Mental Status Examination — MCQs
All are true regarding Fronto-temporal dementia except:
Which of the following speech patterns is most indicative of Wernicke's aphasia?
Which of the following disorders is characterized by intense nihilism, somatization and agitation in old age?
Which of the following hallucinations is pathognomonic of schizophrenia?
A person going to temple experiences unwanted, intrusive thoughts urging them to abuse God, which cause significant distress. The likely diagnosis is
Persistent and inappropriate repetition of response beyond the point of relevance is called
All are feature of Autistic disorder EXCEPT:
Which of the following is the core component of Beck's cognitive theory of depression?
All are required to diagnose major depression except?
Awareness during anaesthesia can be assessed by:
Mental Status Examination Indian Medical PG Practice Questions and MCQs
Question 1: All are true regarding Fronto-temporal dementia except:
- A. Affective symptoms
- B. Age less than 65 years
- C. Insight present (Correct Answer)
- D. Stereotypic behavior
Explanation: ***Insight present*** - In Fronto-temporal dementia (FTD), **insight is typically lost** or severely impaired, particularly in the behavioral variant (bvFTD). Patients often exhibit a profound lack of awareness regarding their behavioral changes and their impact on others. - The presence of insight would argue against a diagnosis of FTD, as it is a hallmark feature of the disease's progression. *Affective symptoms* - **Affective symptoms** such as apathy, anhedonia, and dysphoria are very common in FTD, especially in the behavioral variant. These are often early and prominent features. - Patients may appear emotionally blunted or show inappropriate emotional responses. *Age less than 65 years* - FTD is a relatively common cause of **early-onset dementia**, often manifesting before the age of 65 years. - It frequently affects individuals in their 50s and early 60s, distinguishing it from Alzheimer's disease which typically presents later. *Stereotypic behavior* - **Repetitive, ritualistic, or stereotypic behaviors** are characteristic features of behavioral variant FTD. - Examples include repetitive gestures, ritualistic daily routines, or preoccupation with certain activities or foods.
Question 2: Which of the following speech patterns is most indicative of Wernicke's aphasia?
- A. Normal speech with comprehension
- B. Non-fluent speech with intact comprehension
- C. Fluent but nonsensical speech (Correct Answer)
- D. Speech with meaningful content
Explanation: ***Fluent but nonsensical speech*** - Wernicke's aphasia is characterized by **fluent**, often grammatically correct, speech that is **devoid of meaning** and often includes **paraphasias** (word substitutions) and **neologisms** (made-up words). - Patients have significant **comprehension deficits**, making meaningful conversation difficult despite preserved speech fluency. - This is also known as **receptive aphasia** or **sensory aphasia**, caused by damage to Wernicke's area in the superior temporal gyrus. *Normal speech with comprehension* - This describes **healthy speech patterns**, where both production and understanding of language are intact. - It directly contradicts the definition of **aphasia**, which involves impairment in language abilities. *Non-fluent speech with intact comprehension* - This describes **Broca's aphasia** (expressive aphasia), where speech production is effortful and halting. - Unlike Wernicke's aphasia, patients with Broca's aphasia have **preserved comprehension** but struggle with speech output. - The key differentiator is that Wernicke's has **fluent speech with poor comprehension**, while Broca's has **non-fluent speech with good comprehension**. *Speech with meaningful content* - This indicates that the speaker can convey understandable and relevant information, which is precisely what is lacking in **Wernicke's aphasia**. - In Wernicke's aphasia, the content is typically **empty** or **circumlocutory**, making it difficult to extract any coherent meaning.
Question 3: Which of the following disorders is characterized by intense nihilism, somatization and agitation in old age?
- A. Atypical depression
- B. Bipolar depression
- C. Involutional melancholia (Correct Answer)
- D. Somatized depression
Explanation: ***Involutional melancholia*** - This term refers to a severe depressive disorder in **late adulthood** characterized by profound **nihilism** (belief in the meaninglessness of existence), **somatization** (physical symptoms without a physical cause), and **agitation**. - It often involves prominent **psychotic features** like delusional guilt, nihilistic delusions (e.g., believing one's organs are rotting), and severe anxiety, distinguishing it from other forms of depression in older adults. - **Note**: This is a **historical diagnostic term** no longer used in DSM-5/ICD-11. The condition is now classified as **Major Depressive Disorder with melancholic features** or **with psychotic features** (when delusions are present). *Atypical depression* - Characterized by mood reactivity (mood improves in response to positive events), **increased appetite**, **hypersomnia**, leaden paralysis, and interpersonal rejection sensitivity. - This presentation is largely opposite to the **agitation** and severe **nihilism** seen in the described disorder. *Bipolar depression* - Occurs as part of **bipolar disorder**, involving episodes of both depression and mania/hypomania. - While it can be severe, the specific constellation of **intense nihilism**, prominent **somatization**, and persistent **agitation** in old age is more characteristic of what was historically termed involutional melancholia. *Somatized depression* - Refers to depression where **physical symptoms** are prominent. While somatization is present in the question, the defining features of **intense nihilism** and **agitation** are not specific to somatized depression. - This term usually emphasizes the physical presentation, whereas involutional melancholia describes a broader, severe depressive syndrome typical of later life.
Question 4: Which of the following hallucinations is pathognomonic of schizophrenia?
- A. Auditory hallucinations commanding the patient
- B. Auditory hallucinations giving running commentary (Correct Answer)
- C. Auditory hallucinations criticizing the patient
- D. Auditory hallucinations talking to patient
Explanation: ***Auditory hallucinations giving running commentary*** - **Third-person auditory hallucinations**, particularly those giving a continuous descriptive commentary on the patient's actions, thoughts, or movements, are considered **pathognomonic of schizophrenia** within Schneider's first-rank symptoms. - These are distinguished from other types of auditory hallucinations by their specific content and the perspective from which they are perceived, indicating a fundamental disruption in self-perception and reality testing. *Auditory hallucinations commanding the patient* - **Command hallucinations** involve voices instructing the patient to perform specific actions and can occur in various psychiatric conditions, including other psychoses, mood disorders with psychotic features, and even non-psychotic states. - While significant and potentially dangerous, they are **not unique to schizophrenia** and therefore not pathognomonic. *Auditory hallucinations criticizing the patient* - **Critical auditory hallucinations** involve voices that demean, scold, or negatively evaluate the patient, contributing to distress and low self-esteem. - These are also **nonspecific** and can be found in a range of mental health conditions, including depression with psychotic features and bipolar disorder. *Auditory hallucinations talking to patient* - **Second-person auditory hallucinations**, where voices communicate directly with the patient in a conversational manner, are common in various psychotic disorders. - They are a general feature of psychosis and **do not specifically indicate schizophrenia** over other conditions; the *content* and *form* of the hallucination are crucial for differential diagnosis.
Question 5: A person going to temple experiences unwanted, intrusive thoughts urging them to abuse God, which cause significant distress. The likely diagnosis is
- A. Mania
- B. Schizophrenia
- C. Delusion
- D. Obsessive-Compulsive Disorder (Correct Answer)
Explanation: ***Obsessive-Compulsive Disorder*** - The patient experiences **unwanted, intrusive thoughts** (obsessions) that cause significant anxiety and distress, such as the urge to abuse God. - The **irresistible urge** despite personal values suggests a compulsion to alleviate distress associated with the obsessive thought, even if the action is not performed. *Mania* - Characterized by an **elevated or irritable mood**, increased energy, and goal-directed activity, which does not fit the described symptom of internal, distressing urges. - Symptoms often include **racing thoughts**, grandiosity, and decreased need for sleep. *Schizophrenia* - Involves disruptions in thought processes, perceptions, emotional responsiveness, and social interactions, often including **hallucinations** or **delusions**. - The described symptom is an urge, not a break from reality or a hallucination. *Delusion* - A **fixed, false belief** that is not amenable to change in light of conflicting evidence. - The scenario describes an urge or an intrusive thought, which the person recognizes as distressing and unwanted, not a held belief.
Question 6: Persistent and inappropriate repetition of response beyond the point of relevance is called
- A. Thought insertion
- B. Neologism
- C. Thought block
- D. Perseveration (Correct Answer)
Explanation: ***Perseveration*** - **Perseveration** is the **inappropriate repetition of a response** (e.g., word, phrase, or gesture) beyond the point of relevance or despite the absence of a stimulus. - This symptom is often seen in conditions affecting the **frontal lobes**, such as **organic brain disorders**, **schizophrenia**, or following stroke. *Thought insertion* - **Thought insertion** is a **delusional belief** that one's thoughts are not their own but have been placed into their mind by an external source. - It is a **first-rank symptom of schizophrenia** and reflects a profound disturbance in the sense of self and agency. *Neologism* - A **neologism** is the **creation of new words** or the idiosyncratic use of existing words, often unintelligible to others. - This is a feature of **disorganized speech** commonly observed in conditions like **schizophrenia**. *Thought block* - **Thought block** is the sudden and abrupt cessation of the stream of thought, often in mid-sentence, leaving the person with no idea what they were about to say. - The individual may then resume speaking on an unrelated topic; it is also a **first-rank symptom of schizophrenia**.
Question 7: All are feature of Autistic disorder EXCEPT:
- A. Usually appears by 2-3 years of age
- B. Co-occurring intellectual disability in majority of cases
- C. Absent social smile
- D. Third person hallucination (Correct Answer)
Explanation: ***Third person hallucination*** - **Third-person hallucinations** are a feature of psychotic disorders like **schizophrenia**, where a patient hears voices discussing them in the third person. - They are **not a diagnostic criterion** for **Autistic Disorder**, which primarily involves deficits in social communication and restricted, repetitive behaviors. *Usually appears by 2-3 years of age* - The onset of **Autistic Disorder** is typically identified in early childhood, often becoming apparent between **12 and 24 months of age**, or by 2-3 years, as key developmental milestones are missed or behaviors emerge. - Parents may notice delays in **language development**, lack of social interaction, or unusual play patterns during this period. *Co-occurring intellectual disability in majority of cases* - A significant proportion of individuals diagnosed with **Autistic Spectrum Disorder** have co-occurring **intellectual disability** (intellectual developmental disorder). - Current estimates suggest approximately **30-40%** of individuals with autism have intellectual disability, though this varies depending on diagnostic criteria and population studied. - Many individuals with autism have **average or above-average intelligence**, and some demonstrate exceptional abilities in specific domains. *Absent social smile* - An **absent or delayed social smile** can be an early indicator of **Autistic Disorder**, as it reflects a lack of reciprocal social interaction. - Difficulty engaging in **joint attention** and responding to social cues are core features of the disorder, and lack of social smiling is an early manifestation.
Question 8: Which of the following is the core component of Beck's cognitive theory of depression?
- A. A. Cognitive distortions
- B. B. Automatic thoughts
- C. C. Dysfunctional belief (Correct Answer)
- D. D. Introjection
Explanation: ***Dysfunctional belief*** - **Dysfunctional beliefs**, or **core beliefs**, are the central component of Beck's cognitive theory, acting as underlying assumptions that shape an individual's interpretation of events. - These deep-seated beliefs are often rigid, extreme, and influence the development of maladaptive thoughts and behaviors in depression. *Cognitive distortions* - **Cognitive distortions** are systematic errors in thinking that arise from dysfunctional beliefs but are not the fundamental cause themselves. - They are the *patterned ways* in which individuals misconstrue reality, such as **catastrophizing** or **all-or-nothing thinking**. *Automated thoughts* - **Automatic thoughts** are spontaneous, fleeting thoughts that occur in response to specific situations. - While they are a key symptom and target of therapy in Beck's model, they stem from underlying dysfunctional beliefs and cognitive distortions, rather than being the core component. *Introjection* - **Introjection** is a psychoanalytic concept referring to the unconscious absorption of attitudes, ideas, and behaviors from external sources into one's own personality. - This concept is primarily associated with **psychodynamic theories** and is not part of Beck's cognitive model of depression.
Question 9: All are required to diagnose major depression except?
- A. Depressed mood
- B. Decreased concentration
- C. Nihilistic ideas (Correct Answer)
- D. Insomnia
Explanation: ***Nihilistic ideas*** - While nihilistic ideas (e.g., belief that life is meaningless or that nothing matters) can occur in severe depression, they are **not a mandatory diagnostic criterion** for major depressive disorder (MDD). - The diagnosis of MDD requires a specific number of core symptoms, and nihilistic ideation is not listed as one of them in diagnostic manuals like the DSM-5. *Depressed mood* - A **depressed mood** for most of the day, nearly every day, is one of the two **cardinal symptoms** required for a diagnosis of major depressive disorder. - The other cardinal symptom is anhedonia (loss of interest or pleasure). *Insomnia* - **Insomnia** (difficulty falling or staying asleep) or hypersomnia (sleeping excessively) is a common neurovegetative symptom of major depressive disorder and is one of the **nine diagnostic criteria**. - At least 5 of these 9 criteria must be present for a diagnosis, including at least one of the two cardinal symptoms. *Decreased concentration* - **Diminished ability to think or concentrate**, or indecisiveness, is another of the **nine diagnostic criteria** for major depressive disorder. - This cognitive symptom highlights the impact of depression on mental function beyond mood.
Question 10: Awareness during anaesthesia can be assessed by:
- A. ARTERIAL B.P
- B. ETCO2
- C. BIS (Correct Answer)
- D. NEUROMUSCULAR MONITOR
Explanation: ***
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