FMGE 2023 - Psychiatry PYQs Practice Questions

Q: A 38-year-old professor with depression requests you to prescribe an antidepressant that would be least likely to cause sexual dysfunction. Which of the following drugs would you prescribe?

Bupropion. ***Bupropion***- Bupropion is a **norepinephrine-dopamine reuptake inhibitor (NDRI)** that differs structurally and mechanically from SSRIs and SNRIs. - It is known for its relatively neutral effect on sexual function, often having the **lowest incidence** of sexual side effects among commonly prescribed antidepressants, and is sometimes used to treat SSRI-induced sexual dysfunction.*Escitalopram*- As a **selective serotonin reuptake inhibitor (SSRI)**, escitalopram frequently causes sexual side effects such as decreased libido, delayed orgasm, and anorgasmia.- This class of drugs elevates **serotonin levels**, which is strongly implicated in causing sexual dysfunction.*Venlafaxine*- Venlafaxine is a **serotonin-norepinephrine reuptake inhibitor (SNRI)**, and its serotonergic component carries a medium-to-high risk of causing sexual dysfunction.- The common sexual side effects include **erectile dysfunction** in men and reduced arousal in women.*Fluoxetine*- Fluoxetine is a commonly prescribed **SSRI** with a significant association with sexual side effects, including inhibited orgasm and reduced libido.- Its long half-life means that these adverse effects, if they occur, can persist following **discontinuation**. [Practice more Psychiatry PYQs on OnCourse]

Q: The Mental State Examination (100-7) examines which of the following mental functions?

Concentration. ***Concentration***- The **'100 minus 7' serial subtraction task** is a core component of the Mental State Examination (MSE) specifically designed to test a patient's **concentration** and sustained attention. - Successful completion requires maintaining focus and managing working memory, making it an excellent measure of this cognitive function. *Judgment* - **Judgment** is typically evaluated by asking patients how they would respond to hypothetical situations (e.g., finding a lost wallet or envelope). - This component assesses the patient's ability to understand consequences, make reasoned decisions, and apply social norms. *Language* - **Language** assessment involves testing fluency, comprehension (ability to follow commands), repetition, and naming objects. - The 100-7 task is a test of attention and arithmetic, not of fundamental linguistic abilities. *Orientation* - **Orientation** assesses the patient's awareness of **person**, **place**, and **time** (P-P-T). - This function is tested by asking direct questions about identity, current location, and the date, distinct from computational tasks like 100-7. [Practice more Psychiatry PYQs on OnCourse]

Q: What is the most common symptom of cannabis intake?

Dream-like state. ***Dream-like state***- The most common and defining acute symptom of cannabis intoxication is the **psychoactive effect**, leading to altered sense of time, altered sensory perception, and a relaxed, sometimes euphoric, **dream-like state**.- This perceptual alteration is due to the agonist activity of **delta-9-tetrahydrocannabinol (THC)** primarily on central **CB1 receptors**. *Anxiety*- While **anxiety**, **paranoia**, and panic attacks are frequently reported adverse effects, particularly with high potency strains or accidental overdose, they are not the primary anticipated or most common effect.- The typical desired effect is generally **relaxation** and **euphoria**, which contrasts with the experience of acute anxiety.*Depressed mood*- Acute cannabis intoxication usually leads to a transient sense of **well-being** or **euphoria**, rather than an acutely depressed mood.- A primary depressive state or **amotivational syndrome** is more typically associated with chronic, heavy use or withdrawal states, not the initial acute intoxication.*Decreased appetite*- Cannabis is famously known for significantly **increasing appetite**, often termed **"the munchies,"** due to the stimulation of cannabinoid receptors in appetite centers.- The active component, THC, acts as an **orexigenic agent**, making decreased appetite an incorrect association. [Practice more Psychiatry PYQs on OnCourse]

Q: You see a middle-aged man presenting to the psychiatry OPD who reports aliens have been speaking to him and telling him to kill his relatives over the past 7 months. What is the likely diagnosis?

Schizophrenia. ***Schizophrenia***- The presence of prominent **auditory hallucinations** and **command hallucinations** lasting for 7 months fulfills the diagnostic criteria for Schizophrenia (continuous signs of disturbance for at least 6 months).- The symptoms described (hearing aliens commanding violence) represent **positive symptoms** of psychosis and are often associated with poor insight and significant functional decline characteristic of this disorder.*Mania*- Mania requires a sustained period of abnormally and persistently elevated, expansive, or irritable **mood**, and increased goal-directed activity or energy, which is not the primary complaint here.- Psychotic features in Mania are usually **mood-congruent** (e.g., grandiose delusions about immense power), whereas these command hallucinations are non-mood-congruent.*Delusional disorder*- This disorder is characterized by the presence of one or more **non-bizarre delusions** lasting >1 month, but prominent hallucinations are specifically excluded.- The patient is experiencing persistent and prominent **auditory hallucinations**, making schizophrenia a more appropriate diagnosis.*Brief psychotic disorder*- This diagnosis is reserved for psychotic symptoms (delusions, hallucinations, disorganized speech) that last for a period of **less than one month**.- Since the patient's symptoms have persisted for **7 months**, the duration clearly rules out brief psychotic disorder. [Practice more Psychiatry PYQs on OnCourse]

Q: Which of the following is NOT a symptom associated with chronic cocaine abuse?

Dilated pupils, rapid pulse and sweating.. ***Dilated pupils, rapid pulse and sweating.***- These manifestations (mydriasis, tachycardia, and diaphoresis) are classic signs of **acute cocaine intoxication** resulting from massive sympathetic nervous system overstimulation.- While they occur every time the drug is used, they reflect the transient state of acute drug action rather than structural, neurological, or hygienic **long-term complications** of chronic abuse.*Nasal/palatal perforation.*- Chronic intranasal cocaine abuse leads to severe **vasoconstriction** and subsequent **ischemic necrosis** of the cartilaginous and bony structures in the septum and palate.- This structural destruction is a definitive **long-term consequence** that may lead to chronic sinusitis, dysphonia, and septal perforation.*Black tongue and teeth.*- This presentation is a characteristic finding in individuals who chronically smoke **crack cocaine**, often referred to as "crack mouth."- It is caused by a combination of extreme heat exposure, chemical irritation from the smoke, and severe neglect of **oral hygiene** associated with addiction.*Hallucination of insects crawling on the skin (formication).*- This severe **tactile hallucination**, often colloquially termed "cocaine bugs," is a known psychiatric consequence of **chronic, high-dose stimulant abuse**.- It results from neurotoxicity and is a marker of severe dopaminergic system dysregulation due to long-term substance use. [Practice more Psychiatry PYQs on OnCourse]

Question 1

A 38-year-old professor with depression requests you to prescribe an antidepressant that would be least likely to cause sexual dysfunction. Which of the following drugs would you prescribe?

Accepted Answer

Bupropion

Answer

Venlafaxine

Answer

Fluoxetine

Answer

Escitalopram

Question 2

The Mental State Examination (100-7) examines which of the following mental functions?

Accepted Answer

Concentration

Answer

Judgment

Answer

Language

Answer

Orientation

Question 3

What is the most common symptom of cannabis intake?

Accepted Answer

Dream-like state

Answer

Anxiety

Answer

Depressed mood

Answer

Decreased appetite

Question 4

You see a middle-aged man presenting to the psychiatry OPD who reports aliens have been speaking to him and telling him to kill his relatives over the past 7 months. What is the likely diagnosis?

Accepted Answer

Schizophrenia

Answer

Mania

Answer

Delusional disorder

Answer

Brief psychotic disorder

Question 5

Which of the following is NOT a symptom associated with chronic cocaine abuse?

Accepted Answer

Dilated pupils, rapid pulse and sweating.

Answer

Black tongue and teeth.

Answer

Hallucination of insects crawling on the skin (formication).

Answer

Nasal/palatal perforation.

Question 6

Which of the following does not suggest a medical cause of mental illness?

Accepted Answer

Auditory hallucination

Answer

Acute onset

Answer

Elderly age

Answer

Loss of consciousness

FMGE 2023 — Psychiatry