Neuropsychiatry — MCQs
In a patient with chronic alcoholism, which nutrient deficiency is most likely to cause neurological symptoms?
In chronic alcoholism and its complications, which of the following is seen?
Which of the following is NOT typically associated with Korsakoff's psychosis?
Following statement are true about tremors except:
Emergence Delirium is characteristic of?
What is the most common cause of delirium?
Which of the following conditions does not typically involve delusions?
Which of the following disorders is classified under somatic symptom and related disorders in the DSM-5?
Which of the following is not associated with Korsakoff psychosis?
A patient has been a known alcoholic for the last 20 years. He suddenly develops restlessness, tremors, and agitation. What is the most likely diagnosis?
Neuropsychiatry Indian Medical PG Practice Questions and MCQs
Question 1: In a patient with chronic alcoholism, which nutrient deficiency is most likely to cause neurological symptoms?
- A. Vitamin B6
- B. Thiamine (Correct Answer)
- C. Folate
- D. Vitamin B12
Explanation: ***Thiamine*** - **Thiamine (Vitamin B1)** deficiency is extremely common in chronic alcoholism due to poor nutrition and impaired absorption, leading to neurological disorders like **Wernicke-Korsakoff syndrome** [1]. - **Wernicke-Korsakoff syndrome** manifests with symptoms such as **ataxia**, **ophthalmoplegia**, **confusion**, and **memory impairment** [2]. *Vitamin B6* - While **Vitamin B6 (pyridoxine)** deficiency can occur in alcoholism, it is more commonly associated with peripheral neuropathy rather than the extensive neurological picture seen with thiamine deficiency. - Severe B6 deficiency can cause **seizures** and **encephalopathy**, but these are less common as primary neurological manifestations in typical chronic alcoholics compared to Wernicke-Korsakoff syndrome. *Folate* - **Folate deficiency** is very common in chronic alcoholism and primarily leads to **macrocytic anemia**. - While it can indirectly contribute to neurological issues due to anemia, it does not directly cause the classic acute neurological syndromes seen with thiamine deficiency. *Vitamin B12* - **Vitamin B12 deficiency** can cause neurological symptoms, including **peripheral neuropathy**, **ataxia**, and **cognitive impairment**, but it is less directly associated with alcoholism compared to thiamine deficiency. - B12 deficiency is more commonly seen in strict vegetarians, pernicious anemia, or malabsorption conditions involving the ileum.
Question 2: In chronic alcoholism and its complications, which of the following is seen?
- A. Wernicke's syndrome
- B. Delirium tremens
- C. Korsakoff psychosis
- D. All of the options (Correct Answer)
Explanation: ***All of the options*** - **Wernicke's syndrome**, **Delirium tremens**, and **Korsakoff psychosis** are all well-recognized neurological and psychiatric complications associated with **chronic alcoholism** - Chronic alcohol abuse leads to nutritional deficiencies (especially **thiamine deficiency**) and neurotoxicity, predisposing individuals to these distinct but related conditions *Wernicke's syndrome* - Acute neurological disorder caused by **thiamine deficiency** - Characterized by classic triad: **ataxia**, **ophthalmoplegia**, and **confusion** - If untreated, can progress to **Korsakoff psychosis** *Delirium tremens* - Severe form of **alcohol withdrawal** in individuals with long history of heavy drinking - Symptoms include **delirium**, **severe agitation**, **tremors**, **hallucinations**, and autonomic hyperactivity (**tachycardia**, **hypertension**, **fever**) - Medical emergency requiring prompt treatment *Korsakoff psychosis* - Occurs due to chronic **thiamine deficiency**, often following Wernicke's encephalopathy - Characterized by severe **anterograde and retrograde amnesia**, **confabulation**, and relative preservation of other cognitive functions - Often results in permanent cognitive impairment
Question 3: Which of the following is NOT typically associated with Korsakoff's psychosis?
- A. Long Term Memory Loss
- B. Confabulation
- C. Immediate/Working Memory Loss (Correct Answer)
- D. Mammillary Bodies Involved
Explanation: ***Immediate/Working Memory Loss*** - Korsakoff's psychosis is primarily characterized by **profound anterograde amnesia** (inability to form new long-term memories) and significant **retrograde amnesia** (loss of past memories). - **Immediate/working memory** (the ability to hold information for seconds, such as digit span) is **relatively preserved** in Korsakoff's syndrome, unlike the severe deficits in forming and retrieving long-term memories. - The core deficit is the inability to transfer information from working memory to long-term storage (consolidation failure), not impairment in immediate recall itself. - This preservation of immediate memory with profound long-term memory loss is a key distinguishing feature of the syndrome. *Confabulation* - **Confabulation** (fabrication of memories without intent to deceive) is a **classic and common symptom** of Korsakoff's psychosis. - Patients spontaneously generate false narratives to fill in memory gaps, arising from severe anterograde and retrograde amnesia. - This is a pathognomonic feature used in clinical diagnosis. *Long Term Memory Loss* - **Severe long-term memory loss** (both anterograde and retrograde) is the **defining hallmark** of Korsakoff's psychosis. - Anterograde amnesia prevents formation of new long-term memories, while retrograde amnesia causes loss of previously stored memories, typically with a temporal gradient. - This profoundly impacts daily functioning and is central to diagnosis. *Mammillary Bodies Involved* - Damage to the **mammillary bodies** and **dorsomedial nucleus of the thalamus** due to **thiamine (B1) deficiency** is the **neuropathological basis** of Korsakoff's psychosis. - These structures are critical components of the **Papez circuit** (hippocampus-fornix-mammillary bodies-thalamus-cingulate-hippocampus), essential for memory consolidation. - Often preceded by Wernicke's encephalopathy (acute confusional state, ataxia, ophthalmoplegia).
Question 4: Following statement are true about tremors except:
- A. Essential tremor is an uncommon movement disorder affecting 5%of population (Correct Answer)
- B. Normal individuals can have physiologic tremor that manifest as mild high frequency, postural or action tremors.
- C. PD is characterised by resting tremor
- D. Tremor consist of alternate contraction of agonist and antagonist muscle in oscillating rhythmic manner
Explanation: ***Essential tremor is an uncommon movement disorder affecting 5% of population*** - Essential tremor is, in fact, one of the most common movement disorders, affecting a significant portion of the population (often cited as 0.4% in the general population, with higher prevalence in older adults, ranging from 4-5%). - Therefore, stating it is "uncommon" contradicts its actual prevalence and epidemiological data. *Normal individuals can have physiologic tremor that manifest as mild high frequency, postural or action tremors.* - **Physiologic tremor** is a normal phenomenon present in healthy individuals, characterized by a low amplitude, high-frequency tremor. - It becomes more noticeable under conditions of **stress, fatigue, or stimulant use** and is typically seen as a **postural or action tremor**. *PD is characterised by resting tremor* - **Parkinson's disease (PD)** is classically associated with a **resting tremor**, meaning it occurs when the limb is at rest and supported, and often diminishes with voluntary movement [1], [2]. - This tremor usually presents as a **"pill-rolling"** movement of the fingers and thumb. *Tremor consist of alternate contraction of agonist and antagonist muscle in oscillating rhythmic manner* - Tremors are defined by their **oscillating, rhythmic, and involuntary movements** resulting from the alternating or synchronous contraction of **agonist and antagonist muscles** [1]. - This alternating muscle activity is what produces the characteristic shaking motion [2].
Question 5: Emergence Delirium is characteristic of?
- A. Midazolam
- B. Thiopentone
- C. Opioids
- D. Ketamine (Correct Answer)
Explanation: ***Ketamine*** - **Emergence delirium**, characterized by vivid dreams, hallucinations, and confusion upon recovery from anesthesia, is a known side effect of **ketamine**, particularly in adults. - This effect is attributed to ketamine's action on **NMDA receptors** and can be attenuated by co-administration of benzodiazepines. *Midazolam* - **Midazolam** is a benzodiazepine often used for sedation and anxiolysis, and it typically causes amnesia and relaxation rather than a delirious state upon emergence. - While it can cause paradoxical agitation in some patients, it does not characteristically lead to emergence delirium similar to ketamine. *Thiopentone* - **Thiopentone** is a short-acting barbiturate used for induction of anesthesia, known for rapid onset and offset, leading to smooth emergence without significant delirium. - Its primary effect is general central nervous system depression, not dissociative anesthesia associated with emergence phenomena. *Opioids* - **Opioids** are potent analgesics that, at higher doses, can cause respiratory depression, nausea, and somnolence; however, they do not characteristically cause emergence delirium. - While they can contribute to postoperative cognitive dysfunction, it is distinct from the dissociative emergence state seen with ketamine.
Question 6: What is the most common cause of delirium?
- A. Infection (Correct Answer)
- B. Liver failure
- C. Belladonna poisoning
- D. None of the options
Explanation: ***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].
Question 7: Which of the following conditions does not typically involve delusions?
- A. Delirium
- B. Alcohol withdrawal
- C. OCD (Correct Answer)
- D. Schizophrenia
Explanation: ***OCD*** - **Obsessive-compulsive disorder** is characterized by recurrent, intrusive **thoughts (obsessions)** and repetitive **behaviors (compulsions)**, which the individual typically recognizes as irrational. - While patients with severe OCD may have **poor insight**, they generally do not experience **delusions**, which are fixed, false beliefs held despite evidence to the contrary. *Delirium* - **Delirium** is an acute, fluctuating disturbance of consciousness resulting from medical conditions or substance intoxication/withdrawal, often accompanied by **psychotic symptoms** including **delusions** and **hallucinations**. - The rapid onset and global cognitive impairment make **delusions** a common feature. *Schizophrenia* - **Schizophrenia** is a severe mental disorder characterized by **psychotic symptoms**, with **delusions** being one of the hallmark positive symptoms. - These **delusions** often include **persecutory**, **grandiose**, or **somatic themes**, among others. *Alcohol withdrawal* - Severe **alcohol withdrawal** can lead to **delirium tremens (DTs)**, which is associated with **psychotic symptoms** such as **delusions** and vivid **hallucinations** (often visual or tactile). - These **delusions** are often **persecutory** or referential in nature and contribute to the patient's fear and agitation.
Question 8: Which of the following disorders is classified under somatic symptom and related disorders in the DSM-5?
- A. Post-Traumatic Stress Disorder (PTSD)
- B. Phobic disorders (e.g., social anxiety disorder)
- C. Conversion disorder (functional neurological symptom disorder) (Correct Answer)
- D. Obsessive-Compulsive Disorder (OCD)
Explanation: ***Conversion disorder (functional neurological symptom disorder)*** - **Conversion disorder** is characterized by neurological symptoms (e.g., paralysis, blindness) that are **incompatible with recognized neurological or medical conditions**, yet are not intentionally produced. - It falls under **somatic symptom and related disorders** because the primary features are physical symptoms causing distress or functional impairment, rather than being malingered or feigned. *Phobic disorders (e.g., social anxiety disorder)* - **Phobic disorders** are classified under **anxiety disorders** in the DSM-5, not somatic symptom and related disorders. - They are primarily characterized by **intense, irrational fears** of specific objects or situations, leading to avoidance rather than prominent physical symptoms without a medical cause. *Post-Traumatic Stress Disorder (PTSD)* - **PTSD** is classified under **trauma- and stressor-related disorders** in the DSM-5, distinguished by symptoms developing after exposure to a traumatic event. - Its core features include **intrusive memories, avoidance, negative alterations in cognition and mood, and alterations in arousal and reactivity**, rather than unexplained physical symptoms. *Obsessive-Compulsive Disorder (OCD)* - **OCD** is classified under **obsessive-compulsive and related disorders** in the DSM-5. - It is primarily characterized by the presence of **obsessions (recurrent, intrusive thoughts)** and/or **compulsions (repetitive behaviors or mental acts)**, which are distinct from somatic symptoms.
Question 9: Which of the following is not associated with Korsakoff psychosis?
- A. Ophthalmoplegia (Correct Answer)
- B. Amnesia
- C. Confabulation
- D. Polyneuropathy
Explanation: ***Ophthalmoplegia*** - **Ophthalmoplegia** is a key feature of **Wernicke encephalopathy**, the acute phase preceding Korsakoff psychosis, but is not directly a symptom of Korsakoff psychosis itself. - While both conditions are linked to thiamine deficiency, **Korsakoff psychosis** primarily manifests as chronic memory deficits. *Amnesia* - **Anterograde amnesia** (inability to form new memories) and **retrograde amnesia** (loss of past memories) are defining characteristics of Korsakoff psychosis. - This severe memory impairment is a result of damage to areas like the **mammillary bodies** and **thalamus**. *Confabulation* - **Confabulation**, the fabrication of distorted or misinterpreted memories without an intention to deceive, is a common symptom in patients with Korsakoff psychosis. - This occurs as patients attempt to fill in gaps in their memory loss, often believing their own stories. *Polyneuropathy* - **Polyneuropathy**, nerve damage affecting multiple peripheral nerves, causing symptoms like pain, numbness, and muscle weakness, is associated with chronic **alcoholism** and **thiamine deficiency**. - While not a direct psychological symptom, it is frequently seen in the same patient population that develops Korsakoff psychosis due to shared etiology.
Question 10: A patient has been a known alcoholic for the last 20 years. He suddenly develops restlessness, tremors, and agitation. What is the most likely diagnosis?
- A. Alcoholic hallucinosis
- B. Wernicke's encephalopathy
- C. Korsakoff's syndrome
- D. Delirium tremens (Correct Answer)
Explanation: ***Delirium tremens*** - This condition is characterized by **restless tremors**, **agitation**, and often hallucinations, occurring in chronic alcoholics after sudden cessation or reduction of alcohol intake. - The symptoms typically appear **48-96 hours** after the last drink and can include severe autonomic hyperactivity such as tachycardia, hypertension, and hyperthermia. *Alcoholic hallucinosis* - This involves vivid auditory, visual, or tactile hallucinations that occur in a **clear sensorium**, typically 12-48 hours after decreased alcohol intake. - Unlike delirium tremens, there is usually **no significant disorientation** or severe autonomic instability. *Wernicke's encephalopathy* - This is an acute neurological condition due to **thiamine deficiency**, common in chronic alcoholics, presenting with the classical triad of **ocular disturbances** (nystagmus, ophthalmoplegia), **ataxia**, and **confusion**. - While confusion can be present, the primary symptoms described (restless tremors, agitation) are not the hallmark features. *Korsakoff's syndrome* - This is a chronic neuropsychiatric disorder that often follows untreated Wernicke's encephalopathy, characterized by **severe memory impairment** (anterograde and retrograde amnesia) and **confabulation**. - It primarily affects memory and learning, rather than acute agitation and tremors.
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