Biomarkers in Psychiatry — MCQs
Clang associations are primarily associated with which of the following conditions?
What do motor evoked potentials primarily assess?
Which of the following is considered a poor prognostic factor for schizophrenia?
Match the following drugs in Column A with their contraindications in Column B. | Column A | Column B | | :-- | :-- | | 1. Morphine | 1. QT prolongation | | 2. Amiodarone | 2. Thromboembolism | | 3. Vigabatrin | 3. Pregnancy | | 4. Estrogen preparations | 4. Head injury |
A patient presents with seizures that were controlled with midazolam. Lumbar puncture (LP) revealed no pathology. What is the confirmatory test in the condition shown in the MRI below?
Which of the following is false about bipolar disorder?
Type of schizophrenia with intellectual disability:
Which of the following neurotransmitters is NOT suspected to be involved in the pathophysiology of schizophrenia?
A 45-year-old male's blood test shows an increase in Homovanillic acid (HVA). Which of the following conditions is this finding most likely associated with?
Increased suicidal tendency is associated with which neurochemical imbalance?
Biomarkers in Psychiatry Indian Medical PG Practice Questions and MCQs
Question 1: Clang associations are primarily associated with which of the following conditions?
- A. Depressive disorder
- B. Psychotic disorder
- C. Anxiety disorder
- D. Mania (Correct Answer)
Explanation: ***Mania*** - **Clang associations** are a characteristic **thought disorder** seen in mania, where a person selects words based on their **sound (rhyming)** rather than their meaning or logical connection. - This symptom reflects the **pressured speech** and **racing thoughts** commonly observed during manic episodes. - **Classic example**: "I'm feeling fine, wine, dine, spine" - words rhyme but lack logical connection. *Depressive disorder* - Patients with depressive disorder typically experience **paucity of speech** or **slowed thoughts**, not clang associations. - Their thought content often focuses on themes of **hopelessness, guilt, or worthlessness**. *Psychotic disorder* - While psychotic disorders like **schizophrenia** can occasionally involve clang associations during acute episodes, they are **much more classically and prominently** associated with **mania**. - Schizophrenia more typically shows other thought disorders like **loose associations, derailment, or word salad**. - Other psychotic symptoms like **delusions** and **hallucinations** are more central to psychotic disorders. *Anxiety disorder* - Anxiety disorders are characterized by excessive **worry, fear**, and **physical symptoms of arousal**. - They do not involve formal **thought disorders** like clang associations; thought content is usually coherent but focused on anxious themes.
Question 2: What do motor evoked potentials primarily assess?
- A. Central motor pathways (Correct Answer)
- B. Both central and peripheral motor pathways
- C. Muscle regeneration
- D. Peripheral motor pathways
Explanation: ***Central motor pathways*** - **Motor evoked potentials (MEPs)** are generated by electrical or magnetic stimulation of the **motor cortex** and primarily assess the integrity of **central motor pathways**, specifically the **corticospinal tracts**. - MEPs are the **gold standard** for monitoring **upper motor neuron** function during neurosurgical and spinal procedures. - The technique is most sensitive to dysfunction in the **brain and spinal cord** (central nervous system), making this their primary clinical utility. *Peripheral motor pathways* - While MEPs do eventually activate peripheral motor neurons to produce muscle responses, they are **not the primary tool** for assessing peripheral pathways. - **Nerve conduction studies (NCS)** and **electromyography (EMG)** are direct and more specific measures for evaluating peripheral motor nerve function. *Both central and peripheral motor pathways* - Although MEPs provide information about the entire motor pathway from cortex to muscle, their **primary diagnostic strength and clinical application** is in detecting dysfunction within the **central nervous system**. - The latency and amplitude of MEPs are most sensitive to **conduction abnormalities along the corticospinal tract**, not peripheral nerves. *Muscle regeneration* - MEPs do **not assess muscle regeneration** or intrinsic muscle health. - **Electromyography (EMG)** with needle examination and **muscle biopsy** are the appropriate methods to evaluate muscle regeneration and myopathic processes.
Question 3: Which of the following is considered a poor prognostic factor for schizophrenia?
- A. Presence of depression
- B. Presence of stressor
- C. Early onset (Correct Answer)
- D. Female sex
Explanation: ***Early onset*** - An **earlier age of onset** (e.g., childhood or early adolescence) for schizophrenia is consistently associated with a **worse long-term prognosis**, including more severe symptoms, greater functional impairment, and a lower likelihood of full recovery. - This is thought to be due to the greater developmental disruption caused by the illness when it begins at a younger age. *Presence of depression* - While depression is common in schizophrenia, it is generally considered to be a **treatable co-occurring condition** rather than a primary poor prognostic factor for the core psychotic disorder itself. - Effective treatment for depression can actually **improve overall quality of life** and adherence to antipsychotic medication. *Presence of stressor* - The presence of a significant psychosocial stressor at the onset of schizophrenia is often associated with a **better prognosis**, as it suggests a more reactive and potentially remitting course. - This indicates that the illness might be more environmentally triggered and less intrinsically severe. *Female sex* - **Female sex** is typically associated with a **somewhat better prognosis** in schizophrenia, with a later age of onset and potentially less severe symptoms compared to males. - This may be influenced by hormonal factors and differences in social support networks.
Question 4: Match the following drugs in Column A with their contraindications in Column B. | Column A | Column B | | :-- | :-- | | 1. Morphine | 1. QT prolongation | | 2. Amiodarone | 2. Thromboembolism | | 3. Vigabatrin | 3. Pregnancy | | 4. Estrogen preparations | 4. Head injury |
- A. A-1, B-3, C-2, D-4
- B. A-4, B-1, C-3, D-2 (Correct Answer)
- C. A-3, B-2, C-4, D-1
- D. A-2, B-4, C-1, D-3
Explanation: ***A-4, B-1, C-3, D-2*** - **Morphine** is contraindicated in **head injury** as it can increase intracranial pressure and mask neurological symptoms. - **Amiodarone** is contraindicated in patients with **QT prolongation** due to its risk of inducing more severe arrhythmias like Torsades de Pointes. - **Vigabatrin** is contraindicated during **pregnancy** due to its potential for teratogenicity and adverse effects on fetal development. - **Estrogen preparations** are contraindicated in patients with a history of **thromboembolism** due to their increased risk of blood clot formation. *A-1, B-3, C-2, D-4* - This option incorrectly matches **Morphine** with QT prolongation and **Estrogen preparations** with head injury, which are not their primary contraindications. - It also incorrectly links **Vigabatrin** with thromboembolism and **Amiodarone** with pregnancy. *A-3, B-2, C-4, D-1* - This choice incorrectly associates **Morphine** with pregnancy and **Vigabatrin** with head injury, which are not the most critical or direct contraindications. - It also misaligns **Amiodarone** with thromboembolism and **Estrogen preparations** with QT prolongation. *A-2, B-4, C-1, D-3* - This option incorrectly matches **Morphine** with thromboembolism and **Amiodarone** with head injury, which are not their most significant contraindications. - It also incorrectly links **Vigabatrin** with QT prolongation and **Estrogen preparations** with pregnancy.
Question 5: A patient presents with seizures that were controlled with midazolam. Lumbar puncture (LP) revealed no pathology. What is the confirmatory test in the condition shown in the MRI below?
- A. PET scan
- B. CBNAAT
- C. MR spectroscopy (Correct Answer)
- D. MRI serial scan
Explanation: ***MR spectroscopy*** - The MRI shows multiple **ring-enhancing lesions**, which, combined with the history of seizures and normal LP, strongly suggests **neurocysticercosis**. - **MR spectroscopy** can detect the specific biochemical markers (e.g., lactate, succinate) within the cyst, which are indicative of the parasitic infection, and can help differentiate it from other lesions like tumors or abscesses. *PET scan* - A **PET scan** primarily assesses metabolic activity and is more commonly used in the evaluation of tumors or neurodegenerative diseases. - It is generally not the primary or confirmatory test for neurocysticercosis, as it does not directly visualize the parasite or its specific biochemical markers. *CBNAAT* - **CBNAAT (Cartridge-Based Nucleic Acid Amplification Test)** is a rapid molecular test primarily used for the diagnosis of **tuberculosis**, not neurocysticercosis. - While tuberculosis can cause CNS lesions, the clinical and imaging presentation (multiple ring-enhancing lesions) is more suggestive of neurocysticercosis, and CBNAAT would not confirm this diagnosis. *MRI serial scan* - **Serial MRI scans** are useful for monitoring the progression or resolution of lesions over time, especially in response to treatment. - However, a serial scan is not a "confirmatory test" for the initial diagnosis; it provides prognostic or follow-up information rather than confirming the etiology.
Question 6: Which of the following is false about bipolar disorder?
- A. Unipolar mania is more common than bipolar disorder (Correct Answer)
- B. Genetic factors play important role
- C. Rapid cycling is more common in females
- D. Age of onset is earlier than unipolar depression
Explanation: ***Unipolar mania is more common than bipolar disorder*** - This statement is **false** because **unipolar mania is extremely rare**, while **bipolar disorder (which includes both manic and depressive episodes)** is significantly more common. - **Unipolar mania** refers to recurrent manic episodes without any depressive episodes, a presentation that is seldom observed clinically. *Genetic factors play important role* - This statement is **true**, as **bipolar disorder has a strong genetic component**, with **heritability estimated between 60-80%**. - **First-degree relatives** of individuals with bipolar disorder are at a significantly higher risk of developing the condition. *Rapid cycling is more common in females* - This statement is **true**; **rapid cycling (4 or more mood episodes per year)** occurs more frequently in females with bipolar disorder. - **Women with bipolar disorder** are also more likely to experience **mixed features** and **more depressive episodes** compared to males. *Age of onset is earlier than unipolar depression* - This statement is **true** because the **typical age of onset for bipolar disorder is in early adulthood (late teens to early 20s)**, whereas **unipolar depression often has a later average onset**, though both can occur at any age. - An earlier age of onset in bipolar disorder is linked to poorer prognosis and more severe illness course.
Question 7: Type of schizophrenia with intellectual disability:
- A. Catatonic schizophrenia
- B. Pfropf schizophrenia (Correct Answer)
- C. Paranoid schizophrenia
- D. Hebephrenic schizophrenia
Explanation: ***Pfropf schizophrenia*** - **Pfropf schizophrenia** is a historical term specifically used to describe a form of schizophrenia that develops in individuals with **pre-existing intellectual disability** (formerly termed mental retardation). - The term "Pfropf" is derived from German, meaning "grafted" or "engrafted," referring to schizophrenia being "grafted onto" pre-existing intellectual disability. - This term distinguishes it from other types of schizophrenia where intellectual disability is not a primary defining characteristic. - While this classification is largely historical (modern DSM-5 has removed schizophrenia subtypes), it remains relevant for older examination questions. *Catatonic schizophrenia* - Characterized primarily by prominent **psychomotor disturbances**, which can include stupor, catalepsy, waxy flexibility, mutism, and negativism. - While intellectual disability might coexist, it is not a defining feature of the catatonic subtype itself. *Paranoid schizophrenia* - Marked by the prominence of **delusions**, typically persecutory or grandiose, and **auditory hallucinations**. - Intellectual disability is not a core diagnostic criterion or a defining characteristic of this subtype. *Hebephrenic schizophrenia* - Also known as **disorganized schizophrenia**, this type is characterized by marked **disorganization of thought processes**, flat or inappropriate affect, and bizarre behavior. - While it often presents early and can lead to significant functional impairment, intellectual disability is not a defining feature; rather, the primary disturbance is in thought and emotion.
Question 8: Which of the following neurotransmitters is NOT suspected to be involved in the pathophysiology of schizophrenia?
- A. Ascorbic acid (Correct Answer)
- B. Serotonin (5-HT)
- C. Norepinephrine
- D. Glutamate
Explanation: ***Ascorbic acid*** - **Ascorbic acid (Vitamin C)** is an important antioxidant and cofactor, but it is **not a neurotransmitter**. - While it may have neuroprotective roles, there is **no significant theory** suggesting ascorbic acid dysregulation is involved in the core pathophysiology of schizophrenia. - Unlike the other options, ascorbic acid is not part of any major neurotransmitter hypothesis of schizophrenia. *Serotonin (5-HT)* - The **serotonin hypothesis** of schizophrenia suggests an imbalance in serotonergic activity, particularly involving **5-HT2A receptors**. - Serotonin is targeted by **atypical antipsychotics** (e.g., risperidone, olanzapine) which block 5-HT2A receptors. - Serotonin dysregulation is believed to contribute to both **positive and negative symptoms** of schizophrenia. *Norepinephrine* - Dysregulation of **norepinephrine** has been implicated in the **cognitive and negative symptoms** of schizophrenia. - Alterations in noradrenergic systems contribute to deficits in **attention, working memory, and motivation** in affected individuals. - The prefrontal cortex noradrenergic system is particularly relevant to schizophrenia pathophysiology. *Glutamate* - The **NMDA receptor hypofunction hypothesis** is a major theory in schizophrenia pathophysiology. - **Glutamate** dysfunction, particularly involving NMDA receptors, can explain positive, negative, and cognitive symptoms. - NMDA receptor antagonists (like PCP and ketamine) can **induce psychotic symptoms** similar to schizophrenia, supporting this hypothesis.
Question 9: A 45-year-old male's blood test shows an increase in Homovanillic acid (HVA). Which of the following conditions is this finding most likely associated with?
- A. Phenylketonuria (PKU)
- B. Schizophrenia (Correct Answer)
- C. Depression
- D. Parkinson's disease
Explanation: **Explanation:** The correct answer is **Schizophrenia**. This question tests your knowledge of neurotransmitter metabolites and their clinical significance in psychiatric disorders. **1. Why Schizophrenia is correct:** **Homovanillic acid (HVA)** is the primary metabolic byproduct of **Dopamine**. According to the **Dopamine Hypothesis of Schizophrenia**, the disorder is characterized by dopaminergic hyperactivity, particularly in the mesolimbic pathway. Increased turnover of dopamine leads to elevated levels of HVA in the blood, cerebrospinal fluid (CSF), and urine. Monitoring HVA levels is often used in research to gauge central dopamine activity. **2. Why the other options are incorrect:** * **Phenylketonuria (PKU):** This is a metabolic disorder caused by a deficiency of phenylalanine hydroxylase. It leads to an accumulation of Phenylalanine, not HVA. * **Depression:** Depression is primarily associated with decreased levels of **5-HIAA** (5-Hydroxyindoleacetic acid), which is the metabolite of Serotonin. While dopamine can be involved, HVA is not a diagnostic marker for depression. * **Parkinson’s Disease:** This condition involves the degeneration of dopaminergic neurons in the substantia nigra. Therefore, one would expect a **decrease** in HVA levels due to dopamine deficiency, rather than an increase. **High-Yield Clinical Pearls for NEET-PG:** * **Dopamine → HVA** (Homovanillic Acid) * **Serotonin → 5-HIAA** (Decreased in suicide attempts and impulsive aggression) * **Norepinephrine → VMA** (Vanillylmandelic Acid) and **MHPG** (3-methoxy-4-hydroxyphenylglycol). * **VMA** is a crucial marker for diagnosing **Pheochromocytoma** and **Neuroblastoma**. * In Schizophrenia, HVA levels often correlate with the severity of positive symptoms (hallucinations/delusions).
Question 10: Increased suicidal tendency is associated with which neurochemical imbalance?
- A. Increased Noradrenaline
- B. Decreased Serotonin (Correct Answer)
- C. Decreased Dopamine
- D. Increased GABA
Explanation: **Explanation:** The neurobiology of suicidal behavior is most strongly linked to the **Serotonergic system**. Research consistently shows that low levels of **Serotonin (5-HT)** and its primary metabolite, **5-HIAA (5-hydroxyindoleacetic acid)**, in the cerebrospinal fluid (CSF) are associated with increased impulsivity, aggression, and completed suicide. This finding holds true across various psychiatric diagnoses, including depression and schizophrenia. **Analysis of Options:** * **Decreased Serotonin (Correct):** Low 5-HT levels in the ventromedial prefrontal cortex are linked to a failure in "top-down" inhibition, leading to impulsive-aggressive behaviors and suicidal acts. * **Increased Noradrenaline (Incorrect):** While noradrenergic dysregulation is seen in stress responses and anxiety disorders, it is not the primary neurochemical marker for suicidal tendency. * **Decreased Dopamine (Incorrect):** Low dopamine is primarily associated with anhedonia and motor symptoms (as seen in Parkinson’s or depression), but it is not as specific a predictor for suicide as serotonin. * **Increased GABA (Incorrect):** GABA is the brain's primary inhibitory neurotransmitter. Increased GABA activity is generally associated with sedation and reduced anxiety, not increased suicidality. **NEET-PG High-Yield Pearls:** * **CSF Marker:** The most high-yield fact is that **low CSF 5-HIAA** is the strongest biochemical predictor of violent suicide attempts. * **Post-mortem findings:** Studies of suicide victims often show decreased serotonin receptor binding in the prefrontal cortex. * **Genetics:** The Tryptophan Hydroxylase (TPH) gene mutation, which affects serotonin synthesis, is often studied in relation to suicidal behavior. * **Clinical Correlation:** Antidepressants (SSRIs) may initially increase the risk of suicide in young adults by increasing energy before improving mood (the "activation syndrome").
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free