Psychiatric Manifestations of Medical Illnesses — MCQs

10 questions

Which of the following will have an organic cause?

A 41 year old married female presented with headache for the last 6 months. She had several consultations. All her investigations were found to be within normal limits. She still insists that there is something wrong in her head and seeks another consultation. The most likely diagnosis is:

Which of the following produces neuropsychiatric symptoms?

What is the most common cause of delirium?

Insane paresis is associated with -

The most common cause of hyperthyroidism in a young female is?

Behavioural problems caused by senility, drug damage, brain injury or disease, and the toxic effects of poisons are classified as __________ disorders

Subcortical dementia is seen in all except:

In chronic alcoholism and its complications, which of the following is seen?

Q10

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?

Psychiatric Manifestations of Medical Illnesses Indian Medical PG Practice Questions and MCQs

Question 1: Which of the following will have an organic cause?

A. Schizophrenia
B. Delirium (Correct Answer)
C. Anxiety
D. Obsessive compulsive disorder

Explanation: ***Delirium*** - Delirium is an **acute, fluctuating disturbance of consciousness** and cognition that is directly caused by a **medical condition**, substance intoxication/withdrawal, or medication side effect [1], [2], [3]. - It always has an **underlying organic etiology** such as infection, metabolic derangements, drug toxicity, or neurological disorders [1], [2]. *Schizophrenia* - Schizophrenia is a **chronic psychiatric disorder** characterized by psychosis (hallucinations, delusions), disorganized thinking, and negative symptoms. - While it has a neurobiological basis, it is considered a **primary mental illness** and not typically caused by an acute, identifiable organic illness in the way delirium is. *Anxiety* - Anxiety disorders are characterized by excessive worry, fear, and physical symptoms of arousal. They are considered **primary mental health conditions**. - Although stress can precipitate anxiety, it is not primarily due to a **specific acute organic cause** that resolves with treatment of that cause. *Obsessive compulsive disorder* - Obsessive-compulsive disorder (OCD) is an anxiety-related disorder characterized by **recurrent, intrusive thoughts (obsessions)** and repetitive behaviors (compulsions) aimed at reducing distress. - Like other primary mental health conditions, it has a neurobiological basis but is not classified as having an **acute organic cause** in the medical sense.

Question 2: A 41 year old married female presented with headache for the last 6 months. She had several consultations. All her investigations were found to be within normal limits. She still insists that there is something wrong in her head and seeks another consultation. The most likely diagnosis is:

A. Illness Anxiety Disorder (Correct Answer)
B. Phobia
C. Psychogenic headache
D. Depression

Explanation: ***Illness Anxiety Disorder*** - This patient exhibits persistent **preoccupation with having a serious illness** despite **repeated medical evaluations** showing no underlying pathology. - She continues to **seek multiple consultations**, demonstrating **excessive health-related behaviors** characteristic of health anxiety. - Despite reassurance and normal investigations, she **insists something is wrong**, which is the core feature of this disorder. - Note: The presence of headache doesn't exclude this diagnosis; the key is the **disproportionate anxiety and health-seeking behavior** relative to the symptom. *Phobia* - Phobias involve an **intense, irrational fear** of a specific object or situation (e.g., agoraphobia, social phobia). - The patient's concern is about having an illness and physical symptoms, not a fear of a specific trigger or situation. *Psychogenic headache* - This is a **symptom description**, not a psychiatric disorder diagnosis. - While the headache may have psychological factors, the question asks for the **disorder** that best explains the overall clinical picture. - The primary pathology here is the **persistent health anxiety and reassurance-seeking behavior**, not just the headache itself. *Depression* - Although **depression can present with somatic symptoms** like headaches, the **core features of major depression** are not mentioned (e.g., persistent low mood, anhedonia, sleep/appetite changes, hopelessness). - The patient's **preoccupation with having a disease** despite medical reassurance is more characteristic of Illness Anxiety Disorder than depression alone.

Question 3: Which of the following produces neuropsychiatric symptoms?

A. Cephalosporin
B. Ethambutol
C. Cyclosporine
D. Cycloserine (Correct Answer)

Explanation: ***Cycloserine*** - **Cycloserine** is an antimicrobial agent that can cause a wide array of neuropsychiatric symptoms, including **headache**, **anxiety**, **depression**, **psychosis**, **seizures**, and **peripheral neuropathy**. - Its mechanism of action involves interfering with cell wall synthesis, but it also crosses the **blood-brain barrier**, leading to central nervous system effects. *Cephalosporin* - While some **cephalosporins** (especially at high doses or in patients with renal impairment) can cause CNS effects like **seizures**, they are not typically associated with a broad range of neuropsychiatric symptoms to the same extent as cycloserine. - The primary side effects of cephalosporins are usually **gastrointestinal disturbances** and **allergic reactions**. *Ethambutol* - **Ethambutol** is known for its ocular toxicity, specifically **optic neuritis**, which can lead to reduced visual acuity and **color blindness**. - It does not typically cause the generalized neuropsychiatric symptoms seen with cycloserine. *Cyclosporine* - **Cyclosporine**, an immunosuppressant, can cause neurological side effects such as **tremor**, **headache**, and **seizures**, and rarely **posterior reversible encephalopathy syndrome (PRES)**. - However, it is not primarily associated with the broad spectrum of psychiatric symptoms like depression or psychosis, unlike cycloserine.

Question 4: 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 5: Insane paresis is associated with -

A. Leishmaniasis
B. Yellow fever
C. Syphilis (Correct Answer)
D. Neisseria meningitidis

Explanation: ***Syphilis*** - **General paresis**, or "insane paresis," is a neuropsychiatric manifestation of **tertiary syphilis**, resulting from chronic meningoencephalitis. - It presents with progressive **dementia**, personality changes, delusions, and neurological deficits. *Leishmaniasis* - This parasitic disease is characterized by various forms including **cutaneous**, **mucocutaneous**, and **visceral leishmaniasis** (kala-azar). - It typically causes skin lesions, mucocutaneous destruction, or systemic symptoms like fever, hepatosplenomegaly, and pancytopenia, but not general paresis. *Yellow fever* - **Yellow fever** is a viral hemorrhagic disease transmitted by mosquitoes, primarily affecting the liver and kidneys. - Symptoms include fever, jaundice, hemorrhage, and shock, but not the neurological degeneration seen in general paresis. *Neisseria meningitidis* - This bacterium causes **meningococcal meningitis** and **meningococcemia**, which are acute and severe infectious diseases. - While it can lead to acute neurological symptoms due to meningitis, it does not cause the chronic, progressive neuropsychiatric syndrome known as general paresis.

Question 6: The most common cause of hyperthyroidism in a young female is?

A. TSH-secreting pituitary adenoma
B. Graves' disease (Correct Answer)
C. Subacute thyroiditis
D. Toxic multinodular goiter

Explanation: ***Graves' disease*** - This is an **autoimmune disorder** where antibodies stimulate the thyroid gland, leading to **overproduction of thyroid hormones** [1], [2]. - It is the **most common cause of hyperthyroidism** in young to middle-aged women, making it highly probable in a young female patient [1], [2]. *Toxic multinodular goiter* - This condition is characterized by **multiple nodules** within the thyroid gland that autonomously produce thyroid hormones. - While a cause of hyperthyroidism, it is **more common in older individuals**, typically those over 50 years of age. *Subacute thyroiditis* - This is a **self-limiting inflammatory condition** of the thyroid often following a viral infection, causing a transient hyperthyroid phase due to the release of preformed hormones. - It presents with **painful thyroid enlargement** and is usually followed by a hypothyroid phase, which is different from sustained hyperthyroidism. *TSH-secreting pituitary adenoma* - This is a **very rare cause of hyperthyroidism** where a pituitary tumor produces excess **Thyroid-Stimulating Hormone (TSH)**, leading to thyroid overstimulation. - It is often accompanied by other symptoms of a pituitary mass like **headaches or visual field defects**, which are not implied here.

Question 7: Behavioural problems caused by senility, drug damage, brain injury or disease, and the toxic effects of poisons are classified as __________ disorders

A. Psychosomatic
B. Substance use
C. Organic (Correct Answer)
D. Psychotic

Explanation: ***Organic*** - **Organic disorders** are characterized by behavioral or psychological symptoms that are directly attributable to a **physiological dysfunction** or structural change in the brain. - This category includes conditions arising from **senility**, drug-induced damage, brain injury, disease (e.g., **dementia**), or exposure to **neurotoxins**. *Psychosomatic* - **Psychosomatic disorders** involve physical symptoms that are caused or aggravated by **psychological factors**, like stress. - The primary cause is not a direct physiological injury or disease of the brain itself. *Substance use* - **Substance use disorders** describe maladaptive patterns of substance use leading to clinically significant impairment or distress. - While drug damage is mentioned in the question, this category focuses specifically on the **addiction** and related behaviors, not the broad range of organic causes. *Psychotic* - **Psychotic disorders** are characterized by a significant loss of contact with reality, often involving **hallucinations** or **delusions**. - While some organic conditions can cause psychotic symptoms, the term "psychotic disorders" refers to a specific symptom cluster rather than the underlying physical cause.

Question 8: Subcortical dementia is seen in all except:

A. HIV related dementia
B. Parkinson's disease
C. Alzheimer's disease (Correct Answer)
D. Multiple sclerosis

Explanation: ***Alzheimer's disease*** - Alzheimer's disease is categorized as a **cortical dementia**, primarily affecting the cerebral cortex. - It is characterized by early impairment in **memory**, language, and executive functions due to cortical atrophy and **neurofibrillary tangles** and amyloid plaques primarily in cortical regions. *HIV related dementia* - HIV-associated neurocognitive disorders (HAND) often manifest as a **subcortical dementia**, affecting white matter and deep gray matter structures. - Patients typically present with prominent **psychomotor slowing**, executive dysfunction, and apathy, rather than profound memory deficits in early stages. *Parkinson's disease* - Parkinson's disease, particularly when dementia develops, is considered a **subcortical dementia**. - It involves pathology in the **basal ganglia** and other subcortical structures, leading to deficits in executive function, attention, and visuospatial skills. *Multiple sclerosis* - Cognitive impairments in multiple sclerosis often present as a **subcortical dementia**, particularly involving processing speed, attention, and executive functions. - This is due to **demyelination** and axonal damage primarily affecting white matter tracts and subcortical gray matter.

Question 9: 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 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.

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free