inhibitors** that decrease presynaptic dopamine release, making them the **first-line pharmacological treatment** for established TD. - This combination represents the most definitive approach when the underlying psychiatric condition allows antipsychotic discontinuation. *Increase the antipsychotic dose* - Increasing the antipsychotic dose temporarily masks TD by increasing central dopamine receptor blockade, but this worsens the underlying **striatal dopamine receptor upregulation** that causes TD. - This strategy only delays definitive treatment and prolongs the risk of severe, irreversible dyskinesia. - While it may suppress movements transiently, it is **never** appropriate long-term management. *Start benzodiazepines* - **Benzodiazepines** (GABA agonists) are generally ineffective for the core involuntary movements of established **Tardive Dyskinesia**. - They may be useful for acute movement disorders or anxiety but lack efficacy against chronic, persistent dopamine-related dyskinesia. *Give anticholinergics* - **Anticholinergic drugs** (e.g., benztropine, trihexyphenidyl) are the treatment of choice for **acute dystonia** and drug-induced Parkinsonism. - These agents are generally **contraindicated** in Tardive Dyskinesia because they often worsen or reveal underlying dyskinetic movements. [Practice more Psychiatry PYQs on OnCourse]

Q: A female patient presents with flashbacks and a history of forgetting about her father's death in a road traffic accident 2 weeks ago. What is the most likely diagnosis?

Acute Stress Disorder (ASD). ***Acute Stress Disorder (ASD)*** - This diagnosis is defined by the presence of severe dissociative, intrusive (**flashbacks**), negative mood, and arousal symptoms occurring between **3 days and 1 month** after exposure to a traumatic event (2 weeks in this case). - The combination of **flashbacks** (intrusion symptom) and forgetting/amnesia (dissociative symptom) is characteristic of the acute reaction to trauma seen in ASD. *Post-Traumatic Stress Disorder (PTSD)* - PTSD requires similar symptoms (intrusion, avoidance, negative alterations in cognition/mood) to persist for **more than 1 month** following the traumatic event. - Since the event occurred only 2 weeks ago, the required duration criterion for a PTSD diagnosis has not been fulfilled yet. *Dissociative Amnesia* - While the patient exhibits amnesia, this diagnosis is generally reserved for extensive memory loss concerning important **autobiographical information**, not better explained by another mental disorder. - The presence of accompanying **flashbacks** and the acute time frame following the trauma better support the diagnosis of ASD. *Adjustment Disorder* - Adjustment disorder involves emotional or behavioral symptoms developed within 3 months of an identifiable stressor, but the symptoms are not severe enough to meet criteria for ASD or PTSD. - The presence of severe clinical features like **flashbacks** and **dissociative amnesia** excludes an Adjustment Disorder diagnosis, as it meets the criteria for the more specific and severe ASD. [Practice more Psychiatry PYQs on OnCourse]

Q: A person was found in a bizarre location, appearing confused. The caretaker reports he had no memory of how he got there, and the patient is unaware of his travel to the location. What is the most likely diagnosis?

Dissociative fugue. ***Dissociative fugue*** - This diagnosis is defined by **sudden, unexpected travel** away from home or the known environment, coupled with the inability to recall one's past or identity details (generalized **amnesia** for the journey). - The patient being found in a **bizarre location** and having no memory of the travel perfectly encapsulates the clinical definition of a dissociative fugue (a specifier of Dissociative Amnesia in DSM-5). *Dissociative identity disorder* - The hallmark feature is the presence of **two or more distinct personality states** or alters, which recurrently take control of the person's behavior. - While amnesia is present, it involves gaps in the recall of everyday events, not just isolated memory loss related specifically to an unexpected journey. *Dissociative amnesia* - This involves the inability to recall important personal information, usually of a **stressful or traumatic nature**, that is too extensive to be explained by ordinary forgetting. - Simple dissociative amnesia lacks the specific component of **purposeful, unplanned travel** away from home that characterizes a fugue state. *Psychotic episode* - Psychotic disorders are characterized by **positive symptoms** like **delusions** (fixed false beliefs) and **hallucinations** (perceptual disturbances). - The patient's confusion stems from a lack of memory regarding the journey (**dissociation**), not from a primary break with reality or thought disorder. [Practice more Psychiatry PYQs on OnCourse]

Question 1

A man is extremely particular about being on time and consistently shows a strong need for order, control, and perfectionism. Which personality disorder does this behavior most likely suggest?

Accepted Answer

Obsessive-Compulsive Personality Disorder

Answer

Narcissistic Personality Disorder

Answer

Paranoid Personality Disorder

Answer

Schizoid Personality Disorder

Question 2

A patient on long-term antipsychotics develops involuntary mouth and lip movements (perioral dyskinesia). What is the best treatment?

Accepted Answer

Stop antipsychotic and give tetrabenazine

Answer

Start benzodiazepines

Answer

Give anticholinergics

Answer

Increase the antipsychotic dose

Question 3

A female patient presents with flashbacks and a history of forgetting about her father's death in a road traffic accident 2 weeks ago. What is the most likely diagnosis?

Accepted Answer

Acute Stress Disorder (ASD)

Answer

Dissociative Amnesia

Answer

Post-Traumatic Stress Disorder (PTSD)

Answer

Adjustment Disorder

Question 4

A person was found in a bizarre location, appearing confused. The caretaker reports he had no memory of how he got there, and the patient is unaware of his travel to the location. What is the most likely diagnosis?

Accepted Answer

Dissociative fugue

Answer

Dissociative amnesia

Answer

Dissociative identity disorder

Answer

Psychotic episode

Question 5

A man reports that he is receiving orders from God to follow white birds in a specific direction. What is the most appropriate description of this symptom?

Accepted Answer

Passivity phenomenon

Answer

Delusional perception

Answer

Visual hallucination

Answer

Thought insertion

Question 6

A 25-year-old male was injured during an earthquake. A social worker reports that he was later found in another town, and the man has no memory of how he got there or of his personal identity. What is the most likely diagnosis?

Accepted Answer

Dissociative amnesia with dissociative fugue

Answer

Dissociative identity disorder

Answer

Acute stress disorder

Answer

PTSD

Question 7

A patient on haloperidol for 2 years presents with orofacial dyskinesia and extrapyramidal symptoms. What is the appropriate treatment?

Accepted Answer

Tardive dyskinesia - valbenazine

Answer

Akathisia - propranolol

Answer

Parkinsonism - amantadine

Answer

Acute dystonia - ropinirole

NEET-PG 2025 — Psychiatry